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Table of Contents
Book 9 Hepatitis B Reactivation 9
Hepatitis C Virus 10
Preface i Evaluation of Patients with Chronic HCV 10
Pharmacologic Treatment Options for HCV 10
Editorial Board ii Standard IFN-Based Therapy 12
Book 9 Panel iii Interferon alfacon-1 (Consensus IFN)-
Based Therapy 12
Disclosure of Potential Conflicts of Interest ix Pegylated IFN-Based Therapy 12
Continuing Education and Program Managing Adverse Effects of
Evaluation Instructions x Chronic HCV Treatment 12
Management of Hematologic Adverse Effects 13
Book 9 Post Test x Management of Neuropsychiatric
Role of ACCP xv Adverse Effects 13
Treatment Challenges 14
African American Patients 14
HIV and HCV Coinfection 14
Treatment Nonresponse or Relapse 14
Gastroenterology I Liver Transplantation 14
Future Therapies for Chronic HCV Infection 15
UPDATE ON PHARMACOTHERAPY OF Role of the Pharmacist 15
CHRONIC HEPATITIS B AND C Conclusion 16
Learning Objectives 1 Annotated Bibliography 16
Introduction 1 Self-Assessment Questions 21
Hepatitis B Virus 1 DRUG-INDUCED LIVER DISEASE
Evaluation of Patients with Chronic Learning Objectives 25
HBV Infection 2 Introduction 25
HBeAg-Positive Chronic HBV Infection 3 Epidemiology 25
HBeAg-Negative Chronic HBV Infection 3 Risk Factors 25
Pharmacologic Treatment Options Pathophysiology and Mechanisms
for Chronic HBV Infection 4 of Drug-Induced Hepatotoxicity 26
Interferons for Chronic HBV Infection 5 Diagnosis 26
Oral Nucleoside and Nucleotide Analogues Assessment Instruments 27
for Chronic HBV Infection 6 Roussel Uclaf Causality Assessment Method 27
Lamivudine 6 Clinical Diagnostic Scale 27
Adefovir Dipivoxil 6 Drug-Induced Liver Injury Network 27
Entecavir 6 Classification of Drug-Induced Hepatotoxicity 27
Telbivudine 7 Intrinsic Hepatotoxicity 27
Tenofovir Disoproxil Fumarate 7 Idiosyncratic Hepatotoxicity 28
Combination Antiviral Therapy Spectrum of Clinical Presentation 28
for Chronic HBV Infection 7 Acute Hepatocellular Hepatitis 28
Antiviral Resistance 7 Acute Cholestatic Hepatitis 28
Management of Chronic HBV Mixed Pattern Acute Hepatitis 28
in Special Populations 8 Chronic Hepatitis 28
HIV/HBV Coinfection 8 Vascular Injury 29
Pregnancy 8 Other Forms of Less-Common
Decompensated Cirrhosis 8 Drug-Induced Liver Injury 29
Liver Transplantation 9 Steatosis 29
Pharmacotherapy Self-Assessment Program, 6th Edition xvii Preface
Table of Contents
Neoplastic Lesions 29 Patient Education 53
Granulomatous Hepatitis 29 Role of the Pharmacist 53
Hepatotoxicity from Specific Drugs 29 Conclusion 53
Acetaminophen 29 Annotated Bibliography 54
Anesthetic Agents 30 Self-Assessment Questions 57
Antimicrobial Agents 30
Antibacterial Drugs 30 Gastroenterology II
Antituberculosis Drugs 31
Antifungal Drugs 31
Anticonvulsants 31 MANAGEMENT OF PATIENTS
Phenytoin 31 RECEIVING BARIATRIC SURGERY
Carbamazepine 31 Learning Objectives 63
Valproic Acid 32 Introduction 63
Cardiovascular Agents 32 Using Body Mass Index to Define
Antiarrhythmic Drugs 32 and Classify Obesity 63
Antihypertensives 32 Prevalence of Overweight and Obesity 64
Anticoagulants 32 Current Treatment for Obesity 64
Warfarin 32 Indications, Treatment Goals,
Heparins 33 and Treatment Approaches 64
Lipid-Lowering Agents 33 Lifestyle Modifications and Pharmacotherapy 65
HIV Drugs 33 Surgical Therapy 65
Nucleoside Reverse Transcriptase Inhibitors 33 Evolution of Bariatric Surgery 65
Nonnucleoside Reverse General Principles and Historic Aspect 65
Transcriptase Inhibitors 34 Contemporary Procedures 66
Protease Inhibitors 34 Roux-en-Y Gastric Bypass 66
Hormonal Agents 34 Laparoscopic Adjustable Gastric Banding 68
Nonsteroidal Anti-inflammatory Drugs 34 Perioperative Management 69
