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 12 TH EDITION

DIPIRO’S
PHARMACOTHERAPY
A PAT H O P H YS I O LO G I C A P P R O AC H

AL Grawany
 Assistant Editors
Angela L. Bingham, PharmD, BCPS, Rena A. Gosser, PharmD, BCPS
BCNSP, BCCCP Clinical Ambulatory Pharmacy Manager
Harborview Medical Center
Vice Chair and Clinical Associate Professor
Seattle, Washington
Philadelphia College of Pharmacy
Saint Joseph’s University
Philadelphia, Pennsylvania Lisa M. Holle, PharmD, BCOP
Clinical Professor of Pharmacy Practice
Scott Bolesta, PharmD, BCPS Department of Pharmacy Practice
School of Pharmacy, University of Connecticut
Professor
Storrs, Connecticut
Department of Pharmacy Practice
Nesbitt School of Pharmacy, Wilkes University
Wilkes-Barre, Pennsylvania Amy M. VandenBerg, PharmD, BCPP
Clinical Associate Professor
Robert J. DiDomenico, PharmD, FCCP, College of Pharmacy, University of Michigan
Ann Arbor, Michigan
FHFSA, FACC
Associate Professor and Assistant Head
Department of Pharmacy Practice
College of Pharmacy, University of Illinois Chicago
Chicago, Illinois

FM.indd 2 13-02-2023 16:51:53

 12 TH EDITION

DIPIRO’S
PHARMACOTHERAPY
A PAT H O P H YS I O LO G I C A P P R O AC H

Editors
Joseph T. DiPiro, PharmD Thomas D. Nolin, PharmD, PhD, FCCP,
Professor, School of Pharmacy FCP, FASN
Associate Vice President for Health Sciences
Associate Dean for Research and Sponsored Programs
Virginia Commonwealth University
Associate Professor of Pharmacy and Therapeutics
Richmond, Virginia
School of Pharmacy, University of Pittsburgh
Pittsburgh, Pennsylvania
Gary C. Yee, PharmD
Professor, College of Pharmacy
Vicki L. Ellingrod, PharmD, FCCP
Associate Vice Chancellor for Academic Affairs Dean and John Gideon Searle Professor of Pharmacy
University of Nebraska Medical Center College of Pharmacy
Omaha, Nebraska Professor of Psychiatry, Medical School
University of Michigan
Ann Arbor, Michigan
Stuart T. Haines, PharmD, BCPS, BCACP
Professor, Department of Pharmacy Practice L. Michael Posey, BSPharm, MA
Director, Pharmacy Professional Development President
School of Pharmacy, University of Mississippi PENS Pharmacy Editorial & News Services
Jackson, Mississippi Santa Rosa, California

New York Chicago San Francisco Athens London Madrid Mexico City Milan New Delhi Singapore Sydney Toronto

AL Grawany
Copyright © 2023 by McGraw Hill LLC. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publi-
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 Dedication
To our patients and students, who have challenged and inspired us and given meaning to all our endeavors.
To practitioners who continue to improve patient health outcomes and thereby serve as role models for their colleagues
and students while clinging tenaciously to the highest standards of practice.
To our mentors, whose vision provided educational and training programs that encouraged our professional growth and
challenged us to be innovators in our patient care, research, and education.
To our faculty colleagues for their efforts and support for our mission to provide a comprehensive and challenging educational
foundation for the pharmacists of the future.
And finally to our families for the time that they have sacrificed so that this twelfth edition would become a reality.
—The Editors

AL Grawany
 PAST EDITORS OF DIPIRO’S PHARMACOTHERAPY

Peggy E. Hayes, PharmD

Editions 1 and 2

Gary R. Matzke, PharmD, FCP, FCCP, FASN, FNAP

Editions 2–10

Robert L. Talbert, PharmD, FCCP, BCPS, FAHA

Editions 1–10

Barbara G. Wells, PharmD, FCCP, FASHP

Editions 3–10

FM.indd 6 13-02-2023 16:51:54

Contents
Contributors������������������������������������������������������������������������������������������ xiii
Foreword��������������������������������������������������������������������������������������������xxxiii
e12.  inor Otic Disorders (Cerumen Impaction,
M
Otitis External)�����������������������������������������������������������29
Preface������������������������������������������������������������������������������������������������ xxxv
Lea S. Eiland
e13.  onspecific Respiratory Tract Symptoms
N
SECTION 1 Foundation Issues 1 (with Cough)���������������������������������������������������������������31
Brandon Sucher
Section Editors: Stuart T. Haines, L. Michael Posey, and Thomas D. Nolin e14. Allergic Rhinitis����������������������������������������������������������33
1. Patient Care Process��������������������������������������������������� 1 J. Russell May
Stuart T. Haines, Mary Ann Kliethermes, e15. Oral Health and Systemic Conditions�����������������35
and Todd D. Sorensen Lisa M. Palmisano and Jennifer L. Mazan
e2. Health Literacy and Medication Use��������������������� 9 e16. Oral Hygiene and Minor Oral Disorders�������������37
Oralia V. Bazaldua, Norbert Rosario, and Erica Torres Anna S. Milone, Kristyn M. Williamson, and Maren Hall
e3. E xploring Cultural Diversity and Equity in e17. S kin Care and Minor Dermatologic
Healthcare�������������������������������������������������������������������11 Conditions �������������������������������������������������������������������39
Amanda M. Loya, Jeri J. Sias, Lakesha M. Butler, Rebecca M. Law and Howard I. Maibach
Christopher G. Medlin, and Jessica M. Shenberger-Trujillo
e18. Travel Health ���������������������������������������������������������������41
e4. Medication Safety�����������������������������������������������������13 Douglas Slain and Scott E. Kincaid
Robert J. Weber
19. Contraception���������������������������������������������������������������������43
e5. Medication Adherence �������������������������������������������15 Shareen Y. El-Ibiary
Fang-Ju Lin, Yen-Ming Huang, and Yunn-Fang Ho
e6.  linical Pharmacokinetics and
C
Pharmacodynamics �������������������������������������������������17
SECTION 3 Special Populations 67
Kristin M. Janzen and Samuel M. Poloyac
Section Editors: L. Michael Posey and Thomas D. Nolin
e7. Clinical Pharmacogenomics ���������������������������������19
Roseann S. Gammal, Larisa H. Cavallari, and e20.  ediatrics: General Topics in Pediatric
P
Y. W. Francis Lam Pharmacotherapy �����������������������������������������������������67
Milap C. Nahata and Carol K. Taketomo
e8. Clinical Toxicology�����������������������������������������������������21
Bryan D. Hayes and Natalija M. Farrell e21.  ediatrics: Oral Nutrition and Rehydration of
P
Infants and Children�������������������������������������������������69
Katherine H. Chessman
e22.
section 2 Common Health Problems 23 Pediatrics: Neonatal Critical Care�������������������������71
Kirsten H. Ohler and Jennifer T. Pham
Section Editors: L. Michael Posey, Joseph T. DiPiro, and Vicki L. Ellingrod e23. Geriatrics: Physiology of Aging�����������������������������73
Krista L. Donohoe, Elvin T. Price, Tracey L. Gendron, and
e9. Fever �����������������������������������������������������������������������������23 Patricia W. Slattum
Jamal Brown and Juan Mosley II
e24. Geriatrics: Medication Use in Older Adults�������75
e10. Pain and Headache���������������������������������������������������25 Emily R. Hajjar, Lauren R. Hersh, and Shelly L. Gray
Ryan C. Costantino, Krista B. Highland, and Laura C. Tilley
e25.  eriatrics: Assessing Health and Delivering
G
e11. Minor Ophthalmic Disorders���������������������������������27 Healthcare to Older Adults�������������������������������������77
Jared Ostroff Leigh Ann Mike, Zachary A. Marcum, and Shelly L. Gray
vii

AL Grawany
 viii

e26.  ritical Care: Considerations in Medication

C 45. Chronic Obstructive Pulmonary Disease���������������� 393
Selection, Dosing, Monitoring, and Safety������ 79 Sharya V. Bourdet and Dennis M. Williams
Erin F. Barreto and Amy L. Dzierba 46. Pulmonary Arterial Hypertension������������������������������ 419
e27. Critical Care: Pain, Agitation, and Delirium������ 81 Rebecca L. Attridge Rebecca Moote, and Deborah J. Levine
Caitlin S. Brown and Gilles L. Fraser 47. Cystic Fibrosis�������������������������������������������������������������������� 437
e28. Palliative and End-of-Life Care ���������������������������� 83 Kim G. Adcock, Ha K. Phan, and David Josey Jr.
Mary Lynn McPherson and Jessica E. Geiger e48. Drug-Induced Pulmonary Diseases������������������ 455
CONTENTS

Margaret A. Miklich and Mojdeh S. Heavner

SECTION 4 Cardiovascular Disorders 85

SECTION 6 Gastrointestinal Disorders 457
Section Editor: Stuart T. Haines
Section Editor: Joseph T. DiPiro
e29. Evaluation of Cardiovascular Function������������� 85
Brent N. Reed, Kristin Watson, and Gautam Ramani e49. Evaluation of the Gastrointestinal Tract���������� 457
Keith M. Olsen
30. Hypertension���������������������������������������������������������������������� 87
Eric J. MacLaughlin and Joseph J. Saseen 50. Gastroesophageal Reflux Disease������������������������������ 459
Dianne W. May, Devin L. Lavender, and Satish C. Rao
e31. Acute Hypertensive Crisis �������������������������������������������� 119
Jeffrey J. Mucksavage, Danielle M. Tompkins, and 51. Peptic Ulcer Disease and Related Disorders ���������� 479
Eric J. MacLaughlin Bryan L. Love

32. Dyslipidemia��������������������������������������������������������������������� 121

52. Inflammatory Bowel Disease �������������������������������������� 503
Brian A. Hemstreet
Dave L. Dixon, Daniel M. Riche, and Michael S. Kelly
33. Stable Ischemic Heart Disease������������������������������������ 143
53. Nausea and Vomiting ���������������������������������������������������� 525
Leigh Anne H. Gravatt, Krista L. Donohoe, and
Paul P. Dobesh, Robert J. DiDomenico, and
Mandy L. Gatesman
Kelly C. Rogers
34. Acute Coronary Syndrome ������������������������������������������ 167
54. Diarrhea, Constipation, and Irritable Bowel
Syndrome �������������������������������������������������������������������������� 539
Robert J. DiDomenico, Paul P. Dobesh, and
Patricia H. Fabel and Kayce M. Shealy
Shannon W. Finks
55. Portal Hypertension and Cirrhosis���������������������������� 557
e35. Peripheral Arterial Disease���������������������������������� 197
Julie M. Sease
Kristin Watson and Sarah L. Anderson
e56. Drug-Induced Liver Injury ���������������������������������� 573
36. Chronic Heart Failure������������������������������������������������������ 199 William R. Kirchain and Rondall E. Allen
Robert B. Parker and Jo E. Rodgers
57. Pancreatitis������������������������������������������������������������������������ 575
37. Acute Decompensated Heart Failure������������������������ 231 Scott Bolesta
Brent N. Reed, Stormi E. Gale, and Zachary L. Cox
58. Viral Hepatitis�������������������������������������������������������������������� 591
38. Venous Thromboembolism������������������������������������������ 251 Paulina Deming
Daniel M. Witt, Nathan P. Clark, and Sara R. Vazquez
59. Celiac Disease�������������������������������������������������������������������� 611
39. Stroke���������������������������������������������������������������������������������� 283 Priti N. Patel and Robert A. Mangione
Melody Ryan and Melissa A. Nestor
40. Arrhythmias���������������������������������������������������������������������� 297

