Saturday, October 16, 2010

Pharmacotherapy: A Pathophysiologic Approach by Joseph DiPiro

From The New England Journal of Medicine

"Medicines," wrote Leonardo da Vinci, "will be well used when the doctor understands their nature, what man is, what life is, and what constitution and health are. Know these well and you will know their opposites; you will then know well how to devise a remedy." As the coauthor of a textbook on clinical pharmacology and drug therapy for medical students, in which this principle is espoused, I applaud any attempt by others to do likewise. That is indeed the basis for this textbook on drug therapy for clinical pharmacists. An introductory section on some of the basic principles of clinical pharmacology is followed by 16 sections on the management of diseases, organized according to systems of the body. In each of the chapters dealing with individual diseases, the authors first discuss the pathophysiologic principles and then outline the methods of drug therapy appropriate to each, firmly grounding the therapy in the context of the pathophysiology. Some of the sections on systems of the body include accounts of the evaluation of the diseases to which the system is prey. In each case, the arguments for using one drug or another are based on the most recent evidence, cited in the bibliography at the end of each chapter, although one of the cornerstones of evidence-based medicine, the number of patients who would need to be treated to produce a given outcome (known as the number needed to treat), is conspicuously absent. The discussions are for the most part excellent, but the chapters that include contributions from physicians have a slight edge over those that do not.
It is strange that such a high-quality text is not accompanied by better diagrams. Although there are several good anatomical diagrams, there are few that illustrate normal physiology or the pathophysiology of disease, and those that are provided do not show the use of drugs and where they act. In contrast, for virtually every condition, there is a flow chart indicating what to do when a test is positive or negative, when a patient has a particular clinical feature that might modify therapy, or when a patient does or does not have a response to treatment. But these diagrams are difficult to use. Moreover, their rigid format does not accommodate an understanding that the enormous variability among the patients one encounters in everyday practice greatly militates against such an approach in all but the simplest stepwise problem, such as the treatment of asthma, which is clearly illustrated by the simplicity of the flow chart for asthma.
The introductory chapters are disappointing. To open with a chapter on the economics of drug therapy surely gives the wrong emphasis, even in an increasingly cost-conscious health care system. The chapter on pharmacokinetics and pharmacodynamics sets a high bar to vault, and other chapters are too short to allow their authors a long enough run up to succeed. An introduction of only 90 pages (less than 4 percent of the text) is not enough, although to be fair, some general aspects of drug therapy are discussed in other chapters (for instance, there is a description of how to alter drug dosages in the section on renal disorders). I found few mistakes in the book and none of importance, except for the curious dose ranges for angiotensin-converting-enzyme inhibitors listed in the chapter on heart failure, with daily doses as high as 400 mg given for drugs such as enalapril.
This book is a good reference for clinical pharmacists who can create their own diagrams. But to get the most out of the text, they will need to know their basics pretty well and be prepared to flesh out certain points by consulting the review literature.
Jeffrey K. Aronson, D.Phil., F.R.C.P.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.


"Overall, the book is an excellent review of the pharmacotherapy of specific disease states and fulfills its purpose." (The Annals of Pharmacotherapy )

"This is likely one of the most well-established references in use by practicing pharmacist-clinicians and students. It is more comprehensive than other similar books and has expanded its content since first published in 1988. This new edition continues to provide valuable information for the pharmacotherapeutic management of disease states. " "4 stars" (Doody's ) --This text refers to an out of print or unavailable edition of this title.

Pharmacotherapy: A Pathophysiologic Approach Book Review

The seventh edition of the benchmark evidence-based pharmacotherapy text--now in full color!
Includes Online Learning Center--that features 11 additional chapters, learning objectives, interactive questions, and more!
"This book is, by far, one of the best in pharmacy. It is an exceptionally useful reference for both pharmacists and pharmacy students. It communicates a wealth of information that is well researched and referenced. The seventh edition is a much needed update."--Doody's Review Service
When it comes to helping you develop a mastery of evidence-based medicine for optimal patient outcomes, no book can match Pharmacotherapy: A Pathophysiologic Approach. Like the discipline it covers, the scope of this trusted resource goes beyond drug indications and dosages to include the initial selection, proper administration, and monitoring of drugs. Pharmacotherapy delivers everything you need to know to provide safe, effective drug therapy across the full range of therapeutic categories.
The book also delves into psychosocial issues that affect compliance--topics related to a patient's ability to understand and manage often-complex therapy--and lifestyle changes that may reduce the need for drug therapy or improve pharmacotherapeutic outcomes.

