Pentoxyfilline usage

[cool_vkb]

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I was reading a topic in Cardiac Physiology for the exam and i came across this drug "Pentoxyfilline". It said that Podiatrists use this drug because it decreases the thickness (viscosity) of blood. This change allows your blood to flow more easily, especially in the small blood vessels of the hands and feet. I havent taken pharma yet so i dont know more abt it but reading abt the effects of this drug iam sure it has overall systemic affect (not just local)

Iam just curious. In real life do pods prescribe a lot of drugs which have systemic manifestations or these are very rare and we usually let the IM or other guys take care of these things which involve whole body.

 

[densmore22]

I was reading a topic in Cardiac Physiology for the exam and i came across this drug "Pentoxyfilline". It said that Podiatrists use this drug because it decreases the thickness (viscosity) of blood. This change allows your blood to flow more easily, especially in the small blood vessels of the hands and feet. I havent taken pharma yet so i dont know more abt it but reading abt the effects of this drug iam sure it has overall systemic affect (not just local)

Iam just curious. In real life do pods prescribe a lot of drugs which have systemic manifestations or these are very rare and we usually let the IM or other guys take care of these things which involve whole body.

You'd be hard pressed to find a drug out there that doesn't have systemic manifestations. TCAs are used to treat neuropathic pain in diabetics and pts in with nerve injury, but classically, the TCAs are used for antidepression (via blocking reuptake of Serotonin and NE) as an example. We're giving the same drugs (maybe for different reasons) that a lot if not all other physicians are giving and it would be hard to focus that drugs effects strictly on the lower limb, especially if that drug is metabolized and/or cleared via the liver and/or kidneys, etc. I'm sure there are times when we hold back treatment and reserve it to be done by the patients FP or IM, but we have all of the knowledge to prescribe any drug (DPMs don't have any drug prescription restriction like other health professions do), but honestly, you'd only prescribe a drug (at least I hope you would) based on what the problem in the patient is and if it will help them and not just because you can.

 

[Stafocker]

I was reading a topic in Cardiac Physiology for the exam and i came across this drug "Pentoxyfilline". It said that Podiatrists use this drug because it decreases the thickness (viscosity) of blood. This change allows your blood to flow more easily, especially in the small blood vessels of the hands and feet. I havent taken pharma yet so i dont know more abt it but reading abt the effects of this drug iam sure it has overall systemic affect (not just local)

Iam just curious. In real life do pods prescribe a lot of drugs which have systemic manifestations or these are very rare and we usually let the IM or other guys take care of these things which involve whole body.

consult... 🙂

 

[Feli]

Trental has a very interesting concept and is one of those drugs that's great on paper. It doesn't so much "decrease the thickness" (that'd be something more like ASA or Plavix), but Trental alters red cell rheology (flexibility) so that the cells can flow through smaller or more occluded vessels more easily. I haven't really reviewed enough literature to speak intelligently on the topic, but it seems that the general consensus from many docs is that it doesn't work as well as hoped for and hypothesized.

This would be a great topic to learn more about or even publish a literature review on when you have pharm next year. You will probably find literature saying it works and other articles showing no real difference. Be aware of who is funding the research and possible bias (ie the Trental drug company's trials said it greatly increases blood flow to PVD limbs but neutral hospital study said it has minimal or no effect). Here's one article saying it really doesn't have much effect...

http://www.ncbi.nlm.nih.gov.ezproxy...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

To answer your other question, yes, podiatry uses a lot of drugs that have many systemic effects. Densmore covered the topic pretty well... the foot is attached to the body 😉
Oral antifungals (liver effects and rxns with other Rx) and even local anesthetics (cardio, resp effects if toxic dosages) would be two good examples, and antibiotics all have various degrees of systemic effects also.

 

[krabmas]

Trental has a very interesting concept and is one of those drugs that's great on paper. It doesn't so much "decrease the thickness" (that'd be something more like ASA or Plavix), but Trental alters red cell rheology (flexibility) so that the cells can flow through smaller or more occluded vessels more easily. I haven't really reviewed enough literature to speak intelligently on the topic, but it seems that the general consensus from many docs is that it doesn't work as well as hoped for and hypothesized.

This would be a great topic to learn more about or even publish a literature review on when you have pharm next year. You will probably find literature saying it works and other articles showing no real difference. Be aware of who is funding the research and possible bias (ie the Trental drug company's trials said it greatly increases blood flow to PVD limbs but neutral hospital study said it has minimal or no effect). Here's one article saying it really doesn't have much effect...

http://www.ncbi.nlm.nih.gov.ezproxy...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

To answer your other question, yes, podiatry uses a lot of drugs that have many systemic effects. Densmore covered the topic pretty well... the foot is attached to the body 😉
Oral antifungals (liver effects and rxns with other Rx) and even local anesthetics (cardio, resp effects if toxic dosages) would be two good examples, and antibiotics all have various degrees of systemic effects also.

