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Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at studentconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. 2015v1.0 CLINICAL PHARMACY AND THERAPEUTICS This page intentionally left blank CLINICAL PHARMACY AND THERAPEUTICS SIXTH EDITION EDITED BY CATE WHITTLESEA, BSc, MSc, PhD, MRPharmS Professor of Pharmacy Practice and Associate Director of Clinical Education UCL School of Pharmacy University College London London, UK and KAREN HODSON, BSc(Pharm), MSc, PhD, FRPharmS, FFRPS Director MSc in Clinical Pharmacy and Pharmacist Independent Prescribing Programmes School of Pharmacy and Pharmaceutical Sciences, Cardiff University Cardiff, UK For additional online content visit StudentConsult.com © 2019, Elsevier Limited. All rights reserved. First edition 1994 Second edition 1999 Third edition 2003 Fourth edition 2007 Fifth edition 2012 Sixth edition 2019 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Practitioners and researchers must always rely on their own experience and knowledge in e valuating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent veriication of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: 978-0-7020-7012-9 International Edition ISBN 978-0-7020-7011-2 Senior Content Strategist: Pauline Graham Content Development Specialist: Carole McMurray Project Manager: Beula Christopher Design: Paula Catalano Illustration Manager: Amy Faith Heyden Illustrator: MPS LLC Marketing Manager: Deborah Watkins Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Preface In both primary and secondary health care, the use of medicines altered, the evidence base for a speciic treatment. Together with is the most common intervention. However, the use of medicines the ongoing publication of national and international guidelines is not without risk. Selecting and prescribing drugs is increas- and frameworks, the face of therapeutics is ever changing. It ingly complex and demanding, and it is undertaken as part of is therefore inevitable that some sections of this book will date a multi-disciplinary process that involves pharmacists, some of more quickly than others. whom are now prescribers in their own right, along with doctors, In practice, many licensed drugs are used ‘off label’ or ‘near nurses and other members of the healthcare team. All must strive label’ when prescribed for a certain indication or used in a speciic to promote safe, appropriate and cost-effective prescribing that patient group, such as children. To omit reference to these agents respects patient choice and promotes adherence. This book was in the relevant chapter would leave an apparent gap in therapeutic written to help the reader understand and address many of these management. As a consequence, we have encouraged our authors issues. It is unashamedly written from a pharmacy perspective, to present details of all key drugs used, along with details of the although we do hope those from other disciplines will also ind prescribed regimens, even if not licensed for that speciic indica- it of use. tion. There is, however, a downside to this approach. The reader We have made considerable effort to update each chapter and must always use this text critically and with caution. If this is ensure the content is relevant to current practice. Selected website done, the book will serve as a valuable learning resource and help addresses have been included to assist those who want to obtain the reader understand some of the principles of therapeutics. We further information, and many references are now available hope that, in some small way, this will also assist in achieving electronically. However, knowledge in therapeutics progresses positive patient outcomes. rapidly, changes to dose regimens and licensed indications are frequent, safety issues emerge with established drugs and new Cate Whittlesea medicines appear at regular intervals. Yesterday another land- Karen Hodson mark study may have been published that added to, or perhaps v Acknowledgements