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With each edition of Pharmacotherapy: A Pathophysiologic Approach the pace of change in health care seems to accelerate, and this continues to be true for the 9th edition. At this time, pharmacists across the United States are actively contributing their expertise as integrated and virtual members of the new health care delivery models that are being implemented as part of the Affordable Care Act through accountable care organizations and patient-centered medical homes. These emerging care models have improved outcomes for Medicare and Medicaid beneficiaries and now are poised to affect the care of most individuals. Pharmacists throughout the world are recognizing their potential to improve access to affordable high-quality care in their country. As expectations and opportunities for pharmacists expand, the need for state-of-the-art, patient-centered education and training becomes more acute. The Editors and authors of PAPA continue to strive to make this text relevant to patient-focused pharmacists and other health care providers in this dynamic era.

The 9th edition of Pharmacotherapy: A Pathophysiologic Approach is the product of the editorial team’s reflection on what are the core pathophysiological and therapeutic elements that students and young practioners need. As a result, we have streamlined the offerings in this edition and placed a portion of the foundational chapters on the web to make them accessible to a broader audience. Most importantly, each chapter of the book has been revised and updated to reflect the latest in evidence-based information and recommendations. We trust that you will find that this edition balances the need for accurate, thorough, and unbiased information about the treatment of diseases by presenting concise illustrative analyses of the multiplicity of therapeutic options.

With each edition, the editors recommit to our founding precepts:

• Advance the quality of patient care through evidence-based medication therapy management based on sound pharmacotherapeutic principles.
• Enhance the health of our communities by incorporating contemporary health promotion and disease-prevention strategies in our practice environments.
• Motivate young practitioners to enhance the breadth, depth, and quality of care they provide to their patients.
• Challenge established pharmacists and other primary-care providers to learn new concepts and refine their understanding of the pathophysiologic tenets that undergird the development of individualized therapeutic regimens.
• Present the pharmacy and health care communities with innovative patient assessment, triage, and pharmacotherapy management skills.

The ninth edition builds on and expands the foundation of previous editions. Most of the disease-oriented chapters have incorporated updated evidence-based treatment guidelines that include, when available, ratings of the level of evidence to support the key therapeutic approaches. Also, in this edition new features have been added:

• Most chapters have a section on personalized pharmacotherapy.
• The diagnostic flow diagrams, treatment algorithms, dosing guideline recommendations, and monitoring approaches that were present in the last edition have been revised with color codes to clearly distinguish treatment pathways.
• The Drug Dosing tables have been reformatted for clarity and consistency.
• New Drug Monitoring tables have been added.

The text’s digital home, Access Pharmacy (, has become the primary access point for many in the United States and around the world. Users of Access Pharmacy will find many features to enhance their learning and information retrieval. Thoughtful and provocative updates to PAPA chapters are added as new information mandates to keep our readers relevant in these times of rapid advancements. Also, the site has many new features such as education guides, Goodman & Gilman’s animations, virtual cases, and many other textbooks. As in previous editions, the text coordinates well with Pharmacotherapy: A Patient-focused Approach, which includes in-depth patient cases with questions and answers.

Twenty-four chapters of this edition are being published online and are available to all users in the Online Learning Center at The chapters chosen for online publication include seven, which describe and critique the available means to assess major organ system function, and five, which characterize the adverse effects of drugs on organ systems. They join the 12 foundational chapters, which provide overviews of pharmacy skills in medication safety, pharmacokinetics, and pharmacogenetics, and patient-centered considerations such as health literacy, cultural competency, pediatrics, and geriatrics; finally, there are three chapters that address public health, clinical toxicology, and emergency preparedness. The Online Learning Center continues to provide unique features designed to benefit students, practitioners, and faculty around the world. The site includes learning objectives and self-assessment questions for each chapter. In closing, we acknowledge the many hours that Pharmacotherapy’s more than 300 authors contributed to this labor of love. Without their devotion to the cause of improved pharmacotherapy and dedication in maintaining the accuracy, clarity, and relevance of their chapters, this text would unquestionably not be possible. In addition, we thank Michael Weitz, Brian Kearns, and James Shanahan 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 2014

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