41.
Jessica J. Tilton, Stephen T. Phillips, and Jerry L. Bauman
Cardiopulmonary Arrest������������������������������������������������ 335
SECTION 7 Renal Disorders 619
Jeffrey F. Barletta Section Editor: Thomas D. Nolin
e42. Shock Syndromes�������������������������������������������������� 353 e60. Evaluation of Kidney Function�������������������������� 619
Seth R. Bauer, Robert MacLaren, and Brian L. Erstad Linda Awdishu and Thomas C. Dowling
61. Acute Kidney Injury�������������������������������������������������������� 621
SECTION 5 Respiratory Disorders 355 Jenana H. Maker, Lauren K. Roller, and William Dager
62. Chronic Kidney Disease ������������������������������������������������ 641
Section Editor: Stuart T. Haines Lori D. Wazny
e43. Evaluation of Respiratory Function������������������ 355 63. Chronic Kidney Disease: Management of
Megan L. Carreon, Maria I. Velez, Stephanie M. Levine, and Secondary Complications�������������������������������������������� 653
Jay I. Peters Joanna Q. Hudson
44. Asthma�������������������������������������������������������������������������������� 357 64. Hemodialysis and Peritoneal Dialysis ���������������������� 679
Kathryn V. Blake and Jean Y. Moon Kevin M. Sowinski and Mariann D. Churchwell

FM.indd 8 13-02-2023 16:51:55

 ix
65. Drug-Induced Kidney Disease������������������������������������ 699 e83. Eating Disorders����������������������������������������������������1023
Thomas D. Nolin and Mark A. Perazella Steven C. Stoner, Valerie L. Ruehter, and Melissa C. Palmer
e66. Glomerular Diseases���������������������������������������������� 719 e84. Introduction to Substance Use Disorders���� 1025
Duncan B. Johnstone Jessica L. Moreno, Patrick Leffers, and Vicki L. Ellingrod
67. Personalized Pharmacotherapy for Patients with 85. Substance Use Disorders I: Opioids, Cannabis,
Chronic Kidney Disease ������������������������������������������������ 721 and Stimulants����������������������������������������������������������������1027
Morgan A. Butrovich and Thomas D. Nolin Patrick Leffers, Brittany N. Johnson, and Patrick Aaronson

CONTENTS
68. Disorders of Sodium and Water Homeostasis ������ 737 86. Substance Use Disorders II: Alcohol, Nicotine,
Katherine H. Chessman and Jason S. Haney and Caffeine��������������������������������������������������������������������1047
69. Disorders of Calcium and Phosphorus Lori H. Dupree and Robin Moorman Li
Homeostasis���������������������������������������������������������������������� 763 87. Schizophrenia ����������������������������������������������������������������1073
Angela L. Bingham M. Lynn Crismon, Tawny L. Smith, and Peter F. Buckley
70. Disorders of Potassium and Magnesium 88. Depressive Disorders����������������������������������������������������1107
Homeostasis���������������������������������������������������������������������� 783 Amy M. VandenBerg
Rachel W. Flurie
89. Bipolar Disorder ������������������������������������������������������������1133
71. Acid–Base Disorders ������������������������������������������������������ 801 Jordan C. Haygood and Shannon J. Drayton
Anne M. Tucker and Tami N. Johnson
90. Generalized Anxiety Disorder, Panic Disorder,
and Social Anxiety Disorder��������������������������������������1151
SECTION 8 Neurologic Disorders 823 Sarah T. Melton and Cynthia K. Kirkwood

Section Editor: Vicki L. Ellingrod

91. Posttraumatic Stress Disorder and Obsessive-
Compulsive Disorder����������������������������������������������������1173
e72. Evaluation of Neurological Illness������������������������������ 823 Kristen N. Gardner, Jolene R. Bostwick, and
Melody Ryan and Stephen J. Ryan Ericka L. Crouse

73. Alzheimer Disease ���������������������������������������������������������� 825 92. Sleep Disorders��������������������������������������������������������������1187

Ericka L. Crouse, Kristin M. Zimmerman, Emily P. Peron, John M. Dopp and Bradley G. Phillips
Lana J. Sargent, and Sarah E. Hobgood e93. Developmental Disabilities������������������������������1201
Steven R. Erickson
74. Multiple Sclerosis������������������������������������������������������������ 845
Jacquelyn L. Bainbridge, Augusto Miravelle, Pei Shieen

75.
Wong, Matthew J. Makelky Sr., and Sarah Rajkovic

Epilepsy������������������������������������������������������������������������������ 869
SECTION 10 Endocrinologic Disorders 1203
Viet-Huong V. Nguyen, Sunita Dergalust, and Section Editor: Stuart T. Haines
Edward Chang
94. Diabetes Mellitus ����������������������������������������������������������1203
76. Status Epilepticus������������������������������������������������������������ 905 Jennifer M. Trujillo and Stuart T. Haines
Elizabeth A. Hall, Stephanie J. Phelps, and
James W. Wheless e95. Acute Hyperglycemia������������������������������������������1239
Paul M. Szumita, James F. Gilmore, and Jennifer M. Trujillo
77. Acute Management of the Brain Injury Patient���� 921
Bradley A. Boucher and G. Christopher Wood 96. Thyroid Disorders����������������������������������������������������������1241
Michael P. Kane and Gary Bakst
78. Parkinson Disease������������������������������������������������������������ 935
Jessa M. Koch, Khashayar Dashtipour, and Jack J. Chen 97. Adrenal Gland Disorders ��������������������������������������������1267
Steven M. Smith, Christopher R. Piszczatoski, and
79. Pain Management ���������������������������������������������������������� 953 John G. Gums
Christopher M. Herndon, Courtney M. Kominek, and
Amanda M. Mullins e98. Pituitary Gland Disorders����������������������������������1289
Joseph K. Jordan, Amy Heck Sheehan, and Kashif M. Munir
80. Headache Disorders�������������������������������������������������������� 981
Kimberly B. Tallian and Natalie T. Heinrich
SECTION 11 Gynecologic and Obstetric
SECTION 9 Psychiatric Disorders 1001 Disorders 1291
Section Editor: Vicki L. Ellingrod Section Editor: Vicki L. Ellingrod

e81. Evaluation of Psychiatric Illness����������������������1001 99. Pregnancy and Lactation��������������������������������������������1291

Mark E. Schneiderhan, Leigh Anne Nelson, Alicia B. Forinash and Kylie N. Barnes
Jeffrey R. Bishop, and Steven J. Bauer
100. Menstrual-Related Disorders ������������������������������������1313
82. Attention Deficit Hyperactivity Disorder��������������1003 Kathleen M. Vest and Danielle C. Mayer
Danielle L. Stutzman, Julie A. Dopheide, and Steven
Pliszka

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 x
101. Endometriosis����������������������������������������������������������������1333 e116. Drug-Induced Ophthalmic Disorders������������1609
Kathleen M. Vest and Sarah E. Lynch Rena A. Gosser
102. Menopausal Hormone Therapy��������������������������������1343
Devra K. Dang and Judy T. Chen
SECTION 16 Dermatologic Disorders 1611
Section Editor: L. Michael Posey
SECTION 12 Urologic Disorders 1365
CONTENTS

117. Acne Vulgaris������������������������������������������������������������������1611

Section Editor: L. Michael Posey Debra Sibbald and Cathryn Sibbald
103. Erectile Dysfunction������������������������������������������������������1365 118. Psoriasis����������������������������������������������������������������������������1639
Mary Lee and Roohollah Sharifi Rebecca M. Law and Wayne P. Gulliver
104. Benign Prostatic Hyperplasia������������������������������������1393 119. Atopic Dermatitis����������������������������������������������������������1661
Mary Lee and Roohollah Sharifi Rebecca M. Law and Wayne P. Gulliver
105. Urinary Incontinence����������������������������������������������������1413 120. Alopecia����������������������������������������������������������������������������1677
Eric S. Rovner, Kristine M. C. Talley, and Sum Lam Rebecca M. Law, Le Hanh Dung Do, and
Howard I. Maibach
e121.  ermatologic Drug Reactions,
D
SECTION 13 Immunologic Disorders 1431 Contact Dermatitis, and Common
Skin Conditions ����������������������������������������������������1693
Section Editors: Gary C. Yee and Thomas D. Nolin Rebecca M. Law, David T. S. Law, and Howard I. Maibach

e106. Function and Evaluation of the

Immune System ������������������������������������������������������������1431
Daniel A. Zlott and Geoffrey M. Thiele
SECTION 17 Hematologic Disorders 1695
107. Systemic Lupus Erythematosus��������������������������������1433 Section Editor: Gary C. Yee
Beth H. Resman-Targoff
122. Anemias����������������������������������������������������������������������������1695
e108. Drug Allergy ����������������������������������������������������������1455 Kristen M. Cook and Devon M. Greer
Mary L. Staicu, Christopher M. Bland, and Bruce M. Jones
123. Coagulation Disorders ������������������������������������������������1715
109. Solid-Organ Transplantation��������������������������������������1457 Heidi Trinkman, Timothy L. McCavit, and Lauren Duran
Nicholas W. Lange, David M. Salerno, and
Douglas L. Jennings
124. Sickle Cell Disease ��������������������������������������������������������1733
Jin Han, Santosh L. Saraf, and Victor R. Gordeuk
e125. Drug-Induced Hematologic Disorders����������1753
SECTION 14 Rheumatologic Disorders 1481 Elisa M. Greene and Tracy M. Hagemann

Section Editors: L. Michael Posey and Thomas D. Nolin

110. Osteoarthritis������������������������������������������������������������������1481
SECTION 18 Infectious Diseases 1755
Lucinda M. Buys and Sara A. Wiedenfeld Section Editor: Joseph T. DiPiro
111. Rheumatoid Arthritis����������������������������������������������������1501 e126. L aboratory Tests to Direct Antimicrobial
Stephanie Gruber, Bianca Harris, and Susan Hylland
Pharmacotherapy������������������������������������������������1755
112. Osteoporosis ������������������������������������������������������������������1523 Jordan R. Smith, Brian J. Werth, and Katie E. Barber
Mary Beth O’Connell, Jill S. Borchert, Erin M. Slazak, and 127. Antimicrobial Regimen Selection����������������������������1757
Joseph P. Fava Katie B. Olney and David S. Burgess
113. Gout and Hyperuricemia��������������������������������������������1555 128. Central Nervous System Infections��������������������������1771
Michelle A. Fravel and Michael E. Ernst Delaney E. Hart, Christina Koutsari, Michael A. Wankum,
and Ramy H. Elshaboury
129.
SECTION 15 Ophthalmic Disorders 1577 Lower Respiratory Tract Infections��������������������������1791
Evan J. Zasowski and Martha G. Blackford
Section Editor: L. Michael Posey 130. Upper Respiratory Tract Infections��������������������������1813
Grace C. Lee, Bradi L. Frei, and Christopher R. Frei
114. Glaucoma ������������������������������������������������������������������������1577
Richard Fiscella, Ohoud Owaidhah, and 131. Influenza ��������������������������������������������������������������������������1825
Deepak P. Edward Jessica C. Njoku

115. Age-Related Macular Degeneration ����������������������1595 e132. Coronavirus Disease (COVID-19) ��������������������1839
Alisa K. Escano and Casey S. Washington Jason M. Pogue, Erin K. McCreary, and Julie Ann Justo

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 xi
133. Skin and Soft Tissue Infections����������������������������������1841 152. Lung Cancer��������������������������������������������������������������������2255
Douglas N. Fish Keith A. Hecht and Eve M. Segal
134. Bacteremia and Infective Endocarditis������������������1869 153. Colorectal Cancer����������������������������������������������������������2277
Daniel B. Chastain Lisa M. Holle, Jessica M. Clement, and Lisa E. Davis
135. Tuberculosis��������������������������������������������������������������������1893 154. Prostate Cancer��������������������������������������������������������������2303
Rocsanna Namdar and Charles A. Peloquin Daniel J. Crona and Amber B. Cipriani
136. Gastrointestinal Infections and Enterotoxigenic 155. Lymphomas��������������������������������������������������������������������2323

