Second, Edition PHARMACOTHERAPY

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Second,EditionPHARMACOTHERAPYCasebooka patie nt-focuse dapproachEdited byTerry L. Schwinghammer, PharmD, FCCP, FASHP, BCPSAssociate Professor, Department of Pharmaceutical SciencesSchool of Pharmacy, University of PittsburghPittsburgh, PennsylvaniawithJoseph T. DiPiro, PharmD, FCCPPanoz Professor, College of Pharmacy, Head, Department of Clinicaland Administrative Sciences,',University of Georgia College of PharmacyClinical Professor of Surgery, Medical College of GeorgiaAugusta, GeorgiaGary R. Matzke, PharmD, FCP, FCCPProfessor of Pharmaceutical Sciences and MedicineSchools of Pharmacy and MedicineCenter for Clinical Pharmacology,University of PittsburghPittsburgh, PennsylvaniaRobert L. Talbert, PharmD, FCCP, BCPSProfessor and Division Head, College of PharmacyUniversity of Texas at AustinProfessor, Departments of Medicine and PharmacologyUniversity of Texas Health Science Center at San AntonioSan Antonio, TexasBarbara G. Wells, PharmD, FASHP, FCCP, BCPPProfessor and Dean, Idaho State University College of PharmacyPocatello, IdahoGary C. Yee, PharmD, FCCPProfessor and Chair, Department of Pharmacy Practice,College of Pharmacy,University of Nebraska Medical CenterOmaha, NebraskaAPPLETON & LANGEStamford, ConnecticutL. Michael Posey, RPhPresidentPharmacy Editorial and News ServicesAthens, Georgia

ContentsPrefacexviiAcknowledgmentsChapter44Bradley G. Phillips, PharmDxixChapterPART ONEPrinciples of Patient-focused Therapy8 Atrial Fibrillation9 Hypertrophic Cardiomyopathy46Laura A. Bartels, PharmDChapter 10 Deep Vein ThrombosisTerry L. Schwinghammer, PharmD, FCCP, FASHP, BCPS,Section Editor48NannetteA. Sageser, PharmDChapter 11 Pulmonary Embolism50AmyL. Seybert, PharmD, TedL Rice, MS, BCPSChapter1 Introduction: How to Use This Casebook1Chapter 12 Chronic Anticoagulau'onTerry L. Schwinghammer, PharmD, FCCP, FASHP, BCPS54Beth Bryles Phillips, PharmDChapter2 Active Learning Strategies7Elizabeth S. Gray, PharmD, Gretchen M. Tush,Chapter3 Case Studies in Patient Communication114 Documentation of PharmacistInterventions56Chapter 14 Hyperlipidemia: Primary Prevention58Laura A. Bartels, PharmDMarie E. Gardner, PharmD, Richard N. Herrier, PharmDChapterChapter 13 Ischemic StrokeSusan R. Winkler, PharmD, BCPS, Mark S. Luer, PharmDPharmD, BCPS, Cynthia K Kirkwood, PharmDChapter 15 Hyperlipidemia: Secondary Prevention23Timothy J. lves, PharmD, MPH, FCCP, BCPSChapter 16 Peripheral Vascular DiseaseBruce R. Canaday, PharmD, BCPS, FASHP, FAPhA60Kjel A. Johnson, PharmD, BCPS62Susan D. Bear, BS, PharmDPeggy C. Yarborough, MS, CDE, FAPP, FASHP, NAPPChapter 17 Hypovolemic ShockPART TWODisorders of Organ SystemsSECTION 1Cardiovascular Disorders65Brian L. Erstad, PharmD, FASHP, FCCM27Robert L. Talbert, PharmD, FCCP, BCPS,' '' Section EditorSECTION 