PHARMACOTHERAPY
A Pathophysiologic Approach
Editors
Joseph T. DiPiro, PharmD, FCCP
Professor and Executive Dean, South Carolina College of Pharmacy,
University of South Carolina, Columbia, and Medical University of South Carolina, Charleston
Robert L. Talbert, PharmD, FCCP, BCPS
Professor, College of Pharmacy, University of Texas at Austin;
Professor, Departments of Medicine and Pharmacology, University of Texas Health Science Center at San Antonio, Texas
Gary C. Yee, PharmD, FCCP
Professor and Chair, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
Gary R. Matzke, PharmD, FCP, FCCP
Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, Renal-Electrolyte Division, School of Medicine,
University of Pittsburgh, Pittsburgh, Pennsylvania
Barbara G. Wells, PharmD, FASHP, FCCP, BCPP
Dean and Professor, School of Pharmacy, The University of Mississippi, University, Mississippi
L. Michael Posey, BS Pharm
President, PENS Pharmacy Editorial and News Services, Athens, Georgia
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The editors were Michael Brown, Andrew Hall, Karen G. Edmonson, and Peter J. Boyle.
The production supervisor was Richard Ruzycka. The text designer was Joan O’Connor.
The cover designer was Elizabeth Pisacreta. Barbara Littlewood prepared the index. RR Donnelley was printer and binder.
This book is printed on acid-free paper.
Cover images copyrightC 1999 by Obi-Tabot Tabe. The images used on the cover and spine are taken from a 9′×4-1/2′oil painting by Obi-Tabot Tabe,
PharmD, a painter, graphic designer, scientific illustrator, and pharmacist. Dr. Tabe, originally from Cameroon, is a graduate of the University of Pittsburgh, School of Pharmacy. The painting incorporates the artist’s impressions of concepts introduced in the pharmacy curriculum. The painting can be seen in the student lounge of Salk Hall at the university.
To those pharmacists who had the courage and perseverance to pioneer the development of the clinical practice of pharmacy.
To the contemporary pharmaceutical care practitioners who continue to expand their impact on patient outcomes and thereby serve as role models for their colleagues and students while clinging tenaciously to the highest standards of
practice.
To our mentors, whose vision provided educational and training programs that encouraged our professional growth and challenged us to be innovators in our
patient care, research, and educational endeavors.
To our faculty colleagues for their efforts and support for our mission to provide a comprehensive and challenging educational foundation for the clinical pharmacists
of the future.
C
ONTENTS
. . . .
Foreword
. . .xv
Foreword to the First Edition
. . .xvii
Preface
. . . .xix
Contributors
. . .xxi
Guiding Principles of Pharmacotherapy
. . . . .xxxiii
SECTION 1: BASIC CONCEPTS
. . . .1
L. Michael Posey, Section Editor
1.
Pharmacoeconomics: Principles, Methods,
and Applications
. . . .1
Lisa A. Sanchez
2.
Health Outcomes and Quality of Life
. . . .17
Stephen Joel Coons
3.
Evidence-Based Medicine
. . . .27
Elaine Chiquette
L. Michael Posey
4.
Documentation of Pharmacy
Services
. . .39
George E. MacKinnon, III
Neil J. MacKinnon
5.
Clinical Pharmacokinetics
and Pharmacodynamics
. . .51
Larry A. Bauer
6.
Pharmacogenetics
. . . .75
Larisa H. Cavallari
Y. W. Francis Lam
7.
Pediatrics
. . . .91
Milap C. Nahata
Carol Taketomo
8.
Geriatrics
. . .103
Catherine I. Lindblad
Shelly L. Gray
David R. P. Guay
Emily R. Hajjar
Teresa C. McCarthy
Joseph T. Hanlon
9.
Pharmacoepidemiology
. . .115
Andy Stergachis
Thomas K. Hazlet
10.
Clinical Toxicology
. . .125
Peter A. Chyka
SECTION 2. CARDIOVASCULAR
DISORDERS
. . .149
Robert L. Talbert, Section Editor
11.
Cardiovascular Testing
. . . .149
Robert L. Talbert
12.
Cardiopulmonary Resuscitation
. . . .171
Jeffrey F. Barletta
13.
Hypertension
. . .185
Joseph J. Saseen
Barry L. Carter
14.
Heart Failure
. . . .219
Robert B. Parker
J. Herbert Patterson
Julie A. Johnson
15.
Ischemic Heart Disease
. . .261
Robert L. Talbert
16.
Acute Coronary Syndromes
. . .291
Sarah A. Spinler
Simon de Denus
17.
Arrhythmias
. . . .321
Jerry L. Bauman
Marieke Dekker Schoen
18.
Diastolic Heart Failure and
the Cardiomyopathies
. . .357
Jean M. Nappi
Michael R. Zile
19.
Venous Thromboembolism
. . . .373
Stuart T. Haines
Mario Zeolla
Daniel M. Witt
20.
Stroke
. . . .415
Susan C. Fagan
David C. Hess
21.
Hyperlipidemia
. . .429
Robert L. Talbert
22.
Peripheral Arterial Disease
. . . .453
Barbara J. Hoeben
Robert L. Talbert
23.
Use of Vasopressors and Inotropes in the
Pharmacotherapy of Shock
. . . .461
Maria I. Rudis
Joseph F. Dasta
24.
Hypovolemic Shock
. . .479
Brian L. Erstad
SECTION 3. RESPIRATORY
DISORDERS
. . .495
Robert L. Talbert, Section Editor
25.
Introduction to Pulmonary Function
Testing
. . .495
Jay I. Peters
Stephanie M. Levine
26.
Asthma
. . .503
H. William Kelly
Christine A. Sorkness
27.
Chronic Obstructive Pulmonary Disease
. .537
Sharya V. Bourdet
Dennis M. Williams
28.
Acute Respiratory Distress Syndrome
. . . .557
Peter Gal
J. Laurence Ransom
29.
Drug-Induced Pulmonary Diseases
. . .577
Hengameh H. Raissy
Michelle Harkins
Patricia L. Marshik
30.
Cystic Fibrosis
. . . .591
Gary Milavetz
Jeffrey J. Smith
SECTION 4. GASTROINTESTINAL
DISORDERS
. . .605
Joseph T. DiPiro, Section Editor
31.
Evaluation of the Gastrointestinal
Tract
. . .605
Marie A. Chisholm
Mark W. Jackson
32.
Gastroesophageal Reflux Disease
. . . .613
Dianne B. Williams
Robert R. Schade
33.
Peptic Ulcer Disease
. . . .629
Rosemary R. Berardi
Lynda S. Welage
34.
Inflammatory Bowel Disease
. . . .649
Joseph T. DiPiro
Robert R. Schade
35.
Nausea and Vomiting
. . . .665
Cecily V. DiPiro
A. Thomas Taylor
36.
Diarrhea, Constipation, and Irritable
Bowel Syndrome
. . . .677
William J. Spruill
William E. Wade
37.
Portal Hypertension and Cirrhosis
. . .693
Edward G. Timm
James J. Stragand
38.
