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.
BRAND NAMES: Nitrostat, Nitroquick, Nitrolingual, Nitro-Dur, Minitran,
Nitro-Bid and others
DRUG CLASS AND MECHANISM: Nitroglycerin belongs to a class of drugs
called nitrates. Other nitrates include isosorbide dinitrate (Isordil) and
isosorbide mononitrate (Imdur, Ismo, Monoket). Nitroglycerin is used in the
management of angina pectoris (heart pain). Synthesized in 1846, nitroglycerin
was first used to treat anginal attacks in 1879. It was granted FDA approval in
1938.
Blood returning from the body in the veins must be pumped by the heart
through the lungs and into the arteries against the high pressure in the
arteries. In order to accomplish this work, the heart's muscle must produce and
use energy ("fuel"). The production of energy requires oxygen. Angina pectoris
(angina) or "heart pain" is due to an inadequate flow of blood (and oxygen) to
the muscle of the heart. It is believed that all nitrates, including
nitroglycerin, correct the imbalance between the flow of blood and oxygen to the
heart and the work that the heart must do by dilating (widening) the arteries
and veins in the body. Dilation of the veins reduces the amount of blood
returning to the heart so that the heart does less work and requires less blood
and oxygen. Dilation of the arteries also lowers the pressure in the arteries
against which the heart must pump. As a consequence, the heart works less and
requires less blood and oxygen.
Additionally, in patients with angina, nitroglycerin preferentially dilates
blood vessels that supply the areas of the heart where there is not enough
oxygen thereby delivering oxygen to the heart tissue that needs it most.
STORAGE: All formulations should be kept at room temperature, 15-30 C
(59-86 F). The sublingual tablets are especially susceptible to moisture. They
should NOT be kept in bathrooms or kitchens because of the greater moisture in
these rooms. Care should be taken to replace the sublingual tablets every six
months.
PRESCRIBED FOR: Nitroglycerin is used for the treatment and prevention
of angina caused by coronary artery disease. Transdermal nitroglycerin,
nitroglycerin ointment and capsules do not act rapidly enough to be used for
acute angina attacks. Nitroglycerin also is used intravenously to treat
congestive heart failure associated with
myocardial infarction (heart
attack) and high blood
pressure during surgery.
DOSING:For the treatment of acute angina attacks or for acute
prevention (for example, immediately before encountering situations likely to bring on
an anginal attack), one tablet is allowed to dissolve under the tongue or in the
buccal pouch (between the cheek and gums), or one spray is given of the lingual
spray. Sublingual, spray and buccal nitroglycerin are rapidly absorbed from the
lining of the mouth for immediate effects. This may be repeated every 5 minutes
as needed. If angina is not relieved after a total of 3 doses, the patient
should be taken to a hospital or a physician should be contacted. If lingual
spray is used, the canister of spray should not be shaken prior to use, and it
should be sprayed onto or under the tongue and then the mouth closed.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
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.
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.
Aortic dissection is a small tear in the large blood vessel that leads from the heart and supplies blood to the body. There are two types of aortic dissection, type 1 and type 2. Signs and symptoms of aortic dissection include a tearing or ripping pain, nausea, sweating, weakness, shortness of breath, sweating, or fainting. Treatment depends on the type of aortic dissection, and the severity of the tear in the aorta.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
Scleroderma is an autoimmune disease of the connective tissue featuring skin thickening, spontaneous scarring, blood vessel disease, varying degrees of inflammation, associated with an overactive immune system. Autoimmune diseases are illnesses which occur when the body's tissues are attacked by its own immune system. Scleroderma is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body. This leads to thickness and firmness of involved areas. Scleroderma, when it's diffuse or widespread over the body, is also referred to as systemic sclerosis.
The cause of scleroderma is not known. Researchers have found some evidence that certain genes are important factors, but the environment seems to also play a role. The result is activation of the immune system in a susceptible individual, causing injury to tissues that result in injury similar to scar-tissue formation. The fact that genes seem to cause a predi...
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