2Respiratory Disorders67Robert L. Talbert, PharmD, FCCP, BCPS, Section EditorChapter 18 Acute Asthma67Daniel T. Kennedy, PharmD, BCPSRalph E. Small, PharmD, FCCP, FASHP, FAPhAChapter1 Cardiopulmoriary Resuscitation27TateN. Trujillo, PharmD, Donna S. Wall, PharmD, BCPSChapter 19 Chronic Asthma70Dennis M. Williams, PharmD, FASHP, FCCP, BCPSChapter2 Hypertension29/ Edwin Underwood, Jr., PharmDChapter 20 Chronic Obstructive Lung Disease72Daren L. Knoell, PharmDChapter3 Hypertensive Urgency32James]. Nawarskas, PharmDChapter 21 Respiratory Distress Syndrome75Jennifer L Schoelles, PharmD, Robert J. Kuhn, PharmDChapter4 Heart Failure33Jon D. Horlon, PharmDChapter 22 Cystic Fibrosis77Robert}. Kuhn, PharmDChapter5 Ischemic Heart Disease37AmyJ. Guenette, PharmD, BCPSChapter6 Acute Myocardial Infarction39B. Nhi Nguyen, PharmD, Robert B. Parker, PharmDChapter7 Ventricular TachycardiaAsheshJ. Gandhi, PharmD41SECTION 3Gastrointestinal DisordersJoseph T. DiPiro, PharmD, FCCP, Section Editor80Chapter 23 Gastroesophageal Reflux Disease80Meredith L Rose, PharmDxi

xiiContentsChapter 24 Peptic Ulcer Disease83Chapter 42 Hypokalemia and Hypomagnesemia121DeniseR. Sokos, PharmD, W.Greg Leader, PharmDMarie A. Chisholm, PharmD, Mark W.Jackson, MD, FACGChapter 25 Stress Ulcer Prophylaxis/Upper GIHemorrhage85Steven V. Johnson, PharmD, BCPSChapter 43 Hyperkalemia, Hyperphosphatemia,and Hypocalcemia123. Brian K Bond, PharmD, Mary K Stamatakis, PharmDChristine L. Solberg, PharmD, BCPS, CSPlChapter 44 HypercalcemiaChapter 26 Ulcerative Colitis88NancyS. Yunker, PharmDChapter 45 Metabolic AcidosisRalph E. Small, PharmD, FCCP, FASHP, FAPhA126James S. Lewis II, PharmD, Daniel Sageser, PharmD127Melanie S. Joy, PharmDChapter 27 Nausea and Vomiting90AmyJ. Becker, PharmDChapter 46 Metabolic Alkalosis129Jennifer Stoffel, PharmD, BCPSChapter 28 Diarrhea92Marie A. Abate, PharmDChapter 47 Benign Prostatic Hyperplasia131Catherine A. Heyneman, PharmD, MSCharles D. Ponte, BS, PharmD, BCPS, CDE, FAPhA,Richards. Rhodes, PharmDFASHP, FCCPChapter 29 Pediatric Gastroenteritis94William McGhee, PharmD, Basil J. Zitelli, MD, FAAPChapter 48 Neurogenic Bladder and UrinaryIncontinence134Mary Lee, PharmD, BCPS, FCCPChapter 30 Constipation96Barbara L. KaUenbach, PharmDChapter 31 Cirrhotic Ascites98JoetteM. Meyer, PharmDEsophageal Varices100Cesar Alaniz, PharmDChapter 33 Hepatic Encephalopathy136Cam Lawless-Liday, PharmD, Rex W. Force, PharmD, BCPSBeth Bryles Phillips, PharmDChapter 32Chapter 49 Erectile DysfunctionSECTION 5Neurologic DisordersBarbara G. Wells, PharmD, FASHP, FCCP, BCPP, Section EditorChapter 50 Multiple Sclerosis102138138Barry E. Gidal, PharmD, John 0. Fleming, MDNancy P. Lam, PharmD,, BCPSChapter 34 Acute Pancreatitis104Chapter 51 Complex Partial Seizures140James W. McAuley, RPh, PhDCharles W. Fetrow, PharmD, Maria Yaramus, PharmDChapter 35 Viral