Pharmacotherapy Principles and

Practice, Fifth Edition 5th Edition,

(Ebook PDF)
Visit to download the full and correct content document:
https://ebookmass.com/product/pharmacotherapy-principles-and-practice-fifth-edition-
5th-edition-ebook-pdf/
 CONTENTS vii

58. Osteoarthritis 903 73. Skin and Skin Structure Infections 1121
Scott G. Garland, Nicholas W. Carris, Jaime R. Hornecker and Lauren R. Biehle
and Steven M. Smith
74. Infective Endocarditis 1133
59. Gout and Hyperuricemia 915 Ronda L. Akins
Maria Miller Thurston
75. Tuberculosis 1149
60. Musculoskeletal Disorders 927 Rocsanna Namdar and Charles Peloquin
Jill S. Borchert and Lisa M. Palmisano
76. Gastrointestinal Infections 1161
SECTION 12 Disorders of the Eyes, Ears, Bradley W. Shinn and Sharon Ternullo
Nose, and Throat 939
77. Intraabdominal Infections 1173
61. Glaucoma 939 Joseph E. Mazur and Melanie N. Smith
Mikael D. Jones
78. Parasitic Diseases 1183
62. Minor Ophthalmic and Otic Disorders 953 Madeline A. King and Jason C. Gallagher
Lauren R. Biehle and Michelle L. Hilaire
79. Urinary Tract Infections and Prostatitis 1197
63. Allergic Rhinitis 967 Spencer H. Durham
Hanna Phan and Michael Daines
80. Sexually Transmitted Infections 1207
Marlon S. Honeywell and Evans Branch III
SECTION 13 Dermatologic Disorders 983
81. Osteomyelitis 1225
64. Psoriasis 983
Jessica E. Burchette and David B. Cluck
Amy Kennedy
82. Sepsis and Septic Shock 1233
65. Common Skin Disorders 999
Trisha N. Branan, Susan E. Smith,
Laura A. Perry and Lori J. Ernsthausen
Christopher M. Bland, and S. Scott Sutton

SECTION 14 Hematologic Disorders 1015 83. Superficial Fungal Infections 1243

Kathryn A. Fuller and Lauren S. Schlesselman
66. Anemia 1015
Maribel A. Pereiras 84. Invasive Fungal Disease 1255
Russell E. Lewis and P. David Rogers
67. Coagulation and Platelet Disorders 1027
Anastasia Rivkin, Sandeep Vansal, 85. Antimicrobial Prophylaxis in Surgery 1273
and Anna Dushenkov Mary A. Ullman and John C. Rotschafer

68. Sickle Cell Disease 1045 86. Vaccines and Toxoids 1281
Tracy M. Hagemann and Teresa V. Lewis Marianne Billeter

SECTION 15 Diseases of Infectious Origin 1059 87. Human Immunodeficiency Virus Infection 1291
Emily L. Heil, Mary F. Banoub,
69. Antimicrobial Regimen Selection 1059 and Amanda H. Corbett
Catherine M. Oliphant
SECTION 16 Oncologic Disorders 1313
70. Central Nervous System Infections 1073
April Miller Quidley and P. Brandon Bookstaver 88. Cancer Chemotherapy and Treatment 1313
Lisa M. Holle
71. Lower Respiratory Tract Infections 1091
Diane M. Cappelletty 89. Breast Cancer 1345
Gerald Higa
72. Upper Respiratory Tract Infections 1105
Heather L. Girand 90. Lung Cancer 1361
Val Adams and Justin M. Balko

Chisholm_FM_pi-xxviii.indd 7 05/09/18 5:00 PM

 viii CONTENTS

91. Colorectal Cancer 1375 SECTION 17 Nutrition and Nutritional

Emily B. Borders and Allison Baxley Disorders 1521
92. Prostate Cancer 1391 100. Parenteral Nutrition 1521
Daniel J. Crona and Amber E. Proctor Melissa R. Pleva and Michael D. Kraft

93. Skin Cancer 1405 101. Enteral Nutrition 1539

Alice C. Ceacareanu and Treavor T. Riley Sarah J. Miller

94. Ovarian Cancer 1421 102. Overweight and Obesity 1553

Judith A. Smith April Smith

95. Acute Leukemias 1435 Appendices 1565

Nancy Heideman and Lisa Anselmo Appendix A: Conversion Factors
and Anthropometrics 1565
96. Chronic Leukemias and Multiple Myeloma 1451
Amy M. Pick Appendix B: Common Medical Abbreviations 1569
Appendix C: Glossary 1575
97. Malignant Lymphomas 1467
Keith A. Hecht and Susanne E. Liewer Appendix D: Prescription Writing Principles 1593
Index 1597
98. Hematopoietic Stem Cell Transplantation 1479
Christina Bachmeier and Amber P. Lawson

99. Supportive Care in Oncology 1495

Sarah Scarpace Peters

SI unit conversions were produced by Ed Randell, PhD, DCC, FCACB, Division Chief and Professor of Laboratory Medicine, Department
of Laboratory Medicine, Eastern Health Authority and Faculty of Medicine, Memorial University of Newfoundland, St. John’s,
Newfoundland, Canada.

Chisholm_FM_pi-xxviii.indd 8 05/09/18 5:00 PM

 ABOUT THE EDITORS

Marie A. Chisholm-Burns, PharmD, MPH, MBA, FCCP, FASHP, FAST, is Dean and
Professor at the University of Tennessee Health Science Center College of Pharmacy. She
received her BS and PharmD degrees from the University of Georgia, and completed a
residency at Mercer University Southern School of Pharmacy and at Piedmont Hospital in
Atlanta, Georgia. Dr. Chisholm-Burns is Founder and Director of the Medication Access
Program which increases medication access to transplant recipients. She has also served in
elected positions in numerous professional organizations. Dr. Chisholm-Burns has more
than 320 publications and approximately $11 million in external funding. In 2008 and
2011, textbooks co-edited by Dr. Chisholm-Burns, Pharmacotherapy Principles & Practice
and Pharmacy Management, Leadership, Marketing, and Finance, respectively, received the
Medical Book Award from the American Medical Writers Association. She has also received
numerous awards and honors including the Robert K. Chalmers Distinguished Pharmacy
Educator Award from the American Association of Colleges of Pharmacy, Clinical Pharmacy
Education Award from the American College of Clinical Pharmacy, Daniel B. Smith Practice
Excellence Award from the American Pharmacists Association (APhA), Nicholas Andrew
Cummings Award from the National Academies of Practice, Award of Excellence from
the American Society of Health-System Pharmacists (ASHP), Pharmacy Practice Research
Award (2011 and 2014) and Award for Sustained Contributions to the Literature from the
ASHP Foundation, Research Achievement Award from APhA, and Rufus A. Lyman Award
for most outstanding publication in the American Journal of Pharmaceutical Education
(in 1996 and 2007). Dr. Chisholm-Burns is a Fulbright Scholar and a member of the board
of directors for the Accreditation Council for Pharmacy Education (ACPE). She lives in
Memphis, is married, and has one child, John Fitzgerald Burns Jr. She enjoys writing, cycling,
and playing chess.

