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As 2020 dawns, the professions of pharmacy and medicine mark the 200th anniversary of an important event in the history of the use of medications in management of human disease and ailments: the founding of the United States Pharmacopeia (USP) in Philadelphia in 1820. This was the first effort to compile a formal, accepted list of the ingredients in common use in the fledgling United States and standardize the acceptable quality of the products, most of which were botanical in origin.

The founding of USP led quickly to the maturation of both pharmacy and medicine. While two medical schools had been formed in the United States in the late 1700s, pharmacy remained an apprentice-based profession. Immediately after the USP founding, pharmacy began establishing schools for educating new members of the profession, starting with the Philadelphia College of Pharmacy in 1821. The American Journal of Pharmacy was established soon thereafter in 1825. Formal organizations of physicians and pharmacists were founded in this era, including the British Medical Association in 1832, the American Medical Association in 1847, and the American Pharmaceutical Association in 1852.

As Pharmacotherapy: A Pathophysiologic Approach enters its 11th edition, these events from 200 years ago are important and relevant, for they illustrate the long-standing professional partnership between pharmacists and physicians to ensure the appropriate and optimal use of medications in the prevention and treatment of disease. These events also provide clear evidence of the importance and role of published works in establishing consensus and driving positive changes in healthcare.

As Dr. Peter Vlasses writes eloquently in the foreword to this edition, Pharmacotherapy has been an influential factor over the past three decades in the maturation and recognition of the clinical practice of pharmacy as a patient-oriented specialty separate from the product-oriented tasks that consumed the bulk of pharmacists’ time in the past. In this 11th edition, we sought to ensure that this work continued to provide evidence-based and comprehensive information about pathophysiology of disease states and how diseases can be prevented or treated. Like those who met in Philadelphia in 1820, we also examined trends in healthcare and considered the advice of others in the field.

In doing so, we first considered the Joint Commission for Pharmacy Practitioners (JCPP) framework for providing clinically oriented patient care services, the Pharmacist's Patient Care Process. This framework is directly relevant to the educational and practice process supported by the material in this work. As noted in Chapter 1, “The patient care process is a fundamental series of actions that guide the activities of health professionals. All health professionals who provide direct patient care should use a systematically and consistently applied process of care in their practice.”

When we met to plan this edition in January 2017, we felt this process of care is so congruent to our content that we made substantive changes to the online materials. By adding Patient Care Process boxes to key chapters and posting the material in Chapter 1 of this edition as an online supplemental chapter to the 10th edition, we took our first steps toward making major changes to the online content between the printing of editions. The 11th edition was built online over many months before the print version was typeset and sent to print.

The 11th edition of Pharmacotherapy was also informed by the 2016 version of the American College of Clinical Pharmacy Pharmacotherapy Didactic Curriculum Toolkit. We identified several conditions not covered in our 10th edition, including cardinal symptoms of disease such as pain and fever that are typically managed by the patient using over-the-counter medications and other nonprescription products.

Another trend we noted is the increasing number of specialties recognized by the Board of Pharmacy Specialties (BPS). The first edition of Pharmacotherapy was used as important evidence in the petition to recognize pharmacotherapy as a specialty in the late 1980s. Over the years, we have had added chapters covering areas later recognized as specialties. For this 11th edition, we realized the time had come to provide a greater level of depth for special populations in specialty areas not adequately addressed in our disease-focused, organ system approach to pharmacotherapy.

In making decisions based on these developments, our intent remains the same as in our first edition: to provide both students and practitioners with the tools they need for the contemporary practice of pharmacotherapy. Bringing these threads together, the following are the key changes and new content included in the 11th edition of Pharmacotherapy.

  • All disease-focused chapters have one or more Patient Care Process boxes that summarize considerations for each step.

  • Preclass and postclass engaged learning activities are new to the 11th edition to support new teaching methods now commonly used in higher education.

  • A new Common Health Problems section presents information on cardinal symptoms of disease that are typically managed through self-care. In addition to coverage of symptoms such as pain, fever, and cough, chapters have been added that recognize the importance of oral health to overall health and prepare pharmacists and other primary care professionals to assist patients with their daily oral health needs. Other new chapters in this section cover minor otic, ophthalmic, and dermatologic disorders.

  • In a new Special Populations section, Pediatrics and Geriatrics chapters have been expanded into three-chapter units that present a greater depth of information for those practicing in these areas, which are now recognized as BPS specialties.

  • Likewise, a critical care section is new in the Special Populations section that presents basic information about this specialty and points users to the relevant chapters in other parts of the book for conditions often managed in the intensive care setting.

  • Within the organ-based sections of the book, new chapters have been added on age-related macular degeneration, drug-induced ophthalmic disorders, and alopecia. Other refinements and chapter consolidations are apparent in other parts of the book, especially in the Cardiovascular, Respiratory, Renal, Neurologic, Psychiatric, Endocrinologic, Gynecologic/Obstetric, and Nutritional Disorders sections.

We wish to thank our retiring editors—Barbara Wells, Robert Talbert, and Gary Matzke—who worked on the text for decades and helped make Pharmacotherapy the gold standard in the profession. Continuing editors DiPiro, Yee, and Posey are pleased to welcome our new editors to the team: Vicki L. Ellingrod, Stuart T. Haines, and Thomas D. Nolin.

We acknowledge the many hours that Pharmacotherapy's more than 300 authors—including numerous writers contributing since the first edition—have devoted to this labor of love. Without their dedication to the cause of improving pharmacotherapy and maintaining the accuracy, clarity, and relevance of their chapters, this text would unquestionably not be possible.

A special thanks goes to Michael Weitz and Juanita Thompson of McGraw Hill and Ruma Khurana of MPS Limited for leading us into the new world of online authoring tools implemented with this edition and providing the path to a 21st-century workflow. While at times our impulses bordered on those of the Luddites, we recognize the importance of moving Pharmacotherapy to a world in which content can be continually updated as new data become available.

Many thanks to Terry Schwinghammer for his insights during our editor meetings and continued devotion to the Pharmacotherapy Casebook: A Patient-Focused Approach companion to this work and the tools, chapter updates, and innovations he has shepherded onto the Access Pharmacy website. Finally, we thank James Shanahan, Peter Boyle, and their colleagues at McGraw Hill for their consistent support of the Pharmacotherapy family of resources, insights into trends in publishing and higher education, and the critical attention to detail so necessary in pharmacotherapy.

The Editors
March 2020

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