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Katherine G. Moore, Molly E. Howard, and Timothy J. Ives

Ultraviolet Radiation (UVR) Exposure

Photoaging

Burn Injuries

Key References and Websites

SECTION 9: Rheumatic and Musculoskeletal Diseases

Section Editor: Kamala M. Nola

Osteoarthritis

Dominick P. Trombetta and Christopher M. Herndon

Incidence, Prevalence, and Epidemiology

Etiology

Pathogenesis

Overview of Drug Therapy

Clinical Manifestations

Treatment of Osteoarthritis

Key References and Websites

Rheumatoid Arthritis

Steven W. Chen, Rory E. Kim, and Candace Tan

Epidemiology

Etiology

Pathophysiology

Extra-Articular Manifestations and Complications

Juvenile Idiopathic Arthritis

Key References and Websites

Gout and Hyperuricemia

Kimberly Ference and KarenBeth H. Bohan

Pathophysiology

Acute Gout

Hyperuricemia

Pharmacist’s Role

Key References and Websites

Connective Tissue Disorders

Julie L. Olenak and Jonathan D. Ference

Introduction

47

48

49

General Signs and Symptoms

Selected Connective Tissue Diseases

Key References and Websites

SECTION 10: Women’s Health

Section Editor: Trisha LaPointe

Contraception

Shareen Y. El-Ibiary

Epidemiology

Hormonal Contraception Background and Pharmacology

Combination Hormonal Contraceptives

Contraceptive Patch and Ring

Progestin-Only Contraceptives

Intrauterine Device and Intrauterine System

Other Nonhormonal Contraception

Emergency Contraception

Medical Abortion

Key References and Websites

Infertility

Erin C. Raney

Introduction

Pathophysiology and Diagnosis

Treatment Approaches

Key References and Websites

Obstetric Drug Therapy

Trisha LaPointe

Pregnancy

Teratogenicity

Management of Conditions in Pregnancy

Urinary Tract Infections

Diabetes Mellitus

Hypertension and Preeclampsia

Drug Therapy Management in Labor and Delivery

Postpartum Hemorrhage

Prevention of Rh D Alloimmunization

Lactation

Drug Excretion in Human Milk

Acknowledgment

50

51

52

53

Key References and Websites

Medication Use in Pregnancy and Lactation

General Information

Disorders Related to the Menstrual Cycle

Laura M. Borgelt and Karen M. Gunning

Menstrual Cycle Physiology

Polycystic Ovary Syndrome

Dysmenorrhea

Endometriosis

Premenstrual Syndrome and Premenstrual Dysphoric Disorder

Key References and Websites

The Transition Through Menopause

Louise Parent-Stevens and Trisha LaPointe

Incidence, Prevalence, and Epidemiology

Pathophysiology

Clinical Presentation

Key References and Websites

SECTION 11: Endocrine Disorders

Section Editor: Jennifer D. Goldman

Thyroid Disorders

Eric F. Schneider and Betty J. Dong

Overview

Thyroid Function Tests

Hypothyroidism

Hyperthyroidism

Drug-Induced Thyroid Disease

Key References and Websites

p. xxx

p. xxxi

Diabetes Mellitus

Jennifer D. Goldman, Dhiren K. Patel, and David Schnee

Definition, Classification, and Epidemiology

Carbohydrate Metabolism

Type 1 Diabetes

54

55

Type 2 Diabetes

Gestational Diabetes Mellitus

Long-Term Complications

Relationship of Glycemic Control to Microvascular and Macrovascular Disease

Prevention of Type 1 and Type 2 Diabetes Mellitus

Treatment

Insulin

Treatment of Type 1 Diabetes: Clinical Use of Insulin

Diabetic Ketoacidosis

Treatment of Type 2 Diabetes: Antidiabetic Agents

Treatment of Patients with Type 2 Diabetes

Drug-Induced Alterations in Glucose Homeostasis

Acknowledgment

Key References and Websites

SECTION 12: Eye Disorders

Section Editor: Susan Jacobson

Eye Disorders

Steven R. Abel and Suellyn J. Sorensen

Ocular Anatomy and Physiology

Glaucoma

Primary Open-Angle Glaucoma

Angle-Closure Glaucoma