Terry L. Schwinghammer, PharmD, FCCP, FASHP, FAPhA, BCPS, is Professor

Emeritus at the West Virginia University (WVU) School of Pharmacy. From 2005 to 2018,
he was Professor and Chair of the Department of Clinical Pharmacy, and from 2015 to
2018 he held the Arthur I. Jacknowitz Distinguished Chair in Clinical Pharmacy at WVU.
He was previously Professor of Pharmaceutical Sciences at the University of Pittsburgh
School of Pharmacy. Dr. Schwinghammer received his BS and PharmD degrees from
Purdue University and completed a pharmacy residency at Indiana University Hospitals.
He is a Board Certified Pharmacotherapy Specialist and has practiced in adult inpatient
and ambulatory care. Dr. Schwinghammer is a recipient of the American Pharmacists
Association-APPM Distinguished Achievement Award in Clinical/Pharmacotherapeutic
Practice and is a Distinguished Practitioner in the National Academies of Practice. He is
a member of the Academy of Excellence in Teaching and Learning of the WVU Health
Sciences Center. In addition to authoring over 100 research and other publications, he is
founding editor of The Pharmacotherapy Casebook and co-editor of The Pharmacotherapy
Handbook and the textbook Pharmacotherapy Principles & Practice. Dr. Schwinghammer
has served the American Association of Colleges of Pharmacy (AACP) as Chair of the
Pharmacy Practice Section, Chair of the Council of Faculties, and member of the Board of
Directors. He is a past president of the Pennsylvania Society of Health-System Pharmacists
and received the Pharmacist of the Year, Community Service, and Sister M. Gonzales Duffy
Awards from the organization. He has served as Chair of the Board of Pharmacy Specialties
and elected member of the Board of Regents of the American College of Clinical Pharmacy
(ACCP). He is a Fellow of ACCP, the American Society of Health-System Pharmacists, and
the American Pharmacists Association and has been elected to membership in the Rho Chi
Pharmacy Honor Society and the Phi Lambda Sigma Pharmacy Leadership Society. He was
named a Distinguished Alumnus of Purdue University in 2004. In 2016, he was named the
recipient of the AACP Robert K. Chalmers Distinguished Pharmacy Educator Award.

ix

Chisholm_FM_pi-xxviii.indd 9 05/09/18 5:00 PM

 x ABOUT THE EDITORS

Patrick M. Malone, PharmD, FASHP, is Professor and Associate Dean of Internal Affairs
at The University of Findlay College of Pharmacy. Dr. Malone received his BS in Pharmacy
from Albany College of Pharmacy and PharmD from the University of Michigan. He
completed a clinical pharmacy residency at the Buffalo General Hospital, Drug Information
Fellowship at the University of Nebraska Medical Center, and US West Fellowship in
Academic Development and Technology at Creighton University. His practice and teaching
have centered on drug information, and he is the first author for all six editions of Drug
Information—A Guide for Pharmacists and has overseen the Innovations in Drug Information
Practice and Research sessions at the ASHP Midyear Clinical Meetings for approximately
20 years. Dr. Malone was also the drug information pharmacist at the XIII Winter Olympics.
He has approximately 120 publications and numerous presentations, and has held various
offices in national organizations. He was the Director of the Web-Based Pharmacy Pathway
at Creighton University Medical Center, from its initial establishment until after graduation
of the first class. His hobby is building and flying radio-controlled aircraft.

Jill M. Kolesar, PharmD, MS, FCCP, BCPS, is Professor of Pharmacy at the University of
Kentucky and holds administrative positions at the Markey Cancer Center as the Director
of the Precision Medicine Initiatives, Co-Chair of the Molecular Tumor Board, and the
Co-Leader of the Developmental Therapeutics Program. She is a member of the Graduate
Faculty in the College of Pharmacy, a member of the Markey Cancer Center and holds a
joint appointment in Internal Medicine in the College of Medicine. Dr. Kolesar received her
Doctor of Pharmacy degree at the University of Texas Health Science Center in San Antonio,
where she also completed a specialty practice residency in oncology/hematology and a
fellowship in molecular oncology pharmacotherapy. She received an MS in Epidemiology
with an emphasis in Genetic Epidemiology from the University of Wisconsin-Madison,
College of Medicine and Public Health in 2016. Dr. Kolesar contributes professional service
to both the National Cancer Institute (NCI) and several pharmacy organizations. Serving
on both the Early Phase and Cancer Prevention Central IRBs (CIRBs), multiple NCI
study sections, and the Cancer Therapy and Evaluation Program (CTEP) Pharmacology
task force. She is a board certified Pharmacotherapy Specialist and an elected fellow of
ACCP (American College of Clinical Pharmacy). She has served ACCP as the Chair of the
Hematology Oncology PRN, and as a member of the Board of Regents and the Research
Institute Board of Trustees. Dr. Kolesar is currently the President of ACCP. Dr. Kolesar’s
research focuses on the drug development of anticancer agents with an emphasis on targeted
therapies and biomarkers. She has authored more than 200 abstracts, research articles,
and book chapters, and as a principal investigator she has received more than $2.0 million
in research funding from the NCI, American Cancer Society and other sources. She has
received teaching and research awards from local, national, and international organizations
including the Innovations in Teaching Award from the American Association of Colleges of
Pharmacy. Other books she co-edits are the Top 300 Pharmacy Drug Cards and the Top 100
Nonprescription Drug Cards. Dr. Kolesar loves to read, run, ski, scuba dive, and travel with
her husband and five children. She has completed 2 marathons and 16 half-marathons.

Chisholm_FM_pi-xxviii.indd 10 05/09/18 5:00 PM

 ABOUT THE EDITORS xi

P. Brandon Bookstaver, PharmD, FCCP, FIDSA, BCPS, is Associate Professor and

Director of Residency and Fellowship Training in the Department of Clinical Pharmacy and
Outcomes Sciences at the University of South Carolina College of Pharmacy in Columbia,
South Carolina. He also serves as Infectious Diseases Pharmacist at Palmetto Health Richland.
Following graduation from the University of South Carolina College of Pharmacy in 2004,
he completed a Pharmacy Practice residency and Infectious Diseases specialty residency at
Wake Forest University Baptist Medical Center. Brandon thoroughly enjoys coordinating
student research and is heavily involved in pharmacy residency training, including his role
as the Infectious Diseases PGY2 Residency Director and Clinical Fellowship Director at
USC/Palmetto Health. He has over 75 peer-reviewed publications in the areas of infectious
diseases and teaching and learning. Outside of work, he enjoys spending time with his wife
Nicole, son Aaron, and daughter Maddie Paige; traveling; and Gamecock athletics.

