P1: Trim:8.375in×10.875in Top:0.373in Gutter:0.664in LWBK915-fm LWW-KodaKimble-educational December7,2011 20:13 i Applied Therapeutics The Clinical Use of Drugs T E N T H E D I T I O N EditedBy BrianK.Alldredge,PHARMD PamalaA.Jacobson,PHARMD ProfessorofClinicalPharmacyandAssociate AssociateProfessor Dean,AcademicAffairs DepartmentofExperimentalandClinicalPharmacology DepartmentofClinicalPharmacy CollegeofPharmacy SchoolofPharmacy UniversityofMinnesota UniversityofCalifornia,SanFrancisco Minneapolis,Minnesota SanFrancisco,California WayneA.Kradjan,PHARMD,BCPS RobinL.Corelli,PHARMD DeanEmeritusandProfessorEmeritus ProfessorofClinicalPharmacy CollegeofPharmacy DepartmentofClinicalPharmacy OregonStateUniversity SchoolofPharmacy OregonHealth&ScienceUniversity UniversityofCalifornia,SanFrancisco Corvallis,Oregon SanFrancisco,California BradleyR.Williams,PHARMD,FASCP,CGP MichaelE.Ernst,PHARMD,BCPS,FCCP ProfessorofClinicalPharmacyandClinicalGerontology Professor(Clinical) TitusFamilyDepartmentofClinicalPharmacyand DepartmentofPharmacyPracticeandScience PharmaceuticalEconomicsandPolicy CollegeofPharmacy SchoolsofPharmacyandGerontology DepartmentofFamilyMedicine UniversityofSouthernCalifornia CarverCollegeofMedicine LosAngeles,California TheUniversityofIowa IowaCity,Iowa B.JosephGuglielmo,PHARMD ProfessorandChair TAOliverChairinClinicalPharmacy DepartmentofClinicalPharmacy SchoolofPharmacy UniversityofCalifornia,SanFrancisco SanFrancisco,California P1: Trim:8.375in×10.875in Top:0.373in Gutter:0.664in LWBK915-fm LWW-KodaKimble-educational December9,2011 2:6 AcquisitionsEditor:DavidB.Troy ProjectManager:MeredithL.Brittain MarketingManager:JoyFisher-Williams Designer:DougSmock Compositor:Aptara,Inc. (cid:2)c 2013,2009,2005byLIPPINCOTTWILLIAMS&WILKINS,aWOLTERSKLUWERbusiness TwoCommerceSquare 2001MarketStreet Philadelphia,PA19103USA LWW.com TenthEdition Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproducedinany formbyanymeans,includingphotocopying,orutilizedbyanyinformationstorageandretrievalsystem withoutwrittenpermissionfromthecopyrightowner,exceptforbriefquotationsembodiedincritical articlesandreviews.Materialsappearinginthisbookpreparedbyindividualsaspartoftheirofficialduties asU.S.governmentemployeesarenotcoveredbytheabove-mentionedcopyright. PrintedinChina LibraryofCongressCataloging-in-PublicationData Koda-KimbleandYoung’sappliedtherapeutics:theclinicaluseofdrugs. –10thed./editedbyBrianK.Alldredge... [etal.]. p.;cm. Appliedtherapeutics Rev.ed.of:Appliedtherapeutics:theclinicaluseofdrugs/edited byMaryAnneKoda-Kimble...[etal.].9thed.c2009. Includesbibliographicalreferencesandindex. ISBN978-1-60913-713-7 I.Koda-Kimble,MaryAnne. II.Alldredge,BrianK. III.Appliedtherapeutics. IV.Title:Appliedtherapeutics. [DNLM:1.DrugTherapy–methods.WB330] 615.5(cid:2)8–dc23 2011047631 Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentedandtodescribegenerally acceptedpractices.However,theauthors,editors,andpublisherarenotresponsibleforerrorsoromissions orforanyconsequencesfromapplicationoftheinformationinthisbookandmakenowarranty,expressed orimplied,withrespecttothecurrency,completeness,oraccuracyofthecontentsofthepublication. Applicationoftheinformationinaparticularsituationremainstheprofessionalresponsibilityofthe practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosagesetforthinthistextareinaccordancewithcurrentrecommendationsandpracticeatthetimeof