Katherine G. Moore, Molly E. Howard, and Timothy J. Ives
Ultraviolet Radiation (UVR) Exposure
SECTION 9: Rheumatic and Musculoskeletal Diseases
Section Editor: Kamala M. Nola
Dominick P. Trombetta and Christopher M. Herndon
Incidence, Prevalence, and Epidemiology
Steven W. Chen, Rory E. Kim, and Candace Tan
Extra-Articular Manifestations and Complications
Kimberly Ference and KarenBeth H. Bohan
Julie L. Olenak and Jonathan D. Ference
Selected Connective Tissue Diseases
Section Editor: Trisha LaPointe
Hormonal Contraception Background and Pharmacology
Combination Hormonal Contraceptives
Intrauterine Device and Intrauterine System
Other Nonhormonal Contraception
Management of Conditions in Pregnancy
Drug Therapy Management in Labor and Delivery
Prevention of Rh D Alloimmunization
Medication Use in Pregnancy and Lactation
Disorders Related to the Menstrual Cycle
Laura M. Borgelt and Karen M. Gunning
Premenstrual Syndrome and Premenstrual Dysphoric Disorder
The Transition Through Menopause
Louise Parent-Stevens and Trisha LaPointe
Incidence, Prevalence, and Epidemiology
SECTION 11: Endocrine Disorders
Section Editor: Jennifer D. Goldman
Eric F. Schneider and Betty J. Dong
Jennifer D. Goldman, Dhiren K. Patel, and David Schnee
Definition, Classification, and Epidemiology
Relationship of Glycemic Control to Microvascular and Macrovascular Disease
Prevention of Type 1 and Type 2 Diabetes Mellitus
Treatment of Type 1 Diabetes: Clinical Use of Insulin
Treatment of Type 2 Diabetes: Antidiabetic Agents
Treatment of Patients with Type 2 Diabetes
Drug-Induced Alterations in Glucose Homeostasis
Section Editor: Susan Jacobson
Steven R. Abel and Suellyn J. Sorensen
Systemic Side Effects from Ophthalmic Medication
Ocular Nonsteroidal Anti-Inflammatory Drugs
Ocular Herpes Simplex Virus Infections
Age-Related Macular Degeneration
SECTION 13: Neurologic Disorders
Section Editors: Michele Matthews and Timothy E. Welty
Lee A. Kral and Virginia L. Ghafoor
Incidence, Prevalence, and Epidemiology
Neuropathic Pain and Postherpetic Neuralgia
Central Neuropathic Pain: Poststroke Pain
Functional Pain Syndromes (FPS)
Cancer Pain and Symptom Management
Care of the Critically Ill Adult
Matthew Hafermann, Philip Grgurich, and John Marshall
Home Medications in the Intensive Care Unit
Pharmacokinetic Alterations in the ICU and Management Strategies
Epidemiology, Natural Course of the Disease, and Prognosis
Parkinson’s Disease and Other Movement Disorders
Kristin M. Zimmerman and Natalie Whitmire
Restless Legs Syndrome and Periodic Limb Movements of Sleep
James W. McAuley and Brian K. Alldredge
Clinical Assessment and Treatment of Epilepsy
Ischemic and Hemorrhagic Stroke
Oussayma Moukhachen and Philip Grgurich
Ischemic Stroke, Hemorrhagic Stroke, and Transient Ischemic Attacks
Primary Prevention of Ischemic Stroke and Transient Ischemic Attacks
Treatment of Acute Ischemic Stroke and TIA
Secondary Prevention After Ischemic Stroke or TIA
Spontaneous Intracerebral Hemorrhage
SECTION 14: Infectious Diseases
Section Editors: Dorothea C. Rudorf, G. Christopher Wood, and Caroline S. Zeind
Principles of Infectious Diseases
Establishing the Presence of an Infection
Establishing the Severity of an Infection
Problems in the Diagnosis of an Infection
Establishing the Site of the Infection
Microbiologic Tests and Susceptibility of Organisms
Determination of Isolate Pathogenicity
Antimicrobial Costs of Therapy
Pharmacokinetics and Pharmacodynamics
Antimicrobial Prophylaxis for Surgical Procedures