Just to add to the list of meds that pods rx that effect the whole body...

If the pill or med is ingested orally or thru IV or IM or even applied topically it has the potential to interact with other drugs, get metabolized thru the liver or kidneys and cause side effects to anything including the foot. There is no drug that I can think of that is taken orally, IV or IM that only and specifically acts on the foot.

There was a story in the news a few months ago about a 16 yo girl in NY that applied icy hot to her legs in such high doses that she actually became toxic and died. I think it was the methyl salicylate that was absorbed thru the skin and built up in her blood stream which caused an overdose and killed her.

http://www.foxnews.com/story/0,2933,279482,00.html

Topical steriods that we perscribe can have systemic effects if the patient applies to much.

To really answer the OP's question - podiatrists are restricted from prescribing medicines that are not for treating issues within the scope of practice.

Examples of when not to prescribe:
Patient has strep throat - do not give abx. refer
Patient has back pain - do no rx NSAIDs or Narcotics. refer
Patient has fungal finger nails - do not rx lamisil. refer
Patient has broken arm (do not apply cast) - refer
Patient has sprained knee or knee pain - do not apply splint or rx NSAIDs or narcotics. refer
Patient has tinea corporus - do not rx Lamisil or other antifungal creams. refer


even though all the meds and modalities listed above are within the scope of practice for a pod the complaint being treated is not. Even in states that the knee is in the scope it is better to not get into a turf war and just refer.

 

[cool_vkb]

Even in states that the knee is in the scope it is better to not get into a turf war and just refer.

knee in our scope😕 what states are those?

 

[krabmas]

knee in our scope😕 what states are those?

florida has soft tissue to the hip. So knee sprains are loosely included.

 

[NatCh]

florida has soft tissue to the hip. So knee sprains are loosely included.

Sweet, Feli can start doing ACL repairs.

I don't know if anyone has prescribed Trental in over a decade. How do you like that? Half the stuff you'll learn for exams is already out of date.

 

[Feli]

...I don't know if anyone has prescribed Trental in over a decade. How do you like that? Half the stuff you'll learn for exams is already out of date.

Yep... I totally agree.^ I've realized that pretty fast when you get in clinics. I was thinking "not very many docs use those anymore with Lyrica and Cymbalta" when densmore was talking about writing TCAs for neuropathy.

That's ok... I'm not great at pharm anyways. That's why we have pocket books: even if I was 99% sure, I'd still double check the med and dosage anyways before I wrote the script. Attendings sometimes ask me "what is the mechanism of (brand name drug)" during clinics, and I usually reply, "what's the generic name" since that's what I memorized for boards pt1. I have a tough enough time keeping them strainght with just the generic names, and besides, as soon as you learn em, something new and improved hits the market. I'm glad I'm better at anat and path... there are no pocket books for that, and the nomenclature doesn't change

florida has soft tissue to the hip. So knee sprains are loosely included.

Sweet, Feli can start doing ACL repairs...

No way haha.^

The scope here is great and you see some very cool surgical cases that would not fly in other states (pantalar fusion, tib/fib midshaft fx Taylor frames, etc), but no pod will ever be doing ACLs... way too much $ in that. I've ACE wrapped a sprained knee and wrote NSAID, but I then referred to ortho also. I also did see a pod inject a painful knee once, and I'm not sure if that's in our scope here... he was a MD/DPM so I guess it's in his.

 

[alparkeruab]

Yep... I totally agree.^ I've realized that pretty fast when you get in clinics. I was thinking "not very many docs use those anymore with Lyrica and Cymbalta" when densmore was talking about writing TCAs for neuropathy.

That's ok... I'm not great at pharm anyways. That's why we have pocket books: even if I was 99% sure, I'd still double check the med and dosage anyways before I wrote the script. Attendings sometimes ask me "what is the mechanism of (brand name drug)" during clinics, and I usually reply, "what's the generic name" since that's what I memorized for boards pt1. I have a tough enough time keeping them strainght with just the generic names, and besides, as soon as you learn em, something new and improved hits the market. I'm glad I'm better at anat and path... there are no pocket books for that, and the nomenclature doesn't change

No way haha.^

The scope here is great and you see some very cool surgical cases that would not fly in other states (pantalar fusion, tib/fib midshaft fx Taylor frames, etc), but no pod will ever be doing ACLs... way too much $ in that. I've ACE wrapped a sprained knee and wrote NSAID, but I then referred to ortho also. I also did see a pod inject a painful knee once, and I'm not sure if that's in our scope here... he was a MD/DPM so I guess it's in his.

I know this doesn't have anything to do with the original question, but how did he become a MD/DPM? Did he go through the 4 years of school and residencies for both degrees? What would the advantages be to have both of these degrees?