CONTENTS
Poisonings������������������������������������������������������������������������1913 Alexandre Chan, Chia J. Tan, and Shawn P. Griffin
Andrew M. Roecker and Brittany N. Bates
156. Ovarian Cancer ��������������������������������������������������������������2351
137. Intra-Abdominal Infections����������������������������������������1929 Grace A. Martin and Judith A. Smith
Alan E. Gross, Jamie L. Wagner, and Keith M. Olsen
157. Acute Leukemias������������������������������������������������������������2369
e138. Parasitic Diseases��������������������������������������������������1947 David DeRemer and Tara A. Higgins
Alireza Fakhriravari, Ana Elizabeth Markez, and
Jason M. Cota
158. Chronic Leukemias��������������������������������������������������������2391
Karen M. Fancher and Jill M. Comeau
139. Urinary Tract Infections������������������������������������������������1949
Julianna M. Fernandez and Elizabeth A. Coyle
159. Multiple Myeloma ��������������������������������������������������������2411
Amy M. Pick and Jared E. Matya
140. Sexually Transmitted Infections��������������������������������1967
Yvonne J. Burnett and Humberto R. Jimenez
e160. Myelodysplastic Syndromes ����������������������������2429
Jill S. Bates and Jolynn Knoche Sessions
141. Bone and Joint Infections ������������������������������������������1989
Bryan T. Alexander and Scott J. Bergman
e161. Renal Cell Carcinoma������������������������������������������2431
Erin B. Bailey and David D. Stenehjem
142. Sepsis and Septic Shock����������������������������������������������2003
S. Lena Kang-Birken and Sul R. Jung
162. Melanoma������������������������������������������������������������������������2433
Cindy L. O’Bryant and Christina M. Davis
143. Superficial Fungal Infections ������������������������������������2021
Thomas E. R. Brown and Linda D. Dresser
e163. Hematopoietic Cell Transplantation��������������2453
Elizabeth Dimaggio and Janelle Perkins
144. Invasive Fungal Infections������������������������������������������2039
Peggy L. Carver and Gregory A. Eschenauer
145. Infections in Immunocompromised Patients������2067
Scott W. Mueller and Douglas N. Fish
SECTION 20 Nutritional Disorders 2455
146. Antimicrobial Prophylaxis in Surgery ��������������������2099 Section Editor: Thomas D. Nolin
Salmaan Kanji
164. Assessment of Nutrition Status
147. Vaccines and Immunoglobulins ������������������������������2115 and Nutrition Requirements��������������������������������������2455
Mary S. Hayney Katherine H. Chessman and Angela L. Bingham
148. Human Immunodeficiency Virus Infection����������2129 165. Parenteral Nutrition������������������������������������������������������2481
Peter L. Anderson, Kristina M. Brooks, and Todd W. Mattox and Catherine M. Crill
Courtney V. Fletcher
166. Enteral Nutrition������������������������������������������������������������2501
Diana W. Mulherin
167. Obesity������������������������������������������������������������������������������2519
SECTION 19 Oncologic Disorders 2155 Amy Heck Sheehan, Judy T. Chen, and Jack A. Yanovski
Section Editor: Gary C. Yee
Index 2545
149. Cancer: The Disease and Treatment������������������������2155
Lisa M. Cordes and Sandra Cuellar
150. Supportive Care in Cancer������������������������������������������2209
Amber B. Clemmons and Ashley E. Glode
151. Breast Cancer������������������������������������������������������������������2229
Bonnie Lin Boster, Neelam K. Patel, and Jaime Kaushik

SI unit conversions were produced by Ed Randell, PhD, DCC, FCACB, Division Chief and Professor of Laboratory Medicine,
Department of Laboratory Medicine, Eastern Health Authority and Faculty of Medicine, Memorial University of Newfoundland,
St. John’s, Newfoundland, Canada

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 Conflict of Interest Disclosure and Mitigation
Contributors to Pharmacotherapy: A Pathophysiologic Approach must disclose relevant financial and other interests with entities that
produce, market, sell, or distribute medications, health products, or services related to the medication use process. All contributors com-
pleted, signed, and submitted a conflict of interest (COI) disclosure statement to the Editors. Starting with the 11th edition, the COI
disclosure was submitted after an invitation has been extended and before a contributor agreement was signed.
After reviewing the COI disclosure statement submitted by a contributor, the Editors developed and approved a plan to mitigate any
and all potential COIs that might be reasonably perceived by the readers of Pharmacotherapy: A Pathophysiologic Approach to unduly
influence the contributor’s favorable or unfavorable portrayal of any product or service. The mitigation plan included, but was not
limited to, assigning a coauthor with no COIs to work with the contributor, subjecting the contribution to external peer review, or asking
the contributor to divest the interest(s).
No contributor may receive a payment or services from a third party (commercial entity, government agency, professional o­ rganization,
private foundation, etc.) for any work product submitted to Pharmacotherapy: A Pathophysiologic Approach.
Starting with the 11th edition, potential contributors who are employees of a commercial entity that produces, markets, sells, or
distributes medications or healthcare products are not invited or re-invited to contribute.
COI disclosures for all contributors to Pharmacotherapy: A Pathophysiologic Approach will be made available to readers online. The
internet address for the COI disclosure page will be published in the Contributors section of the text.

FM.indd 12 13-02-2023 16:51:56

Contributors
Patrick Aaronson, PharmD, DABAT Linda Awdishu, PharmD, MAS
Clinical Associate Professor and Emergency Medicine Practitioner Professor of Clinical Pharmacy, Division Head of Clinical
University of Florida Health Pharmacy, Director of Simulation and Interprofessional
Jacksonville, Florida Education
Chapter 85 Skaggs School of Pharmacy and Pharmaceutical Sciences,
University of California, San Diego
Kim G. Adcock, PharmD, CCRC La Jolla, California
Professor of Pharmacy Practice and Director of Faculty and Chapter e60
Academic Affairs
School of Pharmacy, University of Mississippi Erin B. Bailey, PharmD, BCOP
Professor of Pediatrics and Director of the Office of Clinical Pharmacist
Interprofessional Education University of Utah Health, Huntsman Cancer Institute
University of Mississippi Medical Center Salt Lake City, Utah
Jackson, Mississippi Chapter e161
Chapter 47
Jacquelyn L. Bainbridge, PharmD, MSCS
Bryan T. Alexander, PharmD, BCIDP, AAHIVP Professor, Departments of Clinical Pharmacy and Neurology
Pharmacy Coordinator, Outpatient Antimicrobial Therapy Skaggs School of Pharmacy and Pharmaceutical Sciences,
Program University of Colorado, Anschutz Medical Campus
Nebraska Medicine Aurora, Colorado
Omaha, Nebraska Chapter 74
Chapter 141
Gary Bakst, MD
Rondall E. Allen, BS, PharmD Head, Division of Community Endocrinology
Provost and Vice President for Academic Affairs Albany Medical Center
University of Maryland Eastern Shore Albany, New York
Professor, Pharmacy Practice and Administration Chapter 96
Salisbury, Maryland
Chapter e56 Katie E. Barber, PharmD
Associate Professor
Peter L. Anderson, PharmD School of Pharmacy, University of Mississippi
Professor Jackson, Mississippi
University of Colorado Anschutz Medical Campus Chapter e126
Aurora, Colorado
Chapter 148 Jeffrey F. Barletta, BS, PharmD
Professor and Vice Chair of Pharmacy Practice
Sarah L. Anderson, PharmD, BCACP, BCPS College of Pharmacy, Midwestern University
Scientific Director Glendale, Arizona
Clinical Care Options Chapter 41
Denver, Colorado
Chapter e35 Kylie N. Barnes, PharmD, BCPS
Clinical Associate Professor
Rebecca L. Attridge, PharmD, MSc, BCPS, BCCCP University of Missouri–Kansas City School of Pharmacy
Principal, Pharmacotherapy Kansas City, Missouri
The Craneware Group Chapter 99
Colorado Springs, Colorado
Chapter 46

xiii

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 xiv
Erin F. Barreto, PharmD, MSc Jeffrey R. Bishop, PharmD, MS, BCPP
Associate Professor of Medicine and Pharmacy Associate Professor
Mayo Clinic College of Pharmacy
Rochester, Minnesota University of Minnesota
Chapter e26 Minneapolis, Minnesota
Chapter e81
Brittany N. Bates, PharmD, BCPS
CONTRIBUTORS

Assistant Professor of Pharmacy Practice Martha G. Blackford, PharmD, BCPS

Ohio Northern University Clinical Pharmacologist and Toxicologist
Ada, Ohio Akron Children’s Hospital
Chapter 136 North Canton, Ohio
Chapter 129
Jill S. Bates, PharmD, BCOP
National PHASER Pharmacy Program Manager Kathryn V. Blake, PharmD, BCPS
Durham VA Health Care System Director, Center for Pharmacogenomics and Translational Research
Associate Professor of Clinical Education Nemours Children’s Health
Eshelman School of Pharmacy Jacksonville, Florida
Durham VA Health Care System Chapter 44
University of North Carolina
Chapter e160 Christopher M. Bland, PharmD, BCPS
Clinical Professor
Seth R. Bauer, PharmD, BCCCP College of Pharmacy, University of Georgia
Critical Care Clinical Specialist Antimicrobial Stewardship Pharmacist
Cleveland Clinic St. Joseph’s/Candler Health System
Clinical Assistant Professor Athens, Georgia
Cleveland Clinic Lerner College of Medicine Chapter e108
Cleveland, Ohio
Chapter e42 Scott Bolesta, PharmD, BCPS
Professor
Steven J. Bauer, MD Nesbitt College of Pharmacy, Wilkes University
Medical Director of Certified Community Mental Health Clinic Wilkes-Barre, Pennsylvania
Human Development Center Chapter 57
Duluth, Minnesota
Chapter e81 Jill S. Borchert, PharmD, BCPS, BCACP
Professor and Vice Chair
Jerry L. Bauman, PharmD College of Pharmacy
Dean Emeritus and Distinguished Professor Emeritus Midwestern University
College of Pharmacy, University of Illinois at Chicago Downers Grove, Illinois
Chicago, Illinois Chapter 112
Editor-in-Chief
Journal of the American College of Clinical Pharmacy Bonnie Lin Boster, PharmD, BCOP
Lenexa, Kansas Clinical Pharmacy Specialist
Chapter 40 University of Texas MD Anderson Cancer Center
Houston, Texas
Oralia V. Bazaldua, PharmD, BCACP Chapter 151
Professor/Clinical
The University of Texas Health Science Center Jolene R. Bostwick, PharmD
Ambulatory Care Clinical Pharmacy Specialist Assistant Dean for Co-curriculum and Professional Development
University Health System San Antonio and Clinical Professor of Pharmacy, Department of Clinical
San Antonio, Texas Pharmacy, and Clinical Pharmacist, Michigan Medicine
Chapter e2 University of Michigan College of Pharmacy
Ann Arbor, Michigan
Scott J. Bergman, PharmD, BCIDP Chapter 91
Nebraska Coordinator Antimicrobial Stewardship, Clinical
Professor Bradley A. Boucher, PharmD, MCCM
College of Pharmacy Interim Dean and Professor
University of Nebraska Medical Center Department of Clinical Pharmacy and Translational Science
Omaha, Nebraska College of Pharmacy
Chapter 141 University of Tennessee Health Science Center
Memphis, Tennessee
Angela L. Bingham, PharmD, BCPS, BCNSP, BCCCP Chapter 77
Vice Chair and Clinical Associate Professor
Philadelphia College of Pharmacy Sharya V. Bourdet, PharmD, BCPS
Saint Joseph’s University Associate Chief of Pharmacy for Acute Care and Education
Philadelphia, Pennsylvania San Francisco VA Medical Center
Chapters 69, 164 Associate Professor of Clinical Pharmacy
University of California San Francisco School of Pharmacy
San Francisco, California
Chapter 45