Ocular Side Effects of Drugs

Ocular Emergencies

Common Ocular Disorders

Ophthalmic Corticosteroids

Systemic Side Effects from Ophthalmic Medication

Ocular Nonsteroidal Anti-Inflammatory Drugs

Ocular Herpes Simplex Virus Infections

Age-Related Macular Degeneration

Key References and Websites

SECTION 13: Neurologic Disorders

Section Editors: Michele Matthews and Timothy E. Welty

Pain and Its Management

Lee A. Kral and Virginia L. Ghafoor

Incidence, Prevalence, and Epidemiology

56

57

58

59

60

Low Back Pain

Neuropathic Pain and Postherpetic Neuralgia

Central Neuropathic Pain: Poststroke Pain

Functional Pain Syndromes (FPS)

Cancer Pain and Symptom Management

Key References and Websites

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

Key References and Websites

Multiple Sclerosis

Melody Ryan

Epidemiology, Natural Course of the Disease, and Prognosis

Pathophysiology

Clinical Presentation

Diagnosis

Overview of Treatment

Key References and Websites

Headache

Steven J. Crosby

Epidemiology and Description

Migraine Headache

Cluster Headache

Tension-Type Headache

Key References and Websites

Parkinson’s Disease and Other Movement Disorders

Kristin M. Zimmerman and Natalie Whitmire

Parkinson’s Disease

Restless Legs Syndrome and Periodic Limb Movements of Sleep

Essential Tremor

Key References and Websites

Seizure Disorders

James W. McAuley and Brian K. Alldredge

Clinical Assessment and Treatment of Epilepsy

Women’s Issues in Epilepsy

61

62

63

Status Epilepticus

Key References and Websites

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

Rehabilitation

Key References and Websites

SECTION 14: Infectious Diseases

Section Editors: Dorothea C. Rudorf, G. Christopher Wood, and Caroline S. Zeind

Principles of Infectious Diseases

B. Joseph Guglielmo

Approaching the Problem

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

Determining Likely Pathogens

Microbiologic Tests and Susceptibility of Organisms

Determination of Isolate Pathogenicity

Antimicrobial Toxicities

Antimicrobial Costs of Therapy

Route of Administration

Antimicrobial Dosing

Pharmacokinetics and Pharmacodynamics

Antimicrobial Failure

Key References and Websites

p. xxxi

p. xxxii

Antimicrobial Prophylaxis for Surgical Procedures

DanielJ. G. Thirion

Risk Factors for Infection

Classification of Surgical site infections

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65

66

67

Principles of Surgical Antimicrobial Prophylaxis

Optimizing Surgical Antimicrobial Prophylaxis

Key References and Websites

Vaccinations

Molly G. Minze and Katherine Dillinger Ellis

Vaccine Principles

Guidelines

Inactivated Vaccines

Live Attenuated Vaccines

Administration Techniques

Legal Requirements

Key References and Websites

Central Nervous System Infections

Gregory A. Eschenauer, Deanna Buehrle, and Brian A. Potoski

Review of Central Nervous System

Meningitis

Brain Abscess

Key References and Websites

Endocarditis

Michelle L. Chan and Annie Wong-Beringer

Infective Endocarditis

Streptococcus Viridans Group Endocarditis

Staphylococcus Epidermidis: Prosthetic Valve Endocarditis

Staphylococcus Aureus Endocarditis

Enterococcal Endocarditis

Fungal Endocarditis Caused by Candida Albicans

Gram-Negative Bacillary Endocarditis Caused by Pseudomonas Aeruginosa 1400

Culture-Negative Endocarditis

Prophylactic Therapy

Key References and Websites

Respiratory Tract Infections

Jason Cross, Evan Horton, and Dinesh Yogaratnam

Acute Bronchitis

Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Prevention of Common Respiratory Infections by Vaccination