publication.However,inviewofongoingresearch,changesingovernmentregulations,andtheconstant flowofinformationrelatingtodrugtherapyanddrugreactions,thereaderisurgedtocheckthepackage insertforeachdrugforanychangeinindicationsanddosageandforaddedwarningsandprecautions. Thisisparticularlyimportantwhentherecommendedagentisaneworinfrequentlyemployeddrug. SomedrugsandmedicaldevicespresentedinthepublicationhaveFoodandDrugAdministration (FDA)clearanceforlimiteduseinrestrictedresearchsettings.Itistheresponsibilityofthehealthcare providertoascertaintheFDAstatusofeachdrugordeviceplannedforuseintheirclinicalpractice. Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartmentat(800)638-3030orfax ordersto(301)223-2320.Internationalcustomersshouldcall(301)223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customerservicerepresentativesareavailablefrom8:30amto6pm,EST. 987654321 ii P1: Trim:8.375in×10.875in Top:0.373in Gutter:0.664in LWBK915-fm LWW-KodaKimble-educational December7,2011 20:13 Dedication The Editors wish to express their sincere thanks and longstanding admirationtothecreatorsofAppliedTherapeutics,Drs.MaryAnne Koda-KimbleandLloydYoung.Theyaretrulyeducationalvisionaries whomwedeeplyrespectastheinnovatorsandpioneersintheteach- ing of patient-centered drug therapeutics. Their passion has touched thelivesofcountlesshealthcareprofessionalstudents,clinicians,and patientsthroughouttheworld.Astheircolleaguesandfriends,weare foreverindebtedfortheircontributionsandweconsideritaprivilegeto carryforwardtheirlegacy—renamedasKoda-KimbleandYoung’s AppliedTherapeutics—intofutureeditions. iii P1: Trim:8.375in×10.875in Top:0.373in Gutter:0.664in LWBK915-fm LWW-KodaKimble-educational November22,2011 22:21 Preface Ithasbeennearly40yearssincethefirsteditionofAppliedTher- severalappropriateinformationsourceswhenworkingwithnewand apeutics:TheClinicalUseofDrugswaspublished.Thelandscape unfamiliardrugs. ofhealthcarehasevolvedradicallyduringthistime,muchofit spurredbyremarkableadvancementsindrugdiscoveryandclin- ACKNOWLEDGMENTS icaltherapeutics.Despitethesechanges,thefoundingprinciple forthisinnovativetext—apatient-centric,case-basedapproach tolearning—remainsintegraltothecurrentedition.Ourauthors Wearedeeplyindebtedtothemanydedicatedpeoplewhohave presentmorethan860patientcasesthatstimulatethereaderto givenofthemselvestocompletethetentheditionofKoda-Kimble integrateandapplytherapeuticprinciplesinthecontextofspe- andYoung’sAppliedTherapeutics.Asalways,wearemostgrateful cificclinicalsituations.Studentsandpractitionersareprovided to our contributing authors who have been attentive to meet- with a glimpse into the minds of clinicians as they assess and ingourstringenttimedeadlinesanduniquewritingformat.We solvetherapeuticproblemstowardthedevelopmentoftheirown especiallythankthoseauthorswhograciouslyprovidedmulti- critical-thinkingandproblem-solvingskills.Everychapterinthis mediatoaccompanytheirchapter,andwegratefullyrecognize editionhasbeenrevisedandupdatedtoreflectourever-changing the additional time and effort this entailed. We hold their cre- knowledgeofdrugsandtheapplicationofthisknowledgetothe ativityinthehighestregard.Theexceptionalworkofoursection individualizedtherapyofpatients.Additionally,contentwithin editors, Judith Beizer, Marcia Buck, Shareen El-Ibiary, Marcus severalsectionshasbeenextensivelyreorganized,withnewchap- Ferrone,PatrickFinley,TimothyIves,MarkKirstein,LisaKroon, ters introduced to expand important topics. Among