Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Nicardipine belongs to a class of blood pressure
reducing medications called calcium channel blockers
(CCBs). Other medications in this
class include diltiazem (Cardizem), amlodipine (Norvasc), felodipine (Plendil),
verapamil (Calan, Isoptin), clevidipine (Cleviprex), and nifedipine (Adalat,
Procardia). These medications block the movement of calcium into the smooth
muscle cells surrounding the arteries of the body. Since calcium promotes
contraction of muscle, blocking calcium entry into the muscle cells relaxes the
arterial muscles and causes the arteries to become larger. This lowers blood
pressure, which reduces the work that the heart must do to pump blood to the
body. Reducing the work of the heart lessens the heart muscle's demand for
oxygen and thereby helps prevent angina (heart pain) in patients with
coronary
artery disease. Unlike verapamil or diltiazem, nicardipine has little effect on
heart muscle or on electrical conduction within the heart. The FDA approved
nicardipine in December 1988.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS:
Capsules: 20 and 30 mg.
Capsules (sustained release): 30, 45,
and 60 mg.
Injection: 0.1, 0.2, and 2.5 mg/ml.
STORAGE: Nicardipine should be stored at room temperature, 15 to 30 C (59 to
86 F), and protected from light.
PRESCRIBED FOR: Oral nicardipine is used alone or in combination with other
drugs for the treatment of high blood pressure. Conventional capsules (not
sustained release) also are used for the treatment of angina (heart pain).
Nicardipine injections are used for short-term treatment of blood pressure when
oral medications are not possible or desirable.
DOSING: The recommended dose of nicardipine is 20-40 mg three times daily
with conventional capsules or 30-60 mg twice daily with sustained release
capsules. Intravenous infusion rates can range between 0.1 and 15 mg/hr.
DRUG INTERACTIONS: Rifampin, phenobarbital, phenytoin, oxcarbazepine
(suspension oral Trileptal;
oral Trileptal) and
carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol) may reduce blood levels of nicardipine by increasing its
metabolism in the liver. Therapy should be monitored and drug doses should be
adjusted accordingly.
Co-administration of nicardipine and cyclosporine results in increased
cyclosporine blood levels. Cyclosporine blood levels should be monitored and its
dosage reduced when taking nicardipine.
PREGNANCY: There are no adequate studies of nicardipine in pregnant women;
Nicardipine has been used to treat the high blood pressure of preeclampsia
during the third trimester of pregnancy.
NURSING MOTHERS: Animal studies show that nicardipine is secreted in
breast milk. Nicardipine should be avoided by nursing mothers.
SIDE EFFECTS: Side effects of nicardipine include an increased heart rate due
to the drop in blood pressure. Other side effects include swelling of the feet
(edema), dizziness,
headaches,
flushing, palpitations, and nausea. Nicardipine
sometimes can cause an increase in the frequency and duration of angina. The
reason for this side effect is not clearly understood. Excessively
low blood
pressure can occur in rare instances, especially during initiation of treatment
or following adjustments of dosage.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Raynaud's phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold. Occurring as a result of spasm of blood vessels, the cause is unknown. Symptoms of Raynaud's phenomenon depend on the severity, frequency, and duration of the blood vessel spasm. Treatments include protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
Chest pain is one of the most common complaints that will bring a patient to
the Emergency Department. Seeking immediate care may be lifesaving, and
considerable public education has been undertaken to get patients to access
medical care when chest pain strikes. While the patient may be worried about a
heart attack, there are many other causes of pain in the chest that the healthcare provider will need to consider. Some diagnoses are life threatening, while
others are less dangerous.
Deciding the cause of chest pain is sometimes very difficult and may require
blood tests, x-rays, CT scans and
other tests to sort out the diagnosis. Often though,
a careful history taken by the healthcare provider may be all that is needed to find
the answer.
What are the sources of chest pain?
The source of pain may arise from a variety of potential sources:
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