Community-Acquired Pneumonia

Hospital-Acquired Pneumonia, and Ventilator-Associated Pneumonia

Key References and Websites

68

69

70

71

Tuberculosis

Michael B. Kays

History

Treatment of Active Disease

Treatment of Latent Tuberculosis Infection

Adverse Drug Events

Special Treatment Considerations

Therapeutic Drug Monitoring

Key References and Websites

Infectious Diarrhea

Gail S. Itokazu and David T. Bearden

Prevalence and Etiology

Definitions

Pathogenesis

Management Overview

Evaluation and Treatment of Patients with Infectious Diarrhea

Clinical Presentation

Viral Gastroenteritis

Vibrio Species

Staphylococcus Aureus, Bacillus Cereus, and Clostridium Perfringens

Cryptosporidium Parvum

Salmonella

Shigella Species

Campylobacter Jejuni

Travelers’ Diarrhea

Postinfectious Complications of TD

Escherichia Coli O157:H7

Clostridium Difficile Infection

Key References and Websites

Intra-Abdominal Infections

Sheila K. Wang and Carrie A. Sincak

Introduction

Infections of the Biliary Tract

Primary Peritonitis

Secondary Peritonitis

Infections After Abdominal Trauma and Postoperative Complications

Key References and Websites

Urinary Tract Infections

Douglas N. Fish

72

73

74

75

Urinary Tract Infection

Lower Urinary Tract Infection

Treatment of Lower-Tract Infection in Renal Failure

Recurrent Urinary Tract Infections

Asymptomatic Bacteriuria

Symptomatic Abacteriuria

Hospital-Acquired Acute Urinary Tract Infection

Prostatitis

Key References and Websites

Sexually Transmitted Diseases

Jeffery A. Goad, Karl M. Hess, and Albert T. Bach

Gonorrhea

Pelvic Inflammatory Disease

Complicated Gonorrhea

Chlamydia Trachomatis

Syphilis

Chancroid

Vaginitis

Genital Herpes

Genital Warts

Key References and Websites

Osteomyelitis and Septic Arthritis

Jacqueline L. Olin, Linda M. Spooner, and Karyn M. Sullivan

Osteomyelitis

Septic Arthritis

Key References and Websites

Skin and Soft Tissue Infections

Cheryl R. Durand and Kristine C. Willett

Skin and Soft Tissue Infections

Erysipelas

Skin and Soft Tissue Infections in Diabetic Patients

Animal Bite Wounds

Human Bite Wounds

Key References and Websites

p. xxxii

p. xxxiii

Prevention and Treatment of Infections in Neutropenic Cancer Patients

76

77

78

Richard H. Drew

Risk Factors for Infection

Most Common Pathogens

Stratification for Risk of Infection

Prophylaxis Against Infection

Infections in Neutropenic Cancer Patients

Empiric Antibiotic Therapy

Antibiotic Dosing, Administration, and Monitoring Considerations

Host Factors Influencing Response to Therapy

Modifying Initial Empiric Antibiotic Therapy

Antimicrobial Adjuvants

Key References and Websites

Pharmacotherapy of Human Immunodeficiency Virus Infection

Jessica L. Adams and Mackenzie L. Cottrell

Introduction

Epidemiology

Pathophysiology

Pharmacotherapy

Diagnosis

Surrogate Marker Data

Antiretroviral Therapy

Resistance, Viral Genotyping, Phenotyping, and Viral Fitness

Special Circumstances

Keeping Current

Conclusion

Key References and Websites

Opportunistic Infections in HIV-Infected Patients

Emily L. Heil and Amanda H. Corbett

Introduction

Pneumocystis Jiroveci Pneumonia

Toxoplasma Gondii Encephalitis

Cytomegalovirus Disease

Cryptococcosis

Mycobacterium Tuberculosis

Mycobacterium Avium Complex Disease

Mucocutaneous Candidiasis

Acknowledgments

Key References and Websites

Fungal Infections

John D. Cleary and Russell E. Lewis

79

80

81

Mycology

Antimycotics