Kelly C. Lee, PharmD, MAS, FCCP, BCPP, is Professor of Clinical Pharmacy and Associate
Dean for Assessment and Accreditation at the University of California, San Diego (UCSD)
Skaggs School of Pharmacy and Pharmaceutical Sciences. She is also the Director of the
PGY2 Psychiatric Pharmacy Residency at UCSD. Dr. Lee received her B.S. in Biology from
UCLA, her PharmD from UCSF, and Master of Advanced Studies in Clinical Research at
UCSD. She completed a PGY1 Residency in Pharmacy Practice and a 2-year fellowship in
Behavioral Health Sciences at UCSF. She has published numerous peer-reviewed journal
articles and consults for large health systems to optimize psychotropic drug utilization and
establish innovative psychiatric pharmacy care models. She has also received the Dorfman
Journal Paper Award from the Academy of Psychosomatic Medicine. Dr. Lee loves to play
tennis, travel, and spend time with her husband Douglas and son, Travis.

Chisholm_FM_pi-xxviii.indd 11 05/09/18 5:00 PM

 This page intentionally left blank

Chisholm_FM_pi-xxviii.indd 12 05/09/18 5:00 PM

 CONTRIBUTORS

Val Adams, PharmD, BCOP Marianne Billeter, PharmD, BCPS

Associate Professor, Pharmacy Practice and Science, College of Pharmacy Manager, Patient Care Services, New Hanover
Pharmacy, University of Kentucky, Lexington, Kentucky Regional Medical Center, Wilmington, North Carolina
Chapter 90 Chapter 86

Ronda L. Akins, PharmD Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS

Infectious Diseases Clinical Pharmacy Specialist, Methodist
Charlton Medical Center, Dallas, Texas; Adjunct Associate
Professor, Department of Biological Sciences, University of
Texas at Dallas, Richardson, Texas
Chapter 74
Lisa Anselmo, PharmD, BCOP
Director of Clinical Pharmacy, PGY1 Residency Director,
University of New Mexico Hospital, Albuquerque,
New Mexico
Chapter 95
Clinical Associate Professor, Clinical and Administrative
Pharmacy, College of Pharmacy, University of Georgia,
Savannah, Georgia
Chapter 82
P. Brandon Bookstaver, PharmD, FCCP, FIDSA, BCPS
Associate Professor and Director of Residency and Fellowship
Training, Department of Clinical Pharmacy and Outcomes
Sciences, University of South Carolina College of Pharmacy,
Columbia, South Carolina
Chapter 70

Christina A. Bachmeier, PharmD, BCOP Jill S. Borchert, PharmD, BCACP, BCPS

Clinical Pharmacist, Cellular Immunotherapy, H. Lee Moffitt Vice-Chair and Professor of Pharmacy Practice, Chicago
Cancer Center, Tampa, Florida College of Pharmacy, Midwestern University, Chicago, Illinois
Chapter 98 Chapter 60

Opal M. Bacon, PharmD Emily B. Borders, PharmD, BCOP

Clinical Assistant Professor, Eugene Applebaum College of
Pharmacy and Health Sciences, Wayne State University,
Detroit, Michigan
Chapter 39
Justin M. Balko, PharmD, PhD
Assistant Professor, Department of Medicine, Ingram Cancer
Center, Vanderbilt University, Nashville, Tennessee
Chapter 90
Clinical Pharmacist, Stephenson Cancer Center, University of
Oklahoma, Oklahoma City, Oklahoma
Chapter 91
Mary Borovicka, PharmD, BCPP
Assistant Professor of Clinical Pharmacy, Department of
Pharmacy Practice, College of Pharmacy and Pharmaceutical
Sciences, University of Toledo, Toledo, Ohio
Chapter 37

Sheila R. Botts, PharmD, BCPP

Mary F. Banoub, PharmD
Regional Administrator, Clinical Pharmacy Services; Chief,
Infectious Diseases Clinical Pharmacy Specialist, University
Clinical Pharmacy Research and Academic Affairs, Kaiser
of Maryland Medical Center; Clinical Assistant Professor,
Permanente Colorado, Denver, Colorado
School of Pharmacy, University of Maryland, Baltimore,
Chapter 40
Maryland
Chapter 87 Bradley A. Boucher, PharmD, BCPS
Professor, Department of Clinical Pharmacy and Translational
Kylie N. Barnes, PharmD, BCPS
Science, Associate Dean of Strategic Initiatives and
Clinical Assistant Professor, Division of Pharmacy Practice and
Operations, College of Pharmacy, University of Tennessee
Administration, School of Pharmacy, University of Missouri-
Health Science Center, Memphis, Tennessee
Kansas City, Kansas City, Missouri
Chapter 13
Chapter 49
Julia Boyle, PharmD, BCPP
Allison Baxley, PharmD, BCOP
Assistant Professor, Department of Pharmacy Practice and
Clinical Pharmacist, Stephenson Cancer Center, University of
Administrative Sciences, College of Pharmacy, Idaho State
Oklahoma, Oklahoma City, Oklahoma
University, Pocatello, Idaho
Chapter 91
Chapter 42
Régine Béliard, PharmD
Trisha N. Branan, PharmD, BCCCP
Assistant Professor, Department of Clinical and Administrative
Clinical Associate Professor, Clinical and Administrative
Sciences, School of Pharmacy, Notre Dame of Maryland
Pharmacy, College of Pharmacy, University of Georgia,
University, Baltimore, Maryland
Athens, Georgia
Chapter 50
Chapter 82
Lauren R. Biehle, PharmD, BCPS
Evans Branch III, PharmD
Clinical Associate Professor of Pharmacy Practice, School of
Professor, College of Pharmacy and Pharmaceutical Sciences,
Pharmacy, University of Wyoming, Laramie, Wyoming
Florida A&M University, Miami, Florida
Chapters 62 and 73
Chapter 80