Drug-Induced Liver Disease
. . .713
William R. Kirchain
Mark A. Gil
39.
Pancreatitis
. . .721
Rosemary R. Berardi
Patricia A. Montgomery
40.
Viral Hepatitis
. . . .737
Manjunath P. Pai
SECTION 5. RENAL DISORDERS
. . . .761
Gary R. Matzke, Section Editor
41.
Quantification of Renal Function
. . .761
Thomas C. Dowling
Thomas J. Comstock
42.
Acute Renal Failure
. . .781
Bruce A. Mueller
43.
Chronic Kidney Disease:
Progression-Modifying Therapies
. . . .799
Melanie S. Joy
Abhijit Kshirsagar
James Paparello
44.
Chronic Kidney Disease: Therapeutic
Approach for the Management of
Complications
. . . .821
Joanna Q. Hudson
Kunal Chaudhary
45.
Hemodialysis and Peritoneal Dialysis
. . . .851
Rowland J. Elwell
Edward F. Foote
46.
Drug-Induced Kidney Disease
. . .871
Thomas D. Nolin
Jonathan Himmelfarb
Gary R. Matzke
47.
Glomerulonephritis
. . .891
Alan H. Lau
48.
Drug Therapy Individualization for Patients
with Renal Insufficiency
. . .919
Reginald F. Frye
Gary R. Matzke
49.
Disorders of Sodium, Water, Calcium, and
Phosphorus Homeostasis
. . . .937
Melanie S. Joy
Gerald A. Hladik
50.
Disorders of Potassium and Magnesium
Homeostasis
. . . .967
Donald F. Brophy
Todd W. B. Gehr
51.
Acid-Base Disorders
. . . .983
Gary R. Matzke
Paul M. Palevsky
SECTION 6. NEUROLOGIC DISORDERS
. .1003
Barbara G. Wells, Section Editor
52.
Evaluation of Neurologic Illness
. . . .1003
Susan C. Fagan
Fenwick T. Nichols
53.
Multiple Sclerosis
. . .1007
Jacquelyn L. Bainbridge
John R. Corboy
54.
Epilepsy
. . .1023
Barry E. Gidal
William R. Garnett
55.
Status Epilepticus
. . . .1049
Stephanie J. Phelps
Collin A. Hovinga
Bradley A. Boucher
56.
Acute Management of the Brain Injury
Patient
. . .1061
Bradley A. Boucher
Stephanie J. Phelps
Shelly D. Timmons
57.
Parkinson’s Disease
. . . .1075
Merlin V. Nelson
Richard C. Berchou
Peter A. LeWitt
58.
Pain Management
. . . .1089
Terry J. Baumann
59.
Headache Disorders
. . . .1105
Deborah S. King
Katherine C. Herndon
SECTION 7. PSYCHIATRIC DISORDERS
. .1123
Barbara G. Wells, Section Editor
60.
Evaluation of Psychiatric Illness
. . . .1123
Patricia A. Marken
61.
Childhood Disorders
. . .1133
Julie A. Dopheide
Karen A. Theesen
Michael Malkin
62.
Eating Disorders
. . .1147
Patricia A. Marken
Roger W. Sommi
63.
Alzheimer’s Disease
. . .1157
Jennifer D. Faulkner
Jody Bartlett
Paul Hicks
64.
Substance-Related Disorders: Overview
and Depressants, Stimulants, and
Hallucinogens
. . .1175
Paul L. Doering
65.
Substance-Related Disorders: Alcohol,
Nicotine, and Caffeine
. . .1193
Paul L. Doering
66.
Schizophrenia
. . .1209
M. Lynn Crismon
Peter F. Buckley
67.
Depressive Disorders
. . . .1235
Judith C. Kando
Barbara G. Wells
Peggy E. Hayes
68.
Bipolar Disorder
. . .1257
Martha P. Fankhauser
Marlene P. Freeman
69.
Anxiety Disorders I: Generalized Anxiety,
Panic, and Social Anxiety Disorders
. . . .1285
Cynthia K. Kirkwood
Sarah T. Melton
70.
Anxiety Disorders II: Posttraumatic Stress
Disorder and Obsessive-Compulsive
Disorder
. . .1307
Cynthia K. Kirkwood
Eugene H. Makela
Barbara G. Wells
71.
Sleep Disorders
. . . .1321
Cherry W. Jackson
Judy L. Curtis
SECTION 8. ENDOCRINOLOGIC
DISORDERS
. . . .1333
Robert L. Talbert, Section Editor
72.
Diabetes Mellitus
. . . .1333
Curtis L. Triplitt
Charles A. Reasner
William L. Isley
73.
Thyroid Disorders
. . .1369
Robert L. Talbert
74.
Adrenal Gland Disorders
. . .1391
John G. Gums
John M. Tovar
75.
Pituitary Gland Disorders
. . . .1407
Amy M. Heck
Jack A. Yanovski
Karim Anton Calis
SECTION 9. GYNECOLOGIC AND
OBSTETRIC DISORDERS
. . .1425
Barbara G. Wells, Section Editor
76.
Pregnancy and Lactation: Therapeutic
Considerations
. . .1425
Denise L. Walbrandt Pigarelli
Connie K. Kraus
Beth E. Potter
77.
Contraception
. . .1443
Lori M. Dickerson
Kathryn K. Bucci
78.
Menstruation-Related Disorders
. . . .1465
Martha P. Fankhauser
Marlene P. Freeman
79.
Endometriosis
. . .1485
Deborah A. Sturpe
Alkesh D. Patel
80.
Hormone Therapy in Women
. . .1493
Sophia N. Kalantaridou
SECTION 10. UROLOGIC DISORDERS
. . .1515
L. Michael Posey, Section Editor
81.
Erectile Dysfunction
. . .1515
Mary Lee
82.
Management of Benign Prostatic
Hyperplasia
. . .1535
Mary Lee
83.
Urinary Incontinence
. . .1547
Eric S. Rovner
Jean Wyman
Thomas Lackner
David Guay
SECTION 11. IMMUNOLOGIC
DISORDERS
. . .1565
Gary C. Yee, Section Editor
84.
Function and Evaluation of the Immune
System
. . . .1565
Philip D. Hall
Mary S. Hayney
85.
Systemic Lupus Erythematosus and Other
Collagen-Vascular Diseases
. . . .1581
Jeffrey C. Delafuente
Kimberly A. Cappuzzo
86.
Allergic and Pseudoallergic Drug
Reactions
. . . .1599
Joseph T. DiPiro
Dennis R. Ownby
87.
Solid-Organ Transplantation
. . .1613
Heather J. Johnson
Kristine S. Schonder
SECTION 12. BONE AND JOINT
DISORDERS
. . .1645
L. Michael Posey, Section Editor
88.
Osteoporosis and Osteomalacia
. . .1645
Mary Beth O’Connell
Terry L. Seaton
89.
Rheumatoid Arthritis
. . . .1671
Arthur A. Schuna
90.
Osteoarthritis
. . . .1685
Karen E. Hansen
Mary Elizabeth Elliott
91.