Psychotropic Agents 35 Cardiac Management 69
Antidepressants 35 Glycemic Management 69
Antipsychotics 35 Surgical Wound Infection 69
Dietary Supplements 35 Thromboembolic Complications 69
Miscellaneous Drugs 36 Nutritional Management 70
Management of Drug-Induced Liver Disease 36 Drug Management 70
Role of the Pharmacist 37 Effects on Nutrient and Drug Absorption 71
Conclusion 37 Nutrient Absorption 71
Annotated Bibliography 37 Cobalamin, Folate, and Iron 71
Self-Assessment Questions 41 Calcium and Vitamin D 72
Other Nutrients 73
PEPTIC ULCER DISEASE: TREATMENT UPDATE Effect on Drug Absorption 73
Learning Objectives 45 Effect on Drug Metabolism and Transport 74
Overview of Peptic Ulcer Disease 45 Role of the Pharmacist 74
Introduction 45 Conclusion 75
Epidemiology 45 Annotated Bibliography 75
H. pylori–Associated PUD 45 Self-Assessment Questions 79
NSAID-Induced PUD 45
Pathophysiology 46 PROBIOTICS IN GASTROINTESTINAL DISEASE
H. pylori–Associated PUD 46 Learning Objectives 83
NSAID-Induced PUD 47 Introduction 83
Diagnosis of PUD 47 Overview of the Principles of Healthy
Clinical Signs and Symptoms 47 Gastrointestinal Flora 83
Diagnostic Tests for H. pylori 47 History of Probiotic Use 83
Drug Management and Prevention of PUD 48 Overview and Definition of Probiotics 84
NSAID-Induced PUD 48 Therapeutic Use of Probiotics 85
Prevention of NSAID-Induced PUD 48 Antibiotic-Associated Diarrhea 85
Drug Treatment of NSAID-Induced PUD 50 Acute Gastroenteritis 85
H. pylori–Associated PUD 50 Potential Benefits of Probiotic Therapy 86
Drug Treatment of H. pylori 50 Inflammatory Bowel Disease 86
ACG Guidelines 50 Ulcerative Colitis 86
Clinically Relevant Issues Related to Pouchitis 87
H. pylori Eradication Regimens 50 Crohn’s Disease 87
Management of Special Clinical Cases 52 Irritable Bowel Syndrome 87
Monitoring Therapy for PUD 52 Helicobacter pylori 88
Table of Contents
Preface xviii Pharmacotherapy Self-Assessment Program, 6th Edition
Complications of Probiotic Therapy 88 Laboratory Assessment 121
Role of the Pharmacist 89 Nutrition Considerations in
Product Selection 89 Patients Receiving CRRT 121
Patient Education 91 Metabolic Needs and Macronutrients 121
Conclusion 91 Energy Requirements 121
Annotated Bibliography 92 Dextrose 121
Self-Assessment Questions 95 Lipids 121
Protein Requirements 121
COLON CANCER Glutamine 122
Learning Objectives 99 Specialized Amino Acid Formulations 122
Introduction 99 Fluids 122
Epidemiology 99 Micronutrient Considerations 123
Pathophysiology 100 Electrolytes 123
Etiology and Risk Factors 100 Sodium 123
Pathogenesis 100 Potassium 123
Histologic Classification 101 Magnesium 123
Clinical Evaluation 101 Calcium 123
Screening and Prevention 101 Phosphorus 124
Presentation and Diagnosis 102 Vitamins 124
Staging 102 Thiamine 124
Prognosis 102 Folic Acid 124
Treatment Options 103 Vitamin C 124
Early Stage (Stage I) 103 Trace Elements 124
Stage II 103 Selenium 124
Fluorouracil and Leucovorin 103 Copper 124
Advanced Stage (Stage III) 105 Chromium 124
Chemotherapy 105 Zinc 124
Oxaliplatin 105 Acid-Base Balance 125
Capecitabine 105 Glycemic Control 125
Irinotecan 105 Nutritional Intervention 125
Metastatic Disease (Stage IV) 105 Enteral Nutrition 125
Chemotherapy 105 Parenteral Nutrition 125
FOLFOX4 vs. FOLFIRI 105 Monitoring Nutrition Support Therapy 126
Bevacizumab 105 Nitrogen Balance 126
Cetuximab 106 Prealbumin 126
Panitumumab 106 Triglycerides 126
The Role of the Pharmacist 107 The Role of the Pharmacist 126
Conclusion 107 Annotated Bibliography 126
Annotated Bibliography 107 Self-Assessment Questions 129
Self-Assessment Questions 113
HOME PARENTERAL NUTRITION
Nutrition Learning Objectives 133
Introduction 133
Patient Selection 133