xiii

Chisholm_FM_pi-xxviii.indd 13 05/09/18 5:00 PM

 xiv CONTRIBUTORS
Gretchen M. Brophy, PharmD, BCPS
Professor of Pharmacotherapy and Outcomes Science and
Neurosurgery, Virginia Commonwealth University, Medical
College of Virginia, Richmond, Virginia
Chapter 32
Susan P. Bruce, PharmD, BCPS
Associate Dean for Pharmacy Education and Interprofessional
Studies, Chair and Professor of Pharmacy Practice, College
of Pharmacy, Northeast Ohio Medical University, Rootstown,
Ohio
Chapter 57
Jessica E. Burchette, PharmD, BCPS
Professor, Bill Gatton College of Pharmacy,
East Tennessee State University, Johnson City, Tennessee
Chapter 81
Diane M. Cappelletty, PharmD
Professor of Clinical Pharmacy, Chair, Department of Pharmacy
Practice, Co-Director, The Infectious Disease Research
Laboratory, College of Pharmacy and Pharmaceutical
Sciences, University of Toledo, Toledo, Ohio
Chapter 71
Nicholas W. Carris, PharmD, BCPS
Assistant Professor, Department of Pharmacotherapeutics and
Clinical Research, College of Pharmacy; Department of
Family Medicine, Morsani College of Medicine, University of
South Florida, Tampa, Florida
Chapter 58
Marshall E. Cates, PharmD, BCPP
Professor and Chair, Department of Pharmacy Practice,
McWhorter School of Pharmacy, Samford University,
Birmingham, Alabama
Chapter 38
Brandon Cave, PharmD, ASH-CHC
Clinical Assistant Professor, Department of Pharmacy Practice,
South College School of Pharmacy, Knoxville, Tennessee
Chapter 5
Alice C. Ceacareanu, PhD, PharmD
President, ROAKETIN Inc, Amherst, New York
Chapter 93
Kevin W. Chamberlin, PharmD
Associate Clinical Professor, Assistant Head, Department
of Pharmacy Practice, School of Pharmacy, University of
Connecticut, Farmington, Connecticut
Chapter 29
Juliana Chan, PharmD, BCACP
Clinical Associate Professor, Gastroenterology and Hepatology;
Clinical Pharmacist, Ambulatory Pharmacy Services, Clinical
Associate Professor, Pharmacy Practice, Colleges of Pharmacy
and Medicine, University of Illinois, Chicago, Illinois
Chapter 24
Sallie H. Charles, PMHNP-BC, MS, MBA
Advanced Practice Nurse, Psychiatry, Hidden Lake Medical
Offices, Kaiser Permanente Colorado, Westminster, Colorado
Chapter 40
Chisholm_FM_pi-xxviii.indd 14
Judy T. Chen, PharmD, BCPS, BCACP, CDE
Clinical Associate Professor of Pharmacy Practice, Purdue
University College of Pharmacy, West Lafayette, Indiana
Chapters 45 and 46
Kevin W. Cleveland, PharmD
Associate Professor and Assistant Dean for Experiential
Education, Department of Pharmacy Practice and
Administrative Sciences, College of Pharmacy, Idaho State
University, Pocatello, Idaho
Chapter 42
David B. Cluck, PharmD, BCPS, AAHIVP
Associate Professor, Bill Gatton College of Pharmacy,
East Tennessee State University, Johnson City, Tennessee
Chapter 81
Amanda H. Corbett, PharmD, BCPS, AAHIVE
Clinical Associate Professor, Eshelman School of Pharmacy,
University of North Carolina at Chapel Hill, Chapel Hill,
North Carolina
Chapter 87
Brian L. Crabtree, PharmD, BCPP
Professor and Dean, College of Pharmacy, Mercer University,
Atlanta, Georgia
Chapter 39
Daniel J. Crona, PharmD, PhD, CPP
Assistant Professor, Division of Pharmacotherapy and
Experimental Therapeutics, Eshelman School of Pharmacy,
University of North Carolina at Chapel Hill, Chapel Hill,
North Carolina
Chapter 92
Nicole S. Culhane, PharmD, BCPS
Assistant Dean, Experiential Education, and Professor, Clinical
and Administrative Sciences, School of Pharmacy, Notre
Dame of Maryland University, Baltimore, Maryland
Chapter 50
Michael Daines, MD
Division Chief, Allergy, Immunology, and Rheumatology,
Associate Professor, Pediatric Allergy and Immunology,
Associate Director, Pediatric Pulmonary Fellowship, College
of Medicine, University of Arizona Health Sciences, Tucson,
Arizona
Chapter 63
Devra K. Dang, PharmD, BCPS, CDE
Associate Clinical Professor, School of Pharmacy, University of
Connecticut, Storrs, Connecticut
Chapters 45 and 46
Robert J. DiDomenico, PharmD
Associate Professor, Department of Pharmacy Practice, College
of Pharmacy, University of Illinois at Chicago, Chicago,
Illinois
Chapter 7
John M. Dopp, PharmD, MS
Associate Professor, School of Pharmacy, University of
Wisconsin-Madison, Madison, Wisconsin
Chapter 41
05/09/18 5:00 PM