Superficial and Cutaneous Mycoses

Subcutaneous Mycoses

Systemic Mycoses

Key References and Websites

Viral Infections

Milap C. Nahata, Neeta Bahal O’Mara, and Sandra Benavides

Herpes Simplex Virus Infections

Varicella-Zoster Infections

Influenza

Respiratory Syncytial Virus Infections

Hantavirus

West Nile Virus

Severe Acute Respiratory Distress Syndrome

Middle East Respiratory Syndrome

Zika Virus

The Common Cold

Key References and Websites

Viral Hepatitis

Jerika T. Lam and Curtis D. Holt

Causative Agents and Characteristics

Hepatitis A Virus

Hepatitis B Virus

Hepatitis C Virus

Hepatitis D Virus

Hepatitis E Virus

Summary

Key References and Websites

Parasitic Infections

Sheila Seed, Larry Goodyer, and Caroline S. Zeind

Malaria

Amebiasis

Giardiasis

Enterobiasis

Cestodiasis

Pediculosis

Scabies

Acknowledgment

Key References and Websites

82

83

84

Tick-Borne Diseases

Caroline S. Zeind, Michelle L. Ceresia, and Lin H. Chen

Overview

Lyme Disease

Erythema Migrans

Lyme Disease Treatment

Relapsing Fever

Other Bacterial Diseases: Tularemia

The Rickettsia: Rocky Mountain Spotted Fever, Rickettsia Parkeri Infection, Ehrlichiosis, and

Anaplasmosis

The Protozoa: Babesiosis

The Viruses: Colorado Tick Fever, Tick-Borne Encephalitis, and Other Virally Mediated TickBorne Diseases

The Toxins: Tick Paralysis

Mixed Infections

Summary

Acknowledgement

Key References and Websites

SECTION 15: Psychiatric Disorders and Substance Abuse

Section Editors: Michael C. Angelini and Michael G. Carvalho

Anxiety Disorders

Jolene R. Bostwick and Kristen N. Gardner

Generalized Anxiety Disorder

Panic Disorder

Social Anxiety Disorder and Specific Phobias

Post-Traumatic Stress Disorder and Acute Stress Disorder

Obsessive–Compulsive Disorder

Key References and Websites

Sleep Disorders

Devon A. Sherwood and Anna K. Morin

Overview

Circadian Rhythm and Sleep Cycles

p. xxxiii

p. xxxiv

Neurochemistry of Sleep–Wake Cycle

Insomnia

85

86

87

88

Insomnia in a Medically Ill Patient

Insomnia and Psychiatric Disorders

Insomnia in the Elderly

Pediatric Insomnia

Pregnancy and Lactation

Sleep Apnea

Narcolepsy

Acknowledgment

Key References and Websites

Schizophrenia

Richard J. Silvia, Robert L. Dufresne, and Justin C. Ellison

Epidemiology

Economic Burden

Etiology

Clinical Presentation

Treatment

Considerations in Specific Populations

Key References and Websites

Depressive Disorders

Michael C. Angelini

Introduction

Major Depressive Disorder

Drug Management

Key References and Websites

Bipolar Disorders

Megan J. Ehret and Charles F. Caley

Introduction

Clinical Assessment

Treatment of Acute Mania

Treatment of Acute Bipolar Depression

Maintenance Therapy of Bipolar Disorder

Key References and Websites

Developmental Disorders

Lee A. Robinson and Kimberly Lenz

Epidemiology, Natural Course of the Disease, and Prognosis

Pathophysiology: Disease Etiology, Anatomy, and Physiology

Clinical Presentation

Diagnosis

89

90

91

Overview of Treatment

Repetitive Behaviors

Self-Injurious Behavior

Anxiety/Depression

Sleep

Attention Deficit Hyperactivity Disorder in Children, Adolescents, and Adults

Michael C. Angelini and Joel Goldstein

Epidemiology

Pathophysiology

Diagnosis, Signs, and Symptoms

Comorbidity and Prognosis

Treatment

Adults with Attention Deficit Hyperactivity Disorder

Key References and Websites

Substance Use Disorders

Michael C. Angelini

Substance Use Disorder

Opioids

Sedative-Hypnotics (Non-ETOH)

