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: Propranolol is a beta-adrenergic blocking agent
that is used for treating high blood pressure, heart pain (angina),
abnormal
rhythms of the heart, and some neurologic conditions. Examples of other
beta-adrenergic blockers include metoprolol (Lopressor), atenolol (Tenormin),
and timolol (Blocadren).
Neurotransmitters are chemicals that are produced and released by nerves in
order to communicate with each other. The released neurotransmitters attach to
receptors on other cells and induce changes within the receptor-containing
cells. Norepinephrine is a neurotransmitter that is used by the sympathetic
nervous system, a portion of the involuntary nervous system. Nerves of the
sympathetic nervous system release norepinephrine that binds to beta receptors
on other cells. Propranolol inhibits the sympathetic nervous system by blocking
the beta receptors on the nerves of the sympathetic system. Since stimulation of
the sympathetic nervous system is responsible for increasing the rate with which
the heart beats, by blocking the action of these nerves propranolol reduces the
heart rate and is useful in treating abnormally rapid heart rhythms.
Propranolol also reduces the force of contraction of heart muscle and thereby
lowers blood pressure. By reducing the heart rate and the force of muscle
contraction, propranolol reduces the need for oxygen by heart muscle. Since
heart pain (angina pectoris) occurs when oxygen demand of the heart muscle
exceeds the supply of oxygen, propranolol, by reducing the demand for oxygen, is
helpful in treating heart pain. The FDA approved propranolol in November 1967.
STORAGE: Tablets and capsules should be stored at room temperature, 15 to 30 C
(59 to 86 F), in a tightly closed container.
PRESCRIBED FOR: Propranolol is prescribed for patients with high blood
pressure (hypertension). It is also used to treat chest pain (angina pectoris)
related to coronary artery disease. Propranolol is useful in slowing and
regulating certain types of abnormally rapid heart rates (tachycardias). Other
uses for propranolol include the prevention of
migraine headaches and the
treatment of certain types of tremors (familial or hereditary essential
tremors). Propranolol is commonly used in persons with thyrotoxicosis (high
blood levels of thyroid hormone) to slow down rapid heart rate and tremor.
DOSING: The recommended dose for hypertension using short acting formulations
is 80-240 mg twice daily. The maximum dose is 640 mg daily.
The usual dose using
long acting formulations is 80-160 mg daily.
The recommended dose for chest pain
is 80-320 mg daily using short acting formulations and 80-160 mg daily using
long acting formulations.
The usual dose for treatment of abnormal heart rhythms
is 10-30 mg 3-4 times daily of short acting formulations.
The recommended dose
for preventing migraines is 80-240 mg daily.
DRUG INTERACTIONS:Calcium channel blockers and digoxin (Lanoxin) can lower
of blood pressure and heart rate to dangerous levels when administered together
with propranolol. Propranolol can mask the early warning symptoms of low blood
sugar (hypoglycemia) and should be used with caution in patients receiving
treatment for diabetes. Propranolol reduces the metabolism of thioridazine
(Mellaril), increasing the concentration of thioridazine in the body and
potentially causing abnormal heart beats.
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.
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.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizzyness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
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.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
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.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
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.
Mitral valve prolapse (MVP) is also also known as "click murmur syndrome" and "Barlow's syndrome." Mitral valve prolapse is the most common heart valve abnormality. Signs and symptoms of mitral valve prolapse include: fatigue, palpitations, chest pain, anxiety, and migraine headaches. Echocardiography is the most useful test for mitral valve prolapse. Most patients do not need any treatment, however, patients with severe prolapse may need treatment.
There are many types of thyroid disease. Some occur due to the function of the thyroid itself such as hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, etc. Some causes of thyroid disease occur due to problems with the structure of the thyroid gland such as goiters, thyroid nodules, and thyroid cancer. Treatment of thyroid disease depends on the cause of the disease.
Tremor is the involuntary movements of one or more parts of the body. Causes of tremor include neurological disorders, neurodegenerative diseases, drugs, mercury poisoning, overactive thyroid and liver failure. There are several types of tremor. Treatment depends upon the type of tremor and availability of medications for the condition.
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.
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.
Agoraphobia is a fear of being outside or of being in a situation from which escape would be impossible. Symptoms include anxiety, fear, disorientation, rapid heartbeat, diarrhea, or dizziness. Treatment may incorporate psychotherapy, self-exposure to the anxiety-causing situation, and medications such as SSRIs, benzodiazepines, and beta blockers.
Phobias are unrelenting fears of activities (social phobias), situations (agoraphobia), and specific items (arachnophobia). There is thought to be a hereditary component to phobias, though there may be a cultural influence or they may be triggered by life events. Symptoms and signs of phobias include having a panic attack, shaking, breathing troubles, rapid heart beat, and a strong desire to escape the situation. Treatment of phobias typically involves desensitization, cognitive behavioral therapy, and medications such as selective serotonin reuptake inhibitors and beta blockers.
Cocaine is an addictive stimulant that is smoked, snorted, and injected. Crack is cocaine that comes in a rock crystal that is heated to form vapors, which are then smoked. Cocaine has various effects on the body, including dilating pupils, constricting blood vessels, increasing body temperature, heart rate, and blood pressure.
Hyperthyroidism is a condition in which an overactive thyroid gland is producing an excessive amount of
thyroid hormones
that circulate in the
blood. ("Hyper" means "over" in Greek). Thyrotoxicosis is a toxic condition that is caused by
an excess of thyroid hormones from any cause. Thyrotoxicosis can be caused by
an excessive intake of thyroid hormone or by overproduction of thyroid hormones by the thyroid gland. Because both physicians and patients
often use these words interchangeably, we will take some liberty by using the
term "hyperthyroidism" throughout this article.
What are thyroid hormones?
Thyroid hormones stimulate the metabolism of cells. They are produced by the
thyroid gland. The thyroid gland is located in the lower part of the neck, below the Adam's apple. The gland wraps around the
windpipe (trachea) and has a shape that is similar to a butterfly formed by two
wings (lobe...
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