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Pharmacotherapeutics
for
A PRACTICAL APPROACH
Advanced
Practice
FIFTH
EDITION
Virginia
Andrew
Veronica
Tep
M
Poole
M
Wilbur
Kang
.
Arcangelo
.
Peterson
4
i
.
"
Wolters
Kluwer
PharmacotherapeuticsforAdvancedPractice
APRACTICALAPPROACH
FIFTHEDITION
PharmacotherapeuticsforAdvancedPractice
APRACTICALAPPROACH
FIFTHEDITION
EDITORS
VirginiaP.Arcangelo,PhD,NP
FamilyNursePractitioner,Retired
Canton,Georgia
AndrewM.Peterson,PharmD,PhD,FCPP
ExecutiveDirector,
SubstanceUseDisordersInstitute
JohnWyethDeanEmeritus
ProfessorofClinicalPharmacyand
ProfessorofHealthPolity
UniversityoftheSciencesinPhiladelphia
Philadelphia,Pennsylvania
VeronicaF.Wilbur,PhD,APRN-FNP,CNE,FAANP
AssociateProfessor–GraduateNursing
DepartmentofNursing
WestChesterUniversity
WestChester,Pennsylvania
TepM.Kang,PharmD,BCPS
ClinicalPharmacySpecialist,
SurgicalCriticalCare
ChristianaCareHealthServices
AdjunctInstructor,UniversityofDelaware
AcquisitionsEditor:JamieBlum
DevelopmentEditor:MariaM.McAvey
EditorialCoordinator:JulieKostelnik
SeniorProductionProjectManager:SadieBuckallew
DesignCoordinator:StephenDruding
ManufacturingCoordinator:KathleenBrown
MarketingManager:LindaWetmore
PrepressVendor:LuminaDatamatics
5thedition
Copyright©2022WoltersKluwer
Copyright© 2017 Wolters Kluwer. Copyright © 2011,2005Lippincott Williams& Wilkins. All rights reserved.This book isprotected by
copyright.Nopartofthisbookmaybereproducedortransmittedinanyformorbyanymeans,includingasphotocopiesorscanned-inorother
electroniccopies,orutilizedbyanyinformationstorageandretrievalsystemwithoutwrittenpermissionfromthecopyrightowner,exceptfor
briefquotationsembodiedincriticalarticlesandreviews.Materialsappearinginthisbookpreparedbyindividualsaspartoftheirofficialduties
asU.S.governmentemployeesarenotcoveredbytheabove-mentionedcopyright.Torequestpermission,pleasecontactWoltersKluwerat
TwoCommerce Square, 2001 Market Street,Philadelphia, PA19103, via email at permissions@lww.com, or via ourwebsite at lww.com
(productsandservices).
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PrintedinChina
LibraryofCongressCataloging-in-PublicationData
ISBN-13:978-1-9751-6059-3
CataloginginPublicationdataavailableonrequestfrompublisher.
Thisworkisprovided“asis,”andthepublisherdisclaimsanyandallwarranties,expressorimplied,includinganywarrantiesastoaccuracy,
comprehensiveness,orcurrencyofthecontentofthiswork.
Thisworkisnosubstituteforindividualpatientassessmentbaseduponhealthcareprofessionals’examinationofeachpatientandconsideration
of,amongotherthings,age,weight,gender,currentorpriormedicalconditions,medicationhistory,laboratorydataandotherfactorsuniqueto
thepatient.Thepublisherdoesnotprovidemedicaladviceorguidanceandthisworkismerelyareferencetool.Healthcareprofessionals,and
notthepublisher,aresolelyresponsiblefortheuseofthisworkincludingallmedicaljudgmentsandforanyresultingdiagnosisandtreatments.
Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses,
indications, appropriate pharmaceutical selections anddosages,and treatmentoptions should be made and healthcare professionals should
consultavarietyofsources. Whenprescribingmedication,healthcareprofessionalsareadvisedtoconsulttheproductinformationsheet(the
manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and
identifyanychangesindosagescheduleorcontraindications,particularlyifthemedicationtobeadministeredisnew,infrequentlyusedorhasa
narrowtherapeuticrange.Tothemaximumextentpermittedunderapplicablelaw,noresponsibilityisassumedbythepublisherforanyinjury
and/ordamagetopersonsorproperty,asamatterofproductsliability,negligence laworotherwise,orfromanyreferencetoorusebyany
personofthiswork.
LWW.com
Thisbookisdedicatedtoallofourpast,currentandfuturestudentswhohave,orwill
have,touchedourlivessodeeply.Wehopethatourexperienceinclinicalpracticeand
teaching,andthatofallourcontributorsinthisedition,willhelppromoteexcellencein
patientcare.
PREFACE
Pharmacotherapeutics for Advanced Practice originated from our combined experience in teaching
nursepractitionersandpracticeinprimarycare.Asanursepractitionerandeducatorherself,VirginiaP.