Central Nervous System Stimulants

Dissociative Drugs: Phencyclidine, Ketamine, and Dextromethorphan

Hallucinogens

Marijuana

Inhalants

Alcohol Use Disorders

Alcohol Toxicity

Alcohol Withdrawal

Adjunctive Treatments

Pharmacotherapy of Alcohol Dependence

Disulfiram

Acamprosate

Naltrexone

Combination Pharmacotherapy

Acknowledgment

Key References and Websites

Tobacco Use and Dependence

Andrea S. Franks and Sarah E. McBane

Epidemiology of Tobacco Use and Dependence

Pharmacotherapy for Treating Tobacco Use and Dependence

Key References and Websites

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93

94

95

96

SECTION 16: Hematology and Oncology

Section Editor: Christy S. Harris

Anemias

Cindy L. O’Bryant, Ashley E. Glode, and Lisa A. Thompson

Anemias

Iron Deficiency Anemia

Megaloblastic Anemias

Sickle Cell Anemia

Anemia of Inflammation

Key References and Websites

Neoplastic Disorders and Their Treatment: General Principles

Jaime E. Anderson, Andrea S. Dickens, and Katherine Tipton Patel

Introduction to Neoplastic Disorders

Treatment

Handling of Cytotoxic Drugs

Key References and Websites

Adverse Effects of Chemotherapy and Targeted Agents

Amy Hatfield Seung and Emily Mackler

Common and Acute Toxicities

Long-Term Complications of Anticancer Therapy

Key References and Websites

Pediatric Malignancies

David W. Henry and Nicole A. Kaiser

Pediatric Malignancies

Pediatric Solid Tumors

Acute Lymphoblastic Leukemia of Childhood

Pediatric Non-Hodgkin Lymphoma

Key References and Websites

p. xxxiv

p. xxxv

Adult Hematologic Malignancies

Lynn Weber, Jacob K. Kettle, Andy Kurtzweil, Casey B. Williams, Rachel Elsey, and Katie A. Won