these are KellyLee,MyrnaMunar,JeanNappi,TriciaRussell,andJoseph newchaptersintheArthriticDisorders,Women’sHealth,Neu- Saseen,cannotbeoverstated.Thesecontentexpertsgaveuscriti- rologicDisorders,NeoplasticDisorders,andPediatricssections. calfeedbacknecessaryinboththeorganizationalstructureofthe Readersfamiliarwithpasteditionsofthetextwillnoticesome textbookandintheindividualeditingofchapters;withouttheir welcome changes in the tenth edition. The overall design has dedicationandassistance,thiseditionwouldnotbepossible.We beenupdatedforvisualappealandtoallowthereadertomore wouldalsoliketothankFactsandComparisonsforallowingus quicklydistinguishcasesfromsurroundingtext.Inlieuofthetra- tousetheirdatafortheconstructionofsomeofourtables. ditionalchapteroutline,allchaptersnowcontainaCorePrinci- Two individuals from Lippincott Williams and Wilkins, plessectionatthebeginning,whichprovidesthemostimportant Meredith Brittain and Loftin (Paul) Montgomery, Jr., deserve “takehome”informationfromthechapter.EachCorePrinciple specialrecognitionfortheirefforts.Theirexceptionalpatience, ismappedtospecificcaseswithinthechapterwheretheprinci- attentiontodetail,andfirmguidancehelpedusallstayontask. pleisdiscussedindetail.Keyreferencesandwebsitesarelistedat Thiseditionwouldnothavecometocompletionwithouttheir theendofeachchapter,whereasthefullreferencelistsforeach partnership.MaryTod(copyediting),EdSchultes,Jr.(multimedia chapterhavebeenmovedonline. production),andJeriLitteral(typesetting)allplayedkeyrolesin A particularly significant change to the tenth edition is the theproductionofthetenthedition,andwesincerelythankthem incorporationofonlinemultimediacontent,muchofitauthor- fortheirassistanceincompletingthisedition.Mostimportantly, created,formanyofthechapters.Theseincludeimages,videos, wewouldberemissnottoacknowledgethelove,understanding, narratedpresentations,animations,andpodcasts,whichcanbe andsupportofourspouses,children,andinsomecases,grand- foundonthetextbook’swebsite(seethe“AdditionalResources” children.Theyselflesslygavetousthemanyearlymornings,late section,whichfollowsthispreface,formoreinformation).The nights,andweekendswespentwritingandediting. incorporation of supplemental multimedia into the tenth edi- Asinpasteditions,wecontinuetodedicateourworktoour tionmarksacommitmentonthepartoftheeditorialteamto studentswhoinspireusandtothemanypatientswehavebeen ensurethatKoda-KimbleandYoung’sAppliedTherapeuticsincreases privilegedtocarefor.Ourpatientshaverepeatedlytaughtushow itsroleasaviableanddynamicresourcethatcanappealtomul- criticalitistotailorourknowledgetotheirspecificcircumstances, tiplelearningstylesandfuturegenerations.Wewelcomeyour tolistenwell,andtowelcomethemastruepartnersintheircare. feedbackasweundertakeplanningforthenextedition. Theauthorshavedrawnoninformationfromtheliterature, BrianK.Alldredge currentstandards,andtheirownclinicalexperiencestosharethe RobinL.Corelli process involved in making sound and thoughtful therapeutic MichaelE.Ernst decisions.However,itremainstheresponsibilityofeverypractitioner B.JosephGuglielmo toevaluatetheappropriatenessofaparticularopinioninthecontextof PamalaA.Jacobson theactualclinicalsituation,bearinginmindanyrecentdevelopments WayneA.Kradjan in the field. We strongly urge students and practitioners to consult BradleyR.Williams iv P1: Trim:8.375in×10.875in Top:0.373in Gutter:0.664in LWBK915-fm LWW-KodaKimble-educational November22,2011 