Pharmacotherapeutics for Advanced Practice

Pharmacotherapeutics for Advanced Practice originated from our combined experience in teaching nurse practitioners and in practice in primary care. As a nurse practitioner and educator herself, Virginia saw a need for practical exposure to the general principles of prescribing and monitoring drug therapy, particularly in the Family Practice arena. As a PharmD, Andrew saw a need to be able to teach new prescribers how to think about prescribing systematically, regardless of the disease state. For this edition, we have expanded the editorial staff to include Veronica F. Wilbur and Jennifer Reinhold. Veronica, a Family Nurse Practitioner and PhD in Nursing, has extensive experience in education of Advanced Practice Nurses and primary care practice. Jennifer, a PharmD, has expertise in pharmacotherapy and prescribing in primary care. Both of these colleagues were contributors in previous editions and understand the focus, intent, and direction of this text.

This edition still provides basic pharmacology, while also providing a process and framework through which learners can begin to think pharmacotherapeutically. The text still allows learners to identify a disease, review the drugs used to treat the disease, select treatment based on goals of therapy and special patient considerations, and adjust therapy if it fails to meet goals. Pharmacotherapeutics for Advanced Practice

This text meets the needs of both students and practitioners in a practical approach that is user friendly. It teaches the practitioner how to prescribe and manage drug therapy in primary care. The book has evolved over the years, based on input from students, academicians, and practitioners. Long-standing contributors were asked to update their chapters, and new contributors were selected based on their academic or practice expertise 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 evidence-based algorithms that are practical and easy to read and that complement the text.

Additionally, the text guides the practitioner to a choice of second- and third-line therapy when the first line of therapy fails. Since new drugs are being marketed continually, drug classes are discussed with a focus on how the broader, class-specific properties can be applied to new drugs. Each chapter ends with a simple case study or series of questions designed to prompt the learner to think systematically and the teacher to ask critical questions. Also, the disorder chapter’s case study asks the same questions; reinforcing a clinical decision-making process and promoting critical thinking skills. There are no answers to the questions in the text since the authors believe that the purpose of the case studies is to promote discussion and that there may be more than one correct answer to each question, especially as new drugs are developed. However, one potential answer to each question in the case is available online for use by faculty. Additionally, there is an Pharmacotherapeutics for Advanced Practice

additional case with several sample multiple-choice questions for each chapter online. We realize that there may be several answers to these questions and the authors have just provided one option. To assist faculty in the classroom, there are power point slides available online for each chapter. To assist the student, the acronyms contained in each chapter are defined in a separate file online as well.

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ORGANIZATION OF THE BOOK

Unit 1—Principles of Therapeutics As with previous editions, the Principles Unit of the book reviews basic elements of therapeutics necessary for safe and effective prescribing. The first chapter introduces the prescribing process, including how to avoid medication errors. The next two chapters provide the foundation of therapeutics, including information on the pharmacokinetics and pharmacodynamics of drugs and drug–drug/drug–food interactions. The following three chapters review how these foundations change in pediatric, pregnant, and geriatric patients. Similarly, the basics of the principles of pain management and infectious disease therapy are reviewed in the next two chapters so that the reader can learn how these concepts are applied to the disorders discussed in the following units. Updated Complementary and Alternative Medicine (CAM) and Pharmacogenomics chapters are included in this unit, recognizing the growing use of these modalities in all aspects of patient care. Pharmacotherapeutics for Advanced Practice

Units 2 through 12—Disorders This section of the book, consisting of 41 chapters, reviews commonly seen disorders in the primary care setting. Although not all-inclusive, the array of disorders allows the reader to gain an understanding of how to approach the pharmacotherapeutic treatment of any disorder. The chapters are designed to give a brief overview of the disease process, including the causes and pathophysiology, with an emphasis placed on how drug therapy can alter the pathologic state. Diagnostic Criteria and Goals of Therapy are discussed and underlie the basic principles of treating patients with drugs. Osteoarthritis and rheumatoid arthritis have been split and each has a chapter devoted to it. A new chapter on Parkinson Disease has been added since this is frequently treated in primary care. Each chapter has been updated with the newest therapies available at the time of writing.

The drug sections review the agents’ uses, mechanism of action, contraindications and drug interactions, adverse effects, and monitoring parameters. This discussion is organized primarily by drug class, with notation to specific drugs within the text and the tables. The tables provide the reader with quick access to generic and trade names and dosages, adverse events, contraindications, and special considerations. Used together, the text and tables provide the reader with sufficient information to begin to choose drug therapy. Pharmacotherapeutics for Advanced Practice

The section on 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, with rationales for why drugs are classified in these categories. Accompanying this section is an algorithm outlining the thought process by which clinicians select an initial drug therapy. Again, the text organization and the illustrative algorithms provide readers with a means of thinking through the process of

selecting drugs for patients. In the third edition, we have kept the Recommended Order of Treatment tables and updated them, along with the algorithms and drug tables, to reflect current knowledge. Each chapter has been updated to reflect the most current guidelines available at the time of writing. However, medicine and pharmacotherapy are constantly changing, and it remains the clinician’s responsibility to identify the most current information. Pharmacotherapeutics for Advanced Practice

Included in each chapter is a section on Monitoring Patient Response. This encompasses clinical and laboratory parameters, times when these items should be monitored, and actions to take in case the parameters do not meet the specified goals of therapy. In addition, special patient populations are discussed when appropriate. These discussions include pediatric and geriatric patients but may also include ethnic- or sex- related considerations. Last, this section includes a discussion of patient education material relevant to the disease and drugs chosen. In each chapter, there is a patient education section that includes information on CAM related to that disorder as well as sections on external information for patients and practitioners.

Each of the case studies has been reviewed and updated as appropriate. However, the pedagogical style of reasoning remains the same. As previously stated, answers to these case studies are not supplied since the purpose is to promote discussion and evoke a thought process. Also, as time changes, so do therapies. The cases are short, compelling the learner to ask questions about the patient and allowing flexibility for multiple correct answers to be developed by the instructor as they work through the clinical decision-making process. Pharmacotherapeutics for Advanced Practice

Units 13 and 14—Pharmacotherapy in Health Promotion and Women’s Health These units discuss several areas of interest for promoting health or maintaining a healthy lifestyle using medications, including smoking cessation, immunizations, and weight management; the chapter on travel medicine has been eliminated since there are specialty clinics that provide this service, and it is not done frequently in primary care. The four chapters in Women’s Health assist the learner to recognize the special nature of care that this population deserves.

Unit 15—Integrative Approach to Patient Care While there are only two chapters in this unit, they represent the culmination of the text. Practitioners need to have an understanding of the economics of pharmacotherapeutics in order to effectively prescribe medications and treat patients. This chapter is updated with information on the Affordable Care Act and its impact on therapeutic decision making while still being anchored in the basics of pharmacoeconomics, formulary decision making, co-pays, prior authorizations, and Medicare as well as managed care as it applies to prescribing medication Pharmacotherapeutics for Advanced Practice