Spencer H. Durham, PharmD, BCPS AQ-ID
Assistant Clinical Professor, Department of Pharmacy Practice,
Harrison School of Pharmacy, Auburn University, Auburn,
Alabama
Chapter 79
Anna Dushenkov, PharmD
Assistant Professor, Pharmacy Practice, School of Pharmacy
and Health Sciences, Fairleigh Dickinson University, Florham
Park, New Jersey
Chapter 67
Amanda Eades, PharmD, BCACP
Clinical Assistant Professor, Department of Pharmacy Practice;
Clinical Pharmacist, Ambulatory Pharmacy Services, College
of Pharmacy, University of Illinois at Chicago, Chicago,
Illinois
Chapter 14
Megan J. Ehret, PharmD, MS, BCPP
Associate Professor, Department of Pharmacy Practice and
Science, School of Pharmacy, University of Maryland,
Baltimore, Maryland
Chapter 29
Gladys El-Chaar, PharmD
Clinical Professor, College of Pharmacy and Health Sciences,
St. John’s University, Queens, New York
Chapter 53
Lori J. Ernsthausen, PharmD, BCPS
Associate Professor and Chair, Department of Pharmacy
Practice, University of Findlay College of Pharmacy, Findlay,
Ohio
Chapter 65
John Erramouspe, PharmD, MS
Professor Emeritus, Pharmacy Practice and Administrative
Sciences, College of Pharmacy, Idaho State University,
Pocatello, Idaho
Chapter 42
Edward Faught, MD
Professor, Department of Neurology, School of Medicine,
Emory University, Atlanta, Georgia
Chapter 31
Ema Ferreira, BPharm, MSc, PharmD
Pharmacist, Clinical Professor, Associate Dean, Academics, CHU
Ste-Justine, Université de Montréal, Montreal, Quebec, Canada
Chapter 47
Jack E. Fincham, PhD, RPh
Professor of Pharmacy Administration, Department of
Pharmaceutical and Administrative Sciences, Presbyterian
College School of Pharmacy, Clinton, South Carolina
Chapter 1
Shannon W. Finks, PharmD, FCCP, BCPS AQ Cardiology,
ASH-CHC
Professor, Department of Clinical Pharmacy and Translational
Science, College of Pharmacy, University of Tennessee Health
Science Center, Memphis, Tennessee
Chapter 8
Chisholm_FM_pi-xxviii.indd 15
CONTRIBUTORS xv
Joshua W. Fleming, PharmD, BCACP
Clinical Associate Professor, Department of Pharmacy Practice,
University of Mississippi School of Pharmacy, Jackson,
Mississippi
Chapter 35
Kathryn A. Fuller, PharmD
PGY1 Ambulatory Care Resident, University of North Carolina
Medical Center, Chapel Hill, North Carolina
Chapter 83
Steven Gabardi, PharmD, BCPS
Abdominal Organ Transplant Clinical Specialist, Brigham and
Women’s Hospital; Assistant Professor of Medicine, Harvard
Medical School, Boston, Massachusetts
Chapter 55
Jason C. Gallagher, PharmD, BCPS
Clinical Professor, School of Pharmacy, Temple University,
Clinical Pharmacy Specialist, Infectious Diseases, Temple
University Hospital, Philadelphia, Pennsylvania
Chapter 78
Scott G. Garland, PharmD
Postdoctoral Fellow in Family Medicine, University of Florida
College of Pharmacy, Department of Pharmacotherapy and
Translational Research, Gainesville, Florida
Chapter 58
Heather L. Girand, PharmD
Professor and Assistant Chair Department of Pharmacy
Practice, College of Pharmacy, Ferris State University, Big
Rapids, Michigan
Chapter 72
Tracy M. Hagemann, PharmD
Associate Dean and Professor, College of Pharmacy, University
of Tennessee Health Science Center, Nashville, Tennessee
Chapter 68
Stuart T. Haines, PharmD, BCPS, BCACP, BC-ADM
Professor, Department of Pharmacy Practice, Director,
Pharmacy Professional Development, School of Pharmacy,
University of Mississippi, Jackson, Mississippi
Chapter 10
Kim Hawkins, PhD, APRN, FNP-C
Associate Professor, Lansing School of Nursing and Clinical
Sciences, Bellarmine University, Louisville, Kentucky
Appendix D
Kathleen B. Haynes, PharmD, BCPS, CDE
Clinical Coordinator, Bridges to Health, Community Health
Network, Indianapolis, Indiana
Chapter 48
Keith A. Hecht, PharmD, BCOP
Associate Professor, Department of Pharmacy Practice, School
of Pharmacy, Southern Illinois University, Edwardsville,
Illinois
Chapter 97
05/09/18 5:00 PM
 xvi CONTRIBUTORS
Nancy Heideman, PharmD, BCPS, BCOP
Oncology Clinical Pharmacy Lead, University of New Mexico
Comprehensive Cancer Center
Chapter 95
Emily L. Heil, PharmD, BCPS AQ-ID, AAHIVP
Assistant Professor, School of Pharmacy, University of
Maryland, Baltimore, Maryland
Chapter 87
Brian A. Hemstreet, PharmD, BCPS
Assistant Dean for Student Affairs and Professor of Pharmacy
Practice, Regis University School of Pharmacy, Rueckert-
Hartman College for Health Professions, Denver, Colorado
Chapter 19
Gerald Higa, PharmD
Professor, Schools of Pharmacy and Medicine, West Virginia
University, Morgantown, West Virginia
Chapter 89
Michelle L. Hilaire, PharmD, CDE, BCPS, BCACP
Clinical Professor of Pharmacy Practice, Associate Dean of
Students, University of Wyoming School of Pharmacy,
Laramie, Wyoming
Chapter 62
Lisa M. Holle, PharmD, BCOP
Associate Clinical Professor, Department of Pharmacy Practice,
University of Connecticut School of Pharmacy, Storrs,
Connecticut
Chapter 88
Marlon S. Honeywell, PharmD
Executive Associate Dean and Professor, College of Pharmacy
and Pharmaceutical Sciences, Florida A&M University,
Tallahassee, Florida
Chapter 80
Jaime R. Hornecker, PharmD, BCPS, CDE, DPLA
Clinical Professor of Pharmacy Practice, School of Pharmacy,
University of Wyoming, Laramie, Wyoming
Chapter 73
Augustus Hough, PharmD, BCPS AQ Cardiology
Clinical Pharmacy Specialist in Cardiology, PGY2 Cardiology
Pharmacy Residency Program Director, West Palm Beach
Veterans Affairs Medical Center, West Palm Beach, Florida
Chapter 5
Jill L. Isaacs, DNP, ANP, NP-C
Adult Nurse Practitioner, Gastroenterology, Digestive Disease
Consultants, Mesa, Arizona
Appendix D
Cherry W. Jackson, PharmD, BCPP
Professor, Department of Pharmacy Practice, Auburn
University; Clinical Professor, Department of Psychiatric and
Behavioral Neurobiology, School of Medicine, University of
Alabama, Birmingham, Alabama
Chapter 38
Mikael D. Jones, PharmD, BCPS
Associate Professor, Pharmacy Practice and Science, College of
Pharmacy, University of Kentucky, Lexington, Kentucky
Chapter 61
Chisholm_FM_pi-xxviii.indd 16
Desha Jordan, MD
Fellow, Division of Allergy-Immunology, Department of
Pediatrics, Medical College of Georgia, Augusta University,
Augusta, Georgia
Chapter 54
Michael D. Katz, PharmD
Professor and Director, International Education, Department
of Pharmacy Practice and Science, College of Pharmacy,
University of Arizona, Tucson, Arizona
Chapter 44
Deanna L. Kelly, PharmD, BCPP
Professor of Psychiatry, Director and Chief, Treatment Research
Program, Maryland Psychiatric Research Center, University
of Maryland School of Medicine, Baltimore, Maryland
Chapter 37
Amy Kennedy, PharmD
Assistant Professor, Pharmacy Practice and Science, College of
Pharmacy, University of Arizona, Tucson, Arizona
Chapter 64
Madeline A. King, PharmD
Assistant Professor of Clinical Pharmacy, Department
of Pharmacy Practice and Pharmacy Administration,
Philadelphia College of Pharmacy, University of the Sciences,
Philadelphia, Pennsylvania
Chapter 78
Emily Knezevich, PharmD, BCPS, CDE
Associate Professor of Pharmacy Practice, School of Pharmacy
and Health Professions, Creighton University, Omaha, Nebraska
Appendix D
Jon Knezevich, PharmD, BCPS
Pharmacy Coordinator, Diabetes; Nebraska Medicine, Omaha,
Nebraska
Appendix D
Julia M. Koehler, PharmD
Professor and Associate Dean for Clinical Education and
External Affiliations, College of Pharmacy and Health
Sciences, Butler University; Ambulatory Care Clinical
Pharmacist, Methodist Hospital of Indiana University Health,
Indianapolis, Indiana
Chapter 48
Michael D. Kraft, PharmD, BCNSP
Clinical Professor, Department of Clinical Pharmacy, College
of Pharmacy, University of Michigan, Ann Arbor, Michigan;
Assistant Director-Education and Research, Department
of Pharmacy Services, Michigan Medicine, Ann Arbor,
Michigan
Chapter 100
Kelly R. Kroustos, PharmD, BCGP
Associate Professor of Pharmacy Practice, Raabe College of
Pharmacy, Ohio Northern University, Ada, Ohio
Chapter 4
05/09/18 5:00 PM