22:21 Additional Resources TheTenthEditionofKoda-KimbleandYoung’sAppliedTherapeu- (cid:2)Videos(somecreatedbyauthor) tics: The Clinical Use of Drugs includes additional resources for (cid:2)Additionalcontent(createdbyauthor) bothinstructorsandstudents,availableonthebook’scompan- (cid:2)Interactiveversionsofthealgorithmsfoundinthebook ionwebsiteathttp://thepoint.lww.com/AT10e. (cid:2)Full-colorimages STUDENT RESOURCES INSTRUCTOR RESOURCES Students who have purchased Koda-Kimble and Young’s Applied Approvedadoptinginstructorswillbegivenaccesstothefollow- Therapeutics:TheClinicalUseofDrugs,TenthEditionhaveaccess ingadditionalresources: tothefollowingadditionalresourcesforeachchapter: (cid:2)PowerPointslides (cid:2)Anaudiorecordingofthatchapter’scoreprinciples (cid:2)Imagebank(includesallimagesandtablesinthebook) (cid:2)Afullonlinereferencelistforthatchapter (cid:2)Pathophysiologyimagecollection Inaddition,atleastoneofthefollowingsupplementseachchap- Inaddition,purchasersofthetextcanaccessthesearchableFull tertoenhancethechaptercontent: Text On-line by going to the Koda-Kimble and Young’s Applied (cid:2)Audiofiles(mostrecordedbyauthor) Therapeutics:TheClinicalUseofDrugs,TenthEditionwebsiteat (cid:2)PowerPoints(mostcreatedbyauthor) http://thepoint.lww.com/AT10e.Seetheinsidefrontcoverfor (cid:2)PowerPointswithaudio(mostcreated/recordedbyauthor) moredetails,includingthepasscodeyouwillneedtogainaccess (cid:2)Animations tothewebsite. v P1: Trim:8.375in×10.875in Top:0.373in Gutter:0.664in LWBK915-fm LWW-KodaKimble-educational November22,2011 22:21 Section Editors JudithL.Beizer,PharmD,CGP,FASCP LisaA.Kroon,PharmD,CDE ClinicalProfessor ProfessorofClinicalPharmacy DepartmentofClinicalPharmacyPractice DepartmentofClinicalPharmacy CollegeofPharmacy&AlliedHealthProfessions SchoolofPharmacy St.John’sUniversity UniversityofCalifornia,SanFrancisco Jamaica,NewYork ClinicalPharmacist,GeneralInternalMedicineand DiabetesClinics MarciaL.Buck,PharmD,FCCP,FPPAG UniversityofCalifornia,SanFranciscoMedicalCenter AssociateProfessor,Pediatrics SanFrancisco,California SchoolofMedicine ClinicalCoordinator,Pediatrics KellyC.Lee,PharmD,BCPP DepartmentofPharmacy AssistantProfessorofClinicalPharmacy UniversityofVirginia SkaggsSchoolofPharmacyandPharmaceuticalSciences Charlottesville,Virginia UniversityofCalifornia,SanDiego LaJolla,California ShareenY.El-Ibiary,PharmD,BCPS AssociateProfessorofPharmacyPractice MyrnaY.Munar,PharmD DepartmentofPharmacyPractice AssociateProfessor MidwesternUniversity,CollegeofPharmacy—Glendale DepartmentofPharmacyPractice Glendale,Arizona CollegeofPharmacy OregonStateUniversity MarcusFerrone,PharmD,BCNSP OregonHealthandScienceUniversity AssociateProfessorofClinicalPharmacy Portland,Oregon Director,DrugProductsServicesLaboratory DepartmentofClinicalPharmacy JeanM.Nappi,PharmD,FCCP,BCPS SchoolofPharmacy Professor UniversityofCalifornia,SanFrancisco ClinicalPharmacyandOutcomeSciences SanFrancisco,California SouthCarolinaCollegeofPharmacy ClinicalPharmacySpecialistinCardiology PatrickR.Finley,PharmD,BCPP MedicalUniversityofSouthCarolina ProfessorofClinicalPharmacy Charleston,SouthCarolina DepartmentofClinicalPharmacy SchoolofPharmacy UniversityofCalifornia,SanFrancisco TriciaM.Russell,PharmD,BCPS,CDE SanFrancisco,California AssistantProfessor DepartmentofPharmacyPractice TimothyJ.Ives,PharmD,MPH,FCCP,BCPS WilkesUniversity,NesbittCollegeofPharmacy&Nursing Wilkes-Barre,Pennsylvania