Gout and Hyperuricemia
. . .1705
David W. Hawkins
Daniel W. Rahn
SECTION 13. DISORDERS OF THE
EYES, EARS, NOSE,
AND THROAT
. . .1713
L. Michael Posey, Section Editor
92.
Glaucoma
. . .1713
Timothy S. Lesar
Richard G. Fiscella
Deepak Edward
93.
Allergic Rhinitis
. . .1729
J. Russell May
Philip H. Smith
SECTION 14. DERMATOLOGIC
DISORDERS
. . .1741
L. Michael Posey, Section Editor
94.
Dermatologic Drug Reactions,
Self-Treatable Skin Disorders, and Skin
Cancer
. . .1741
Nina H. Cheigh
95.
Acne Vulgaris
. . .1755
Dennis P. West
Lee E. West
Maria Letizia Musumeci
Giuseppe Micali
96.
Psoriasis
. . .1769
Dennis P. West
Lee E. West
Laura Scuderi
Giuseppe Micali
SECTION 15. HEMATOLOGIC
DISORDERS
. . .1793
Gary C. Yee, Section Editor
98.
Hematopoiesis
. . .1793
William P. Petros
Solveig Ericson
99.
Anemias
. . . .1805
Beata Ineck
Barbara J. Mason
E. Gregory Thompson
100.
Coagulation Disorders
. . .1833
Betsy Bickert
Janet L. Kwiatkowski
101.
Sickle Cell Disease
. . . .1855
C. Y. Jennifer Chan
Reginald Moore
102.
Drug-Induced Hematologic Disorders
. . .1875
S. Jay Weaver
Thomas E. Johns
SECTION 16. INFECTIOUS DISEASES
. . .1891
Joseph T. DiPiro, Section Editor
103.
Laboratory Tests to Direct Antimicrobial
Pharmacotherapy
. . . .1891
Michael J. Rybak
Jeffrey R. Aeschlimann
104.
Antimicrobial Regimen Selection
. . .1909
David S. Burgess
Betty J. Abate
105.
Central Nervous System Infections
. . . .1923
Elizabeth D. Hermsen
John C. Rotschafer
106.
Lower Respiratory Tract Infections
. . . .1943
Mark L. Glover
Michael D. Reed
107.
Upper Respiratory Tract Infections
. . . .1963
Yasmin Khaliq
Sarah Forgie
George Zhanel
108.
Skin and Soft Tissue Infections
. . .1977
Susan L. Pendland
Douglas N. Fish
Larry H. Danziger
109.
Infective Endocarditis
. . . .1997
Michael A. Crouch
Angie Veverka
110.
Tuberculosis
. . .2015
Charles A. Peloquin
111.
Gastrointestinal Infections and
Enterotoxigenic Poisonings
. . .2035
Steven Martin
Rose Jung
112.
Intraabdominal Infections
. . . .2055
Joseph T. DiPiro
Thomas R. Howdieshell
113.
Parasitic Diseases
. . . .2067
JV Anandan
114.
Urinary Tract Infections and Prostatitis
. .2081
Elizabeth A. Coyle
Randall A. Prince
115.
Sexually Transmitted Diseases
. . .2097
Leroy C. Knodel
116.
Bone and Joint Infections
. . . .2119
Edward P. Armstrong
Leslie L. Barton
117.
Sepsis and Septic Shock
. . .2131
S. Lena Kang-Birken
Joseph T. DiPiro
118.
Superficial Fungal Infections
. . .2145
Thomas E. R. Brown
Thomas W. F. Chin
119.
Invasive Fungal Infections
. . . .2161
Peggy L. Carver
120.
Infections in Immunocompromised
Patients
. . . .2191
Douglas N. Fish
121.
Antimicrobial Prophylaxis in Surgery
. . .2217
Salmaan Kanji
John W. Devlin
122.
Vaccines, Toxoids, and Other
Immunobiologics
. . . .2231
Mary S. Hayney
123.
Human Immunodeficiency Virus
Infection
. . .2255
Courtney V. Fletcher
Thomas N. Kakuda
SECTION 17. ONCOLOGIC DISORDERS
. .2279
Gary C. Yee, Section Editor
124.
Cancer Treatment and Chemotherapy
. . .2279
Carol McManus Balmer
Amy Wells Valley
Andrea Iannucci
125.
Breast Cancer
. . .2329
Celeste Lindley
Laura Boehnke Michaud
126.
Lung Cancer
. . .2365
Rebecca S. Finley
Jeannine S. McCune
127.
Colorectal Cancer
. . . .2383
Patrick J. Medina
Lisa E. Davis
128.
Prostate Cancer
. . . .2421
Jill M. Kolesar
129.
Lymphomas
. . .2439
Val R. Adams
Gary C. Yee
130.
Ovarian Cancer
. . . .2467
William C. Zamboni
Laura L. Jung
Margaret E. Tonda
131.
Acute Leukemias
. . . .2485
Helen L. Leather
Betsy Bickert
132.
Chronic Leukemias
. . . .2513
Timothy R. McGuire
Steven Z. Pavletic
133.
Melanoma
. . .2525
Rowena N. Schwartz
134.
Hematopoietic Stem Cell
Transplantation
. . . .2541
Janelle B. Perkins
Gary C. Yee
SECTION 18. NUTRITIONAL
DISORDERS
. . .2559
Gary R. Matzke, Section Editor
135.
Assessment of Nutrition Status and
Nutrition Requirements
. . . .2559
Katherine Hammond Chessman
Vanessa J. Kumpf
136.
Prevalence and Significance of
Malnutrition
. . .2579
Gordon Sacks
Pamela D. Reiter
137.
Parenteral Nutrition
. . . .2591
Todd W. Mattox
Pamela D. Reiter
138.
Enteral Nutrition
. . .2615
Vanessa J. Kumpf
Katherine Hammond Chessman
139.
Nutritional Considerations in
Major Organ Failure
. . .2635
Renee M. DeHart
Sunshine J. Yocum
140.
Obesity
. . . .2659
John V. St. Peter
Mehmood A. Khan
Glossary
. . .2677
Index
. . .2695
F
OREWORD
. . . .
Drug therapy often represents the best treatment for human diseases and illnesses, and the spectrum of effective medications continues to improve at a remarkable pace. This is likely to continue over the com-ing years, as our understandcom-ing of disease pathogenesis and molecular pharmacology rapidly expands, fueling the discovery of new classes of medication. This, coupled with impressive advances in technology and our understanding of the human genome, promises to usher in a new wave of targeted therapies and individualized medicine that may further improve the efficacy and reduce the toxicity of medications. However, most of the highly effective medications currently available for clinical use emerged from classical pharmacology and chemistry, on a foundation of incomplete knowledge of disease mechanisms. This may contribute in part to the propensity of many medications to produce adverse drug effects or to exhibit limited efficacy in a subset of patients with a given diagnosis. These imperfect medications will remain the mainstay of therapeutics for years to come.