Sum Lam, PharmD, BCGP, BCPS
Associate Clinical Professor, Department of Clinical Health
Professions, College of Pharmacy and Health Sciences, St.
John’s University, Queens, New York; Clinical Specialist in
Geriatric Pharmacy, Divisions of Geriatric Medicine and
Pharmacy, NYU Winthrop Hospital, Mineola, New York
Chapter 53
Dejan Landup, PharmD, BCPS
Heart Failure Clinical Pharmacist, Advocate Medical Group,
Chicago, Illinois
Chapter 7
Amber P. Lawson, PharmD, BCOP
Assistant Professor, Pharmacy Practice and Science, College of
Pharmacy, University of Kentucky, Lexington, Kentucky
Chapter 98
James C. Lee, PharmD, BCACP
Clinical Assistant Professor, Department of Pharmacy Practice,
Clinical Pharmacist, Ambulatory Pharmacy Services, College
of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
Chapter 10
Jeannie K. Lee, PharmD, BCPS, BCGP
Assistant Dean for Student Services and Associate Professor
College of Pharmacy; Clinical Associate Professor, College of
Medicine, The University of Arizona, Tucson, Arizona
Chapter 2
Mary Lee, PharmD, BCPS, FCCP
Professor of Pharmacy Practice, Chicago College of Pharmacy,
Vice President and Chief Academic Officer, Midwestern
University, Chicago, Illinois
Chapter 52
Russell E. Lewis, PharmD, BCPS
Associate Professor, Department of Medical and Surgical
Sciences, University of Bologna, Bologna, Italy
Chapter 84
Teresa V. Lewis, PharmD, BCPS
Assistant Professor, Department of Clinical and Administrative
Sciences, College of Pharmacy, University of Oklahoma
College of Pharmacy, Oklahoma City, Oklahoma
Chapter 68
Cara Liday, PharmD, BCPS, CDE
Associate Professor, Department of Pharmacy Practice, College
of Pharmacy, Idaho State University; Clinical Pharmacist,
InterMountain Medical Clinic, Pocatello, Idaho
Chapter 51
Susanne E. Liewer, PharmD, BCOP
Pharmacy Coordinator, Blood and Marrow Transplant; Clinical
Associate Professor, College of Pharmacy, University of
Nebraska Medical Center, Omaha, Nebraska
Chapter 97
Melissa Lipari, PharmD, BCACP
Clinical Assistant Professor, Wayne State University Eugene
Applebaum College of Pharmacy and Health Sciences;
Clinical Pharmacy Specialist, Ambulatory Care, St. John
Hospital and Medical Center, Detroit, Michigan
Chapter 20
Chisholm_FM_pi-xxviii.indd 17
CONTRIBUTORS xvii
Mark A. Malesker, PharmD, FCCP, FCCP, FCCM, FASHP, BCPS
Professor of Pharmacy Practice and Medicine, Creighton
University, Omaha, Nebraska
Chapters 27 and 28
Joel C. Marrs, PharmD, BCPS AQ Cardiology, BCACP
Associate Professor, Department of Clinical Pharmacy, Skaggs
School of Pharmacy and Pharmaceutical Sciences, University
of Colorado, Aurora, Colorado
Chapter 12
Spencer T. Martin, PharmD, BCPS
Clinical Pharmacy Manager, Department of Pharmacy Services,
Hartford Hospital, Hartford, Connecticut
Chapter 55
J. Russell May, PharmD
Clinical Professor and Associate Head, Department of Clinical
and Administrative Pharmacy, College of Pharmacy,
University of Georgia, Augusta, Georgia
Chapter 54
Kathleen May, MD
Division Chief and Associate Professor of Pediatrics, Division of
Allergy, Immunology and Pediatric Rheumatology, Medical
College of Georgia, Augusta University, Augusta, Georgia
Chapter 54
Joseph E. Mazur, PharmD, BCPS, BCNSP
Critical Care Clinical Specialist, Medical Intensive Care Unit;
Adjunct Clinical Associate Professor, Medical University
of South Carolina College of Pharmacy, Charleston, South
Carolina
Chapter 77
J. Michael McGuire, PharmD
Associate Professor of Pharmacy Practice, Psychiatry, College of
Pharmacy, Belmont University, Nashville, Tennessee
Chapter 38
Damian M. Mendoza, PharmD, CGP
Clinical Pharmacy Specialist, Geriatrics, Southern Arizona VA
Health Care System, Tuscon, Arizona
Chapter 2
Sarah J. Miller, PharmD, BCNSP
Professor, Department of Pharmacy Practice, University of
Montana Skaggs School of Pharmacy; Pharmacy Clinical
Coordinator, Province Saint Patrick Hospital, Missoula,
Montana
Chapter 101
Beverly C. Mims, PharmD
Associate Professor of Pharmacy Practice, College of Pharmacy,
Howard University; Clinical Pharmacist, Howard University
Hospital, Washington, DC
Chapter 21
M. Jane Mohler, NP-C, MSN, MPH, PhD
Co-Director, Arizona Geriatric Education Center, Associate
Director, Reynolds Program in Applied Geriatrics, College of
Medicine, University of Arizona, Tucson, Arizona
Chapter 2
05/09/18 5:00 PM
 xviii CONTRIBUTORS
Caroline Morin, BPharm, MSc
Pharmacist in Obstetrics and Gynecology, Associated Clinician,
CHU Ste-Justine, Université de Montreal Pharmacist,
Montreal, Quebec, Canada
Chapter 47
Lee E. Morrow, MD, MSc
Professor, Division of Pulmonary, Critical Care, and Sleep
Medicine, Creighton University School of Medicine, Omaha,
Nebraska
Chapters 27 and 28
Milap C. Nahata, PharmD, MS
Professor Emeritus of Pharmacy, Pediatrics and Internal
Medicine; Director of the Institute of Therapeutic Innovations
and Outcomes, College of Pharmacy, Ohio State University;
Columbus, Ohio
Chapter 3
Rocsanna Namdar, PharmD, FCCP, BCPS
Inpatient Pharmacy Supervisor, New Mexico Veterans Affairs
Healthcare System, Albuquerque, New Mexico
Chapter 75
Douglas A. Newton, MD, MPH
Child and Adolescent Psychiatrist, Colorado Permanente
Medical Group, Denver, Colorado
Chapter 40
Tien M.H. Ng, PharmD, BCPS AQ Cardiology
Associate Professor, Clinical Pharmacy, School of Pharmacy,
University of Southern California, Los Angeles, California
Chapter 6
Kimberly J. Novak, PharmD, BCPS, BCPPS
Clinical Pharmacy Specialist, Pediatric Pulmonary Medicine,
Nationwide Children’s Hospital, Columbus, Ohio
Chapter 16
Edith A. Nutescu, PharmD, MS, FCCP
Associate Professor, Department of Pharmacy Systems,
Outcomes and Policy, and Director, Center for
Pharmacoepidemiology and Pharmacoeconomic Research,
College of Pharmacy, University of Illinois, Chicago, Illinois
Chapter 10
Catherine M. Oliphant, PharmD
Professor and Interim Chair, Department of Pharmacy Practice
and Administrative Sciences, College of Pharmacy, Idaho
State University, Meridian, Idaho
Chapter 69
Ali J. Olyaei, PharmD
Professor, Department of Medicine and Pharmacy Practice,
Oregon State University and Oregon Health and Sciences
University, Portland, Oregon
Chapter 55
Christine Karabin O’Neil, BS, PharmD, BCPS, CGP
Professor of Pharmacy Practice, Division of Clinical, Social,
and Administrative Sciences, School of Pharmacy, Duquesne
University, Pittsburgh, Pennsylvania
Chapter 34
Chisholm_FM_pi-xxviii.indd 18
Vinita B. Pai, PharmD, MS
Associate Professor of Clinical Pharmacy, Ohio State University,
College of Pharmacy; Clinical Pharmacy Specialist, Pediatric
Blood and Marrow Transplant Program, Nationwide
Children’s Hospital, Columbus, Ohio
Chapter 3
Lisa M. Palmisano, PharmD, BCACP
Assistant Professor, Department of Pharmacy Practice, Clinical
Pharmacist, Chicago College of Pharmacy, Midwestern
University, Chicago, Illinois
Chapter 60
David Parra, PharmD, FCCP, BCPS
Clinical Pharmacy Program Manager in Cardiology &
Anticoagulation, Veterans Integrated Service Network 8,
Pharmacy Benefits Management, Bay Pines, Florida; Clinical
Associate Professor, Department of Experimental and Clinical
Pharmacology, College of Pharmacy, University of Minnesota,
Minneapolis, Minnesota
Chapter 5
Chris Paxos, PharmD, BCPP, BCPS, BCGP
Associate Professor of Pharmacy Practice, Associate Professor
of Psychiatry, College of Pharmacy, Northeast Ohio Medical
University, Rootstown, Ohio
Chapter 36
Charles Peloquin, PharmD, FCCP
Professor, Department of Pharmacotherapy and Translational
Research, College of Pharmacy, University of Florida,
Gainesville, Florida
Chapter 75
Maribel A. Pereiras, PharmD, BCPS, BCOP
Clinical Oncology Pharmacist, Hematopoietic Stem Cell
Transplant and Cellular Therapy, John Theurer Cancer Center
at Hackensack University Medical Center, Hackensack,
New Jersey
Chapter 66
Laura A. Perry, PharmD, BCPS
Associate Professor, Department of Pharmacy Practice,
University of Findlay College of Pharmacy, Findlay, Ohio
Chapter 65
Sarah Scarpace Peters, PharmD, MPH, BCOP
Associate Professor, Pharmacy Practice, Albany College of
Pharmacy and Health Sciences in Albany, NY
Chapter 99
Hanna Phan, PharmD, FCCP, FPPAG
Associate Professor, Department of Pharmacy Practice and
Science, Associate Professor, Department of Pediatrics,
Colleges of Pharmacy and Medicine; Associate Research
Scientist, Asthma and Airway Disease Research Center, The
University of Arizona, Tucson, Arizona
Chapters 3 and 63
Beth Bryles Phillips, PharmD, FASHP, FCCP, BCPS, BCACP
Rite Aid Professor, College of Pharmacy, University of Georgia;
Director VAMC/UGA PGY2 Ambulatory Care Residency
Program, Athens, Georgia
Chapter 56
05/09/18 5:00 PM