Professor EshelmanSchoolofPharmacy TheUniversityofNorthCarolinaatChapelHill JosephJ.Saseen,PharmD,FCCP,FASHP,BCPS ChapelHill,NorthCarolina Professor UniversityofColoradoAnschutzMedicalCampus MarkN.Kirstein,PharmD SchoolsofPharmacyandMedicine AssociateProfessor Director,PGY2AmbulatoryCare/FamilyMedicine DepartmentofExperimentalandClinicalPharmacology Residency CollegeofPharmacy ClinicalPharmacySpecialist UniversityofMinnesota DepartmentofFamilyMedicine Minneapolis,Minnesota Aurora,Colorado vi P1: Trim:8.375in×10.875in Top:0.373in Gutter:0.664in LWBK915-fm LWW-KodaKimble-educational December8,2011 11:5 Contributors StevenR.Abel,PharmD,FASHP MariaBallod,PharmD AssociateDeanforClinicalPrograms NutritionSupportPharmacist BuckeProfessorandHead DepartmentofPharmacy DepartmentofPharmacyPractice InstructorofPharmacy PurdueUniversityCollegeofPharmacy CollegeofMedicine WestLafayette,Indiana MayoClinic Jacksonville,Florida JessicaL.Adams,PharmD HumanImmunodeficiencyVirusPharmacologyFellow AndrewD.Barnes,PharmD EshelmanSchoolofPharmacy ClinicalProfessor UniversityofNorthCarolinaChapelHill SchoolofPharmacy ChapelHill,NorthCarolina UniversityofWashington Director,CriticalCareResidency,PharmacyServices BrianK.Alldredge,PharmD UniversityofWashingtonMedicine ProfessorandAssociateDean Seattle,Washington DepartmentofClinicalPharmacy SchoolofPharmacy DavidT.Bearden,PharmD UniversityofCalifornia,SanFrancisco ClinicalAssociateProfessor SanFrancisco,California DepartmentofPharmacyPractice CollegeofPharmacy JudithA.Alsop,PharmD OregonStateUniversity HealthSciencesClinicalProfessor Portland,Oregon DepartmentofClinicalPharmacy SchoolofPharmacy SandraBenavides,PharmD UniversityofCalifornia,SanFrancisco AssistantProfessor Director,SacramentoDivision,CaliforniaPoisonControlSystem PharmacyPractice UniversityofCalifornia,DavisHealthSystem CollegeofPharmacy SanFranciscoandSacramento,California NovaSoutheasternUniversity ClinicalPharmacist J.V.Anandan,PharmD DepartmentofPharmacy AdjunctAssociateProfessor JoeDiMaggioChildren’sHospital EugeneApplebaumCollegeofPharmacyandHealthSciences FortLauderdaleandHollywood,Florida WayneStateUniversity PharmacySpecialist RosemaryR.Berardi,PharmD,FCCP,FASHP,FAPhA DepartmentofPharmacyServices ProfessorofPharmacy HenryFordHospital CollegeofPharmacy Detroit,Michigan UniversityofMichigan AnnArbor,Michigan HeatherM.Arnold,PharmD,BCPS CriticalCareClinicalPharmacist PaulM.Beringer,PharmD,FASHP,FCCP DepartmentofPharmacy AssociateProfessor Barnes-JewishHospital DepartmentofClinicalPharmacy St.Louis,Missouri UniversityofSouthernCalifornia MagdaleneM.Assimon,PharmD LosAngeles,California NephrologyPharmacotherapyResearchFellow DepartmentofPharmacyPractice JeffF.Binkley,PharmD,BCNSP,FASHP AlbanyCollegeofPharmacyandHealthSciences AssistantProfessor Albany,NewYork DepartmentofClinicalPharmacy UniversityofTennesseeCollegeofPharmacy FrancescaT.Aweeka,PharmD DirectorofPharmacy Professor MauryRegionalMedicalCenter DepartmentofClinicalPharmacy MemphisandColumbia,Tennessee SchoolofPharmacy UniversityofCalifornia,SanFrancisco KarenBethH.Bohan,PharmD,BCPS SanFrancisco,California AssociateProfessor DepartmentofPharmacyPractice JenniferH.Baggs,PharmD,BCPS WilkesUniversity ClinicalStaffPharmacist ClinicalPharmacist DepartmentofPharmacy DepartmentofPharmacy UniversityMedicalCenter Wilkes-BarreGeneralHospital Tucson,Arizona Wilkes-Barre,Pennsylvania vii P1: Trim:8.375in×10.875in Top:0.373in Gutter:0.664in