The irst edition of this book was published in 1994 by Roger A textbook of this size cannot, of course, be produced without Walker and Clive Edwards. We very much hope that this edition the invaluable help, support and occasional comments of numer- lives up to the high standards of both past editors. We acknowl- ous colleagues, particularly from the Department of Pharmacy, edge the enormous contribution Roger Walker made to all previ- Durham University, UCL School of Pharmacy and the Associate ous editions and very much hope he will look in pride at this, our Course Directors of the MSc in Clinical Pharmacy within the irst edition, without him at the helm. Like Roger, undergradu- School of Pharmacy and Pharmaceutical Sciences, Cardiff ate and postgraduate students have sustained our enthusiasm University. It would be invidious to name individuals who have and commitment while continuing to be the inspiration and the helped us, in part for fear of offending anyone we might miss. raison d’etre for this book. To all those who have provided feed- We do, however, continue to make one exception to this rule. back in the past, thank you. For those who would like to comment The administrative support from Dean Routledge has been on this edition, we welcome your feedback; please contact us at invaluable. [email protected] or [email protected]. Finally, and on a personal note, we would like thank our close We remain indebted to all authors who, through their hard families for their support and tolerance with our indulgence in work, patience and tolerance, have contributed to the sixth edi- editing this text. At times it may have appeared that everything in tion of this book. We are particularly grateful to those who have our lives took second place to ‘the book’. We are eternally grate- again contributed to another edition of this textbook and who ful for their understanding, particularly when we got our priori- strive, along with us, to produce an ever-better book. To our irst- ties in life wrong. Without the unfailing support of Rob and Phil, time authors, we are very grateful for your contribution, that you Maddy and Logan, this book would never have materialised. accepted our cryptic editorial comments in good faith and still managed to submit on time. We hope that you will continue to Cate Whittlesea work with us on future editions. Karen Hodson vi List of Contributors The editors would like to acknowledge and offer grateful thanks for the input of all previous editions’ contributors, without whom this new edition would not have been possible. Tamara Ahmed Ali Jonathan Berry Directorate Lead Pharmacist-Ophthalmology, City Academic Clinical Educator, School of Pharmacy, Keele Hospitals Sunderland NHS Trust, Sunderland, UK University, Staffordshire, UK 56. Glaucoma 14. Constipation and diarrhoea Sotiris Antoniou Stephen Bleakley Consultant Pharmacist, Cardiovascular Medicine, Barts Chief Pharmacist, Salisbury NHS Foundation Trust, Health NHS Trust, St Bartholomew’s Hospital, London, UK Salisbury, UK 22. Arrhythmias 28. Anxiety disorders Kelly Atack Gonçalo Cação Advanced Clinical Pharmacist, Medicines Management UCL Institute of Neurology, London, UK and Pharmacy, St James’s University Hospital, Leeds 31. Epilepsy Teaching Hospital NHS Trust, Leeds, UK 25. Asthma Anthony Cadogan Macmillan Advanced Pharmacist, Haematology and Deborah Baidoo Oncology, Prince Charles Hospital (Merthyr Tydfil) Chief Pharmacist (Interim), West London Trust, and Royal Glamorgan Hospital (Llantrisant), Cwm Taf St Bernard’s Hospital, Middlesex, London, UK University Health Board, Wales, UK 27. Insomnia 50. Anaemia David S. Baldwin Laura Cameron Professor of Psychiatry, Clinical and Experimental Principal Pharmacist - Cancer Services Operational Lead, Sciences Academic Unit, Faculty of Medicine, University Guy’s and St Thomas’ NHS Foundation Trust, London, UK of Southampton, Southampton, UK 52. Lymphomas 28. Anxiety disorders Toby Capstick Catrin Barker Lead Respiratory Pharmacist, Pharmacy Department, Chief