Patient centered Pharm BK.pdf - 2585_FM_i-xvi 6:29 PM Page i Patient-Centered Pharmacology Learning System for the Conscientious Prescriber

Patient centered Pharm BK.pdf - 2585_FM_i-xvi 6:29 PM Page...

This preview shows page 1 out of 575 pages.

You've reached the end of your free preview.

Want to read all 575 pages?

Unformatted text preview: 2585_FM_i-xvi 02/07/13 6:29 PM Page i Patient-Centered Pharmacology: Learning System for the Conscientious Prescriber 2585_FM_i-xvi 02/07/13 6:29 PM Page ii Resources for Classroom and Professional Success! Diamond DAVIS’S PA EXAM REVIEW Focused Review for the PANCE and PANRE Pass your PANCE and PANRE exams...guaranteed! Organized in a unique and highly effective dual-learning structure, more than 1,600 questions in the text and on the CD-ROM mirror actual PANCE and PANRE exams. Prepare for success—or your money back! Weber, Vilensky, & Fog PRACTICAL RADIOLOGY A Symptom-Based Approach Master the basics of using medical imaging in patient care. This real-world approach shows you when and how to use medical imaging to diagnose and treat common diseases and disorders—as well as the financial ramifications of various procedures. Sullivan GUIDE TO CLINICAL DOCUMENTATION Documentation requires the utmost skill and accuracy. Are you prepared? Rely on sample notes, writing exercises, and screening tools to help you develop the skills you need to effectively and efficiently document patient care for children and adults in clinical and hospital settings. Sedrak & Massey CLASSROOM TO CLINIC STUDY SYSTEM Personal Professor for Clinical Rotations and PANCE/PANRE Review Think Taber’s is just another dictionary? Take another look! Prepare for classroom, PANCE, PANRE, or clerkship exam success—guaranteed! Choose how you want to study—by the NCCPA Content Blueprint for PANCE and PANRE exams or by clerkship. Multiple checkpoints assess your progress. Order your copies today! 2585_FM_i-xvi 02/07/13 6:29 PM Page iii Patient-Centered Pharmacology: Learning System for the Conscientious Prescriber William N. Tindall, PhD, RPh Professor Emeritus, Family Medicine Wright State University Boonshoft School of Medicine, Dept. of Family Medicine Dayton, Ohio Mona M. Sedrak, PhD, PA-C Associate Dean, School of Health and Medical Sciences Division of Health Sciences Associate Professor, Physician Assistant Program Seton Hall University South Orange, New Jersey John M. Boltri, MD, FAAFP Professor and Chair Department of Family Medicine and Public Health Sciences Wayne State University School of Medicine Detroit, Michigan 2585_FM_i-xvi 02/07/13 6:29 PM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 Copyright © 2014 by F. A. Davis Company Copyright © 2014 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Andy McPhee Manager of Content Development: George W. Lang Developmental Editor: Patricia Gillivan Art and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Patient-Centered Pharmacology: learning system for the conscientious prescriber / [edited by] William N. Tindall, Mona M. Sedrak, John M. Boltri. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8036-2585-3 I. Tindall, William N., editor of compilation. II. Sedrak, Mona, editor of compilation. III. Boltri, John M., editor of compilation. [DNLM: 1. Pharmaceutical Preparations. 2. Drug Therapy. QV 55] RM300 615.1—dc23 2013007350 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-2585-3/14 0 + $.25. 2585_FM_i-xvi 02/07/13 6:29 PM Page v Dedication I dedicate this book to my three grandchildren, Aidan, Cameron, and Kendall Taylor, who light my days with their love, wonder, and joy; my daughters, Christine and Laura, who continue to teach me the meaning of unconditional love; and my best friend and loving wife, Sylvia, for all she has sacrificed in support of me, my career, and my many pursuits. William N. Tindall I dedicate this book first and foremost to my parents Edward and Marcelle Naim. Mom and Dad, you gave me the courage and the confidence to dream big, reach for the stars and beyond, and to never give up. Also, I dedicate this book to the one I lost and that I hope to find fully again one day. Working on this project helped keep me sane when I found solace in little else. My precious child, you were with me in each word I wrote and each page I turned, as you are now and will forever be. Mona M. Sedrak I dedicate this book to my wife and best friend, Shelley; to my children, Mark, Joe, and Mary; and to my parents, Lillian and Mario. You have all taught me the meaning of love and what is really important in life—to love and be loved. John M. Boltri v 2585_FM_i-xvi 02/07/13 6:29 PM Page vi 2585_FM_i-xvi 02/07/13 6:29 PM Page vii Preface This textbook is designed to be used as a learning system about medications for students who will one day possess prescribing rights. We believe every clinician should be a conscientious prescriber. To us, conscientious prescribing refers to a thoughtful process that always places the patient’s well-being first, ahead of every prescribing decision, before any prescription is written, and includes appropriate follow-up after the patient has completed the course of medication. Being a conscientious prescriber is based on the following tenets: 1. That each time a medication is chosen, the choice should be based on a substantial body of literature supporting the decision. 