Arcangelo, PhD, NP, saw a need for practical exposure to the general principles of prescribing and
monitoringdrugtherapy,particularlyintheFamilyPractice arena.As a PharmD,Andrew M.Peterson
sawaneedtobeabletoteachnewprescribershowtothinkaboutprescribingsystematically,regardless
ofthediseasestate.Veronica F.Wilbur,PhD,NP, joinedtheeditorialteaminthelastedition,andher
expertise asa FamilyNurse Practitionerandeducatoradded tremendous valuetothestaff.Joiningthe
editorial team in the 5th editionis Dr. TepM.Kang, a clinical pharmacist working in the acutecare
setting.Asapastchapterauthorandnoweditor,headdsanotherdimensiontothetext.
Thiseditioncontinuestobuilduponthefoundationsofthepreviousfoureditionsbyprovidingup-todatepharmacologyanddiseasestateknowledgeunderscoredbyaprocessandframeworkthroughwhich
learnerscanbegintothinkpharmacotherapeutically.Whileprimarilygearedtowardthelearner,thistext
meets both students’ and practitioners’ needs by providing a user-friendly, practical approach to
prescribing and managing drug therapy. The book has evolved over the years, based on input from
students,academicians,andpractitioners.Long-standingcontributorsandnewcontributorsupdatedtheir
chapters to provide a combination of evidence-based medicine and practical experience. The text
considers disease-and patient-specific information. With each chapter, there are tables and evidencebasedalgorithmsthatarepracticalandeasytoreadandcomplementthetext.
Thistextprovidesastep-therapyapproachthatallowsthelearnertoseeselectfirst-line,second-line,
and even third-line therapy for treating the diseases. New drugs are always coming on the market;
therefore,drugclasses areemphasizedwiththefocus ontheapplicationofthebroader,class-specific
propertiesofnewdrugs.Eachchapterendswithasimplecasestudyorseriesofquestionsdesignedto
promptthelearnertothinksystematicallyandtheteachertoaskcriticalquestions.Eachsectionhastwo
cases/sets of questions—one available to the student and one available for just the faculty
member/teacher.Theanswerstobothsetsofcases/questionsareprovidedforthefacultyviatheonline
portal.Therearenoanswerstothequestionsinthetextsincewebelievethepurposeofthecasestudies
istopromotediscussion.Theremaybemorethanonecorrectanswertoeachquestion,especiallyasnew
drugsenterthemarketandtreatmentguidelineschange.Werealizethattheremaybeseveralanswersto
thesequestions,andwehaveprovidedjustoneoption.
Newtothiseditionistheprovisionofadditionalancillarytoolsforstudentsandinstructors.Students
haveonlineaccesstoConceptsinActionandcurrentarticlesrelatedtovariousdrugs.Theadditionofa
test bank online for instructors provides ready-made questions for each chapter to use to create
examinations. As in the past, faculty can access PowerPoint slides for each chapter to prepare for
classroominstruction,andacronymsareavailableonlineforstudentstohelpintheirlearning.
ORGANIZATIONOFTHEBOOK
Units1and2—PrinciplesofTherapeutics
Aswithpreviouseditions,thebook’sPrinciplesUnitreviewsthebasictherapeuticselementsnecessary
forsafeandeffectiveprescribing.Thefirstchapterintroducestheprescribingprocess,includinghowto
avoid medicationerrors.The following two chapters provide the foundationof therapeutics, including
information on the pharmacokinetics and pharmacodynamics of drugs and drug–drug/drug–food
interactions.Inthisedition,we’vecombinedthepediatricandpregnancy/lactationchapterstoprovidea
morecohesiveapproachtothespectrumofbirththroughchildhood.We’vekeptgeriatric,antimicrobial,
andpharmacogenomics chapters inthe foundational sectionandmovedtheEconomics ofTherapeutics
chapterheretoemphasizefurtherthecriticalrolethiselementhastoplayindrugtherapyselectionand
management.
However,thereaderwillnoteweaddedaseparatesectiononpainmanagement.Thebookstillhasa
chapteranchoredinpainmanagementbasics,buttwonewchaptershavebeenadded.Thefirstfocuseson
treatingpaininthepatientwithopioidusedisorder (OUD)andanotheroncannabisas atoolforpain
management. These additions reflect the ever-changing landscape of medicine, and we hope to help
introducethestudentandpractitionertothese–once-taboo–topics.
Units3through15—Disorders
This unitofthebook,consistingof45chapters,reviews commonlyseendisorders intheprimarycare
setting.Althoughnotall-inclusive,thearrayofdisorders allows thereadertogainanunderstandingof
howtoapproachthepharmacotherapeutictreatmentofanycondition.Thechaptersaredesignedtogivea
briefoverviewofthediseaseprocess,includingthecausesandpathophysiology,emphasizinghowdrug
therapycanalterthepathologicstate.
Wehavemadesomesignificantchangestothecontentoftheseunits.Wehaveaddedthreenewchapters
—liver diseases, organ transplantation, and substance use disorders. These additions reflect the
clinician’sexpandedresponsibilitytohaveamorein-depthunderstandingofhowtheseconditionsaffect
patients’careandtreatment.Itis well knownthatliver dysfunctionaffectsdrugmetabolism.Still,the
clinician needs to understand liver diseases as an entity to appreciate better how to care for patients
livingwithsuchdisorders.