FM.indd 14 13-02-2023 16:51:56

 xv
Kristina M. Brooks, PharmD Megan L. Carreon, MHA, RRT, RRT
Assistant Professor-Research Assistant Professor, Division of Respiratory Care
University of Colorado Anschutz Medical Campus UT Health San Antonio
Aurora, Colorado University of Texas Health Science Center
Chapter 148 San Antonio, Texas
Chapter e43
Caitlin S. Brown, PharmD, BCCCP

CONTRIBUTORS
Neurocritical and Emergency Medicine Pharmacist Peggy L. Carver, PharmD
Mayo Clinic Associate Professor
Assistant Professor of Pharmacy & Emergency Medicine College of Pharmacy
Mayo School of Medicine University of Michigan
Minneapolis, Minnesota Clinical pharmacist, Infectious diseases
Chapter e27 Ann Arbor, Michigan
Chapter 144
Jamal Brown, PharmD, BCGP
Associate Professor of Pharmacy Practice Larisa H. Cavallari, PharmD
College of Pharmacy, Florida A&M University Professor of Pharmacotherapy and Translational Research
Tampa, Florida College of Pharmacy
Chapter e9 University of Florida
Gainesville, Florida
Thomas E. R. Brown, PharmD Chapter e7
Associate Professor
Leslie Dan Faculty of Pharmacy Alexandre Chan, PharmD, MPH, BCPS, BCOP
University of Toronto Founding Chair and Professor of Clinical Pharmacy
Toronto, Ontario University of California, Irvine
Chapter 143 Clinical Pharmacist
Chao Family Comprehensive Cancer Center
Peter F. Buckley, MD Irvine, California
Chancellor Chapter 155
University of Tennessee Health Science Center
Memphis, Tennessee Edward Chang, MD, PhD
Chapter 87 Clinical Neurophysiology Fellowship Program Director
Harbor UCLA Medical Center
Yvonne J. Burnett, PharmD, BCIDP West Carson, California
Associate Professor of Pharmacy Practice Chapter 75
University of Health Sciences and Pharmacy in Saint Louis
Clinical Pharmacy Specialist, Infectious Diseases Daniel B. Chastain, PharmD, BCIDP, AAHIVP
Missouri Baptist Medical Center Clinical Associate Professor
St. Louis, Missouri College of Pharmacy
Chapter 140 University of Georgia
David S. Burgess, PharmD Athens, Georgia
Professor and Chair, Department of Pharmacy Practice & Science Chapter 134
College of Pharmacy
University of Kentucky
Jack J. Chen, PharmD, BCPS, BCGP
Consultant
Lexington, Kentucky
Clinical Movement Disorders
Chapter 127
Chino Hills, California
Lakesha M. Butler, PharmD, BCACP, CDFT Chapter 78
Associate Vice President, Inclusion, Diversity and Health Equity
and Clinical Professor Judy T. Chen, PharmD, BCPS, BCACP, CDCES
College of Pharmacy Clinical Associate Professor
University of Florida College of Pharmacy
Gainesville, Florida Purdue University
Chapter e3 Clinical Pharmacy Specialist, Women’s Health
Indianapolis, Indiana
Morgan A. Butrovich, PharmD Chapters 102, 167
PhD Candidate
University of Pittsburgh School of Pharmacy Katherine H. Chessman, BS-Pharm, PharmD, BCPS,
Pittsburgh, Pennsylvania BCNSP
Chapter 67 Professor and Chair, Clinical Pharmacy and Outcome Sciences
College of Pharmacy
Lucinda M. Buys, PharmD, BCACP
Medical University of South Carolina
Clinical Pharmacist and Clinical Services Director
Clinical Pharmacy Specialist, Pediatrics/Pediatric Surgery/
Siouxland Medical Education Foundation
Intestinal Rehabilitation
Sioux City, Iowa
MUSC Shawn Jenkins Children’s Hospital
Chapter 110
Charleston, South Carolina
Chapters e21, 68, 164

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 xvi
Mariann D. Churchwell, PharmD, BCPS Ryan C. Costantino, PharmD, MS, BCPS, BCGP, CPHIMS
Professor Chief, Data Science Branch
University of Toledo College of Pharmacy and Pharmaceutical Enterprise Intelligence & Data Solutions Program Management
Sciences Office
Clinical Pharmacy Specialist Program Executive Office, Defense Healthcare Management Systems
Toledo, Ohio San Antonio, Texas
Chapter 64 Chapter e10
CONTRIBUTORS

Amber B. Cipriani, PharmD, BCOP Jason M. Cota, PharmD, MS, BCIDP

Precision Medicine Pharmacy Coordinator Vice Chair and Professor of Pharmacy Practice
UNC Health Medical Center Feik School of Pharmacy. University of the Incarnate Word
University of North Carolina San Antonio, Texas
Clinical Assistant Professor Chapter e138
UNC Eshelman School of Pharmacy
Chapel Hill, North Carolina Zachary L. Cox, PharmD
Chapter 154 Professor
Lipscomb University College of Pharmacy
Nathan P. Clark, PharmD, BCPS Heart Failure Clinical Pharmacy Specialist
Clinical Pharmacy Cardiovascular Services Manager Vanderbilt University Medical Center
Kaiser Permanente Colorado Nashville, Tennessee
Denver, Colorado Chapter 37
Chapter 38
Elizabeth A. Coyle, PharmD, BCPS
Jessica M. Clement, MD Associate Dean for Academic Affairs, Clinical Professor
Medical Director of Oncology Research College of Pharmacy, University of Houston
Hartford HealthCare Cancer Institute Houston, Texas
Hartford, Connecticut Chapter 139
Chapter 153 Catherine M. Crill, PharmD, FCCP, BCNSP
Amber B. Clemmons, PharmD, BCOP Associate Professor
Clinical Professor Departments of Clinical Pharmacy & Translational Science and
College of Pharmacy Pediatrics
University of Georgia Director of Experiential Learning and International Programs
Clinical Pharmacy Specialist - Hematology/Bone Marrow College of Pharmacy, University of Tennessee Health Science Center
Transplantation Memphis, Tennessee
Augusta University (AU) Medical Center Chapter 165
Augusta, Georgia M. Lynn Crismon, PharmD, DABCP, BCPP
Chapter 150 Behrens Centennial Professor of Pharmacy
Jill M. Comeau, PharmD, BCOP College of Pharmacy
Associate Professor of Clinical Sciences University of Texas at Austin
College of Pharmacy Professor of Psychiatry
University of Louisiana Monroe Dell Medical School
Gratis Assistant Professor of Internal Medicine University of Texas at Austin
Feist-Weiller Cancer Center Austin, Texas
LSU-Health Shreveport Chapter 87
Monroe, Louisiana Daniel J. Crona, PharmD, PhD, CPP
Chapter 158 Associate Professor
Kristen M. Cook, PharmD, BCACP Division of Pharmacotherapy and Experimental Therapeutics
Clinical Associate Professor, College of Pharmacy Eshelman School of Pharmacy
University of Nebraska Medical Center Clinical Pharmacist Practitioner
Ambulatory Care Pharmacist Genitourinary Malignancies, Department of Pharmacy
Nebraska Medicine University of North Carolina Medical Center
Omaha, Nebraska Chapel Hill, North Carolina
Chapter 122 Chapter 154

Lisa M. Cordes, PharmD, BCACP, BCOP Ericka L. Crouse, PharmD, BCPP, BCGP
Oncology Clinical Pharmacy Specialist Associate Professor
Office of Clinical Research and National Cancer Institute, National Virginia Commonwealth University School of Pharmacy
Institutes of Health Clinical Pharmacy Specialist – Psychiatry
Washington, D.C. VCU Health
Chapter 149 Richmond, Virginia
Chapters 73, 91

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 xvii
Sandra Cuellar, PharmD, BCOP Robert J. DiDomenico, PharmD
Clinical Associate Professor Associate Professor and Assistant Head of Pharmacy Practice
College of Pharmacy University of Illinois Chicago
University of Illinois Chicago, Illinois
Clinical Oncology Pharmacist Chapters 33, 34
UI Health
Chicago, Illinois Elizabeth Dimaggio, PharmD, BCOP

CONTRIBUTORS
Chapter 149 Clinical Pharmacy Specialist
Blood and Marrow Transplantation and Cellular Immunotherapy
William Dager, PharmD, BCPS, MCCM H. Lee Moffitt Cancer Center
Cardiovascular Pharmacist Specialist Tampa, Florida
University of California, Davis Medical Center Chapter e163
Clinical Professor of Pharmacy
University of California San Francisco School of Pharmacy Dave L. Dixon, PharmD, BCACP, CLS
Clinical Professor of Medicine Nancy L. and Ronald H. McFarlane Professor of Pharmacy
University of California Davis School of Medicine Virginia Commonwealth University School of Pharmacy
Sacramento, California Chair
Chapter 61 Department of Pharmacotherapy & Outcomes Science
Richmond, Virginia
Devra K. Dang, CDCES, FNAP Chapter 32
Associate Clinical Professor of Pharmacy Practice
Department of Pharmacy Practice Le Hanh Dung Do, MD
University of Connecticut College of Pharmacy Attending Physician
Storrs, Connecticut Hiep Loi Cosmetic Surgery Hospital
Chapter 102 Ho Chi Minh City, Vietnam
Chapter 120
Khashayar Dashtipour, MD, PhD
Associate Professor of Neurology and Basic Sciences Paul P. Dobesh, PharmD, BCCP
Loma Linda University Professor of Pharmacy Practice and Science
Loma Linda, California College of Pharmacy
Chapter 78 University of Nebraska Medical Center
Cardiology Clinical Pharmacy Specialist
Christina M. Davis, PharmD, BCOP Nebraska Medicine
Clinical Oncology Pharmacy Specialist Omaha, Nebraska
University of Colorado Hospital Chapters 33, 34
Denver, Colorado
Chapter 162 Krista L. Donohoe, PharmD, BCPS, BCGP
Associate Professor
Lisa E. Davis, PharmD, FCCP, BCPS, BCOP Virginia Commonwealth University School of Pharmacy
Clinical Professor Richmond, Virginia
R. Ken Coit College of Pharmacy Chapters e23, 53
University of Arizona
Clinical Pharmacist Julie A. Dopheide, PharmD, BCPP
University of Arizona Cancer Center Professor of Clinical Pharmacy, Psychiatry and the Behavioral
Tucson, Arizona Sciences
Chapter 153 University of Southern California School of Pharmacy
Keck School of Medicine
Paulina Deming, PharmD Los Angeles, California
Clinician Educator—Associate Professor Chapter 82
University of New Mexico Health Sciences Center
Albuquerque, New Mexico John M. Dopp, PharmD
Chapter 58 Associate Professor
School of Pharmacy
David DeRemer, PharmD, BCOP University of Wisconsin
Clinical Professor Madison, Wisconsin
College of Pharmacy, University of Florida Chapter 92
Assistant Director, Experimental Therapeutics Group
University of Florida Health Cancer Center Thomas C. Dowling, PharmD, PhD
Gainesville, Florida Assistant Dean and Professor
Chapter 157 Director, Office of Research and Sponsored Programs
College of Pharmacy
Sunita Dergalust, PharmD Ferris State University
Neurology Pharmacist Grand Rapids, Michigan
Department of Veterans Affairs Chapter e60
Ventura County, California
Chapter 75

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Shannon J. Drayton, PharmD, BCPP Steven R. Erickson, PharmD
Associate Professor Associate Professor
College of Pharmacy College of Pharmacy
Medical University of South Carolina University of Michigan
Charleston, South Carolina Ann Arbor, Michigan
Chapter 89 Chapter e93
CONTRIBUTORS

