Preface

The purpose of the Pharmacotherapy Casebook is to help students in the health professions and practicing clinicians develop and refine the skills required to identify and resolve drug therapy problems by using realistic patient cases. Case studies can actively involve students in the learning process; engender self-confidence; and promote the development of skills in independent self-study, problem analysis, decision-making, oral communication, and teamwork. Patient case studies can also be used as the focal point of discussions about pathophysiology, medicinal chemistry, pharmacology, and the pharmacotherapy of individual diseases. By integrating the biomedical and pharmaceutical sciences with pharmacotherapeutics, case studies can help students appreciate the relevance and importance of a sound scientific foundation in preparation for practice.

The patient cases in this book are intended to complement the scientific and clinical information in the 11th edition of Pharmaco therapy: A Pathophysiologic Approach. This edition of the casebook contains 157 unique patient cases, with case chapters organized into organ system sections corresponding to the Pharmacotherapy textbook. Students should read the relevant textbook chapter to become thoroughly familiar with the pathophysiology and pharmacotherapy of each disease state before attempting to identify and address the medication therapy problems of the patients described in this casebook. The Pharmacotherapy textbook, casebook, and other useful learning resources are also available on AccessPharmacy.com (subscription required). By using these realistic cases to practice creating, defending, and implementing pharmacotherapeutics care plans, students can begin to develop the skills and self-confidence that will be necessary to make the real decisions required in professional practice.

The knowledge and clinical experience required to answer the questions associated with each patient presentation vary from case to case. Some cases deal with a single disease, whereas others have multiple diseases and drug therapy problems. As a guide for instructors, each case is identified as being one of three complexity levels; this classification system is described in more detail in Chapter 1.

Casebook Section 1: Principles of Patient-Focused Therapy includes five chapters that provide guidance on use of the casebook and six patient cases related to managing special patient populations (pediatrics, geriatrics, palliative care) and toxicology situations.

Chapter 1 describes the format of case presentations and the means by which students and instructors can maximize the usefulness of the casebook. Previous editions of the casebook employed a systematic problem-solving approach to each case. Briefly, the steps involved in this approach include: (1) identifying drug therapy problems, (2) establishing therapeutic goals, (3) evaluating therapeutic options to achieve the goals, (4) designing an optimal patient care plan, (5) establishing monitoring parameters, and (6) providing patient education. A major innovation for the 11th edition is that the case questions and answers now use the Joint Commission of Pharmacy Practitioners (JCPP) Pharmacists’ Patient Care Process (PPCP; https://jcpp.net/patient-care-process/). The disease state chapters in the Pharmacotherapy textbook also include an outline of the PPCP for the relevant disorders. It is important for all clinicians to use a consistent process in delivering care so patients and other healthcare providers know what to expect from them. In addition, the PPCP is similar to the patient care process used by other healthcare professionals, and the Accreditation Council for Pharmacy Education (ACPE) requires schools/colleges of pharmacy to teach the PPCP in the curriculum.

Chapter 2 presents the philosophy and implementation of active learning strategies. This chapter sets the tone for the casebook by describing how these approaches can enhance student learning. The chapter provides useful active learning strategies for instructors and provides advice to students on how to maximize their learning opportunities in active learning environments.

Chapter 3 discusses the importance of patient communication and offers strategies to get the most out of the time that the clinician shares with the patient during each encounter. The information can be used as the basis for simulated counseling sessions related to the patient cases.

Chapter 4 describes in detail the steps involved in the PPCP: (1) Collect, (2) Assess, (3) Plan, (4) Implement, and (5) Follow-up: Monitor and Evaluate. The chapter includes example of patient case vignettes to demonstrate implementation of the PPCP. Implementing the PPCP profession-wide provides a common terminology for pharmacist patient care services and focuses on quality improvement, provider collaboration, improved patient outcomes, and cost savings. All pharmacists providing direct patient care should employ the PPCP, regardless of practice setting.

Chapter 5 describes the critically important process of documenting patient encounters and interventions to serve as a record of patient care services provided and to communicate effectively with other healthcare providers. The authors discuss documentation of medication therapy management (MTM) and comprehensive medication management (CMM) encounters as well as use of the traditional SOAP note for documenting the identification and resolution of drug therapy problems. A sample case presentation is provided to illustrate construction of a SOAP note with appropriate documentation of drug therapy problems.

Casebook Sections 2 through 18 contain patient cases organized by organ systems that correspond to those of the Pharmacotherapy textbook. Section 19 (Complementary and Alternative Therapies) contains patient vignettes that are directly related to patient cases that were presented earlier in this casebook. Each scenario involves the potential use of one or more dietary supplements. Additional follow-up questions are then asked to help the reader gain the scientific and clinical knowledge required to provide evidence-based recommendations about use of the supplement in that particular patient. Sixteen different dietary supplements are discussed: garlic, fish oil (omega-3 fatty acids), ginger, butterbur, feverfew, St. John’s wort, kava, melatonin, cinnamon, α-lipoic acid, black cohosh, soy, Pygeum africanum, glucosamine, chondroitin, and elderberry.

We are grateful for the broad acceptance that previous editions of the casebook have received. It has been adopted by many schools of pharmacy and nurse practitioner programs. It has also been used in institutional staff development efforts and by individual pharmacists striving to upgrade their pharmacotherapy skills. It is our hope that this new edition will be even more valuable in assisting healthcare practitioners to meet society’s need for safe and effective drug therapy.