Similarly, more andmore people are receiving andliving with transplanted organs. The drugs and
treatmentsrequiredtomaintainremissionaffectthetreatmentofotherchronicconditions,thusobligingthe
practitioner to grasp these life-savingdrugs. And lastly, the opioid epidemic has brought theissueof
substanceusedisordersintotheforefrontofsociety’smind,anditisbeingrecognizedthatthesedisorders
are not limited to just prescription drugs. People are—and have been—living with substance use
disorders—most notably alcohol and opioid use disorders—and the clinician must understand these
conditionstotreatthepatientholistically.
Othertextchangesincludecombiningthegastrointestinal(GI)disorderssuchasnausea/vomitingand
diarrhea withphysiologic andpathophysiologic diseases like irritable bowel andinflammatorybowel
syndrome.We’vealsocombinedseveralskindisordersintoasinglechapter,thusreducingredundancyin
diagnosis andtreatmentstrategies. Andtoreflecttheintegralnatureofsomebehavioraldisorders, we
haveaddedBipolarDiseasetotheDepressionchapter.
ChapterOrganization
This edition continues the consistent format approach throughout each disorder chapter. Each chapter
begins with the background and pathophysiology of the disorder, followed by a discussion of the
DiagnosticCriteriaandGoals ofTherapythatunderlie the basicprinciples oftreatingpatientswith
drugs.
The drug sections review the “agents” uses, mechanism of action, contraindications and drug
interactions,adverseeffects,andmonitoringparameters.Thisdiscussionisorganizedprimarilybydrug
class,witha notationtospecificdrugswithinthetextandthetables. TheDrugOverview Tables are
organized consistently, giving the reader much information on each drug, including the usual dose,
contraindications, side effects, andany special considerationsa prescribershould be awareof during
therapy.Thetablesprovidethereaderwithquickaccesstogenericandtradenamesanddosages,adverse
events,contraindications,andspecialconsiderations.Together,thetextandtablesprovidethereaderwith
sufficientinformationtobegintochoosedrugtherapy.
The sectionon Selecting the Most Appropriate Agent aids the reader in deciding which drug to
choose for a given patient. This section contains information on first-line, second-line, and third-line
therapies,withrationalesfortheclassificationofdrugsinthesecategories.Accompanyingthissectionis
analgorithmoutliningthethoughtprocessbywhichcliniciansselectaninitialdrugtherapy. Again,the
text organizationandtheillustrative algorithmsprovide readers witha means of thinking byselecting
drugs for patients. As with previouseditions, we have kept the Recommended Order of Treatment
tablesandupdatedthem, alongwiththealgorithmsanddrugtables, toreflectcurrentknowledge.Each
chapterhasbeenupdatedtoreflectthemostcurrentguidelinesavailableatthetimeofwriting.However,
medicineandphar-macotherapyare constantlychanging,anditremainstheclinician’sresponsibilityto
identifythemostcurrentinformation.
Included in each chapter is a section onMonitoring Patient Response. Eachsection encompasses
clinicalandlaboratoryparameters,timestomonitoritems,andactionstotaketheparametersthatdonot
meetthespecifiedtherapygoals.Also,specialpatientpopulationsarediscussedwhenappropriate.These
discussions include pediatric and geriatric patients but may also include ethnic- or sex-related
considerations.Thelastiteminthissectionconsistsofadiscussionofpatienteducationmaterialrelevant
tothedisease,anddrugsarechosen.Ineachchapter,apatienteducationsectionincludesinformationon
complementaryandalternativemedicinerelatedtothatdisorderandsectionsonexternalinformationfor
patientsandpractitioners.
ACaseStudy is provided foreachdisorder discussed anddesignedto stimulate discussionamong
studentsandinstructors.Inthisedition,eachcasehasbeenreviewedandupdatedwithquestionstailored
toreinforcetheprocessofthinkingpharmacotherapeutically.Aspreviouslystated,answerstothesecase
studies arenot supplied tothestudentsince thepurpose isto promotediscussionandevokea thought
process. Also, as time changes, so do therapies. The cases are short, compelling the learner to ask
questionsaboutthepatientandallowingflexibilityformultiplecorrectanswerstobedevelopedbythe
instructorastheyworkthroughtheclinicaldecision-makingprocess.
Pharmacotherapeutics for Advanced Practice continues to provide primary care students with a
reasoned approach to learning pharmacotherapeutics and serves as a reference for the seasoned
practitioner.Prescribingisbecomingincreasinglycomplex,andtheinformationinthisbookhashelpedus
inourownpractices.Asexperiencededucatorsandpractitioners,weprovide youwithatextbookthat
willmeetyourneeds.
VirginiaP.Arcangelo
AndrewM.Peterson
VeronicaF.Wilbur
TepM.Kang
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