Linda D. Dresser, BScPhm, PharmD Michael E. Ernst, PharmD

Assistant Professor, Teaching Stream Clinical Professor
Leslie Dan Faculty of Pharmacy College of Pharmacy
University of Toronto University of Iowa
Elgin, Ontario Iowa City, Iowa
Chapter 143 Chapter 113

Lori H. Dupree, PharmD, BCPS Brian L. Erstad, PharmD, MCCM, BCPS

Clinical Assistant Professor Professor and Head
College of Pharmacy R. Ken Coit College of Pharmacy
Mercer University University of Arizona
Suwanee, Georgia Tucson, Arizona
Chapter 86 Chapter e42

Lauren Duran, PharmD, MBA, BCPPS Alisa K. Escano, PharmD, BCPS

Clinical Pharmacist – Hematology/Oncology Clinical Assistant Professor
Cook Children’s Medical Center Virginia Commonwealth University, Inova campus
Fort Worth, Texas Clinical Pharmacy Specialist, Internal Medicine
Chapter 123 Richmond, Virginia
Chapter 115
Amy L. Dzierba, PharmD, BCCCP Gregory A. Eschenauer, PharmD
Clinical Pharmacist, Adult Critical Care
Clinical Associate Professor
NewYork–Presbyterian Hospital
College of Pharmacy
New York, New York
University of Michigan
Chapter e26
Clinical Specialist, Infectious Diseases
Deepak P. Edward, MD FACS FARVO Michigan Medicine
Professor of Ophthalmology Ann Arbor, Michigan
Department of Ophthalmology and Visual Sciences Chapter 144
Chicago, Illinois Patricia H. Fabel, PharmD, BCPS
Chapter 114 Clinical Associate Professor
Lea S. Eiland, PharmD, BCPS, BCPPS University of South Carolina College of Pharmacy
Clinical Professor and Associate Department Head Columbia, South Carolina
Harrison College of Pharmacy Chapter 54
Auburn University Alireza Fakhriravari, PharmD, BCPS, BCIDP, AAHIVP
Auburn, Alabama Clinical Assistant Professor and Director of Advanced Pharmacy
Chapter e12 Practice Experiences
School of Pharmacy, Loma Linda University
Shareen Y. El-Ibiary, PharmD, BCPS
Loma Linda, California
Professor and Department Chair
Chapter e138
College of Pharmacy
Midwestern University Karen M. Fancher, PharmD, BCOP
Glendale, Arizona Associate Professor of Pharmacy Practice
Chapter 19 School of Pharmacy, Duquesne University
Clinical Pharmacy Specialist, Oncology
Vicki L. Ellingrod, PharmD, FCCP University of Pittsburgh Medical Center Passavant
Dean and John Gideon Searle Professor of Pharmacy, Pittsburgh, Pennsylvania
College of Pharmacy Chapter 158
Professor of Psychiatry, Medical School
University of Michigan Natalija M. Farrell, PharmD, BCPS, DABAT
Ann Arbor, Michigan Clinical Coordinator—Emergency Medicine & Toxicology
Chapter e84 Boston Medical Center
Assistant Professor of Emergency Medicine
Ramy H. Elshaboury, PharmD, BCPS Boston University School of Medicine
Director—Clinical Pharmacy Services Boston, Massachusetts
Massachusetts General Hospital Chapter e8
Boston, Massachusetts Joseph P. Fava, PharmD, BCACP
Chapter 128 Clinical Assistant Professor
Wayne State University
Detroit, Michigan
Chapter 112

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 xix
Julianna M. Fernandez, PharmD, BCPS, BCGP Christopher R. Frei, PharmD, MS, BCPS
Clinical Associate Professor and Vice Chair of Pharmacy Practice Professor and Pharmacotherapy Division Head
and Translational Research University of Texas at Austin College of Pharmacy
College of Pharmacy Pharmacotherapy Education and Research Center Director
University of Houston University of Texas Health Science Center at San Antonio Long
Houston, Texas School of Medicine
Chapter 139 Boerne, Texas

CONTRIBUTORS
Chapter 130
Shannon W. Finks, PharmD, BCPS, BCCP, ASHCP-CHC
Professor of Clinical Pharmacy and Translational Science Stormi E. Gale, PharmD, BCCP, BCPS
College of Pharmacy, University of Tennessee Health Science Center Clinical Pharmacist, Cardiology
Memphis, Tennessee Novant Health Matthews Medical Center
Chapter 34 Charlotte, North Carolina
Chapter 37
Richard Fiscella, PharmD, MPH
Clinical Professor Emeritus Roseann S. Gammal, PharmD, BCPS
University of Illinois at Chicago Associate Professor of Pharmacy Practice
Chicago, Illinois Massachusetts College of Pharmacy and Health Sciences
Chapter 114 Boston, Massachusetts
Chapter e7
Douglas N. Fish, PharmD, BCCCP
Professor and Chair, Department of Clinical Pharmacy Kristen N. Gardner, PharmD, BCPP
Skaggs School of Pharmacy and Pharmaceutical Sciences Clinical Pharmacy Specialist – Behavioral Health
University of Colorado Kaiser Permanente Colorado
Aurora, Colorado Denver, Colorado
Chapters 133, 145 Chapter 91
Courtney V. Fletcher, PharmD Mandy L. Gatesman, PharmD, BCOP
Professor Clinical Pharmacy Specialist, Hematology & Oncology
College of Pharmacy VCU Health
University of Nebraska Medical Center Richmond, Virginia
Omaha, Nebraska Chapter 53
Chapter 148
Jessica E. Geiger, PharmD, MS, BCPS
Rachel W. Flurie, PharmD, BCPS Pharmacy Coordinator, Palliative Care
Assistant Professor
OhioHealth
Virginia Commonwealth University School of Pharmacy
Columbus, Ohio
Richmond, Virginia
Chapter e28
Chapter 70
Alicia B. Forinash, PharmD, BCPS, BCACP Tracey L. Gendron, MS, PhD
Professor, Pharmacy Practice Associate Professor and Chair, Department of Gerontology
Pharmacy Practice Virginia Commonwealth University
University of Health Science and Pharmacy Executive Director, Virginia Center on Aging
St. Louis, Missouri Richmond, Virginia
Chapter 99 Chapter e23

Gilles L. Fraser, PharmD, MCCM James F. Gilmore, PharmD, BCCCP, BCPS

Professor of Medicine (ret.) Pharmacy Manager
School of Medicine, Tufts University Adult Critical Care and Emergency Department Medicine
Boston, Massachusetts Cedars-Sinai
Clinical Specialist in Critical Care (ret.) Los Angeles, California
Maine Medical Center Chapter e95
Portland, Maine
Chapter e27 Ashley E. Glode, PharmD, BCOP
Associate Professor
Michelle A. Fravel, PharmD, BCPS Skaggs School of Pharmacy and Pharmaceutical Sciences
Clinical Associate Professor of Pharmacy Practice and Science University of Colorado
University of Iowa College of Pharmacy Aurora, Colorado
Clinical Pharmacy Specialist Chapter 150
University of Iowa Hospitals and Clinics
Iowa City, Iowa Victor R. Gordeuk, MD
Chapter 113 Professor of Medicine
Department of Medicine
Bradi L. Frei, PharmD, MSc, BCPS, BCOP University of Illinois at Chicago
Professor Chicago, Illinois
Feik School of Pharmacy Chapter 124
University of the Incarnate Word
San Antonio, Texas
Chapter 130

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Rena A. Gosser, PharmD, BCPS Tracy M. Hagemann, PharmD
Clinical Ambulatory Pharmacy Manager Professor and Associate Dean, Nashville
Harborview Medical Center College of Pharmacy
Seattle, Washington University of Tennessee Health Science Center
Chapter e116 Nashville, Tennessee
Chapter e125
Leigh Anne H. Gravatt, PharmD, BCPS
CONTRIBUTORS

Associate Professor, Vice-Chair of Education of The Department of Stuart T. Haines, PharmD, BCPS, BCACP
Pharmacotherapy and Outcomes Sciences Professor, Department of Pharmacy Practice
VCU School of Pharmacy Director, Pharmacy Professional Development
Clinical Specialist, Internal Medicine School of Pharmacy, University of Mississippi
Chesterfield, Virginia Jackson, Mississippi
Chapter 53 Chapters 1, 94
Shelly L. Gray, PharmD, MS
Emily R. Hajjar, PharmD, MS, BCPS, BCACP, BCGP
Professor and Plein Endowed Director
Professor
Plein Center for Geriatric Pharmacy Research, Education and
Jefferson College of Pharmacy
Outreach
Philadelphia, Pennsylvania
School of Pharmacy, University of Washington
Chapter e24
Seattle, Washington
Chapters e24, e25 Elizabeth A. Hall, PharmD, BCPS, BCPPS
Assistant Professor and Director of Assessment
Elisa M. Greene, PharmD, BCACP
College of Pharmacy, University of Tennessee Health Science Center
Associate Professor of Pharmacy Practice
Memphis, Tennessee
College of Pharmacy
Chapter 76
Belmont University
Nashville, Tennessee
Maren Hall, DDS
Chapter e125
General Dentist
Devon M. Greer, PharmD, BCOP Elk Plaza Dental
Clinical Pharmacy Specialist - Medical Oncology Maple Grove, Minnesota
Barnes-Jewish Hospital Chapter e16
St. Louis, Missouri
Jin Han, PharmD, PhD, BCPS
Chapter 122
Clinical Associate Professor and Clinical Pharmacist
Shawn P. Griffin, PharmD, BCOP College of Pharmacy, University of Illinois at Chicago
Health Sciences Assistant Clinical Professor Chicago, Illinois
School of Pharmacy & Pharmaceutical Sciences Chapter 124
University of California, Irvine
Jason S. Haney, PharmD, BCPS, BCCCP
Irvine, California
Associate Professor
Chapter 155
College of Pharmacy, Medical University of South Carolina
Alan E. Gross, PharmD, BCIDP, BCPS Charleston, South Carolina
Clinical Associate Professor Chapter 68
Department of Pharmacy Practice, University of Illinois at Chicago
Bianca Harris, PharmD
College of Pharmacy
Clinical Pharmacy Practitioner
Infectious Diseases Pharmacist
William S. Middleton Memorial Veteran’s Hospital
University of Illinois Hospital and Health Sciences System
Madison, Wisconsin
Chicago, Illinois
Chapter 111
Chapter 137
Delaney E. Hart, PharmD, BCIDP
Stephanie Gruber, PharmD, BCACP Clinical Pharmacist
Clinical Pharmacy Practitioner
Allina Health
William S. Middleton Memorial Veterans Hospital
Minneapolis, Minnesota
Madison, Wisconsin
Chapter 128
Chapter 111
Bryan D. Hayes, PharmD, DABAT
Wayne P. Gulliver, MD, FRCPC Clinical Pharmacy Manager
Professor of Dermatology and Medicine
Massachusetts General Hospital
Memorial University of Newfoundland
Associate Professor of Emergency Medicine, Division of Medical
Clinical Pharmacy Practitioner
Toxicology
Chapters 118, 119
Harvard Medical School
John G. Gums, PharmD Boston, Massachusetts
Associate Dean for Clinical and Administrative Affairs and Chapter e8
Professor of Pharmacy and Medicine
College of Pharmacy
St. John’s, Newfoundland and Labrador, Canada
Gainesville, Florida
Chapter 97

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 xxi
Jordan C. Haygood, PharmD, BCPP Yunn-Fang Ho, BPharm, MD, PhD
Clinical Assistant Professor Associate Professor
University of South Carolina College of Pharmacy Graduate Institute of Clinical Pharmacy, College of Medicine
Psychiatric Clinical Pharmacist National Taiwan University
Columbia, South Carolina Taipei City, Taiwan
Chapter 89 Chapter e5

