Insights: Experts Discuss Importance of CAD/PAD Management


Peripheral artery disease (PAD) and coronary artery disease (CAD) are similar conditions caused by atherosclerosis. This is when the arteries in critical regions of the body narrow and are blocked. In a Pharmacy Times® Practice Pearls video series, experts discussed the importance of CAD/PAD management, education, and best practices.

The panel included Paul P. Dobesh, PharmD, FCCP, BCPS, professor in the Department of Pharmacy Practice and Science University of Nebraska Medical Center’s College of Pharmacy and James B. Groce, PharmD, CACP, a professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences.

The presentation of CAD generally revolves around chest pain related to a mismatch of supply and demand, according to the experts.

“The typical symptoms—obviously, many of us are familiar with coronary artery disease in that usually it leads to chest pain or angina. Why this happens can be for different reasons. Patients can have fairly stable disease where plaques have grown—atherosclerotic plaques have grown—slowly over decades,” Dobesh said. “And then when they exert themselves—maybe they walk for 20 minutes or they’re in the garden or doing laundry, whatever it may be—their myocardial oxygen demand outstrips the supply because of the atherosclerotic plaque and they get some chest pain. They rest; supply and demand come back into balance as pain goes away.”

Pharmacists who work with CAD/PAD patients should be continuously educating themselves on changes to care and best practices. Without proper data, understanding or support, the consequences could be dire, according to the panel.

“That again brings us to another point that I believe can be one of the things that we professionally…which is trying to educate our colleagues; educate ourselves about knowing the data, the outcomes of safety and efficacy,” Groce said.

CAD/PAD is treated using anticoagulants. Dobesh and Groce addressed the interchangeability of different direct oral anticoagulants (DOACs) at 2.5 mg strength.

“We’re not seeing any effort or concerted effort to interchange the different DOACs, and I think, of course, we’re probably both having flashbacks to the mid to late 1980s regarding low-molecular-weight heparins, in which this was just something that was routinely done or within different health care systems. The good news is, I’ve seen no such effort for that happening,” Groce said.

According to Groce, the changing and expanding role of the pharmacist will help the future of CAD/PAD care.

“I think certainly over the long course of both of our careers, Paul, we’ve seen the role of pharmacists and pharmacy change, to where today it’s really that our providers, our physicians, our advanced practice providers, really do look to us as someone who is knowledgeable in drug therapy,” Groce said.

“So I encourage, if not challenge, my other pharmacy colleagues to be a part of change in not only making certain that order sets are created within the health care system, making certain that there are smooth transitions of care, but also maybe picking up a phone and speaking with someone and indicating, ‘Yes, I want this particular DOAC [direct oral anticoagulant] for this particular indication for my patient,’ to make certain that the person receiving the prescription is aware and understanding of the new evidence and the new data and the new FDA-approved indication.”

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