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

In relation to cardiovascular drugs oral healthcare providers (OHCPs) must (1) recognize drugs by name (generic and/or brand name); (2) know their mechanisms of action and indications for use; (3) be aware of the spectrum of ADRs and be actively involved in monitoring for and reporting such drug effects; and (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 Since the top 200 drugs alone are associated with nearly 10,000 potential ADRs ranging from mild to severe illness and can lead to hospitalization, permanent disability, and even death, access to informational resources is imperative.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