The limited efficacy and potential toxicity of many of today’s medications, coupled with the rapidly expanding portfolio of medi-cations for disease treatment and prevention, creates enormous com-plexity in selecting optimal medications for individual patients. Thus, the expertise of clinically educated and trained pharmacists is increas-ingly important if we are to ensure patients receive the most effective medications in the doses and combinations that are optimal for them and their illnesses.
The sixth edition of Pharmacotherapy: A Pathophysiologic Approachcontains a wealth of information that will be an invaluable resource to students and practitioners who work to expand their knowledge of pharmacotherapy and translate it into better drug ther-apy for individual patients. In a perfect world, every patient would benefit from the collective talents of a health care team that is fully able to integrate knowledge of disease pathogenesis and pharmacotherapy, thereby optimizing drug therapy for each individual. Such a team is incomplete without a clinical pharmacist.
How many clinical pharmacists does it take in this day and age? Can one justify 25 pharmacists for a 58-bed hospital? That’s the real-ity at St. Jude Children’s Research Hospital, where I have worked for the last 25 years. And this wasn’t even seriously challenged when the “health care consultants” rolled into town 10 years ago. Why not? The reasons are multiple, yet simple in the end: Pharmacists are integrally involved in the pharmacotherapy of every patient. The medical staff would not have it any other way, and the patients deserve no less. That’s as it should be everywhere, in hospitals and clinics and com-munity pharmacies. Moreover, pharmacists have become integral to the process of defining the future state of pharmacotherapy, by bring-ing unique expertise to the research enterprise. That must continue as well. The pharmacists of the present and future must integrate phar-macology, pathophysiology, therapeutics, and, increasingly, genetics into complex treatment decisions.
Pharmacotherapy: A Pathophysiologic Approachis an impor-tant tool to this end. By providing pharmacy students and practicing pharmacists (plus physicians and nurses) with a comprehensive and definitive source of information about diseases and their drug treat-ment, it is a conduit to the clinical use of pharmacotherapeutic princi-ples by pharmacists, which is thesine qua nonof pharmacy practice in the twenty-first century.
Health care in the United States and other developed countries has made great progress in recent decades, yet there are many
opportu-nities to improve the way these advances are deployed, especially drug therapy. Studies have shown that even when there are clear guidelines for appropriate use of medications for specific diseases, too many pa-tients receive suboptimal drug therapy for too long. This is caused in part by far more drug therapy choices than most clinicians can master and also by aggressive marketing—to physicians, pharmacists, and directly to consumers—which can inappropriately shape prescribing habits. Who is to intervene in the name of rational therapeutics? The well-armed pharmacist, for one!
Reality is even more alarming when one also considers adverse drug effects. A 2000 Institute of Medicine (IOM) report documented that adverse drug effects are common in the United States, represent-ing the sixth leadrepresent-ing cause of death accordrepresent-ing to published meta-analyses. This is staggering news. Yet even if overstated by 100% it is an enormous concern for patients. Pharmacists must intervene and make definitive strides to reduce the adverse effects of medications, and they must be armed with pharmacotherapeutic knowledge and given time in their clinical practice to do so. This textbook serves as a source of such knowledge for those who are devoted to this end, whether they are matriculating toward their pharmacy degree or striv-ing to advance their contributions in a busy clinical practice.
A 2001 IOM report documented a substantial gap in health care between those who receive the best and those who receive the average in health care in the United States. Recent studies have also documented that when patients exceed their cap in prescription drug coverage, they often discontinue medications or take fewer doses of prescribed therapy, even when adverse consequences can result if chronic diseases are left untreated. The cost-consequences of inade-quate prescription drug coverage may well exceed the cost-savings of capping or limiting prescription drug benefits.
How might pharmacists change this equation for the better? Per-haps one approach would be to avoid the use of unnecessarily ex-pensive medications when less exex-pensive medications are equally effective. Another would be to help minimize the adverse economic and health care impact of adverse drug effects. The pages of this text are filled with information that could simultaneously translate into greater efficacy, lower toxicity, and more cost-effective use of medica-tions. Pharmacists who translate this knowledge to everyday treatment decisions can play a vital role in showing not only that the best drug therapy can be safe and cost-effective, but that it does not always require the newest medication on the market. This will require a wealth of knowledge and determination by pharmacists, if they are to offset the power of marketing prescription drugs to prescribers and directly to the public.Pharmacotherapy: A Pathophysiologic Approachis a comprehensive scholarly effort by leading practitioners and educators who have created a definitive and unbiased resource that is based on a wealth of clinical experience and academic expertise. It offers a solid foundation for the education of future clinicians and for the practice of pharmacotherapy today, loaded with ammunition to fight the forces of irrational prescribing.
William E. Evans, PharmD
Professor of Pharmacy and Pediatrics
University of Tennessee Colleges of Pharmacy and Medicine Director and CEO
St. Jude Children’s Research Hospital Memphis, Tennessee
F
OREWORD TO THE
F
IRST
E
DITION
. . . .
Evidence of the maturity of a profession is not unlike that character-izing the maturity of an individual; a child’s utterances and behavior typically reveal an unrealized potential for attainment, eventually, of those attributes characteristic of an appropriately confident, inde-pendently competent, socially responsible, sensitive, and productive member of society.
Within a period of perhaps 15 or 20 years, we have witnessed a profound maturation within the profession of pharmacy. The utter-ances of the profession, as projected in its literature, have evolved from mostly self-centered and self-serving issues of trade protection to a composite of expressed professional interests that prominently include responsible explorations of scientific/technological questions and ethical issues that promote the best interests of the clientele served by the profession. With the publication ofPharmacotherapy: A Pathophysiologic Approach,pharmacy’s utterances bespeak a ma-tured practitioner who is able to call upon unique knowledge and skills so as to function as an appropriately confident, independently competent pharmacotherapeutics expert.
In 1987, the Board of Pharmaceutical Specialties (BPS), in deny-ing the petition filed by the American College of Clinical Pharmacy (ACCP) to recognize “clinical pharmacy” as a specialty, conceded nonetheless that the petitioning party had documented in its petition a specialist who does in fact exist within the practice of pharmacy and whose expertise clearly can be extricated from the performance char-acteristics of those in general practice. A refiled petition from ACCP requests recognition of “pharmacotherapy” as a Specialty Area of Pharmacy Practice. While the BPS had issued no decision when this book went to press, it is difficult to comprehend the basis for a rejec-tion of the second petirejec-tion.
Within this book one will find the scientific foundation for the essential knowledge required of one who may aspire to specialty prac-tice as a pharmacotherapist. As is the case with any such publication, its usefulness to the practitioner or the future practitioner is limited to providing such a foundation. To be socially and professionally responsible in practice, the pharmacotherapist’s foundation must be continually supplemented and complemented by the flow of informa-tion appearing in the primary literature. Of course this is not unique to the general or specialty practice of pharmacy; it is essential to the fulfillment of obligations to clients in any occupation operating under the code of professional ethics.