Classification of Surgical site infections
Principles of Surgical Antimicrobial Prophylaxis
Optimizing Surgical Antimicrobial Prophylaxis
Molly G. Minze and Katherine Dillinger Ellis
Central Nervous System Infections
Gregory A. Eschenauer, Deanna Buehrle, and Brian A. Potoski
Review of Central Nervous System
Michelle L. Chan and Annie Wong-Beringer
Streptococcus Viridans Group Endocarditis
Staphylococcus Epidermidis: Prosthetic Valve Endocarditis
Staphylococcus Aureus Endocarditis
Fungal Endocarditis Caused by Candida Albicans
Gram-Negative Bacillary Endocarditis Caused by Pseudomonas Aeruginosa 1400
Jason Cross, Evan Horton, and Dinesh Yogaratnam
Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Prevention of Common Respiratory Infections by Vaccination
Hospital-Acquired Pneumonia, and Ventilator-Associated Pneumonia
Treatment of Latent Tuberculosis Infection
Special Treatment Considerations
Gail S. Itokazu and David T. Bearden
Evaluation and Treatment of Patients with Infectious Diarrhea
Staphylococcus Aureus, Bacillus Cereus, and Clostridium Perfringens
Postinfectious Complications of TD
Clostridium Difficile Infection
Sheila K. Wang and Carrie A. Sincak
Infections of the Biliary Tract
Infections After Abdominal Trauma and Postoperative Complications
Treatment of Lower-Tract Infection in Renal Failure
Recurrent Urinary Tract Infections
Hospital-Acquired Acute Urinary Tract Infection
Jeffery A. Goad, Karl M. Hess, and Albert T. Bach
Osteomyelitis and Septic Arthritis
Jacqueline L. Olin, Linda M. Spooner, and Karyn M. Sullivan
Skin and Soft Tissue Infections
Cheryl R. Durand and Kristine C. Willett
Skin and Soft Tissue Infections
Skin and Soft Tissue Infections in Diabetic Patients
Prevention and Treatment of Infections in Neutropenic Cancer Patients
Stratification for Risk of Infection
Infections in Neutropenic Cancer Patients
Antibiotic Dosing, Administration, and Monitoring Considerations
Host Factors Influencing Response to Therapy
Modifying Initial Empiric Antibiotic Therapy
Pharmacotherapy of Human Immunodeficiency Virus Infection
Jessica L. Adams and Mackenzie L. Cottrell
Resistance, Viral Genotyping, Phenotyping, and Viral Fitness
Opportunistic Infections in HIV-Infected Patients
Emily L. Heil and Amanda H. Corbett
Pneumocystis Jiroveci Pneumonia
Toxoplasma Gondii Encephalitis
Mycobacterium Avium Complex Disease
John D. Cleary and Russell E. Lewis
Superficial and Cutaneous Mycoses
Milap C. Nahata, Neeta Bahal O’Mara, and Sandra Benavides
Herpes Simplex Virus Infections
Respiratory Syncytial Virus Infections
Severe Acute Respiratory Distress Syndrome
Middle East Respiratory Syndrome
Jerika T. Lam and Curtis D. Holt
Causative Agents and Characteristics
Sheila Seed, Larry Goodyer, and Caroline S. Zeind
Caroline S. Zeind, Michelle L. Ceresia, and Lin H. Chen
Other Bacterial Diseases: Tularemia
The Rickettsia: Rocky Mountain Spotted Fever, Rickettsia Parkeri Infection, Ehrlichiosis, and
SECTION 15: Psychiatric Disorders and Substance Abuse
Section Editors: Michael C. Angelini and Michael G. Carvalho
Jolene R. Bostwick and Kristen N. Gardner
Social Anxiety Disorder and Specific Phobias
Post-Traumatic Stress Disorder and Acute Stress Disorder
Devon A. Sherwood and Anna K. Morin
Circadian Rhythm and Sleep Cycles
Neurochemistry of Sleep–Wake Cycle
Insomnia in a Medically Ill Patient
Insomnia and Psychiatric Disorders
Richard J. Silvia, Robert L. Dufresne, and Justin C. Ellison
Considerations in Specific Populations
