Cardiovascular Drugs in the Top 300

Therapeutic agents in the Top 300 Prescription Drugs dispensed by U.S. community pharmacies indicated for the treatment of cardiovascular diseases fall into 6 major categories: (1) drugs that regulate cholesterol and lipoprotein metabolism, (2) drugs that regulate extracellular fluid volume, (3) drugs that regulate vascular tone, (4) drugs that regulate cardiac rhythm, (5) drugs that regulate cardiac contractility, and (6) drugs that affect hemostasis, i.e., platelet function and coagulation.^2-9

Oral healthcare providers (OHCPs) need to (1) recognize medications by name (generic and/or brand name); (2) know their mechanisms of action and indications for use; (3) be aware of the spectrum of their ADRs and be actively involved in monitoring for and reporting such adverse effects; (4) have access to reliable informational resources. DailyMed is the official repository for FDA-approved individual drug-related clinically relevant data and it is a useful online resource for clinicians.¹⁰

The Council of International Organizations of Medical Sciences in their publication “Reporting Adverse Drug Reactions: Definitions of Terms and Criteria for Their Use” codified ADRs under 21 major headings and defined 179 conditions considered reportable.¹¹ ADRs range from mild to severe and can lead to hospitalization, permanent disability, and even death. The issue of identifying and addressing ADRS cannot be overstated. ADRs occur in up to 35% of older outpatients and 44% of older inpatients. Patients taking 7 or more medications have an 80% risk of experiencing an ADR and ADRs account for 10% of all emergency department visits.¹²

Adverse drug effects may be explained by one of five mechanisms: (1) “on-target” adverse reactions, (2) “off-target” adverse reactions, (3) cytotoxic reactions, (4) immune-mediated reactions, and (5) idiosyncratic reactions, i.e., reactions of unknown mechanisms.¹³ A discussion of mechanisms of ADRs, common ADRs associated with drugs dispensed by U.S. community pharmacies, and less common ADRs that may manifest in the head and neck area is presented elsewhere.^13-15