CONTRIBUTORS
Mary S. Hayney, PharmD, MPH, BCPS Sarah E. Hobgood, MD
Professor Associate Professor Internal Medicine and Assistant Dean for
School of Pharmacy Clinical Medical Education
University of Wisconsin Virginia Commonwealth University
Madison, Wisconsin Richmond, Virginia
Chapter 147 Chapter 73
Mojdeh S. Heavner, PharmD, BCPS, BCCCP Lisa M. Holle, PharmD, BCOP
Associate Professor and Vice Chair for Clinical Services Clinical Professor
School of Pharmacy, University of Maryland School of Pharmacy, University of Connecticut
Baltimore, Maryland UConn Health Carole & Ray Neag Comprehensive Cancer Center
Chapter e48 Storrs, Connecticut
Chapter 153
Keith A. Hecht, PharmD, BCOP
Associate Professor, Pharmacy Practice Yen-Ming Huang, BPharm, PhD
School of Pharmacy Assistant Professor
Southern Illinois University Edwardsville Graduate Institute of Clinical Pharmacy, College of Medicine
St Charles, Missouri National Taiwan University
Chapter 152 Taipei City, Taiwan
Chapter e5
Natalie T. Heinrich, PharmD
Medication Therapy Management (MTM) Pharmacist Joanna Q. Hudson, PharmD, BCPS
M Health Fairview Professor
Minnesota College of Pharmacy, University of Tennessee Health Science Center
Chapter 80 Clinical Pharmacy Specialist – Nephrology
Memphis, Tennessee
Brian A. Hemstreet, PharmD, BCPS
Chapter 63
Associate Dean for Student Affairs and Professor
Skaggs School of Pharmacy and Pharmaceutical Sciences Humberto R. Jimenez, PharmD, MPH, BCPS, AAHIVP
University of Colorado Clinical Assistant Professor and Director of Diverse Scholar
Aurora, Colorado Engagement and Advancement
Chapter 52 Ernest Mario School of Pharmacy, Rutgers University
Clinical Pharmacist – HIV / Ambulatory Care
Christopher M. Herndon, PharmD, BCACP
St. Joseph’s University Medical Center
Professor
Piscataway, New Jersey
Southern Illinois University Edwardsville
Chapter 140
Edwardsville, Illinois
Chapter 79 Susan Hylland, MD
Attending Physician—Rheumatology Clinic
Lauren R. Hersh, MD
William S. Middleton Memorial Veterans Hospital
Associate Professor
Madison, Wisconsin
Department of Family and Community Medicine, Thomas
Chapter 111
Jefferson University
Philadelphia, PA Kristin M. Janzen, PharmD, BCPS
Chapter e24 Clinical Assistant Professor, Pharmacy Practice
College of Pharmacy
Tara A. Higgins, PharmD, BCPPS
University of Texas
Assistant Professor
Clinical Pharmacy Specialist, Internal Medicine
School of Pharmacy
Dell Seton Medical Center at the University of Texas
Lake Erie College of Osteopathic Medicine
Austin, Texas
Bradenton, Florida
Chapter e6
Chapter 157
Douglas L. Jennings, PharmD, BCPS
Krista B. Highland, PhD
Associate Professor of Pharmacy
Research Associate Professor
Clinical Pharmacist, Heart Transplant & LVAD Team
Uniformed Services University of the Health Sciences
Arnold & Marie Schwartz College of Pharmacy and Health Sciences
Henry M. Jackson Foundation for the Advancement of Military
Long Island University
Medicine
New York-Presbyterian Hospital
Washington, D.C.
Columbia University Irving Medical Center
Chapter e10
New York, New York
Chapter 109

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Brittany N. Johnson, PharmD, CPh S. Lena Kang-Birken, PharmD, AAHIVP
Pain and Palliative Care Stewardship Pharmacist and Clinical Associate Professor
Assistant Professor Thomas J. Long School of Pharmacy
UF Health Jacksonville University of the Pacific
University of Florida Santa Barbara, California
Jacksonville, Florida Chapter 142
Chapter 85
CONTRIBUTORS

Salmaan Kanji, BScPharm, PharmD

Clinical Pharmacy Specialist
Tami N. Johnson, PharmD, BCPS The Ottawa Hospital
Clinical Pharmacy Specialist, Emergency Medicine
Associate Scientist
University of Texas MD Anderson Cancer Center
The Ottawa Hospital Research Institute
Houston, Texas
Ottawa, Ontario
Chapter 71
Chapter 146

Duncan B. Johnstone, MD, PhD Jaime Kaushik, PharmD, BCOP

Clinical Associate Professor Clinical Pharmacy Specialist
School of Medicine, University of Buffalo University of Texas MD Anderson Cancer Center
Buffalo, New York Houston, Texas
Chapter e66 Chapter 151

Bruce M. Jones, PharmD, BCPS Michael S. Kelly, PharmD, BCACP, CLS

Infectious Diseases Clinical Pharmacy Specialist Assistant Professor
St. Joseph’s/Candler Health System, Inc. School of Pharmacy, Chapman University
Savannah, Georgia Irvine, California
Chapter e108 Chapter 32

Joseph K. Jordan, PharmD, BCPS Scott E. Kincaid, PharmD, BCPS

Professor of Pharmacy Practice Assistant Dean for Student Affairs
Butler University School of Pharmacy, Presbyterian College
Drug Information Specialist Clinton, South Carolina
Indiana University Health Chapter e18
Indianapolis, Indiana
Chapter e98 William R. Kirchain, PharmD, CDCES
Clinical Associate Professor and Director Xavier University Health
David Josey Jr., MD and Wellness Center
Associate Professor of Pediatrics Xavier University of Louisiana
University of Mississippi Medical Center New Orleans, Louisiana
Jackson, Mississippi Chapter e56
Chapter 47
Cynthia K. Kirkwood, PharmD, BCPP
Sul R. Jung, PharmD, BCPS, BCCCP Professor and Executive Associate Dean for Academic Affairs
Associate Director of Pharmacy Services Virginia Commonwealth University
Ventura County Medical Center Richmond, Virginia
Ventura, California Chapter 90
Chapter 142
Mary Ann Kliethermes, BS Pharm, PharmD, FAPhA,
Julie Ann Justo, PharmD, MS, BCPS-AQ ID FCIOM
Clinical Associate Professor Director of Medication safety and quality
University of South Carolina College of Pharmacy American Society of Health-System Pharmacists
Infectious Diseases Clinical Pharmacy Specialist Bethesda, Maryland
Prisma Health Richland Hospital Chapter 1
Columbia, South Carolina
Chapter e132
Jessa M. Koch, PharmD, BCPP
Associate Professor
Michael P. Kane, PharmD, BCPS, BCACP School of Pharmacy, Loma Linda University
Professor, Department of Pharmacy Practice Loma Linda, California
Albany College of Pharmacy and Health Sciences Chapter 78
Clinical Pharmacy Specialist
Albany Medical Center Division of Community Endocrinology Courtney M. Kominek, PharmD, BCPS, CPE
Albany, New York Clinical Pharmacy Specialist in Pain Management
Chapter 96 Harry S. Truman Memorial Veterans’ Hospital
Columbia, Missouri
Chapter 79

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 xxiii
Christina Koutsari, PharmD, PhD, BCPS, BCIDP Patrick Leffers, PharmD, DABAT
Antimicrobial Stewardship and Infectious Disease Pharmacist Emergency Medicine Pharmacist
Children’s Minnesota University of Florida Health Jacksonville
Minneapolis, Minnesota Clinical Assistant Professor
Chapter 128 College of Pharmacy, University of Florida
Jacksonville, Florida
Sum Lam, PharmD, BCPS, BCGP Chapters e84, 85

CONTRIBUTORS
Clinical Professor
College of Pharmacy and Health Sciences, Saint John’s University Deborah J. Levine, MD
Clinical Pharmacotherapy Specialist, Geriatrics Professor
NYU Langone Health Medical Director Lung Transplantation
YU Langone Hospital—Long Island Director of Pulmonary Hypertension Center
Queens, New York University of Texas Health Science Center at San Antonio
Chapter 105 San Antonio, Texas
Chapter 46
Y. W. Francis Lam, PharmD
Professor of Pharmacology Stephanie M. Levine, MD
University of Texas Health Science Center at San Antonio, Professor
San Antonio, Texas Medical Director Lung Transplantation
Clinical Associate Professor of Pharmacy Director of Pulmonary Hypertension Center
University of Texas at Austin University of Texas Health Science Center
Austin, Texas San Antonio, Texas
Chapter e7 Chapter e43

Nicholas W. Lange, PharmD, BCTXP Robin Moorman Li, PharmD, BCACP

Clinical Pharmacy Manager Clinical Associate Professor
NewYork–Presbyterian Hospital College of Pharmacy, University of Florida
New York, New York Gainesville, Florida
Chapter 109 Chapter 86

Devin L. Lavender, PharmD, BCPS, BCACP Fang-Ju Lin, BPharm, MClinPharm, PhD
Clinical Assistant Professor Associate Professor
College of Pharmacy National Taiwan University
University of Georgia Deputy Director, Department of Pharmacy
Athens, Georgia National Taiwan University Hospital
Chapter 50 Taipei City, Taiwan
Chapter e5
David T. S. Law, BSc, MD, PhD, CCFP
Assistant Professor Bryan L. Love, PharmD, MPH
Department of Family and Community Medicine Associate Professor
Temerty Faculty of Medicine, University of Toronto University of South Carolina College of Pharmacy
Staff, Department of Family Practice Columbia, South Carolina
The Scarborough Hospital and Rouge Valley Health System Chapter 51
Scarborough, Ontario, Canada
Chapter e121 Amanda M. Loya, PharmD, BCPS
Clinical Associate Professor and Founding Chair of Pharmacy
Rebecca M. Law, PharmD Practice & Clinical Sciences Dept.
Associate Professor College of Pharmacy, University of Texas at El Paso
Memorial University of Newfoundland El Paso, Texas
St. John’s, Newfoundland Chapter e3
Chapters e17, 118, 119,120, e121
Sarah E. Lynch, PharmD, BCACP
Grace C. Lee, PharmD, PhD, BCPS Clinical Associate Professor and Director of Skills Education
Assistant Professor School of Pharmacy and Pharmaceutical Sciences, Binghamton
College of Pharmacy University
University of Texas at Austin Binghamton, New York
Austin, Texas Chapter 101
Chapter 130
Robert MacLaren, BSc, PharmD, MPH, MCCM
Mary Lee, PharmD, BCPS Professor
Vice President and Special Assistant to the President Skaggs School of Pharmacy and Pharmaceutical Sciences,
Midwestern University University of Colorado
Professor of Pharmacy Practice Aurora, Colorado
College of Pharmacy, Midwestern University Chapter e42
Downers Grove, Illinois
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Eric J. MacLaughlin, PharmD, BCPS Dianne W. May, PharmD, BCPS
Professor and Chair, Department of Pharmacy Practice Clinical Professor and Campus Director for Pharmacy Practice
Texas Tech University Health Sciences Center Experiences
Amarillo, Texas College of Pharmacy
Chapters 30, e31 University of Georgia
Athens, Georgia
Howard I. Maibach, MD Chapter 50
CONTRIBUTORS