Hepatitis106Chapter 52 Status Epilepticus142Sharon M. Tramonte, PharmDNancy P. Lam, PharmD, BCPSSECTION 4Renal'and Genitourinary Tract Disorders.,.Chapter 53 Acute Management of the Head InjuryPatient109Gary R. Matzke, PharmD, FCP, FCCP, Section EditorChapter 36 Drug-induced Acute Renal FailureChapter 54 Parkinson's Disease109MaryK. Stamatakis, PharmDChapter 37 Progression of Chronic Renal DiseaseReina Bendayan, PharmD, Winnie M. Yu, PharmD, BCPSChapter 38 End-stage Renal Disease148Karen Beauchamp, BPharm, RPh, Daniel Sageser, PharmDChapter 56 Headache Disorders113146Mary Louise Wagner, MS, PharmDChapter 55 Pain Management111144DeniseH. Rhoney, PharmD, Mark S. Luer, PharmD150Mark S. Luer, PharmD, Susan R. Winkler, PharmD, BCPSJames D. Coyle, PharmDChapter 39 Renal Transplantation115Marie A. Chisholm, PharmD, Tana R. Bagby, PharmDSECTION 6Psychiatric Disorders153Barbara G. Wells, PharmD, FASHP, FCCP, BCPP, Section EditorLaura Mulloy, DOChapter 40 " Chronic Glomerulonephritis117Rex W. Force, PharmD, BCPS, Jonathan D. Hubbard, DO153William H. Benefieldjr, PharmD, BCPP, FASCPMelanie S. Joy, PharmDChapter 41 Syndrome of Inappropriate AntidiureticHormone ReleaseChapter 57 Attention-deficit Hyperactivity DisorderDonna M. Jermain, PharmD, BCPP119Chapter 58 Anorexia NervosaRaeAnn Maxwell, RPh, PhD155

ContentsCynthia P. Koh-Knox, PharmDSECTION 8Gynecologic DisordersVirginia L. Stauffer, PharmD, BCPSBarbara G. Wells, PharmD, FASHP, FCCP, BCPP, Section EdiChapter 59 Alzheimer's DiseaseChapter 60 Alcohol Withdrawal157159Chapter 76Jill Slimick-Ponzetto, PharmD, BCPSChapter 61 Nicotine AddictionSchizophreniaContraception195195Carla B. Frye, PharmD, BCPS161Chapter 77 Premenstrual Dysphoric DisorderJulie A. Cold, PharmD, BCPPChapter 62xiii198Donna M.Jermain, PharmD, BCPP163Chapter 78 Hormone Replacement TherapyWilliam H. Benefieldjr, PharmD, BCPP, FASCP200Alka I. Somani, PharmDLawrence J. Cohen, PharmD, BCPP, FASHP, FCCPChapter 63 Major Depression165Brian L. Crabtree, PharmD, BCPPChapter 64Bipolar Disorder168Andrea Eggert, PharmD, BCPPSECTION 9Immunologic DisordersChapter 79 Systemic Lupus ErythematosusWilliam H. Benefield, Jr., PharmD, BCPP, FASCP203Gary C. Yee, PharmD, FCCP, Section Editor203Thomas W. Redford, PharmDChapter 65 Generalized Anxiety Disorder170Ralph E. Small, PharmD, FCCP, FASHP, FAPhAChadM. VanDenBerg, PharmDMichael W.Jann, PharmD, FCP, FCCPChapter 66 Panic Disorder172W. Alexander Morton, PharmD, BCPPChapter 67Obsessive-Compulsive Disorder174SECTION 10Bone and Joint DisordersChapter 80 OsteoporosisLyleK Laird, PharmD, BCPPChapter 68 Insomnia206L. Michael Posey, RPh, Section Editor206Carla B. Frye, PharmD, BCPS177Chapter 81Rheumatoid ArthritisPenny S. Shelton, PharmD, BCPP, FASCRalph E. Small, PharmD, FCCP, FASHP, FAPhAMollieAshe Scott, PharmD, BCPSThomas W. Redford, PharmD, Amy L. Whitaker, PharmDChapter 