Pharmacotherapy Using Cardiovascular Agents: Focus on the Top 200 Drugs

Abstract

Objective:

To summarize pharmacologic agents available to treat cardiovascular diseases, including heart failure, hypertension, and hyperlipidemia.

Data Sources:

Drugs used in the management of cardiovascular disease were identified from a list of the top 200 drugs of 2008 by number of prescriptions dispensed. Relevant articles were obtained via a MEDLINE search (2000-March 2010) using the key words pharmacy technician, hypertension, heart failure, hyperlipidemia, β-blocker, ACE inhibitor, angiotensin receptor blocker, diuretic, calcium-channel blocker, clonidine, HMG-CoA reductase inhibitor, ezetimibe, fenofibrate, niacin, clopidogrel, warfarin, isosorbide mononitrate, and digoxin. In addition, evidence-based practice guidelines, monographs, package inserts, and other secondary sources were reviewed.

Study Selection and Data Extraction:

Relevant information regarding dosages, trade/generic names, pharmacology, and adverse effects associated with common agents to treat cardiovascular disease was included.

Data Synthesis:

Despite falling mortality rates, cardiovascular disease continues to be the leading cause of death in the US and is a significant cause of morbidity. Pharmacy technicians should be familiar with the basic pharmacology of the most commonly prescribed medications. Selected agents used to treat heart failure and hypertension from the following classes of drugs were reviewed: β-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics, calcium-channel blockers, and a centrally acting agent. Additionally, common drugs used to treat hyperlipidemia, including hydroxymethylglutaryl coenzyme A reductase inhibitors, cholesterol absorption inhibitors, fibric acids, and niacin, were reviewed. Antiplatelet agents, selected vasodilators, warfarin, and digoxin were also reviewed.

Conclusions:

Drug therapy is the key to successful management of cardiovascular disease. Health-care providers, including knowledgeable pharmacy technicians, can assist patients in the proper use of agents in the treatment of cardiovascular diseases.

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References

Lloyd-Jones

Adams

Carnethon

. Heart disease and stroke statistics—2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119: e21–181.

Academy of Managed Care Pharmacy. White paper on pharmacy technicians 2002: needed changes can no longer wait. Am J Health Syst Pharm 2003; 60: 37–51.

Chobanian

Bakris

Black

. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–52.

Sasseen

Maclaughlin

. Hypertension. In: DiPiro

Talbert

Yee

., eds. Pharmacotherapy: a pathophysiologic approach. 7th ed. New York: McGraw Hill, 2008: 139–72.

Lamb

. Top 200 drugs of 2008. Pharmacy Times. Published May 15, 2009. http://www.pharmacytimes.com/issue/pharmacy/2009/2009–05/RxFocusTop200Drugs-0509 (accessed 2009 Oct 1)

Parker

Rodgers

Cavallari

. Heart failure. In: DiPiro

Talbert

Yee

., eds. Pharmacotherapy: a pathophysiologic approach. 7th ed. New York: McGraw Hill, 2008: 173–216.

Jessup

Abraham

Casey

. 2009 Focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2009; 119:1977–2016.

Mahley

Bersot

. Drug therapy for hypercholesterolemia and dyslipidemia. In: Brunton

Lazo

Parker

, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw Hill, 2006: 933–66.

Talbert

. Hyperlipidemia. In: DiPiro

Talbert

Yee

., eds. Pharmacotherapy: a pathophysiologic approach. 7th ed. New York: McGraw Hill, 2008: 385–407.

10.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Final report. Circulation 2002; 106: 3143–421.

11.

Westfall

. Adrenergic agonists and antagonists. In: Brunton

Lazo

Parker

, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw Hill, 2006: 237–95.

12.

Smith

Jr Allen

Blair

. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. Circulation 2006; 113: 2363–72.

13.

Package insert. Lopressor (metoprolol tartrate). East Hanover, NJ: Novartis, February 2009.

14.

Package insert. Coreg (carvedilol). Research Triangle Park, NC: GlaxoSmithKline, June 2009.

15.

Jackson

. Renin and angiotensin. In: Brunton

Lazo

Parker

, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw Hill, 2006: 789–821.

16.

Jackson

. Diuretics. In: Brunton

Lazo

Parker

, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw Hill, 2006: 737–69.

17.

The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–97.

18.

Michel

. Treatment of myocardial ischemia. In: Brunton

Lazo

Parker

, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw Hill, 2006: 823–44.

19.

Hoffman

. Therapy of hypertension. In: Brunton

Lazo

Parker

, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw Hill, 2006: 845–68.

20.

Package insert. Calan (verapamil). Chicago, IL: Pharmacia, July 2003.

21.

Package insert. Catapres (clonidine). Ridgefield, CT: Boehringer Ingelheim, November 2009.

22.

HMG-CoA reductase inhibitors. Drug facts and comparisons. Indianapolis, IN: Walters Kluwer Health, Inc.; 2009. http://online.fact-sandcomparisons.com (accessed 2009 Jun 11).

23.

Kastelein

Akdim

Stroes

. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med 2008; 358: 1431–44.

24.

Package insert. Plavix (clopidogrel). Bridgewater, NJ: Bristol-Myers Squibb/Sanofi, May 2009.

25.

Majerus

Tollefsen

. Blood coagulation and anticoagulant, thrombolytic, and antiplatelet drugs. In: Brunton

Lazo

Parker

, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw Hill, 2006: 1467–88.

26.

Fagan

Hess

. Stroke. In: DiPiro

Talbert

Yee

., eds. Pharmacotherapy: a pathophysiologic approach. 7th ed. New York: McGraw Hill, 2008: 373–84.

27.

Becker

Meade

Berger

. The primary and secondary prevention of coronary artery disease. Chest 2008; 133 (suppl 6): 776S–814S.

28.

Salicylates. Wickersham

Novak

, eds. Drug facts and comparisons. 2009 ed. St. Louis, MO: Wolters Kluwer Health, 2009: 1212–4.

29.

Warfarin sodium. Wickersham

Novak

, eds. Drug facts and comparisons. 2009 ed. St. Louis, MO: Wolters Kluwer Health; 2009: 229–36.

30.

Package insert. Imdur (isosorbide mononitrate). Princeton, NJ: Kremers Urban, September 2008.

31.

Rocco

Fang

. Pharmacotherapy of congestive heart failure. In: Brunton

Lazo

Parker

, eds. Goodman & Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw Hill, 2006: 869–97.