Professor
University of California San Francisco
Danielle C. Mayer, PharmD, BCACP
Assistant Professor, Department of Pharmacy Practice and
San Francisco, California
Director, Pharmacy Practice Laboratories
Chapters e17, 120, e121
Jefferson College of Pharmacy
Matthew J. Makelky Sr., PharmD, MSCS Philadelphia, Pennsylvania
Operations Manager Chapter 100
UCHealth, University of Colorado Jennifer L. Mazan, PharmD
Fort Collins, Colorado Professor
Chapter 74 Midwestern University
Downers Grove, Illinois
Jenana H. Maker, PharmD, BCPS Chapter e15
Professor
Thomas J. Long School of Pharmacy, University of the Pacific Timothy L. McCavit, MD, MSCS
Santa Barbara, California Staff Hematologist
Chapter 61 Director, Bleeding Disorder Program
Cook Children’s Medical Center
Robert A. Mangione, BPharm, EdD Fort Worth, Texas
Provost Emeritus, Professor of Pharmacy (retired) Chapter 123
College of Pharmacy and Health Sciences, Saint John’s University
Erin K. McCreary, PharmD, BCPS, BCIDP
Queens,
Director of Infectious Diseases Improvement and Clinical Research
New York
Innovation
Chapter 59
University of Pittsburgh Medical Center
Clinical Assistant Professor
Zachary A. Marcum, PharmD, PhD
University of Pittsburgh School of Medicine
Associate Professor
Pittsburgh, Pennsylvania
School of Pharmacy, University of Washington
Chapter e132
Seattle, Washington
Chapter e25 Mary Lynn McPherson, PharmD, MA, MDE, FAAHPM
Professor and Executive Director, Online Graduate Studies in
Ana Elizabeth Markez, MD, LTC, MC, USA Palliative Care
Internal Medicine, Infectious Disease, Fellow ACP and IDSA University of Maryland, Baltimore
Brooke Army Medical Center, United States Army Baltimore, Maryland
Chief, Infectious Disease ServiceDeputy Chief of Operations and Chapter e28
Administration, Department of Medicine
San Antonio, Texas
Christopher G. Medlin, PharmD, BCPS
Clinical Assistant Professor
Chapter e138
College of Pharmacy, University of Texas at El Paso
Grace A. Martin, PharmD, BCOP El Paso, Texas
Clinical Pharmacy Coordinator - Cancer Care Chapter e3
The University of Kansas Cancer Center Sarah T. Melton, PharmD, BCPP, BCACP, CGP, FASCP
Kansas City, Kansas Professor of Pharmacy Practice
Chapter 156 Gatton College of Pharmacy at East Tennessee State University
Clinical Pharmacist
Todd W. Mattox, BS, PharmD, BCNSP
Highpower, PC in Lebanon, Virginia and the Johnson City
Medicine/Surgery Clinical Pharmacist
Community Health Center
Moffitt Cancer Center
Johnson City, Tennessee
Tampa, Florida
Chapter 90
Chapter 165
Leigh Ann Mike, PharmD, BCPS, BCGP
Jared E. Matya, PharmD, BCOP Clinical Associate Professor and Assistant Director for Education,
Clinical Pharmacist Practitioner - BMT and Cellular Therapy
Plein Center for Pharmacy Research, Education & Outreach
Nebraska Medicine
School of Pharmacy, University of Washington
Omaha, Nebraska
Seattle, Washington
Chapter 159
Chapter e25
J. Russell May, PharmD Margaret A. Miklich, PharmD, BCACP
Clinical Professor and Assistant Dean for Extended Campuses Clinical Associate Professor of Pharmacy Practice
College of Pharmacy, University of Georgia School of Pharmacy, Temple University
Athens, Georgia Philadelphia, Pennsylvania
Chapter e14 Chapter e48

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 xxv
Anna S. Milone, PharmD, BCPS Kashif M. Munir, MD
Teaching Specialist and Director of Pharmacy Learning Professor of Medicine
Collaborative School of Medicine, University of Maryland
College of Pharmacy, University of Minnesota Baltimore, Maryland
Minneapolis, Minnesota Chapter e98
Chapter e16

CONTRIBUTORS
Milap C. Nahata, PharmD
Augusto Miravelle, MD
Director, Institute of Therapeutic Innovations and Outcomes;
Associate Professor of Clinical Neurology University of Colorado,
Professor Emeritus of Pharmacy, Pediatrics and Internal
Anschutz Medical Campus
Medicine
Aurora, Colorado
Colleges of Pharmacy and Medicine, Ohio State University
Chapter 74
Columbus, Ohio
Chapter e20
Jean Y. Moon, PharmD, BCACP
Associate Professor and Postgraduate Year One Pharmacy
Residency Program Director Rocsanna Namdar, PharmD
College of Pharmacy, University of Minnesota PGY1 Residency Director; Strategic Planning and Learning
Minneapolis, Minnesota Resources Director
Chapter 44 New Mexico Veterans Affairs Health Care System
Clinical Pharmacy Specialist
Rebecca Moote, PharmD, MSc, BCPS Albuquerque, New Mexico
Clinical Associate Professor and Assistant Division Head Chapter 135
University of Texas at Austin College of Pharmacy
Internal Medicine Clinical Pharmacy Specialist Leigh Anne Nelson, PharmD, BCPP
University Hospital, San Antonio, Texas Professor of Pharmacy Practice and Administration
Chapter 46 University of Missouri-Kansas School of Pharmacy
Kansas City, Missouri
Jessica L. Moreno PharmD, BCPP Chapter e81
Psychiatric Clinical Pharmacist
Integrated Behavioral Health Melissa A. Nestor, PharmD, BCCCP
Detroit Michigan Clinical Pharmacist, Critical Care/Stroke Neurology
Chapter e84 UK HealthCare
Assistant Professor
Juan Mosley II, PharmD, CPh, AAHIVP College of Pharmacy, University of Kentucky
Chair and Associate Professor Lexington, Kentucky
College of Pharmacy, Larkin University Chapter 39
Miami, Florida
Chapter e9 Viet-Huong V. Nguyen, PharmD, MPH, MSc, BCCCP
Associate Professor (Neurology)
Jeffrey J. Mucksavage, PharmD School of Pharmacy, Chapman University, Irvine, California
Clinical Assistant Professor Clinical Pharmacy Specialist, Neurology and Critical Care
Department of Pharmacy Practice Harbor UCLA Medical Center
University of Illinois at Chicago College of Pharmacy West Carson, California
Chicago, Illinois Chapter 75
Chapter e31
Jessica C. Njoku, PharmD, MPH, BCPS
Scott W. Mueller, PharmD, BCCCP System Formulary Coordinator
Burn Services and Critical Care Pharmacy Specialist Harris Health System
University of Colorado Hospital Pearland, Texas
Clinical Associate Professor Chapter 131
University of Colorado Skaggs School of Pharmacy and
Pharmaceutical Sciences Thomas D. Nolin, PharmD, PhD
Denver, Colorado Associate Dean for Research and Sponsored Programs
Chapter 145 University of Pittsburgh School of Pharmacy
Pittsburgh, Pennsylvania
Diana W. Mulherin, PharmD, BCNSP, BCCCP Chapters 65, 67
Clinical Pharmacist Specialist, Nutrition Support
Cindy L. O’Bryant, PharmD, FCCP, FHOPA, BCOP
Vanderbilt University Medical Center
Professor of Clinical Pharmacy
Nashville, Tennessee
Skaggs School of Pharmacy and Pharmaceutical Sciences
Chapter 166
University of Colorado Anschutz Medical Campus
Aurora, Colorado
Amanda M. Mullins, PharmD, BCPS Chapter 162
Clinical Pharmacist Practitioner
VA St. Louis Healthcare System, St. Louis, Missouri
St. Louis, Missouri
Chapter 79

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Mary Beth O’Connell, PharmD, BCPS Charles A. Peloquin, PharmD
Professor Professor and Division Head, Translational Research
Wayne State University, Eugene Applebaum College of Pharmacy College of Pharmacy
and Health Sciences University of Florida
Detroit, Michigan Gainesville, Florida
Chapter 112 Chapter 135
CONTRIBUTORS

Kirsten H. Ohler, PharmD, BCPS, BCPPS Mark A. Perazella, MD, MS

Clinical Associate Professor, Pharmacy Practice; Program Director, Professor of Medicine
PGY1 Pharmacy Residency Yale University School of Medicine
College of Pharmacy, University of Illinois at Chicago New Haven, Connecticut
Clinical Pharmacist, Neonatal Intensive Care Unit Chapter 65
University of Illinois Hospital & Health Sciences System
Chicago, Illinois Janelle Perkins, PharmD, BCOP
Chapter e22 Professor
Taneja College of Pharmacy
Katie B. Olney, PharmD, BCIDP University of South Florida
Infectious Diseases Clinical Pharmacist
Tampa, Florida
University of Kentucky HealthCare
Chapter e163
Lexington, Kentucky
Chapter 127 Emily P. Peron, PharmD, MS, BCPS, BCGP
Keith M. Olsen, Pharm.D Associate Professor
Dean and Professor Virginia Commonwealth University School of Pharmacy
College of Pharmacy Richmond, Virginia
University of Nebraska Medical Center Chapter 73
Omaha, Nebraska Jay I. Peters, MD
Chapters e49, 137 Professor and Chief (Retired) Division of Pulmonary and Critical
Jared Ostroff, PharmD, MBA, BCACP, BCGP Care
Ambulatory Pharmacy Supervisor UT Health San Antonio
Baystate Health University of Texas Health Science Center
Granby, Connecticut San Antonio, Texas
Chapter e11 Chapter e43

Ohoud Owaidhah, MD Jennifer T. Pham, PharmD, BCPS, BCPPS

Senior Consultant, Glaucoma Division Clinical Associate Professor, Department of Pharmacy Practice,
King Khaled Eye Specialist Hospital College of Pharmacy
Riyadh, Saudi Arabia Department of Pediatrics, College of Medicine
Chapter 114 University of Illinois at Chicago
Clinical Pharmacist, Neonatal Intensive Care Unit
Melissa C. Palmer, PharmD, BCPS, BCPP University of Illinois Hospital & Health Sciences System
Clinical Pharmacist Practitioner Chicago, Illinois
Alaska VA Healthcare System Chapter e22
Eagle River, Alaska
Chapter e83 Ha K. Phan, PharmD, CDCES, BCACP
Clinical Assistant Professor
Lisa M. Palmisano, PharmD, BCACP School of Pharmacy, University of Mississippi
Associate Professor and Clinical Pharmacist
Jackson, Mississippi
College of Pharmacy, Midwestern University
Chapter 47
Downers Grove, Illinois
Chapter e15 Stephanie J. Phelps
Emeritus Professor
Robert B. Parker, PharmD
University of Tennessee Health Science Center College of Pharmacy
Professor
Memphis, Tennessee
College of Pharmacy, University of Tennessee Health Science Center
Chapter 76
Memphis, Tennessee
Chapter 36 Bradley G. Phillips, PharmD, BCPS, FCCP
Neelam K. Patel, PharmD, BCOP Clinical and Administrative Pharmacy
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Houston, Texas University of Georgia
Chapter 151 Augusta, Georgia
Chapter 92
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Gainesville, Florida Oak Lawn, Illinois
Chapter 59 Chapter 40

FM.indd 26 13-02-2023 16:51:56

 xxvii
Amy M. Pick, PharmD, MS, BCOP Beth H. Resman-Targoff, PharmD
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College of Pharmacy Department of Pharmacy, Clinical and Administrative Sciences
University of Nebraska Medical Center University of Oklahoma College of Pharmacy
Omaha, Nebraska Oklahoma City, Oklahoma
Chapter 159 Chapter 107

CONTRIBUTORS
Christopher R. Piszczatoski, PharmD, BCPS Daniel M. Riche, PharmD, CLS, ASH-CHC
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AL Grawany
 xxviii
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Chapter e160

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Another random document with
no related content on Scribd:
 Peals on 5 bells, with twelve Singles.

Blunderbus. 1——2.

In this peal every bell is a Hunt. When Treble and 2d are

together either before or behind, the farthest bells from them dodg
till either of them part, excepting the extreams. When the Treble is
before a single in 3d and 4th place, which is unmade the next time
except 1——————2; for then the Hunts being together before, the
bells behind must dodg according to the rule forementioned.
21354 14325 13452 51234 23154
23145 41235 13542 15324 21345
32415 42153 31452 15234 12354
34251 24513 34125 51324 12534
43521 25431 43215 53142
34512 52341 42351 35412 21543
43152 53214 24531 53421 25134
41325 35124 25413 35241 &c.
14235 31542 52143 32514

Hudibras. 1 and 2.

