Table 17: Top 20 Products in the U.S. Market by Number of Prescriptions Dispensed in 2017 Drug Name Prescriptions Class of Medication: Targeted Condition 19. Insulin 30,588,285
Insulin hormone replacement: type I diabetes mellitus
20. Fluticasone
30,573,156
Corticosteroid: breathing difficulties (asthma)
GERD = gastroesophageal reflux disease; SOB = shortness of breath. Note . Based on information from ClinCalc DrugStats Database, Version 17.0, by S. P. Kane, 2017, ClinCalc: http://clincalc.com/DrugStats, Updated 2017; National Institutes of Health, U.S. National Library of Medicine, MedlinePlus, references from 2014 through 2017.
This section discusses the common side effects of the most frequently prescribed medications and the physiological system or systems most likely to be adversely affected by their use. The importance of the initial evaluation is underscored by the fact that many of the adverse reactions to these medications would generate an affirmative response to one or more general
health questions and the specific physiological system screening questions. Any indication of an adverse effect should be reported to the patient’s physician immediately. Symptoms of adverse drug reactions are listed by physiological system in Table 18.
Table 18: Five Physiological Systems Commonly Affected by Adverse Drug Reactions, the Associated Symptoms, and the Classes of Drugs Frequently Associated with Those Reactions Physiological Systems Commonly Affected by Adverse Reactions Symptoms of an Adverse Reaction Medications Associated with Adverse Drug Reactions
• Analgesics : NSAIDs, opioids, salicylates. • Cardiovascular : statins, beta-1 blockers, beta-2 agonist, calcium channel blockers, antiplatelet agents. • CNS : antidepressants. • Others : leukotriene receptor antagonists, antibiotics, proton pump inhibitors, thyroid replacement hormone, glucose regulators. • Analgesics : NSAIDs, opioids, salicylates. • Cardiovascular : statins, beta-1 blockers, beta-2 agonists, ACE inhibitors, antiplatelet agents. • Others : antibiotics. • Analgesics : NSAIDs, opioids. • Cardiovascular : beta-1 blockers, beta-2 agonists, calcium channel blockers, ACE inhibitors, antiplatelet agents • CNS : antidepressants. • Others : leukotriene receptor antagonists, glucose regulators, thyroid replacement hormone. • Analgesics : NSAIDs, opioids. • Cardiovascular : statins, beta-1 blockers, beta-2 agonist, ACE inhibitors, antiplatelet agents. • Others : antibiotics, leukotriene receptor antagonists, proton pump inhibitors. • Cardiovascular : statins, calcium channel blockers, ACE inhibitors, beta-2 agonists. • Others : proton pump inhibitors, leukotriene receptor antagonists, glucose regulators.
Gastrointestinal
Nausea, vomiting, dyspepsia, heartburn, indigestion, abdominal pain/cramps, diarrhea, constipation, dysphagia, dry mouth.
Pulmonary
Shortness of breath, bronchospasm, respiratory depression, dyspnea, apnea.
Central Nervous
Dizziness, drowsiness, confusion, depression, insomnia, headache, weakness, fatigue, anxiety, tremor, restlessness, agitation.
Integumentary
Skin rash, pruritus (itching), flushing of the face, acne.
Musculoskeletal
Weakness, fatigue, muscle cramps, arthralgias, myalgias, decreased exercise tolerance.
ACE = angiotensin-converting enzyme; CNS = central nervous system; NSAID = nonsteroidal anti-inflammatory drug. Note . Based on information from Pharmacology for Nurses: A Pathophysiologic Approach, 3rd ed., by M. P. Adams and L. N. Holland, 2011, Upper Saddle River, NJ: Pearson/Epocrates; National Institutes of Health, U.S. National Library of Medicine, MedlinePlus, references from 2014 through 2017. TOP 20 PRESCRIPTION DRUGS IN THE UNITED STATES IN 2017 – NARRATIVE SUMMARY
Lisinopril was the most prescribed medication in 2017 (Kane, 2017). Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to block the conversion of angiotensin I to angiotensin II. Angiotensin II is a powerful vasoconstrictor that elevates the blood pressure and expands the blood volume. Blocking the impact of angiotensin II leads to a reduction in vasomotor tone (vasodilation) and a reduced blood volume, which results in a lowering of the blood pressure.
Nine of the 20 most prescribed medications in 2017 were used to treat or prevent various forms of cardiovascular disease (Kane, 2017). The reader should remember that approximately 21% of the subjects in Boissonault’s outpatient study (1999) reported a history of hypertension, and seven different drugs used to treat hypertension were among the 20 most frequently prescribed medications in 2017. This group of anti-hypertensive medications included five different classes of medications each with different mechanisms of action.
EliteLearning.com/Physical-Therapy
Book Code: PTOH1324
Page 96
Powered by FlippingBook