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.
For prevention of angina, ointment may be applied using special
dose-measuring application papers provided with the ointment. The usual dose is
1/2 to 2 inches applied every 4-6 hours. The appropriate amount of ointment is
squeezed as a thin layer onto the paper, and the paper is used to spread the
ointment onto a non-hairy area of the skin. The ointment should not be allowed
to come into contact with the hands so that absorption from the hands does not
occur.
Transdermal patches also are used for prevention. The usual dose is
0.2-0.8 mg/hr applied for 12 hours and then removed. An additional 12 hours
should be allowed before applying the next patch because a 12 hour nitroglycerin
free period reduces the occurrence of tolerance to the effects (reduced
effectiveness) of nitroglycerin. Patches may be applied to any hairless site but
should not be applied to areas with cuts or calluses which can alter absorption.
Firm pressure should be used over the patch to ensure contact with the skin. The
patch should not be cut or trimmed. Patches are waterproof and should not be
affected by showering or bathing.
Capsules of long-acting nitroglycerin also are
used for prevention. The usual dose is 2.5-9 mg administered 2 to 3 times per
day 1 to 2 hours after a meal. Capsules should be swallowed whole and not
chewed.
DRUG INTERACTIONS: Since nitroglycerin can cause hypotension (low
blood pressure), other medications which also cause hypotension may produce
severe hypotension. Such drugs might include medicines used to treat high blood
pressure, some antidepressants; some anti-psychotics, quinidine
(Quinaglute, Quinidex), procainamide
(Pronestyl, Procan-SR, Procanbid),
benzodiazepines such as diazepam (Valium) or opiates,
for example, morphine. Since
alcohol also may intensify the blood pressure lowering effect of nitroglycerin,
patients receiving nitroglycerin should be advised to drink alcoholic beverages
with caution.
Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) exaggerate
the blood pressure lowering effects of nitroglycerin and may cause excessive
blood pressure reduction. Patients taking nitrates should not receive
sildenafil, tadalafil or vardenafil.
Ergot alkaloids, for example, ergotamine with caffeine-rectal (Cafergot,
Migergot), and sumatriptan (Imitrex) can oppose the vasodilatory actions of
nitroglycerin and may cause angina. A similar effect can occur with ephedrine
and the decongestants pseudoephedrine (Sudafed) and propanolamine which is
contained in many drugs used for treating the symptoms of colds.
PREGNANCY: Nitroglycerin has not been adequately studied in
pregnant
women.
NURSING MOTHERS: It is not known if nitroglycerin is secreted in
breast milk.
SIDE EFFECTS: A persistent, throbbing headache commonly occurs with
nitroglycerin therapy. Aspirin, acetaminophen, or ibuprofen may be used to
relieve the pain. Flushing of the head and neck can occur with nitroglycerin
therapy as can an increase in heart rate or palpitations. This can be associated
with a drop in blood pressure which can be accompanied by dizziness or weakness.
To reduce the risk of low blood pressure, patients often are told to sit or lie
down during and immediately after taking nitroglycerin.
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.
Heart RSS
Healthy Living Tips