In this peal every bell is a Hunt. When Treble is before a single

always in 3d and 4th place which is unmade the next time, except it
be 1——2, for then the bells behind dodg until Treble parts them.
 21354 15423 14532 31245 25143
23145 51243 14352 13425 21534
32415 52134 41532 13245 12354
34251 25314 45123 31425 12534
43521 23541 54213 34152
45312 32451 52431 43512 21543
54132 34215 25341 45321 25134
51423 43125 23514 54231 &c.
15243 41352 32154 52413

Weston Doubles. 1 and 5.

In this peal Treble is a perfect Hunt. Every other time Treble is

leaving the 3ds place hunting up, the bells before dodg till it comes
and parts them: the bells behind dodg but when Treble hinders
them, except the extremes which are in 3d and 4ths place when it is 1
——2 before; all the other singles are made behind when Treble is
leading. It may be rang by making all the singles behind, by making
the change before it is 1——2 on the bells before.
12345 13254 51432 45123 32514
21354 13245 15423 41532 23154
23145 31254 15432 14523 21345
32415 32145 51423 14532 12354
23451 23415 54132 41523
32541 24351 45312 45132 12534
23514 42531 54321 54312 &c.
32154 45213 45231 53421
31245 54123 54213 35241
 Peals on five bells with 10 singles.

The Antilope.

In this peal the bells hunt as in Grandsire. When Treble is

before, a single is always made by the Tenor, and the bell which
followeth it, except two doubles which are made as the singles in
Grandsire. It may be rang like Cambridg delight either way by
observing the same method if like Cambridg delight the common
way; and by making the singles by the half-hunt and the bell before
it, if like Cambridg delight the other way.
21354 15243 34152 24531 53214 41253
23145 12543 31425 25413 52341
32415 21534 13452 52143 25431 15432
34251 25143 13425 51234 24513 14532
43521 52413 31452 15324 42153
45312 54231 34125 13524 41235 12354
54132 45321 43215 31542 14253 Extr.
51423 43512 42351 35124 14235 13245

The Maremaid.
 13254 12435
31245 21345
32154 12354
23145 21534
21354 12543
12534 15234
15243 51243
51234 15423
52143 51432
25134 15342
21543 51324
21453 53124
&c.
In this peal behind dodg twelve changes, excepting the sixth
which is made on the bells before, and the twelfth which is a single in
the 3d and 4ths places; and twelve changes before, excepting also the
sixth, which is made by the bells behind, and the twelfth which is a
single in 2d and 3ds places. When they dodg behind, every odd
change is on the last bells, and every even one a bob, excepting these
two changes. When they dodg before, every odd change is a bob, and
every even one on the four first bells, excepting likewise those two
changes which are made according to the forementioned rule.

The Checkquer. 1 and 5.

 21354 31254
23145 13524
32415 15342
34251 51432
43521 54123
45312 45213
54132 42531
51423 24351
15432 42315
14523 24135
41532 42153
45123 24513
54213 25431
52431 52341
25341 53214
23514 35124
32154 31542
31245 13452
13254 31425
13245 13425
&c.
In this peal the Treble is whole-hunt, and Tenor the half-hunt
for twenty changes; and then Tenor the whole-hunt and treble the
half-hunt for the next twenty, and so they hunt by turns throughout
the peal. When Treble is the whole-hunt the bells behind always
dodg, except it hinders them; and when Tenor is the whole-hunt, the
bells before, except that hinders them; when Treble is before and
Tenor dodging behind, a single made by the Tenor and the bell which
dodged with it; when Tenor is behind and Treble dodging before, a
single made by the Treble and the bell which dodgeth with that.
 21354 12543
23145 21453
32415 24135
34251 42315
43521 43251
45312 34521
54132 35412
51423 53142
15432 35124
14523 53214
41532 35241
45123 53421
54213 54312
52431 45132
25341 41523
52314 14532
25134 15423
21543 51243
12534 15234
21534 15243
&c.
This peal may be rang by hunting the Treble and Tenor as
before, and it differeth from it only in this; when it is 1——5 behind in
the hunting of the Treble, the bells before dodg till Tenor parts them;
and when it is 1——5 before, in the hunting of the Tenor the bells
behind dodg till Treble parts them: and then when Treble is the
whole-hunt and Tenor half, it is plain Cambridg delight inverted. It
may be rang by hunting the half-hunt, as in Cambridg Delight the
other way, in either of those ways of ringing it, but then the single is
always made by the hunting bell.
An example in that like Cambridg Delight the other way.

Gogmagog. 1. 5.
 21354 34512 12543
23145 43152 21534
32415 41325 25143
34251 14352 52413
43521 54231
45312 14325 45321
54132 41352 43512
51423 43125 34152
15243 34215 31425
12534 32451 13452
21543 23541
25134 25314 13425
52314 52134 31452
53241 51243 34125
35421 15234 &c.
In this peal the bells hunt as in Grandsire, and it differeth from
it in this, That there is not every other time a single bob, but in stead
of a single one every other time a double one: so that only once in
four times there is a single bob; when Tenor is dodging behind there
is always a single made by it, and the bell which dodgeth with it if
Treble leadeth, otherwise not.

1——4.

This peal may be rung like Cambridg Delight, if every other time
the dodging before be omitted; or it may be rang by dodging
constantly as in Cambridg Delight, by making double bobs and
single bobs as in Grandsire: it may likewise be rang by making the
course of the half-hunt in all the ways of ringing it the same with
Cambridg delight the other way; observing in all of them to make
the singles as before directed.
An example of that like Cambridg Delight the other way, in
which the dodging before is every other time omitted. 1——4.
 21354 14523 12534 34152 25314
23145 41532 31425 52134
32415 45123 12543 13452 51243
34251 54213 21534 14325 15234
43521 52431 25143 41352
45312 25341 52413 43125 15243
54132 52314 54231 34215 51234
51423 25134 45321 32451 52143
15432 21543 43512 23541

Cambridg Marigold. 1. 2. and 3.

214356 312564 165432

241536 321654 164523
425136 236154
452316 263514 146253
453261 265341 142635
542361 623541
543216 625314 124365
534126 652134 124635
351426 561234 &c.
315246 516324
132546 153624
135264 156342
In this peal are 720 changes, which are all doubles except 12
singles which are made as in Plain trebles and doubles. Treble is a
perfect Hunt, and except the dodges (which are the same as in
Oxford double Bob) every double change is made by the treble and
the three next bells to it: observing always that the bell in Tenor’s
place lieth still ’till it giveth place to the Treble, or be removed by a
dodg behind when the Treble is before. When Treble leaveth 3ds
place hunting up, the bell that then comes before, leads thrice, and
likewise the next bell after it till Treble cometh back into 3ds place
again; at all other times every bell leads twice. The bell in Tenor’s
place lieth five times behind, (and when the single is made in the
middle ten times) till treble remove it; and when treble comes back it
lieth five times more behind, and then is displaced by a dodg behind
and hunts down at whole-pulls. This peal may be rang by making
bobs single and double as in Grandsire Bob with but two singles or
two trebles, which must be made just Eighteen score changes one
from the other.

The Nightingall. 1. 2. and 3.

In this peal are 720 changes, which are all doubles except twelve
singles, which are made as in the former peal; and if you ring
Grandsire Bob upon it, there may be but two singles, or else two
trebles, as in the Marigold. Treble is a perfect Hunt: the bells in 4th
and 5th places dodg till treble parts them, and then the two foremost
bells do the like for eight changes together till treble hinders them,
and gives way to the other two bells to dodg again in the 4th and 5th
places, which is always for three changes and no more, except when
the single is made in that place, and then they dodg six times. When
treble is behind, dodg the four first; when it is before on the four last,
as in Marigold.
123456 356241
213546 536214
231456 356124
324156 531624
234516 513264
324561 153624
235461 156342
325416
235146 165432
321546 164523
312456
132546 146253
135264 142635
315624
351264 124365
532164 sing.
352614 124635
532641

FINIS.
TRANSCRIBER’S NOTES
Page Changed from Changed to
14 1564364160 1744364160
14 29554290720 29654190720
14 2446144 2496144
14 99728079819200 99638080819200
14 1402645824276320 1402556105125320
15 561058329 561022442
15 140564582 140255610.5
18 one Load,
one Load, consistng
consisting of five
of five hundred
hundred
18 rate of thrteen rate of thirteen
shillings and four shillings and four
pence the pence the
21 I have therefoae I have therefore
penn’d the penn’d the
following Treatise following Treatise
34 cannot soon attain, cannot soon attain,
are therefore much are therefore much
puzled puzzled
47 which we will which we will
imagine so be made imagine to be made
at the at the
59 2d. 3d. 4. 2d. 3d. 4th.
59 3134 1243 2134 2134 1243 2134
64 course, threfore an course, therefore
extream an extream
70 123459 —————— 123456 ——————
a 213456 a 213456
83 13257 15342 14523 13254 15342 14523
86 the motion of the the motion of the
Hunt, (which a little Hunt, (with a little
further further
88 hapens to be single, happens to be
 it must be made at single, it must be
the made at the
97 those bels do hunt those bells do hunt
the contrary way, the contrary way,
then the then the
97 of the peal. If the 1 of the peal. If the
or 3d do hunt 1st or 3d do hunt
98 12345 ————— 12345 —————
21435 24135 42315 21435 24135 42315
32351 42351
100 12345 ————— 12345 —————
21354 23154 32513 21354 23154 32514
102 13254 23245 12354 13254 13245 12354
12345 12345
104 single exery time single every time
the treble leads. the treble leads.
The The
106 51423 15243 12534 51423 15243 12534
31543 21543
120 31245 23254 13524 31245 13254 13524
131 54231 52413 52134 54231 52413 25431
24513 42153 24513 42153
132 third change at the third change at the
heginning, and that beginning, and that
six six
133 the rest of the the rest of the
changes there are changes there are
made hehind made behind
134 the 2d and 3d the 2d and 3d
places as hefore places as before
134 he made in the 2d be made in the 2d
and 3d places as and 3d places as
hefore before
137 The treble is the
treble is the whole
whole
138 times hehind, and times behind, and
 twice in every other twice in every other
place. place.
140 making of bobs it making of bobs it
will will go
145 next time the next time the
whole-hont whole-hunt
149 153624 135642 153624 135642
135652 —————— —————— 125463
125463 bob bob
156 165432 156342 165432 156342
513634 531642 513624 531642
356124 356124
156 165243 156423 165243 156423
—————— 132495 —————— 132465
bob bob
168 ’Tis plainly ’Tis plainly
demonstrable, that demonstrable, that
he Principle the Principle
181 peal, succeding peal, succeeding
each other in the each other in the
several several
182 change; and with change; and with
peals of the later, peals of the latter,
the 3d the 3d
185 42361875
42361875 24368157 24368157
42631865 24613857 42631875
42168375 24613857
42168375
189 four middle hells, four middle bells,
except the bobs except the bobs
which are which are
192 42513 42531 45214 42513 42531 45213
45231 54321 45231 54321
193 45213 45123 41532 45213 45123 41532
14523 14251 14523 14253
 205 dodg till the whole- dodg till the whole-
hunt dindreth hunt hindreth
them, till them, till
206 together either together either
hehind or before: behind or before:
for then for then
212 42315 24153 41231 42315 24153 41235
14352 13425 14352 13425
223 24531 25413 42143 24531 25413 52143
51234 15324 51234 15324
223 31245 13425 63245 31245 13425 13245
31425 34152 31425 34152
225 25143 52413 54131 25143 52413 54231
45321 43512 45321 43512
225 as the singles in as the singles in
Gransire. It may be Grandsire. It may
rang like be rang like
229 54231 45321 43521 54231 45321 43512
34152 31425 34152 31425
229 —————— 146253 —————— 146253
142645 —————— 142635 ——————

1. Corrected the Errata faults.

2. Typos fixed; non-standard spelling and dialect retained.
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