Megan J. Ehret and Charles F. Caley
Treatment of Acute Bipolar Depression
Maintenance Therapy of Bipolar Disorder
Lee A. Robinson and Kimberly Lenz
Epidemiology, Natural Course of the Disease, and Prognosis
Pathophysiology: Disease Etiology, Anatomy, and Physiology
Attention Deficit Hyperactivity Disorder in Children, Adolescents, and Adults
Michael C. Angelini and Joel Goldstein
Diagnosis, Signs, and Symptoms
Adults with Attention Deficit Hyperactivity Disorder
Central Nervous System Stimulants
Dissociative Drugs: Phencyclidine, Ketamine, and Dextromethorphan
Pharmacotherapy of Alcohol Dependence
Andrea S. Franks and Sarah E. McBane
Epidemiology of Tobacco Use and Dependence
Pharmacotherapy for Treating Tobacco Use and Dependence
SECTION 16: Hematology and Oncology
Section Editor: Christy S. Harris
Cindy L. O’Bryant, Ashley E. Glode, and Lisa A. Thompson
Neoplastic Disorders and Their Treatment: General Principles
Jaime E. Anderson, Andrea S. Dickens, and Katherine Tipton Patel
Introduction to Neoplastic Disorders
Adverse Effects of Chemotherapy and Targeted Agents
Amy Hatfield Seung and Emily Mackler
Long-Term Complications of Anticancer Therapy
David W. Henry and Nicole A. Kaiser
Acute Lymphoblastic Leukemia of Childhood
Pediatric Non-Hodgkin Lymphoma
Adult Hematologic Malignancies
Lynn Weber, Jacob K. Kettle, Andy Kurtzweil, Casey B. Williams, Rachel Elsey, and Katie A. Won
Chemotherapy and Radiation for Early-Stage Rectal Cancer
Marina D. Kaymakcalan and Christy S. Harris
Incidence, Prevalence, and Epidemiology
Clinical Presentation and Diagnosis
Castration-Resistant Prostate Cancer
Hematopoietic Cell Transplantation
Autologous Hematopoietic Stem Cell Transplantation
Allogeneic Hematopoietic Stem Cell Transplantation
Complications Associated with Hematopoietic Cell Transplantation
Issues of Survivorship After Hematopoietic Cell Transplantation
Section Editor: Marcia L. Buck
Growth and Development During Childhood
Pediatric Pharmacokinetic Differences
Pediatric Pharmacodynamic Differences
Preventing Medication Errors in Children
Increasing Availability of Pediatric Medication Information
Pediatric Fluid, Electrolytes, and Nutrition
Michael F. Chicella and Jennifer W. Chow
Fluid and Electrolyte Maintenance
Chephra McKee, Brooke Gildon, and Bethany Ibach
Administering Medication to Children
Donna M. Kraus, Jennifer T. Pham, and Kirsten H. Ohler
Neonatal Sepsis and Meningitis
Care of the Critically Ill Child
Elizabeth Anne Farrington and Marcia L. Buck
Pediatric Cardiopulmonary Resuscitation
Medications for Intubation and Mechanical Ventilation
Sepsis and Septic Shock in Infants and Children
Initial Management of Pediatric Septic Shock
Corticosteroid Administration in Pediatric Septic Shock
Pediatric Traumatic Brain Injury
Section Editor: Judith L. Beizer
Suzanne Dinsmore, Mary-Kathleen Grams, and Kristin Zimmerman
Demographic and Economic Considerations
Age-Related Physiologic, Pharmacokinetic, and Pharmacodynamic Changes
Problems Associated with Drug Use in Older Adults
Disease-Specific Geriatric Drug Therapy
Geriatric Neurocognitive Disorders
Nicole J. Brandt and Bradley R. Williams
Behavioral Disturbances in Dementia
R. Rebecca Couris, Suzanne Dinsmore, and Mary-Kathleen Grams
Incidence, Prevalence, and Epidemiology
Medication Therapy Management Services (MTMS) are a service or
group of services that optimize therapeutic outcomes for individual
A successful MTMS encounter includes medication reconciliation and a
comprehensive medication history.