Acute Myeloid Leukemia

Chronic Myelogenous Leukemia

97

98

99

100

101

Chronic Lymphocytic Leukemia

Multiple Myeloma

Lymphoma

Key References and Websites

Breast Cancer

Kellie Jones Weddle

Breast Cancer

Metastatic Breast Cancer

Key References and Websites

Lung Cancer

Sara K. Butler

Lung Cancer

Acknowledgment

Key References and Websites

Colorectal Cancer

Marlo Blazer

Colorectal Cancer

Chemotherapy and Radiation for Early-Stage Rectal Cancer

Acknowledgment

Key References and Websites

Prostate Cancer

Marina D. Kaymakcalan and Christy S. Harris

Incidence, Prevalence, and Epidemiology

Pathophysiology

Clinical Presentation and Diagnosis

Overview of Treatment

Risk Factors

Screening

Prognostic Factors

Treatment

Castration-Resistant Prostate Cancer

Prevention

Survivorship

Key References and Websites

Hematopoietic Cell Transplantation

Valerie Relias

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103

104

105

Overview

Autologous Hematopoietic Stem Cell Transplantation

Allogeneic Hematopoietic Stem Cell Transplantation

Complications Associated with Hematopoietic Cell Transplantation

Graft-Versus-Host Disease

Infectious Complications

Issues of Survivorship After Hematopoietic Cell Transplantation

Key References and Websites

SECTION 17: Pediatrics

Section Editor: Marcia L. Buck

Pediatric Pharmacotherapy

Marcia L. Buck

Growth and Development During Childhood

Pediatric Pharmacokinetic Differences

Pediatric Pharmacodynamic Differences

Medication Dosing in Children

Preventing Medication Errors in Children

Increasing Availability of Pediatric Medication Information

Key References and Websites

Pediatric Fluid, Electrolytes, and Nutrition

Michael F. Chicella and Jennifer W. Chow

Fluid and Electrolyte Maintenance

Infant Enteral Nutrition

Key References and Websites

Common Pediatric Illnesses

Chephra McKee, Brooke Gildon, and Bethany Ibach

Administering Medication to Children

Infant Care

Viral Gastroenteritis

Gastroesophageal Reflux

Common Pediatric Infections

Key References and Websites

Neonatal Therapy

Donna M. Kraus, Jennifer T. Pham, and Kirsten H. Ohler

Neonatal Therapy

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107

Respiratory Distress Syndrome

Bronchopulmonary Dysplasia

Patent Ductus Arteriosus

Necrotizing Enterocolitis

Neonatal Sepsis and Meningitis

Congenital Infections

Apnea of Prematurity

Neonatal Seizures

Key References and Websites

Care of the Critically Ill Child

Elizabeth Anne Farrington and Marcia L. Buck

Pediatric Cardiopulmonary Resuscitation

Respiratory Distress

Medications for Intubation and Mechanical Ventilation

Pediatric Shock

Sepsis and Septic Shock in Infants and Children

Initial Management of Pediatric Septic Shock

Cardiovascular Drug Therapy

Corticosteroid Administration in Pediatric Septic Shock

Adjunctive Therapies

Congenital Heart Disease

Pediatric Traumatic Brain Injury

Key References and Websites

p. xxxv

p. xxxvi

SECTION 18: Geriatric Therapy

Section Editor: Judith L. Beizer

Geriatric Drug Use

Suzanne Dinsmore, Mary-Kathleen Grams, and Kristin Zimmerman

Demographic and Economic Considerations

Age-Related Physiologic, Pharmacokinetic, and Pharmacodynamic Changes

Pharmacodynamic Changes

Problems Associated with Drug Use in Older Adults

Disease-Specific Geriatric Drug Therapy

Long-Term Care Facilities

Key References and Websites

108

109

110

Geriatric Neurocognitive Disorders

Nicole J. Brandt and Bradley R. Williams

Geriatric Dementias

Alzheimer’s Disease

Lewy Body Dementias

Vascular Dementia (Vad)

Behavioral Disturbances in Dementia

Key References and Websites

Geriatric Urologic Disorders

Tran H. Tran

Urinary Incontinence

Benign Prostatic Hyperplasia

Sexual Dysfunction

Key References and Websites

Osteoporosis

R. Rebecca Couris, Suzanne Dinsmore, and Mary-Kathleen Grams

Incidence, Prevalence, and Epidemiology

Key References and Websites

Drug Index

Subject Index

p. xxxvi

Medication Therapy Management Services (MTMS) are a service or

group of services that optimize therapeutic outcomes for individual

patients.

Case 1-5 (Questions 1–4)

A successful MTMS encounter includes medication reconciliation and a

comprehensive medication history.

Case 1-1 (Questions 1–3)

Sources of patient information for MTMS include the patient, the

electronic health record, the paper chart, and the pharmacy information

system.

Case 1-5 (Questions 1, 5),

Table 1-1

A careful and complete patient interview should include medical,

medication, and social histories, and it must be provided in a culturally

sensitive manner.

Case 1-1 (Questions 1–3),

Table 1-2, Online Content

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.

Case 1-5 (Question 1), Table

1-4

Case 1-2 (Question 1),

Case 1-3 (Question 1),

Case 1-4 (Question 1)

The clinician must assess the drug therapy or disease-specific problem

and create a treatment plan.

Case 1-5 (Questions 1, 2)

The finalstep in documenting the MTMS encounter is developing the

medication action plan and processing any billing requirements.

Case 1-5 (Questions 1, 2, 4)

Accurate and complete communication of the MTMS encounter to the

patient’s health care team is vital.

Case 1-5 (Question 3)

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.

2,3

In fact, MTM has

been described as a service provided in the practice of pharmaceutical care.

4

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.

5,6 One of the hallmarks of

this law is delivery system reform. As health care delivery systems change,

pharmacists have an opportunity to improve overall quality of

p. 1

p. 2

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

chronic medical condition.

7

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.

5,6

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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