Bradley G. Phillips, PharmD, BCPS
Millikan-Revee Professor and Head, Department of Clinical and
Administrative Pharmacy, College of Pharmacy, University of
Georgia, Athens, Georgia
Chapter 41
Amy M. Pick, PharmD, BCOP
Professor of Pharmacy Practice, Creighton University School of
Pharmacy and Health Professions, Omaha, Nebraska
Chapter 96
Melissa R. Pleva, PharmD, BCNSP, BCCCP, BCPS
Manager-Surgery and Cardiovascular Services, Department
of Pharmacy Services, Michigan Medicine, Ann Arbor,
Michigan; Adjunct Clinical Assistant Professor, Department
of Clinical Pharmacy, College of Pharmacy, University of
Michigan, Ann Arbor, Michigan
Chapter 100
Christina M. Polomoff, PharmD, BCACP, BCGP
Assistant Clinical Professor, University of Connecticut School of
Pharmacy; Population Health Clinical Pharmacist, Hartford
HealthCare Integrated Care Partners, Storrs, Connecticut
Chapter 45
Elizabeth A. Price, PharmD, MSCR, BCPS
PGY2 Ambulatory Care Pharmacy Resident, University of
Georgia College of Pharmacy, Athens, Georgia
Chapter 56
Amber E. Proctor, PharmD
Clinical Assistant Professor, Division of Pharmacotherapy
and Experimental Therapy, Eshelman School of Pharmacy,
University of North Carolina at Chapel Hill, Chapel Hill,
North Carolina
Chapter 92
Jeremy J. Prunty, PharmD, BCPS
Clinical Pharmacy Specialist—Oncology Internal Medicine,
University Hospitals Cleveland Medical Center, Cleveland,
Ohio
Chapter 17
Leesa M. Prunty, PharmD, BCPS, BCPPS
Clinical Pharmacy Specialist—Cystic Fibrosis, University
Hospitals Home Care Services & Rainbow Babies and
Children’s Hospital, Cleveland, Ohio
Chapter 17
April Miller Quidley, PharmD, BCPS, BCCCP
Critical Care Pharmacist and Critical Care Residency Program
Director, Vidant Medical Center, Greenville, North Carolina
Chapter 70
Catherine Bourg Rebitch, PharmD, BCPS, BCACP
Clinical Associate Professor, Clinical and Administrative
Pharmacy; Director, PGY1 Community Residency Program,
College of Pharmacy, University of Georgia, Athens, Georgia
Chapter 18
Treavor T. Riley, PharmD, BCPS, BCCCP
Associate Professor, School of Pharmacy, Wingate University,
Hendersonville, North Carolina
Chapter 93
Chisholm_FM_pi-xxviii.indd 19
CONTRIBUTORS xix
Anastasia Rivkin, PharmD, BCPS
Assistant Dean for Faculty and Professor of Pharmacy Practice,
School of Pharmacy, Fairleigh Dickinson University, Florham
Park, New Jersey
Chapter 67
Kelly C. Rogers, PharmD, FCCP, FACC
Professor, Department of Clinical Pharmacy and Translational
Science, College of Pharmacy, University of Tennessee Health
Science Center, Memphis, Tennessee
Chapter 8
P. David Rogers, PharmD, PhD
First Tennessee Endowed Chair of Excellence in Clinical
Pharmacy, Vice Chair for Research, Director, Clinical
and Experimental Therapeutics, and Professor of Clinical
Pharmacy and Pediatrics, College of Pharmacy, University of
Tennessee Health Science Center, Memphis, Tennessee
Chapter 84
Brendan S. Ross, MD
Staff Physician, G.V. (Sonny) Montgomery Veterans Affairs
Medical Center; Clinical Associate Professor, Department
of Pharmacy Practice, University of Mississippi School of
Pharmacy, Jackson, Mississippi
Chapter 35
Leigh Ann Ross, PharmD, BCPS
Associate Dean for Clinical Affairs, Professor and Chair,
Department of Pharmacy Practice, University of Mississippi
School of Pharmacy, Jackson, Mississippi
Chapter 35
John C. Rotschafer, PharmD
Professor, College of Pharmacy, University of Minnesota,
Minneapolis, Minnesota
Chapter 85
Laurajo Ryan, PharmD, MSc, BCPS, CDE
Clinical Associate Professor, University of Texas at Austin
College of Pharmacy; University of Texas Health Science
Center, Department of Medicine, Pharmacotherapy
Education Research Center, Austin, Texas
Chapter 22
Melody Ryan, PharmD, MPH
Professor, Department of Pharmacy Practice and Science,
College of Pharmacy, University of Kentucky, Lexington,
Kentucky
Chapter 30
Lauren S. Schlesselman, MEd, PharmD
Director, Learning Initiatives & Educational Technology,
Adjunct Assistant Clinical Professor, University of
Connecticut, Storrs, Connecticut
Chapter 83
Kristine S. Schonder, PharmD
Assistant Professor, University of Pittsburgh School of
Pharmacy; Clinical Specialist, Transplant, University of
Pittsburgh Medical Center Health System, Pittsburgh,
Pennsylvania
Chapter 26
05/09/18 5:00 PM
 xx CONTRIBUTORS