82Osteoarthritis208210Michael A. Oszko, PharmD, BCPSSECTION 7Endocrinologic Disorders.Chapter 83180180Scott Jacob'er, DO, CDE, Linda A. Jaber, PharmDChapter 70 Type 2 Diabetes Mellitus182MilissaA. Rock, RPh, CDESECTION 11Eyes, Ears, Nose, and Throat Disorders.Chapter 84Hypothyroidism185Chapter 85 Allergic Rhinitis188190SECTION 12Dermatologic DisordersHyperprolactinemiaAmy M. Heck, PharmDKarim A. Calis, PharmD, MPH, BCPS, BCNSP, FASHP221L. Michael Posey, RPh, Section EditorChapter 86 Acne VulgarisCynthia P. Koh-Knox, PharmD, Bruce C. Carlstedt, PhDChapter 75218187Jerry D. Smith, PharmD, John G. Gums, PharmDChapter 74 Addison's Disease216W. Greg Leader, PharmDTara L. Posey, PharmDChapter 73 Cushing's SyndromeGlaucomaTien T. fSat-Winarko, PharmD, BScKristine E. Santus, PharmD, Tara L. Posey, PharmDChapter 72216L. Michael Posey, RPh, Section EditorJean-Venable (Kelly) R. Goode, PharmD, BCPSChapter 71 Hyperthyroidism: Graves'Disease213Ralph E Small, PharmD, FCCP, FASHP, FAPhARobert L. Talbert, PharmD, FCCP, BCPS, Section EditorChapter 69 Type 1 Diabetes MellitusGout and HyperuricemiaPage H. Pigg, PharmD221Rebecca M. Law, PharmDWayne P. Gulliver, MD, FRCPC192Chapter 87PsoriasisRebecca M. Law, PharmD222

xivContentsSECTION 13Hematoiogic DisordersChapter 104225Gary C. Yee, PharmD, FCCP, Section EditorPelvic Inflammatory Disease and OtherSexually Transmitted Diseases259Denise L. Howrie, PharmDPamela], Murray, MD, MPHChapter 88 Iron Deficiency Anemia225William E Wade, PharmD, FASHP, FCCPChapter 105Lower Urinary Tract Infection262Christine A. Lesch, PharmDWilliam]. Spruill, PharmDKeith A. Rodvold, PharmD, FCCP, BCPSChapter 89 Vitamin B12 Deficiency228Barbara]. Mason, PharmD, Beata Saletnik, PharmDChapter 90Folic Acid DeficiencyAcute Pyelonephritis264Margaret E. McGuinness, PharmD230Beata Saletnik, PharmD, Barbara]. Mason, PharmDChapter 91 Sickle Cell AnemiaChapter 106Chapter 107Syphilis267Alex K. McDonald, PharmD232R. Donald Harvey III, PharmD, BCPSDennis M. Williams, PharmD, FASHP, FCCP, BCPSChapter 108Celeste C. Lindley, PharmD, MS, FASHP, FCCP, BCPSGenital Herpes and Chlamydial Infections269SuellynJ. Sorensen, PharmD, BCPSPART THREEDiseases of Infectious OriginChapter 109Joseph T. DiPiro, PharmD, FCCP, Section Editor271Victor A. Elsberry, PharmD, BCNSP, Leslie L. Barton, MDChapter 110Chapter 92OsteomyelitisEdward P. Armstrong, PharmD, BCPS, FASHPUsing Laboratory Tests in InfectiousDiseasesGram-negative Sepsis273MaryM. Hess, PharmD235Steven] Martin, PharmD, BCPSChapter 111Systemic Fungal Infection276Aaron D. Killian, PharmD, BCPSChapter 93 Bacterial Meningitis237Sherry Luedtke, PharmDChapter 112Dermatophytosis278Winnie M. Yu, PharmD, BCPSChapter 94 Community-acquired Pneumonia239Patrick P. Gleason, PharmD, BCPSChapter 113Bacterial Vaginosis280Charles D. Ponte, PharmD, BCPS, CDE, FAPhA, FASHP, FCCPChapter 95Otitis