Applied Thrapeutics: The Clinical Use of Drugs, Seventh Edition

American Journal of Pharmaceutical Education, Spring 2002 by Janer, Ann L

MARY ANNE KODA-KIMBLE AND LLOYD YEE YOUNG. Applied Therapeutics: The Clinical Use of Drugs. Seventh Edition. Baltimore, MD: Lippincott Williams & Wilkins, 2001. xviii 4052 pp., 421 figs., 93 tbls. $125.00.

This is the seventh edition of a reference that many educator-clinicians have used as students and as practitioners. In the preface to the seventh edition, the editors and associate editors state that all chapters have been revised and updated - a reassuring bit of information as some texts produce only minor alterations in some chapters while providing major substantive revisions of others. The book contains twenty sections and ninety- nine chapters. Sections continue with established favorites, Interpretation of Clinical Laboratory Tests, for example but reflect changes in the healthcare mindset with a chapter "Herbs and Nutritional Supplements." A section on "Women's Health" reflects attention to contemporary issues in health care.

One hundred and fifty practitioners provide the individual expertise for chapter authorship. Each chapter is individually paginated using a section number/page number system which this reviewer finds cumbersome. However, the unique system has been a part of this reference since its inception, and most of us have learned to live with it. Tables in each chapter are offset in light blue which facilitates retrieval of information. Each case or case related question is numbered, presumably to enable faster retrieval, however the individual chapter indices contain no reference to those numbers. The reader just encounters them. Although the chapters are individually authored, a common organizational thread may be found in each chapter. Chapters are introduced with a statement of the importance or significance of the disease problem, followed by demographic information (incidence and prevalence of the problem) and general diagnostic issues. Each disease state chapter contains information on etiology, clinical presentation, laboratory or other assessment measures, nondrug therapy, and of course, pharmacotherapy. Suggestions for drug therapy selection are provided as well as important comparisons within a drug class. Important pharmacokinetic and pharmacodynamic aspects are reviewed as well as important adverse effects, dosing issues, and implications for special populations (pregnancy, lactation, pediatric patients, geriatric patients, etc.) Additionally, pharmacoeconomic issues are addressed. This is an important plus in this reference.

There are a few inclusions that should be noted. One is the addition of reference normals in cases that use laboratory data to enhance the case presentation. The inclusion of normals is particularly helpful for students as they learn to appreciate the value of laboratory assessment. Most diagrams included in the chapters are large, uncluttered and easy to read. Assessment forms (e.g., Hamilton Depression Scale) are generally full page. One unfortunate negative is the lack of color plates. Although this would probably add substantially to the cost and the overall weight of the text, some things, notably dermatological problems are probably better appreciated in color, although the authors of the "Dermatotherapy" chapter did pair the black and white photographs with diagrams of the problem. Some of the pictures included a reference measure at the bottom of the picture. However, some details of dermatologic problems are too dependent on the exposure of the picture. Finally, in the chapter on "Mood Disorders" describes the diagnostic evaluation of a patient using the Axis I, Axis II and Axis III description without any explanation of the derivation of the Axis.

Within the area of pharmacotherapy, this reviewer was somewhat surprised to see the detail given to explaining therapies such as Brompton's Cocktail in pain management and bite and swallow nifedipine in hypertensive emergencies. It is the concern of this reviewer that a casual scan and observation of the terms, without a complete reading of the discussion may imply acceptability of the treatment modalities. Finally, one area which eluded the update was the in the "Cardiac Arrhythmia" chapter- Drug Use in Cardiac Arrest. The treatment algorithm is taken from the 1992 Guidelines rather than the 2000 Guidelines.

In the preface to the seventh edition, the editors and associate editors state one of their goals - to share "sufficient thought processes to assist students in the formulation of problem solving skills..." Later in that same preface, the desire to develop and improve therapeutic problem solving skills for both students and practitioners is repeated. Clearly, the intent of the editors and associate editors to produce a text that will help guide students in solving therapeutic problems has been met. Practitioners may also benefit from the text in that the chapter authors include many real life examples that require some thought and consideration rather than an answer readily available in a tertiary reference.