Because of the growing complexity of pharmacotherapeutic agents, their dosing regimens, and techniques for delivery, pharmacy is obligated to produce, recognize, and remunerate specialty practi-tioners who can fulfill the profession’s responsibilities to society for service expertise where the competence required in a particular case exceeds that of the general practitioner. It simply is a component of our covenant with society and is as important as any other facet of that relationship existing between a profession and those it serves.
The recognition by BPS of pharmacotherapy as an area of spe-cialty practice in pharmacy will serve as an important statement by the profession that we have matured sufficiently to be competent and
willing to take unprecedented responsibilities in the collaborative, pharmacotherapeutic management of patient-specific problems. It commits pharmacy to an intention that will not be uniformly or rapidly accepted within the established health care community. Nonetheless, this formal action places us on the road to an avowed goal, and acceptance will be gained as the pharmacotherapists proliferate and establish their importance in the provision of optimal, cost-effective drug therapy.
Suspecting that other professions in other times must have faced similar quests for recognition of their unique knowledge and skills I once searched the literature for an example that might parallel phar-macy’s modern-day aspirations. Writing in thePhiladelphia Medical Journal,May 27, 1899, D. H. Galloway, MD, reflected on the need for specialty training and practice in a field of medicine lacking such expertise at that time. In an article entitled “The Anesthetizer as a Speciality,” Galloway commented:
The anesthetizer will have to make his own place in medicine: the profession will not make a place for him, and not until he has demonstrated the value of his services will it concede him the position which the importance of his duties entitles him to occupy. He will be obliged to define his own rights, duties and privileges, and he must not expect that his own estimate of the importance of his position will be conceded without opposition. There are many surgeons who are unwilling to share either the credit or the emoluments of their work with anyone, and their opposition will be overcome only when they are shown that the importance of their work will not be lessened, but enhanced, by the increased safety and dispatch with which operations may be done. . ..
It has been my experience that, given the opportunity for one-on-one, collaborative practice with physicians and other health profes-sionals, pharmacy practitioners who have been educated and trained to perform at the level of pharmacotherapeutics specialists almost invariably have convinced the former that “the importance of their work will not be lessened, but enhanced, by the increased safety and dispatch with which” individualized problems of drug therapy could be managed in collaboration with clinical pharmacy practitioners.
It is fortuitous—the coinciding of the release of Pharmacother-apy: A Pathophysiologic Approachwith ACCP’s petitioning of BPS for recognition of the pharmacotherapy specialist. The utterances of a maturing profession as revealed in the contents of this book, and the intraprofessional recognition and acceptance of a higher level of responsibility in the safe, effective, and economical use of drugs and drug products, bode well for the future of the profession and for the improvement of patient care with drugs.
Charles A. Walton, PhD San Antonio, Texas
P
REFACE
. . . .
Pharmacists and other health care professionals who evaluate, de-sign, and recommend pharmacotherapy for the management of their patients face many new and exciting challenges in these early years of the twenty-first century. As we complete our work on the sixth edition ofPharmacotherapy: A Pathophysiologic Approach,we rec-ognize just how much our tasks as editors have become equally com-plicated, trying to balance the need to provide accurate, thorough, and unbiased information about the treatment of diseases against the hard publishing realities of deadlines, word counts, and book length. We thus strive to keep foremost in our minds the precepts that first led us to embark on this endeavor:
r Advance the quality of patient care through optimal medication management based on sound pharmacotherapeutic principles. r Stimulate the student to achieve higher levels of learning. r Motivate young practitioners to enhance the breadth, depth, and
quality of care they can provide to each of their patients. r Challenge established pharmacists and other primary-care
providers to learn the new concepts and refine their understanding of the basic tenets of pathophysiology and therapeutics.
r Inform the pharmacy and medical communities about the standards of medication therapy management toward which we all should strive and which all patients will one day expect and, yes, demand.
While our emphasis in past editions has been on how to incor-porate diseases that were previously untreatable with pharmacologic agents, new features in this sixth edition are focused more on the real-ities of teaching entry-level doctor of pharmacy students and meeting their postgraduate needs. We have incorporated a number of new pedagogical devices into chapters that will enable students and prac-titioners to more quickly grasp the important concepts and find related passages in the text. The addition of more features to disease-oriented chapters and the inclusion of more design elements give this edition a striking new look:
r Key concepts are listed at the beginning of each chapter and are identified in the text with numbered icons so that the reader can jump to the material of interest.
r The most common signs and symptoms of diseases as manifested in typical patients are presented in highlighted Clinical Presentation tables in disease-specific chapters. r Clinical controversies in treatment or patient management are
highlighted in shaded boxes to assure that the reader is aware of these issues and how practitioners are responding to them. r Each chapter has about 100 of the most important and current
references relevant to each disease, with most published since 1997.
r For easy reference, abbreviations and acronyms and their meanings are presented at the end of each chapter. r
A glossary of the medical terms used throughout the text is tabulated and presented at the end of the book.
r Finally, the diagnostic flow diagrams, desired outcomes of treatment, dosing guidelines, monitoring approaches, and treatment algorithms that were present in the fifth edition have been refined.
This edition includes two new chapters: Documentation of Phar-macy Services, which addresses the critical need for pharmacists to record their medication therapy management interventions, and Solid-Organ Transplantation, which combines material that was previously spread throughout several organ-specific chapters.
Before writing for this edition began, each editor read chapters from other editors’ sections and made suggestions for enhancement. During editing, we reviewed each passage of text—and the refer-ences cited—for continued relevance and accuracy. We made dele-tions, asked authors to summarize concepts more succinctly or use tables to present details more concisely, included new medications as they entered the U.S. market or emerged in other countries, and updated references. This process continued as the book entered pro-duction, and even during the review of final proofs, we continued to make changes to ensure that this book is as current and complete as is possible.
Standard formats have remained relatively unchanged since the first edition ofPharmacotherapy. When seeking information in the disease-oriented chapters, users will find these sections: Key Con-cepts, Epidemiology, Etiology, Pathophysiology, Clinical Presen-tation (including diagnostic considerations), Treatment (including desired outcomes, general approaches, nonpharmacologic therapy, pharmacologic therapy, and pharmacoeconomic considerations), and Evaluation of Therapeutic Outcomes.
As the world increasingly relies on electronic means of com-munication, we are committed to keepingPharmacotherapyand its companion works,Pharmacotherapy Casebook: A Patient-Focused ApproachandPharmacotherapy Handbook,integral components of clinicians’ toolboxes. With the launch of this edition the Web site with unique features designed to benefit students, practitioners, and faculty that was initiated with the fifth edition has been extensively expanded. One can now find learning objectives and self-assessment questions for each chapter on the site.
In closing, we also stop once again to acknowledge the many hours thatPharmacotherapy’s 200 authors contributed to this labor of love. Without their devotion to the cause of improved pharma-cotherapy and dedication in maintaining the accuracy, clarity, and relevance of their chapters, this text would unquestionably not be possible. In addition, we thank Michael Brown and his colleagues at McGraw-Hill—especially Jack Farrell, Marty Wonsiewicz, and Peter Boyle—for their consistent support of thePharmacotherapyfamily of resources, insights into trends in publishing and higher education, and the necessary and critical attention to detail so necessary in a book such as this one.