METABOLIC AND NUTRITION ISSUES Indications 133
IN PATIENTS RECEIVING CONTINUOUS Home Assessment 134
RENAL REPLACEMENT THERAPY Availability of Emergency Services 134
Learning Objectives 119 Discharge Planning 134
Introduction 119 Setting Clinical and Nutritional Goals 134
Continuous Renal Replacement Therapy 119 Cost and Coverage for Home PN 135
Acute Renal Failure and CRRT 119 Medicare 135
Access for CRRT 119 Medicaid 135
Principles of CRRT 120 Private Insurance 135
Continuous Renal Replacement Modalities 120 Central Venous Access Devices 135
Slow Continuous Ultrafiltration 120 Tunneled CVADs 135
Continuous Hemofiltration 120 Implanted Ports 136
Continuous Hemodialysis 120 Peripherally Inserted Central Venous Catheters 136
Continuous Hemodiafiltration 120 Inappropriate CVADs for Home PN 136
Nutritional Assessment in Infusion Delivery Devices 136
Patients Receiving CRRT 120 Selecting an HCP 136
Anthropometrics 120 Patient Education 137
Bioelectrical Impedance Analysis 121 Starting PN in the Home 137
Table of Contents
Pharmacotherapy Self-Assessment Program, 6th Edition xix Preface
Complications of Home PN 137 Guidelines for Immunonutrition Use 158
Acute Complications 137 Pharmacist’s Role 159
Dehydration 137 Conclusion 159
CVAD Malposition, Occlusion, Annotated Bibliography 159
and Thrombosis 138 Self-Assessment Questions 163
CVAD-Related Infections 138
Electrolyte Imbalances 138 DIETARY SUPPLEMENTS
Sodium and Chloride 138 Learning Objectives 167
Potassium, Magnesium, and Phosphorus 139 Introduction 167
Calcium 139 Definitions 167
Acid-Base Abnormalities 139 Demographics of Dietary Supplement Use 167
Blood Urea Nitrogen and Creatinine 139 Impetus for Dietary Supplement Use 167
Macronutrient Complications 139 Regulatory and Legal Issues 168
Glucose 139 Dietary Supplement Health
Lipids 140 and Education Act of 1994 168
Chronic Complications 140 Verification Programs and
PN-Associated Liver Disease 140 Industry Self-regulation 168
Metabolic Bone Disease 140 Good Manufacturing Practices 168
Small Intestine Bacterial Overgrowth 141 Advertising 170
Vitamin Imbalances 141 General Overview of Safety Issues 171
Anemia 141 Adverse Events and Dangerous Supplements 171
Zinc, Manganese, and Copper 142 Dietary Supplement Use in Special Populations 171
Additional Monitoring of Home PN Therapy 142 Pediatrics 171
Weight 142 Pregnancy and Lactation 171
Activities of Daily Living 143 Geriatrics 171
Laboratory and Other Tests 143 Specific Dietary Supplements
Adherence 143 Subjected to Recent Clinical Trials 171
Quality of Life 143 Black Cohosh 171
Conclusion 143 Ginkgo 172
Annotated Bibliography 143 Glucosamine 172
Self-Assessment Questions 147 Green Tea 173
IMMUNONUTRITION Policosanol 174
Learning Objectives 151 Saint John’s Wort 174
Introduction 151 Soy 175
Pathophysiology 151 Role of the Pharmacist 177
Supplements and Mechanisms 151 Conclusion 177
Glutamine 151 Annotated Bibliography 177
Metabolism and Use 151 Self-Assessment Questions 181
Immune Effects 152
Arginine 152
Metabolism and Use 152
Immune Effects 152
Nucleotides 153
Metabolism and Use 153
Immune Effects 153
Omega-3 Polyunsaturated Fatty Acids 153
Metabolism and Use 153
Immune Effects 153
Antioxidant Vitamins/Minerals 153
Therapeutic Goals/Outcomes 153
Effect of Preexisting Nutritional Status 154
Effect of Illness Severity 154
Quality Patient Care 154
Pharmacotherapy 154
Treatment Plan 154
Results in Critically Ill Patient Populations 154
Trauma 154
General and Oncologic Surgery 156
Acute Respiratory Distress
Syndrome/Acute Lung Injury 156
Burns 157
Mixed Critically Ill Populations 157
Table of Contents
Preface xx Pharmacotherapy Self-Assessment Program, 6th Edition
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