LWBK915-fm LWW-KodaKimble-educational December8,2011 11:5 viii LauraM.Borgelt,PharmD,BCPS,FCCP StevenW.Chen,PharmD,FASHP AssociateProfessor AssociateProfessor C DepartmentsofClinicalPharmacyandFamily DepartmentofClinicalPharmacyandPharmaceutical o ntr Medicine EconomicsandPolicy ib UniversityofColoradoAnschutzMedicalCampus HygeiaCentennialChairinClinicalPharmacy u to Aurora,Colorado UniversityofSouthernCaliforniaSchoolofPharmacy r s LosAngeles,California JoleneR.Bostwick,PharmD,BCPS,BCPP MichaelF.Chicella,PharmD ClinicalAssistantProfessor ClinicalCoordinator DepartmentofClinical,Social,andAdministrative DepartmentofPharmacy Sciences Children’sHospitalofTheKing’sDaughters UniversityofMichiganCollegeofPharmacy Norfolk,Virginia ClinicalPharmacistinPsychiatry DepartmentofPharmacyServices JenniferW.Chow,PharmD UniversityofMichiganHealthSystem PediatricClinicalSpecialist AnnArbor,Michigan DepartmentofPharmacy Children’sHospitalofTheKing’sDaughters NicoleJ.Brandt,PharmD,CGP,BCPP,FASCP Norfolk,Virginia AssociateProfessor DepartmentofPharmacyPracticeandScience CaryR.Chrisman,PharmD UniversityofMaryland,Baltimore AssistantProfessor ClinicalPharmacist,Geriatrics DepartmentofClinicalPharmacy VeteransAffairs UniversityofTennesseeCollegeofPharmacy Baltimore,Maryland ClinicalPharmacist,DepartmentofPharmacy MethodistMedicalCenter MemphisandOakRidge,Tennessee TinaPenickBrock,MSPharm,EdD ProfessorandAssociateDean DepartmentofClinicalPharmacy ThomasE.Christian,BSPharm,BCPS SchoolofPharmacy PharmacyTherapeuticsManager,Infectious UniversityofCalifornia,SanFrancisco DiseaseCoordinator SanFrancisco,California DepartmentofPharmacy PeaceHealthSouthwest Vancouver,Washington MichaelR.Brodeur,PharmD,CGP,FASCP AssociateProfessor JohnD.Cleary,PharmD DepartmentofPharmacyPractice ProfessorandViceChairofResearch AlbanyCollegeofPharmacyandHealthSciences DepartmentofPharmacyPractice Albany,NewYork AssistantProfessor,Medicine DepartmentofInfectiousDiseases GlenR.Brown,PharmD UniversityofMississippiSchoolsofPharmacyandMedicine ClinicalProfessor Jackson,Mississippi FacultyofPharmaceuticalSciences UniversityofBritishColumbia MichelleCondren,PharmD,AE-C,CDE ClinicalPharmacySpecialist,CriticalCare AssociateProfessorandViceChair DepartmentofPharmacy DepartmentofClinicalandAdministrativeSciences—Tulsa St.Paul’sHospital CollegeofPharmacy Vancouver,BritishColumbia,Canada AssociateProfessor,Pediatrics SchoolofCommunityMedicine UniversityofOklahoma MarciaL.Buck,PharmD,FCCP,FPPAG Tulsa,Oklahoma AssociateProfessor,Pediatrics SchoolofMedicine AmandaH.Corbett,PharmD,BCPS,FCCP,AAHIVE UniversityofVirginia ClinicalAssistantProfessor ClinicalCoordinator,Pediatrics EshelmanSchoolofPharmacy DepartmentofPharmacy UniversityofNorthCarolina UniversityofVirginia ChapelHill,NorthCarolina Charlottesville,Virginia RobinL.Corelli,PharmD JamieJ.Cavanaugh,PharmD ProfessorofClinicalPharmacy ClinicalInstructor DepartmentofClinicalPharmacy DivisionofPharmacyPracticeandExperientialEducation SchoolofPharmacy EshelmanSchoolofPharmacy UniversityofCalifornia,SanFrancisco UniversityofNorthCarolinaatChapelHill SanFrancisco,California ChapelHill,NorthCarolina TimothyW.Cutler,PharmD,CGP StanleyW.Chapman,PharmD,MD AssociateProfessorofClinicalPharmacy ProfessorEmeritus DepartmentofClinicalPharmacy DepartmentofMedicine SchoolofPharmacy UniversityofMississippiMedicalCenter UniversityofCalifornia,SanFrancisco Jackson,Mississippi SanFrancisco,California