  • Key Concepts in each chapter
  • Critical Presentation boxes that summarize common disease signs and symptoms
  • Clinical Controversies boxes that examine complicated issues you face when providing drug therapy
  • Therapeutic recommendations in each disease-specific chapter
  • Evaluation of Therapeutic Outcomes Information in each disease-specific chapter containing key monitoring guidelines
  • NEW MATERIAL! including chapters on Pulmonary Hypertension, Disorders of Calcium and Phosphorous Homeostatis, and Multiple Myeloma
  • NEW! Expanded evidence-based recommendations
  • NEW! Extended coverage of the timely issue of palliative care and pain medicine

From the Back Cover

Joseph T. DiPiro, PharmD, FCCP

Robert L. Talbert, PharmD, FCCP, BCPS

Gary C. Yee, PharmD, FCCP

Gary R. Matzke, PharmD, FCP, FCCP

Barbara G. Wells, PharmD, FASHP, FCCP, BCPP

L. Michael Posey, BS Pharm

"The best pharmacotherapy textbook available.”

—Annals of Pharmacotherapy on an earlier edition

Pharmacotherapy: A Pathophysiologic Approach is the authority on evidence-based drug treatment. The gold standard in pharmacotherapy for fifteen years, it is an essential text in most schools of pharmacy and in the education of other healthcare professionals, and a trusted resource in practice.


• NEW Key Concepts with Locator Icons—Use the Key Concepts to see what is most important, and use the Locator Icons to quickly locate the discussion of each important concept within the chapter.

• NEW Clinical Controversies show that the understanding of drug therapeutics is evolving and that there is not always a definitive consensus.

• NEW chapter on The Documentation of Pharmacy Services explains how to document pharmaceutical care in a systematic way and its importance in obtaining reimbursement and in communicating with other health professionals.

• NEW chapter consolidating coverage of Solid-Organ Transplantation

• NEW expanded coverage of dermatological conditions: separate chapters on Acne Vulgaris and Psoriasis; new chapter on Atopic Dermatitis

• NEW chapter on Dermatologic Drug Reactions and Self-Treatable Skin Disorders guides you through the likely causes of a particular skin problem and provides what you need to know about the initiation and monitoring of therapy.

• NEW section of color photographs helps to identify common skin problems.

• NEW format of clinical presentation information is more accessible and user-friendly.

• NEW Glossary


• The Online Resource Center for Students and Faculty Includes—Learning Objectives, Interactive Test Questions for Self-Assessment, and more.

• Online Drug Update Newsletter-PNN Pharmacotherapy Line edited by Michael Posey. This newsletter keeps you updated on the latest drug developments.

Fully searchable e-book version of the entire textbook in an instant download to your computer.


Schwinghammer, PHARMACOTHERAPY CASEBOOK, Sixth Edition

ISBN 0-07-143360-0

Featuring over 140 cases, this essential guide develops skills in problem analysis and decision making, and demonstrates the relevance and importance of a sound scientific foundation for pharmacy practice.


Coming this fall

Wells, DiPiro, Schwinghammer & Hamilton, PHARMACOTHERAPY HANDOOK, Sixth Edition Print and PDA

ISBN 0-07-143322-8

This handy reference provides quick information to drug selection and management for more than 85 of the most common disorders.


--This text refers to an out of print or unavailable edition of this title.

About the Author: Joseph DiPiro

Joseph T. DiPiro, PharmD, FCCP, Executive Dean and Professor, South Carolina School of Pharmacy, University of South Carolina, Columbia, South Carolina; Medical University of South Carolina, Charleston, SC
Robert L. Talbert, PharmD, FCCP, BCPS, CLS, SmithKline Professor, College of Pharmacy, University of Texas, Austin; Professor, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
Gary C. Yee, PharmD, FCCP, BCOP, Professor, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medicial Center, Omaha, NE
Gary R. Matzke, PharmD, FCP, FCCP, Professor of Pharmacy and Pharmaceutics and Associate Dean for Clinical Research and Public Policy, School of Pharmacy, Professor of Internal Medicine, Mephrology Division, School of Medicine, Virginia Commonwealth University, Richmond, VA
Barbara G. Wells, PharmD, FASHP, FCCP, BCPP, Dean and Professor, Executive Director of the Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, Oxford, MS
L. Michael Posey, BSPharm, Editorial Director, Periodicals Department, American Pharmacists Association, Washington, DC