Pharmacist, Pharmacy Department, Alder Hey Leeds Teaching Hospitals NHS Trust, Leeds, UK Children’s NHS Foundation Trust, Liverpool, UK 41. Tuberculosis 10. Paediatrics Neil J. B. Carbarns Roger Barker Consultant Medical Microbiologist, Aneurin Bevan Professor of Clinical Neuroscience, Honorary University Health Board, Abergavenny, Consultant in Neurology, University of Cambridge and Monmouthshire, UK Addenbrooke’s Hospital, Cambridge, UK 37. Urinary tract infections 32. Parkinson’s disease Sheena Castelino Lee Beale Principal Pharmacist, HIV and Sexual Health, Guy’s Anaesthetic Registrar ST7, University Hospital of Wales, and St Thomas’ NHS Foundation Trust, Pharmacy Cardiff, UK Department, St Thomas’ Hospital, London, UK 6. Laboratory data 42. HIV infection vii LIST OF CONTRIBUTORS Ben Challocombe Sarah Cripps Consultant Urologist, Guy’s and St Thomas’ NHS Consultant Pharmacist - Gastroenterology/Hepatology, Foundation Trust, London, UK Oxford University Hospitals NHS Foundation Trust, 49. Prostate disease Oxford, UK 13. Inflammatory bowel disease Ian Clifton Consultant Respiratory Physician and Honorary Senior Emma Crosbie Lecturer, Department of Respiratory Medicine, NIHR Clinician Scientist, Senior Lecturer and Honorary St James’s University Hospital, Leeds Teaching Hospital Consultant in Gynaecological Oncology, Division of NHS Trust, Leeds, UK Molecular and Clinical Cancer Sciences, University of 25. Asthma Manchester, St Mary’s Hospital, Manchester, UK 46. Menstrual cycle disorders Paul Cockwell 47. Menopause Consultant Nephrologist, University Hospital Birmingham and Professor of Nephrology, University of Octavio Aragon Cuevas Birmingham, Birmingham, UK Lead Rheumatology Pharmacist, Pharmacy Department, 17. Acute kidney injury Alder Hey Children’s NHS Foundation Trust, Liverpool, UK 18. Chronic kidney disease and end-stage renal disease 10. Paediatrics Katie Conway J. Graham Davies Consultant Physician in GU/HIV Medicine, Guy’s and Professor of Clinical Pharmacy and Therapeutics, King’s St Thomas’ NHS Foundation Trust, Pharmacy College London, London, UK Department, St Thomas’ Hospital, London, UK 1. Clinical pharmacy practice 42. HIV infection Nemesha Desai Jonathan Cooke Consultant Dermatologist, St John’s Institute of Honorary Professor, Manchester Pharmacy School, Dermatology, Guy’s and St Thomas’ NHS Foundation Faculty of Biology, Medicine and Health, University Trust, London, UK of Manchester, Manchester; Visiting Professor in the 58. Eczema and psoriasis Infectious Diseases and Immunity Section, Division of Infectious Diseases, Department of Medicine, Imperial Mark D. Doherty College London, London, UK Consultant Ophthalmologist, Sunderland Eye Infirmary, 8. Pharmacoeconomics Sunderland, UK 56. Glaucoma Alan G. Cosslett Lecturer, School of Pharmacy and Pharmaceutical Tobias Dreischulte Sciences, Cardiff University, Cardiff, UK Research Pharmacist, NHS Tayside, Community Health 7. Parenteral nutrition Sciences Division, Dundee, UK 21. Chronic heart failure Anthony R. Cox Senior Lecturer in Clinical Pharmacy and Drug Safety, Jackie Elliott School of Pharmacy, University of Birmingham, Senior Clinical Lecturer in Diabetes and Honorary Birmingham, UK Consultant, Diabetes and Endocrine Centre, Northern 5. Adverse drug reactions General Hospital, Sheffield, UK 45. Diabetes mellitus Netty (Annette) Cracknell Specialist Oncology Pharmacist, Netty Cracknell Sarah Fenner Consultancy; Pharmacy Manager, Springfield Hospital, Director, West Midlands Medicines Information Service Chelmsford, UK; Executive Committee Member, British and UK Drugs in Lactation Advisory Service, Good Hope Oncology Pharmacy Association (BOPA), UK Hospital, Sutton Coldfield, UK 53. Solid tumours 48. Drugs in pregnancy and lactation Daniel Creamer Ray W. Fitzpatrick Consultant Dermatologist, Department of Clinical Director of Pharmacy, New Cross Hospital, Dermatology, King’s College Hospital NHS Foundation Wolverhampton, UK Trust, London, UK 3. Practical pharmacokinetics 57. Drug-induced skin disorders viii