Sources of patient information for MTMS include the patient, the
electronic health record, the paper chart, and the pharmacy information
A careful and complete patient interview should include medical,
medication, and social histories, and it must be provided in a culturally
A successful MTMS encounter must be well documented following the
Problem Oriented Medical Record (POMR). Documentation involves
collecting subjective and objective data to identify the primary problem.
The clinician must assess the drug therapy or disease-specific problem
The finalstep in documenting the MTMS encounter is developing the
medication action plan and processing any billing requirements.
Accurate and complete communication of the MTMS encounter to the
patient’s health care team is vital.
This chapter discusses medication therapy management services (MTMS) with a
focus on the assessment of drug therapy. The illustrations in this chapter primarily
focus on the pharmacist; however, the principles used to assess patient response to
drug therapy are of value to all health care providers.
As defined by the American Pharmacists Association, medication therapy
management (MTM) is a term used to describe a broad range of health care services
provided by pharmacists, the medication experts on the health care team. A
consensus definition created by 11 pharmacy associations, adopted by the pharmacy
profession in 2004, defines MTM as a service or group of services that optimize
therapeutic outcomes for individual patients.
1 Pharmacists provide MTM to help
patients get the best benefits from their medications by actively managing drug
therapy and by identifying, preventing, and resolving medication-related problems.
MTM has a direct relationship to pharmaceutical care. Pharmaceutical care has
been described as the responsible provision of drug therapy to achieve definite
outcomes that are intended to improve a patient’s quality of life.
been described as a service provided in the practice of pharmaceutical care.
However, unlike pharmaceutical care, MTM is recognized by payers, has current
procedural terminology (CPT) codes specifically for pharmacists, and has several
clearly defined interventions. Therefore, MTMS will be the term used to describe the
activity of MTM in various patient populations.
With the passage of the Patient Protection and Affordable Care Act and the Health
Care and Education Reconciliation Act of 2010, pharmacists have tremendous
opportunities in the implementation of health care reform.
this law is delivery system reform. As health care delivery systems change,
pharmacists have an opportunity to improve overall quality of
care, to become involved in coordinated health care approaches such as medical
home teams and accountable care organizations, and to collaborate to improve care
for high-risk patients and those with chronic conditions in primary-care settings. In
the United States, there are an estimated 133 million people that have at least one
In 2010, 86% of all health care spending was for people
with one or more chronic health condition(s).
8 Pharmacists will have additional
opportunities as hospitals will have financial incentives to improve quality, reduce
costs, and decrease hospital-acquired conditions.
Both patient self-care and medication reconciliation are critical aspects of any
MTMS encounter regardless of the setting (i.e., inpatient, community, ambulatory, or
institutional). Patient self-care requires the patient to take responsibility for the
illness; however, the help of a professional to structure healthy self-care is important.
For example, patients with diabetes who monitor their blood glucose levels regularly
and adjust their diet according to the guidelines published from the American
Diabetes Association (ADA) would be practicing self-care. Self-care is often the
work that the patient performs between visits with the provider. The patient should
be involved in his or her own care to ensure the best outcomes.
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