The Editors March 2005
C
ONTRIBUTORS
. . . .
Betty J. Abate, PharmD, BCPS
Coordinator of Drug Information Services, Hurley Medical Center, Department of Pharmacy, Farmington Hills, Michigan
Chapter 104
Val R. Adams, PharmD
Associate Professor, University of Kentucky College of Pharmacy, Oncology Clinical Specialist, Markey Cancer Center, Lexington, Kentucky
Chapter 129
Jeffrey R. Aeschlimann, PharmD
Assistant Professor, Division of Infectious Diseases, University of Connecticut School of Pharmacy, Adjunct Assistant Professor of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
Chapter 103
JV Anandan, PharmD, BCPS
Adjunct Associate Professor, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University; Pharmacy Specialist, Department of Pharmacy Services, Detroit, Henry Ford Hospital, Detroit, Michigan
Chapter 113
Edward P. Armstrong, PharmD, BCPS, FASHP
Professor, Department of Pharmacy Practice and Science, University of Arizona, College of Pharmacy, Tucson, Arizona
Chapter 116
Jacquelyn L. Bainbridge, PharmD
Associate Professor, Department of Clinical Pharmacy, School of Pharmacy; Department of Neurology, School of Medicine, University of Colorado Health Sciences Center, Denver, Colorado
Chapter 53
Carol McManus Balmer, PharmD
Associate Professor and Director, Postgraduate Professional Education, University of Colorado School of Pharmacy, Denver, Colorado
Chapter 124
Jeffrey F. Barletta, PharmD
Critical Care Specialist, Department of Pharmacy, Spectrum Health, Grand Rapids, Michigan
Chapter 11
Jody Don Bartlett, PharmD, BCPP
Clinical Specialist in Psychiatry, Central Texas Veterans Health Care System, Waco VA Medical Center, Waco, Texas
Chapter 63
Leslie L. Barton, MD
Professor of Pediatrics, University of Arizona School of Medicine, Director, Pediatric Residency Program, University Medical Center, Tucson, Arizona
Chapter 116
Larry A. Bauer, PharmD, FCP, FCCP
Professor, Departments of Pharmacy and Laboratory Medicine, University of Washington, Seattle, Washington
Chapter 5
Jerry L. Bauman, PharmD, BCPS, FCCP, FACC
Professor, Departments of Pharmacy Practice and Medicine, University of Illinois, Chicago, Illinois
Chapter 17
Terry J. Baumann, PharmD, BCPS
Adjunct Assistant Professor, Ferris State University, Clinical Pharmacy Manager, Department of Pharmacy, Munson Medical Center, Traverse City, Michigan
Chapter 58
Rosemary R. Berardi, PharmD, FASHP, FCCP
Professor of Pharmacy, University of Michigan College of Pharmacy, Clinical Pharmacist, Gastroenterology and Liver Diseases,
Department of Pharmacy, University of Michigan Health System, Ann Arbor, Michigan
Chapters 33 and 39
Richard C. Berchou, PharmD
Assistant Professor, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan
Chapter 57
Betsy Bickert, PharmD
Pediatric Oncology/Stem Cell Transplant Clinical Pharmacist, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Chapters 100 and 131
Bradley A. Boucher, PharmD, FCCP, FCCM
Professor of Clinical Pharmacy and Associate Professor of Neurosurgery, University of Tennessee Health Sciences Center, Clinical Pharmacist, Regional Medical Center at Memphis, Memphis, Tennessee
Chapters 55 and 56
Sharya V. Bourdet, PharmD, BCPS
Clinical Assistant Professor, University of North Carolina School of Pharmacy, Clinical Specialist, Medicine Intensive Care Unit, University of North Carolina Hospitals, Chapel Hill, North Carolina
Chapter 27
Donald F. Brophy, PharmD, FCCP, BCPS
Associate Professor of Pharmacy and Medicine, Virginia
Commonwealth University School of Pharmacy, Richmond, Virginia
Chapter 50
Thomas E. R. Brown, BScPhm, PharmD
Clinical Coordinator–Women’s Health, and Assistant Professor, University of Toronto, Pharmacy, Sunnybrook and Women’s College Health Science Centre, Toronto, Ontario, Canada
Chapter 118
Kathryn K. Bucci, PharmD, BCPS, FASHP
Clinical Education Consultant, Pfizer, Inc., Southold, New York
Chapter 77
Peter F. Buckley, MD
Professor and Chairman, Department of Psychiatry, Medical College of Georgia, Augusta, Georgia
Chapter 66
David S. Burgess, PharmD
Clinical Associate Professor, College of Pharmacy, University of Texas at Austin, Department of Pharmacology and Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
Chapter 104
Karim Anton Calis, PharmD, MPH, BCPS, BCNSP, FASHP
Clinical Professor, Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore Maryland, Clinical Specialist, Endocrinology and
Women’s Health, Coordinator, Drug Information Service,
Pharmacy Department, Clinical Research Center, National Institutes of Health, Bethesda, Maryland
Chapters 75 and 80
Kimberly A. Cappuzzo, PharmD, MS
Assistant Professor of Pharmacy, Virginia Commonwealth University School of Pharmacy, Clinical Pharmacist/Geriatric Pharmacotherapy Specialist, Virginia Commonwealth University (VCU) Medical Center, Richmond, Virginia
Chapter 85
Barry L. Carter, PharmD, FCCP, BCPS
Professor and Head, Division of Clinical and Administrative Pharmacy, University of Iowa College of Pharmacy, Iowa City, Iowa
Chapter 13
Peggy L. Carver, PharmD
Associate Professor of Pharmacy, University of Michigan College of Pharmacy, Clinical Pharmacist, Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan
Chapter 119
Larisa H. Cavallari, PharmD, BCPS
Assistant Professor of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois
Chapter 6
C. Y. Jennifer Chan, PharmD
Clinical Associate Professor in Pharmacy, University of Texas in Austin, College of Pharmacy, Clinical Associate Professor of Pediatrics, University of Texas Health Science Center in San Antonio, Clinical Manager, Pediatrics, Methodist Children’s Hospital of South Texas, San Antonio, Texas
Chapter 101
Kunal Chaudhary, MD, FACP
Assistant Professor, Pennsylvania State University, Nephrologist, Lehigh Valley Hospital, Allentown, Pennsylvania
Chapter 44
Nina Han Cheigh, PharmD
Clinical Assistant Professor and Coordinator of Academic Programs, University of Illinois College of Pharmacy, Chicago, Illinois
Chapters 94 and 97
Kathy Hammond Chessman, BS, PharmD, BCNSP, BCPS
Associate Professor, Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, Medical University of South Carolina, Clinical Pharmacy Specialist, Pediatrics, Medical University of South Carolina Children’s Hospital, Charleston, South Carolina
Chapters 135 and 138
Thomas W. F. Chin, BScPhm, PharmD