2. That for most patients, monotherapy is a better choice than polytherapy. 3. That low doses are preferred over high doses. 4. That short-term therapy is preferred over long-term therapy. 5. That although newer medications may have promotional advantages, there is not always the best evidence available to support these advantages until clinical trials are conducted to prove the existence of significant “risk-benefit” advantages. 6. That before any prescription is written, the clinician must consider the patient’s lifestyle behaviors, adherence issues, economic issues, mind-body-spiritual issues, health-risk issues, age, weight, and other physical issues that might affect pharmacodynamic and pharmacokinetic parameters and hence final outcomes. 7. That after a prescription is written, treatment failure can be the result of inappropriate prescribing, dosing or dosage errors, misdiagnoses of its need, interference by other illnesses, administration of concurrent foods or drugs, environmental factors, or genetic issues. 8. That a conscious effort should be made to confirm a patient’s response to a medication, manage adverse reactions, change the dosage, or discontinue the medication. 9. That patient education is vital for compliance. 10. That all patients should know at least the following drug information before they leave the clinician’s office: name of the medication, indication, expected side effects, and contraindications. 11. That sophisticated clinical, financial, and administrative systems in health care can change quickly, requiring clinicians to remain vigilant about therapeutic decisions and be focused on which treatments benefit the patient’s health most effectively. Our approach is based on the belief that clinicians must always put the patient first in any decision regarding drug choices. Putting the patient first allows you to assess the patient as a unique individual in need of your skills as a conscientious clinician. Organization The text is designed as a teaching tool and not as a reference, with our goal of making you think twice before prescribing once. In other words we hope to make you a more conscientious prescriber. Whereas a typical college course in pharmacology focuses on the pharmacokinetics and pharmacodynamics of drugs by grouping similar chemical classes of medications together, this textbook presents similar information, but groups medications by the patient’s clinical problem(s) or issues, thereby emphasizing the clinical application of the information presented. The book is divided into three units. The first unit presents basic pharmacological principles that, once mastered, make it easier to assimilate the rest of the text. The second unit contains chapters that focus on the treatment of patients with common diseases and disorders seen in primary care, such as hypertension, diabetes, infections, and so forth. The third unit focuses on the treatment of patients that fall under specific patient populations with special considerations. These include pediatric patients, women, men, and the elderly. Each chapter progresses from general information that clinicians need to know about the drugs discussed in the chapter, including conscientious prescribing and patient education points applicable to all drugs in a particular class. It covers specific information about individual drugs, including mechanism of action, pharmacokinetics, dosage and administration, clinical uses, adverse reactions, interactions, contraindications, conscientious considerations, and patient and family education. Here are other elements to the chapters: ■ ■ ■ ■ Generic and trade names are given for each drug in this format: generic name (Trade Name). Adverse reactions are listed by system. Life-threatening adverse reactions are printed in capital letters, whereas common side effects are printed in regular text. These lists are not exhaustive; readers are advised to consult a drug guide for a complete list of adverse reactions. Conscientious Considerations are clinical tips for