The first edition of Pharmacotherapy Principles & Practice received the Medical Book Award, Healthcare Professionals Category, from the American Medical Writers Association. We credit this award to our outstanding team of authors, reviewers, and assistants who worked tirelessly to deliver a quality pharmacotherapy textbook.

The second edition, with fully updated clinical content, additional chapters, and enhanced features, is designed to prepare the next generation of pharmacists, nurse practitioners, and physician assistants. Now more than ever, health care practitioners who design, implement, monitor, and evaluate medication therapy bear an important responsibility to their patients and society. Development of these practice abilities requires an integration of knowledge, skills, attitudes, beliefs, and values that can be acquired only through a structured learning process that includes classroom work, independent study, mentorship, and, ultimately, direct involvement in the care of patients.

Pharmacotherapy Principles & Practice is designed to meet the classroom and independent study needs of today's learners in the health care professions. The first edition was accepted enthusiastically by pharmacy, nursing, and physician assistant schools. Chapters are written by content experts and reviewed critically by pharmacists, nurse practitioners, physician assistants, and physicians who are authorities in their fields. The book is written in a concise style that facilitates in-depth understanding of essential concepts. The disease states and treatments discussed focus on those disorders most often seen in practice.

The second edition of Pharmacotherapy Principles & Practice contains 102 chapters. The Introduction chapter is followed by three new chapters on pediatrics, geriatrics, and palliative care. The remainder of the book consists of 98 disease-based chapters that review disease etiology, epidemiology, pathophysiology, and clinical presentation, followed by clear therapeutic recommendations for drug selection, dosing, and patient monitoring. The following features in Pharmacotherapy Principles & Practice were designed in collaboration with educational design specialists to enhance learning and retention:

• Structured learning objectives are included at the beginning of each chapter, with information in the text that corresponds to each learning objective identified by a vertical rule with a circle in the margin, allowing the reader to find content related to each objective quickly.

• Key concepts related to patient assessment and treatment are listed at the beginning of each chapter to help focus learning. Numbered icons are used throughout the chapter to identify content that develops these concepts.

• Patient encounters are distributed throughout each chapter to facilitate critical thinking skills and lend clinical relevance to the scientific foundation provided. This feature has been expanded in the second edition.

• Patient care and monitoring guidelines are placed near the end of each chapter to assist students in their general approach to assessing, treating, and monitoring patients for therapeutic response and adverse events.

• Up-to-date literature citations for each chapter are provided to support treatment recommendations.

• Key references and readings provide a mechanism to acquire a deeper understanding of the subject matter.

• Tables, figures, text boxes, and algorithms are used liberally to enhance understanding of pathophysiology, clinical presentation, drug selection, pharmacokinetics, and patient monitoring.

• Medical abbreviations and their meanings are placed at the end of each chapter to facilitate learning the accepted shorthand used in real-world medical practice.

• A glossary of medical terms is included as an appendix to the book; the first use of each glossary term in a chapter appears in bold font.

• Self-assessment questions and answers for each chapter are located in the Online Learning Center to evaluate student learning.

• Laboratory values are expressed as both conventional units and Systeme International (SI) units to facilitate learning by those in countries where these units of measure are used.

• Appendices contain: (1) conversion factors and anthropometrics; (2) common laboratory tests and their reference ranges; and (3) common medical abbreviations.

Enhancements found in the second edition include:

• Additional drug dosing guidelines for renal failure and hepatic failure.

• More drug dosing information for special populations (e.g., pediatric and geriatric patients).

• Issues related to cultural competency in patient encounters.

• Incorporation of pharmacogenomic information as appropriate.

The Online Learning Center at provides complete reference lists, self-assessment questions, a testing center that has the ability to grade and provide immediate feedback on the self-assessment questions as well as reporting capabilities, and other features designed to support learning.

We would like to acknowledge the commitment and dedication of the more than 170 contributing authors and more than 110 reviewers of the chapters contained in this text. We also would like to thank the many educators who have adopted this text in their courses. We also extend our thanks to McGraw-Hill Medical, especially Michael Weitz, Peter Boyle, and Laura Libretti, as well as the support teams at our individual universities including Christina Spivey, Tricia Pierre, and Barb Beinborn for their dedication to this project. Finally, we thank those students, practitioners, and educators who provided feedback on the first edition to help us make the second edition even better.

The Editors March 2010

Part I

Basic Concepts of Pharmacotherapy Principles and


1 Introduction

Jack E. Fincham

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