Clinical Pharmacy Specialist, and Assistant Professor, St. Michael’s Hospital, and University of Toronto, Pharmacy and Innercity Health Programme Department, Toronto, ON, Canada
Chapter 118
Elaine Chiquette, PharmD, BCPS
Clinical Assistant Professor, University of Texas at Austin, College of Pharmacy, Medical Science Liaison, Amylin Pharmaceuticals, San Antonio, Texas
Chapter 3
Marie A. Chisholm, PharmD
Associate Professor of Pharmacy, University of Georgia College of Pharmacy, Clinical Associate Professor of Medicine, Medical College of Georgia, Augusta, Georgia
Chapter 31
Peter A. Chyka, FAACT, DABAT
Professor, Department of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee
Chapter 10
Thomas J. Comstock, PharmD
Senior Manager, Global Medical Affairs, Nephrology Medical Communications, Amgen, Inc., Thousand Oaks, California
Chapter 41
Stephen Joel Coons, PhD
Professor, University of Arizona College of Pharmacy, Tucson, Arizona
Chapter 2
John R. Corboy, MD
Associate Professor of Neurology, University of Colorado School of Medicine, Director, University of Colorado Multiple Sclerosis Center, Denver, Colorado
Chapter 53
Elizabeth A. Coyle, PharmD
Clinical Assistant Professor, University of Houston College of Pharmacy, Clinical Specialist, Infectious Diseases, University of Texas M.D. Anderson Cancer Center, Houston, Texas
M. Lynn Crismon, PharmD, FCCP, BCPP
Behrens Inc Centennial Professor of Pharmacy, Associate Dean for Clinical Programs, Director of Psychiatric Pharmacy Program, University of Texas at Austin College of Pharmacy, Clinical Pharmacologist, Office of the Medical Director, Texas Department of Mental Health and Mental Retardation, Austin, Texas
Chapter 66
Michael A. Crouch, PharmD, BCPS
Assistant Professor, School of Pharmacy, Department of Pharmacy Practice, Virginia Commonwealth University, Richmond, Virginia
Chapter 109
Judy L. Curtis, PharmD, BCPP, FASHP
Assistant Director, CNS Regional Medical Services, Janssen Medical Affairs, LLC, Owing Mills, Maryland
Chapter 71
Larry H. Danziger, PharmD
Professor, Department of Pharmacy Practice, Associate Vice Chancellor for Research, University of Illinois at Chicago, Chicago, Illinois
Chapter 108
Joseph F. Dasta, MSc
Professor, Division of Pharmacy Practice and Administration, Ohio State Unviersity College of Pharmacy, Ohio State University Medical Center, Columbus, Ohio
Chapter 23
Lisa E. Davis, PharmD, FCCP, BCPS, BCOP
Associate Professor of Clinical Pharmacy, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia,
Philadelphia, Pennsylvania
Chapter 127
Susan R. Davis, PhD, MBBS, FRACP
Director of Research, Jean Hailes Foundation, Clayton, Australia
Chapter 80
Simon de Denus, Bpharm, MSc
Invited Professor, Faculty of Pharmacy, University of Montreal, Fellow in Cardiovascular Research, Montreal Heart Institute, Montreal, Quebec, Canada
Chapter 16
Renee M. DeHart, PharmD, BCPS
Associate Professor, Pharmacy Practice, Samford University, McWhorter School of Pharmacy, Clinical Pharmacy Specialist, Medical Center East Family Practice Residency Program, Birmingham, Alabama
Chapter 139
Jeffrey C. Delafuente, MS, FCCP, FASCP
Professor, Director of Geriatric Programs, Interim Director
Community Pharmacy Program, Virginia Commonwealth University, Richmond, Virginia
Chapter 85
John W. Devlin, PharmD, BCPS, FCCM
Associate Professor, Northeast University School of Pharmacy, Boston, Massachusetts, Clinical Pharmacist, Medical ICU, Tufts-New England Medical Center, Boston, Massachusetts
Chapter 121
Lori M. Dickerson, PharmD, FCCP, BCPS
Associate Professor of Family Medicine, Assistant Residency Program Director, Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina
Chapter 77
Cecily V. DiPiro, PharmD
Clinical Assistant Professor, University of Georgia College of Pharmacy, Manager, Department of Pharmacy, MCG Health System, Augusta, Georgia
Chapter 35
Joseph T. DiPiro, PharmD, FCCP
Professor and Executive Dean, South Carolina College of Pharmacy, University of South Carolina, Columbia, and Medical University of South Carolina, Charleston
Chapters 34, 86, 112, and 117
Paul L. Doering, MS
Distinguished Service Professor of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville, Florida
Chapters 64 and 65
Julie A. Dopheide, PharmD, BCPP
Associate Professor of Clinical Pharmacy, Psychiatry, and
Behavioral Sciences, Schools of Pharmacy and Medicine, University of Southern California, Psychiatric Pharmacist Specialist,
Los Angeles and USC Medical Center, Los Angeles, California
Chapter 61
Thomas C. Dowling, PharmD, PhD
Assistant Professor, Director, Renal Clinical Pharmacology Laboratory, University of Maryland School of Pharmacy, Baltimore, Maryland
Chapter 41
Deepak P. Edward, MD
Associate Professor, Department of Ophthalmology, University of Illinois at Chicago Eye and Ear Infirmary, Chicago, Illinois
Chapter 92
Mary Elizabeth Elliott, PharmD, PhD
Associate Professor, School of Pharmacy, University of
Wisconsin–Madison, Pharmacist, Veterans Affairs Medical Center, Madison, Wisconsin
Chapter 90
Rowland J. Elwell, PharmD
Assistant Professor of Pharmacy Practice, Albany College of Pharmacy, Albany, New York
Solveig G. Ericson, MD, PhD
Associate Professor of Medicine, West Virginia University School of Medicine, Director, Blood and Marrow
Transplant/Hematologic Malignancy Program, WVU Hospitals, Inc, Mary Babb Randolph Cancer Center, Morgantown, West Virginia
Chapter 98
Brian L. Erstad, PharmD, FCCM, FCCP, FASHP
Professor, Department of Pharmacy Practice and Sciences, College of Pharmacy, University of Arizona, Tucson, Arizona
Chapter 24
Susan C. Fagan, PharmD, BCPS, FCCP
Professor of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Adjunct Professor of Neurology, Medical College of Georgia, Augusta, Georgia
Chapters 20 and 52
Martha P. Fankhauser, MS Pharm, FASHP, BCPP
Clinical Associate Professor, Department of Pharmacy Practice and Science, University of Arizona, College of Pharmacy,
Tucson, Arizona
Chapters 68 and 78
Jennifer D. Faulkner, PharmD, BCPP
Clinical Practitioner Faculty, University of Texas, Clinical Pharmacy Specialist, Psychiatry, Central Texas Veterans Health Care System, Temple, Texas
Chapter 63
Rebecca S. Finley, PharmD, MS, FASHP
Vice President, Meniscus Educational Institute, West Conshohocken, Pennsylvania
Chapter 126
Richard G. Fiscella, BS Pharm, MPH
Clinical Professor, Department of Pharmacy Practice, Adjunct Assistant Professor, Department of Ophthalmology, University of Illinois at Chicago