clinicians. Patient/Family Education content conveys information that clinicians should communicate to patients about the drugs they are prescribed. vii 2585_FM_i-xvi 02/07/13 6:29 PM Page viii viii Preface ■ ■ ■ ■ ■ Spotlight features focus on treating specific conditions with the drugs discussed in the chapter. Special Case boxes discuss treatment of uncommon conditions such as digitalis and cyanide toxicity. Other boxes and tables highlight and summarize important information for easy access. Implications for pregnant, pediatric, and geriatric patients are given for each class of drugs discussed. Learning Exercises present case studies related to the chapter content and are followed by critical thinking questions designed to apply the content to real-world prescribing situations. Answers to the critical thinking questions are found at the end of the book. Each chapter coordinates with the companion online website, providing a comprehensive learning system that reinforces key concepts. Web Resources for Instructors The Instructor’s area on DavisPlus ( Keyword Tindall) provides online support through chapter outlines and learning objectives, PowerPoint presentations for each chapter, additional case studies for class discussion or homework assignments, and a test bank for each of the 26 chapters. Web Resources for Students Because the patient should be your first consideration in the clinical application of any medication, you as a learner are the first consideration in our learning program. Thus, the authors have prepared a unique group of ancillary learning products to support you as a learner and help you improve your understanding of the clinical application of pharmacological principles. The Web resources include chapter outlines and learning objectives, pre- and post-study chapter quizzes, additional case studies for independent study, links to helpful websites, and a “Create Your Own Formulary and Drug Card” system. We firmly believe that our approach will help further develop your basic problem-solving and decision-making skills related to prescribing medications, thereby improving your critical thinking skills. Real-World Constraints No teaching text can cover every drug used in a modern society, especially when new drugs are continuingly being introduced. However, this textbook and its companion pieces are designed to focus your attention on common medicinal agents likely to be encountered in primary care settings and also likely to be found on a typical prescription benefit list. Any attempt to build a working knowledge of drug therapy will be tempered by real-world constraints such as the following: ■ ■ ■ ■ Alternative therapies Guidelines and algorithms suggested by government agencies Use of some medicines based on local habits and customs Therapeutic choices that vary by health plan benefits ■ Accepted knowledge that any patient at any time may change his or her medication regimen due to individual economics, compliance behavior, health risks, multiple therapeutic needs, and other demands. Importance of Study We study medications to prepare for that ultimate clinical act of prescribing a medication in such a way that the patient will adhere to its regimen and ultimately obtain the best benefit. The mental gymnastics that go into this process are conscientious, and when done so illuminate a path to better patient care. We need to fuse pharmacology, therapeutics, practical realities, market realities, and the human side of medicine together in the learning process. You can then see at the onset of your career how your choice of drugs to prescribe can affect health outcomes. Studying pharmacology is much different from studying other scientific and medical topics. Many students are tempted to use rote memorization to learn drug actions, names, side effects, contraindications, and so forth. Approaching the study of pharmacology in this manner is, frankly, a waste of time. We believe the best way to truly learn pharmacology is to focus on distinguishing information about each class of drugs. You then can better understand similar drugs used to treat similar conditions. For example, if agents used to treat cancer seek out and destroy fast-growing cells, is it not logical to assume they would do the same to the host taking them? Of course. So cells in the blood, gastrointestinal tract, hair, and certain other organs bear the brunt of those agents and tend to manifest as side effects— such a bone marrow suppression, enteritis, and hair loss—all related to damage done to fast turnover cells. As you undertake the important task of becoming a conscientious prescriber, instead of trying to memorize facts, ask yourself a