Media.r.r.241Carla Wallace, PharmD, BCPSChapter 114 Antimicrobial Prophylaxis for Surgery282Susan]. Skledar, RPh, MPH, Paige Robbins Gross, RPhChapter 96Streptococcal Pharyngitis243DeniseL. Howrie, PharmD, Elaine McGhee, MDChapter 97Rhinosinusitis244Chapter 116:.246Chapter 117Cytomegalovirus (CMV) Retinitis286Diabetic Foot InfectionTreatment of HTv* Infection288Susan Chuck, PharmDCatherine A. Heyneman,. PharmD, MS':284Winnie M. Yu, PharmD, BCPSRichards. Rhodes, PharmDChapter 99Pediatric ImmunizationDaniel T. Casto, PharmD, PCCPAaron D. Killian, PharmD, BCPSChapter 98 Pressure Sores.Chapter 115Keith A. Rodvold, PharmD, FCCP, BCPS248Renee-Claude Mercier, PharmDChapter 118HIV Infection and PCP Pneumonia290Linda M. Page, PharmD, Peter L. Anderson, PharmDChapter 100Infective Endocarditis250Courtney V. Fletcher, PharmDRenata Smith, PharmDKeith A. Rodvold, PharmD, FCCP, BCPSChapter 101Susan Shaffer, PharmDPART FOUROncologic DisordersDennis M. Williams, PharmD, FASHP, FCCP, BCPSGary C. Yee, PharmD, FCCP, Section EditorPulmonary TuberculosisChapter 102- Clostridium difficile-associatedDiarrhea252255Chapter 119MargaretB. Zak, PharmDChapter 103Intra-abdominal InfectionRenee-Claude Mercier, PharmDBreast Cancer.295Laura Boehnke Michaud, PharmD257Chapter 120Non-small Cell Lung Cancer298Kimberly Heying, PharmD, Jane M. Pruemer, PharmD, FASHP

ContentsChapter 121Colon Cancer301Daniel Sageser, PharmDChapter 122Prostate Cancer-302xvPART FIVENutrition and Nutritional DisordersGary R. Matzke, PharmD, FCP, FCCP, Section EditorJudith A. Smith, PharmD, Barry R. Goldspiel, PharmD, FASHPChapter 123Malignant Lymphoma305Chapter 129KristaM. King, PharmD, BCOPChapter 124Ovarian Cancer308Chapter 130Acute Lymphocytic Leukemia310Chronic Myelogenous LeukemiaMelanomaBone Marrow TransplantationSimon Cronin, PharmD, MSObesityAppendix A. Common Laboratory Tests315Appendix B. Common MedicalAbbreviationsAppendix C. Sample Responses toCase QuestionsJennifer A. Tbrma, PharmD, RowenaN. Schwartz, PharmDChapter 128Chapter 131313TerriG. Davidson, PharmD, Catherine A. Smith, PharmDChapter 127Adult Enteral Nutrition324326Dannielle C. O'Dmnell, PharmD, BCPSMark T. Holdsworth, PharmD, BCPSChapter 126321Carol J. Rollins, MS, RD, PharmD, BCNSPWilliam C. Zamboni, PharmD, James A. Trovato, PharmDChapter 125Parenteral NutritionDouglas D.Janson, PharmD, BCNSP317329335343Note: Additional cases with questions and suggested answers mayfound on the Internet at www.pharmacy.pitt. edu/ce/pharmacotherapy

PHARMACOTHERAPY Casebook a p atie nt-focuse d approach Edited by Terry L. Schwinghammer, PharmD, FCCP, FASHP, BCPS Associate Professor, Department of Pharmaceutical Sciences School of Pharmacy, University of Pittsburgh Pittsburgh, Pennsylvania with Joseph T. DiPiro, PharmD, FCCP Panoz Professor, College of Pharmacy, Head,

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