Chapter 92
Douglas N. Fish, PharmD, BCPS
Associate Professor and Vice Chair, Department of Clinical Pharmacy, University of Colorado Health Sciences Center, Clinical Specialist in Infectious Diseases/Critical Care, University of Colorado Hospital, Denver, Colorado
Chapters 108 and 120
Courtney V. Fletcher, PharmD
Professor, Department of Pharmacy Practice, University of Colorado Health Sciences Center, School of Pharmacy, Denver, Colorado
Chapter 123
Edward F. Foote, PharmD, FCCP, BCPS
Chair and Associate Professor of Pharmacy, Wilkes University, Nesbitt School of Pharmacy, Wilkes-Barre, Pennsylvania
Chapter 45
Sarah Forgie, MD, FRCP(C)
Assistant Professor, Pediatrics, Division of Infectious Diseases, University of Alberta, Consultant, Pediatric Infectious Diseases, Associate Director, Infection Control, Stollery Children’s Hospital, Department of Pediatrics, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
Chapter 107
Marlene P. Freeman, MD
Assistant Professor of Psychiatry and Obstetrics and Gynecology, University of Arizona College of Medicine, Director, Women’s Mental Health Program, Tucson, Arizona
Chapters 68 and 78
Reginald F. Frye, PharmD, PhD
Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville, Florida
Chapter 48
Peter Gal, PharmD, BCPS, FCCP, FASHP
Clinical Professor, School of Pharmacy, University of North Carolina at Chapel Hill, Director, Neonatal Pharmacotherapy Laboratory and Fellowship Program, Department of Neonatal Medicine, Women’s Hospital of Greensboro, Greensboro, North Carolina
Chapter 28
William R. Garnett, PharmD, FCCP
Professor of Pharmacy and Neurology, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia
Chapter 54
Todd W. B. Gehr, MD
Professor of Internal Medicine, Chairman of Nephrology, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia
Chapter 50
Barry E. Gidal, PharmD
Professor, School of Pharmacy, University of Wisconsin, Madison, Wisconsin
Chapter 54
Mark A. Gil, PharmD
Professor of Clinical Pharmacy, University of Southern California, Clinical Pharmacy, Los Angeles, California
Chapter 38
Mark L. Glover, PharmD
Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Palm Beach Gardens, Florida, Clinical Pharmacist/Faculty, Miami Children’s Hospital, Miami, Florida
Chapter 106
S. Diane Goodwin, PharmD, FCCP
Clinical Pharmacist, Durham Regional Hospital, Duke University Health System, Durham, North Carolina
Chapter 120
Shelly L. Gray, PharmD, MS, BCPS
Associate Professor and Director, Geriatric Pharmacy Program, University of Washington School of Pharmacy, Seattle, Washington
David R. P. Guay, PharmD, CGP, FCP, FCCP, FASCP
Professor, Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy,
Minneapolis, Minnesota
Chapters 8 and 83
John G. Gums, PharmD
Professor of Pharmacy and Medicine, Departments of Pharmacy Practice and Community Health and Family Medicine, Director of Clinical Research in Family Medicine, University of Florida, Family Practice Medical Group, Gainesville, Florida
Chapter 74
Stuart T. Haines, PharmD, BCPS, CDE, CACP, FASHP
Professor and Vice Chair, University of Maryland School of Pharmacy, Clinical Specialist, Antithrombosis Service, University of Maryland Medical System, Baltimore, Maryland
Chapter 19
Emily R. Hajjar, PharmD
Assistant Professor of Clinical Pharmacy, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia,
Philadelphia, Pennsylvania
Chapter 8
Philip D. Hall, PharmD, FCCP, BCPS, BCOP
Associate Professor, Department of Pharmaceutical Sciences, Medical University of South Carolina, Clinical Specialist in Hematology/Oncology, Hollings Cancer Center and Medical University Hospital, Charleston, South Carolina
Chapter 84
Joseph T. Hanlon, PharmD, MS, BCPS, FASCP, FASHP
Visiting Professor, Geriatrics Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Chapter 8
Karen E. Hansen, MD
Assistant Professor of Medicine, University of Wisconsin, Chief of Rheumatology at the VA Hospital, Madison, Wisconsin
Chapter 90
Michelle Sue Harkins, MD
Assistant Professor of Medicine, University of New Mexico Health Science Center, Albuquerque, New Mexico
Chapter 29
David W. Hawkins, PharmD
Professor and Senior Associate Dean, Mercer University Southern School of Pharmacy, Atlanta, Georgia
Chapter 91
Peggy E. Hayes, MD
President, Hayes CNS Services, LLC, San Diego, California
Chapter 67
Mary S. Hayney, PharmD, BCPS
Assistant Professor of Pharmacy, University of Wisconsin School of Pharmacy, Madison, Wisconsin
Chapters 84 and 122
Thomas K. Hazelet, PharmD, DrPH
Associate Professor, Department of Pharmacy, University of Washington, Pharmaceutical Outcomes Research and Policy Program, Seattle, Washington
Chapter 9
Amy M. Heck Sheehan, PharmD
Associate Professor of Pharmacy Practice, Purdue University School of Pharmacy, Drug Information Specialist, Clarian Health Partners, Indianapolis, Indiana
Chapter 75
Elizabeth D. Hermsen, PharmD, MBA
Infectious Diseases Research Fellow, University of Minnesota College of Pharmacy, Minneapolis, Minnesota
Chapter 105
Katherine C. Herndon, PharmD, BCPS
Clinical Education Consultant, Pfizer, Inc., Birmingham, Alabama
Chapter 59
David C. Hess, MD
Professor and Chairman, Department of Neurology, Medical College of Georgia, Augusta, Georgia
Chapter 20
Paul B. Hicks, MD, PhD
Professor, Department of Psychiatry and Behavioral Science, Texas A&M University System Health, Science Center College of Medicine, Deputy Director, Mental Health and Behavioral Medicine, Central Texas Veterans Health Care System, Waco, Texas
Chapter 63
Jonathan Himmelfarb, MD
Director, Division of Nephrology and Transplantation, Maine Medical Center, Portland, Maine
Chapter 46
Gerald A. Hladik, MD
Associate Professor of Medicine, Department of Medicine, Division of Nephrology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Chapter 49
Barbara J. Hoeben, PharmD
Clinical Pharmacy Flight Commander, 59th Wilford Hall Medical Center, Lackland AFB, Texas
Chapter 22
Collin A. Hovinga, PharmD
Assistant Professor of Neurosurgery, University of Miami School of Medicine, Neuropharmacologist, Miami Children’s Hospital Institute, Miami, Florida
Chapter 55
Thomas R. Howdieshell, MD, FACS, FCCP
Associate Professor of Surgery, Division Chief,
Trauma/Burns/Surgical Critical Care, Department of Surgery, University of New Mexico Health Sciences Center,
Albuquerque, New Mexico