series of questions. ■ ■ ■ ■ If this is what a drug is doing to combat a disease, what is the body doing to combat the presence of the drug? How much of this drug should I give to achieve the desired outcome and not harm the patient? What information do I need to know about the patient and the patient’s health status to prescribe safely? What information do I need to tell the patient about his or her health and prescribed regimen so that the patient feels like a partner in health-care decisions and is encouraged to take responsibility for his or her health? We hope that this approach and the approaches we offer throughout the book afford you the ability to separate the forest from the trees and understand that, at the end of the day, every day, it is truly all about the patient. Providing patient-centered medicine, putting the patient first, and prescribing conscientiously are at the root of providing quality patient care. We thank you for allowing us to play a small, yet important, part in your education. WILLIAM N. TINDALL, PHD, RPH MONA M. SEDRAK, PHD, PA-C AND JOHN M. BOLTRI, MD 2585_FM_i-xvi 02/07/13 6:29 PM Page ix Contributors Richard Ackermann, Sr., MD, Geriatrician, Family Practitioner Family Health Center Director, Geriatric Fellowship Macon, Georgia Justin B. Beverly, MD, Pediatrician Family Health Center Primary Pediatrics of Macon McDonough, Georgia Florence T. Baralatei, MD, Geriatrician, Family Practitioner Family Health Center Macon, Georgia David E. Burtner, MD, Family Practitioner Family Health Center Macon, Georgia Edward K. Clark, MD, Pediatrician Children’s Health Center Macon, Georgia Y. Monique Davis-Smith, MD, Family Practitioner Health Services of Central Georgia Director, Residency Program Macon, Georgia Sabry A. Gabriel, MD, Family Practitioner Mercer Health Systems Professor, Family Medicine, Mercer University Macon, Georgia Fred S. Girton, MD, Family Practitioner Health Services of Central Georgia Professor and Chairman, Dept. Family Medicine, Mercer University Macon, Georgia Alice A. House, MD, Family Practitioner Byron Family Health Care Byron, Georgia Steven A. House, MD, Family Practitioner Family Practice Physicians Associate Professor, Assistant Director, Family Residency University of Kentucky Glasgow, Kentucky Kathy A. Kemle, MS, PA-C, Family Practitioner Health Services of Central Georgia Assistant Professor, Assistant Director, Division of Geriatrics, Mercer University Macon, Georgia Hugh L. McLaurin, MD, Family Practitioner Family Health Center Assistant Professor of Family Medicine Macon, Georgia Dipesh R. Patel, MD, Geriatrician and Family Practitioner Family Health Center Assistant Professor, Family Medicine Macon, Georgia W. Patrick Roche, III, MD, Family Practitioner & Internal Medicine Family Health Center Macon, Georgia Roberta J. Weintraut, MD, Family Practitioner Family Health Center Assistant Professor Macon, Georgia Ancillaries Mary Banahan, MS, PA-C, LCCE Chair, Physician Assistant Admissions Committee, Assistant Professor Touro College Physician Assistant Program Manhattan, New York Georgina Ferriero, MSPA PA-C Hospitalist Physician Assistant Evangelical Community Hospital Lewisburg, Pennsylvania Pamela Gregory-Fernandez, MS, PA-C, GEA, DFAAPA Assistant Professor–Industry Professional College of Pharmacy and Health Sciences Physician Assistant Education St. John’s University Queens, New York ix 2585_FM_i-xvi 02/07/13 6:29 PM Page x x Contributors Sandra Kaminski, MS, PA-C Assistant Professor, PA Program School of Health and Medical Sciences Seton Hall University South Orange, New Jersey Krisie Kupryk, MS, PA-C Emergency Department, Physician Assistant Overlook Hospital Summitt, New Jersey Michelle McWeeney, MS, PA-C Assistant Professor, PA Program School of Health and Medical Sciences Seton Hall University South Orange, New Jersey Raffi Manjikian, MS Adjunct Instructor Department of Physics Seton Hall University South Orange, New Jersey Jurga Marshall, MS, PA-C Clara Maass Medical Center Emergency Department St. Mary’s Hospital Emergency Department Belleville, New Jersey Jennifer Hofmann Ribowsky, MS, RPA-C Academic Faculty/Pre-clinical Coordinator Pace University–Lenox Hill Hospital Physician Assistant Program New York, New York Denise Rizzolo, PhD, PA-C Associate Professor, PA Program School of Health and Medical...
View Full Document

  • Fall '19
  • Pharmacology, Prescription drug, Food and Drug Administration, Over-the-counter drug, Mona M. Sedrak

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

Stuck? We have tutors online 24/7 who can help you get unstuck.
A+ icon
Ask Expert Tutors You can ask You can ask You can ask (will expire )
Answers in as fast as 15 minutes