Julie Sease, PharmD, FCCP, BCPS, CDE, BCACP
Professor of Pharmacy Practice and Associate Dean for
Academic Affairs, School of Pharmacy, Presbyterian College,
Clinton, South Carolina
Chapter 43
Mary K. Stamatakis, PharmD
Senior Associate Dean for Academic Affairs and Educational
Innovation and Professor, West Virginia University School of
Pharmacy, Morgantown, West Virginia
Chapter 25

Corinne M. Self, MD Robert J. Straka, PharmD

Assistant Professor of Geriatrics, Division of Internal Medicine, Professor and Head, Experimental and Clinical Pharmacology
Geriatrics and Palliative Care, University of Arizona, College Department, University of Minnesota College of Pharmacy,
of Medicine, Tucson, Arizona Minneapolis, Minnesota
Chapter 2 Chapter 5

Roohollah Sharifi, MD, FACS S. Scott Sutton, PharmD, BCPS AQ-ID

Professor, Department of Urology and Surgery, College of Professor and Chair, Department of Clinical Pharmacy and
Medicine, University of Illinois at Chicago, Chicago, Illinois Outcomes Sciences, College of Pharmacy, University of South
and Section Chief of Urology, Jesse Browns Veterans Carolina, Columbia, South Carolina
Administration Medical Center, Chicago, Illinois Chapter 82
Chapter 52
Marc A. Sweeney, PharmD, MDiv
Bradley W. Shinn, PharmD Professor and Dean, School of Pharmacy, Cedarville University,
Professor of Pharmacy Practice, University of Findlay College of Cedarville, Ohio
Pharmacy, Findlay, Ohio Chapter 4
Chapter 76 Marie-Lou Tardif, MD, FRCPC
Staff Physician, Université de Montréal
April Smith, PharmD, BCPS
Montreal, Quebec
Associate Professor, School of Pharmacy and Health Professions,
Chapter 47
Creighton University, Omaha, Nebraska
Chapter 102 Sharon Ternullo, PharmD, DABAT
Assistant Professor of Pharmacy Practice, University of Findlay
Judith A. Smith, PharmD, BCOP, CPHQ College of Pharmacy, Findlay, Ohio
Associate Professor, Department of Obstetrics, Gynecology and Chapter 76
Reproductive Sciences, University of Texas Medical School at
Houston, Houston, Texas Eljim P. Tesoro, PharmD, BCPS
Chapter 94 Clinical Associate Professor, College of Pharmacy, Clinical
Pharmacist, Neurosciences, Director, PGY2 Critical Care
Melanie N. Smith, PharmD, BCPS, BCCCP Residency, University of Illinois Hospital and Health Sciences
Critical Care Specialist, Surgery-Trauma ICU, Affiliate Assistant System, Chicago, Illinois
Professor, Medical University of South Carolina College of Chapter 32
Pharmacy, Charleston, South Carolina
Chapter 77 Christian J. Teter, PharmD, BCPP
Manager, Medical Affairs, Alkermes, Waltham, Massachusetts
Steven M. Smith, PharmD, MPH, BCPS Chapter 36
Assistant Professor, Departments of Pharmacotherapy and
Heather M. Teufel, PharmD, BCPS, BCCCP
Translational Research and Community Health & Family
Clinical Pharmacist, Emergency Medicine, University of
Medicine, Colleges of Pharmacy and Medicine, University of
Pennsylvania Health System, Chester County Hospital, West
Florida, Gainesville, Florida
Chester, Pennsylvania
Chapter 58
Chapter 23
Susan E. Smith, PharmD, BCPS, BCCCP Janine E. Then, PharmD, BCPS
Clinical Assistant Professor, Clinical and Administrative Pharmacy, Lead Pharmacist–Clinical Services, University of Pittsburgh
College of Pharmacy, University of Georgia, Athens, Georgia Medical Center, Presbyterian-Shadyside Hospital, Pittsburgh,
Chapter 82 Pennsylvania
Chapter 23
Thomas R. Smith, PharmD
Assistant Professor of Pharmacy Practice, College of Pharmacy, Michael L. Thiman, PharmD
Natural, and Health Sciences, Manchester University, Clinical Assistant Professor, Clinical and Administrative
Fort Wayne, Indiana Pharmacy, College of Pharmacy, University of Georgia,
Chapter 33 Athens, Georgia
Chapter 18
Sarah A. Spinler, PharmD, FCCP, FAHA, FASHP, AACC, BCPS
AQ Cardiology Maria Miller Thurston, PharmD, BCPS
Professor and Chair, Department of Pharmacy Practice, School Clinical Associate Professor, Department of Pharmacy Practice,
of Pharmacy and Pharmaceutical Sciences, Binghamton College of Pharmacy, Mercer University, Atlanta, Georgia
University, Binghamton, New York Chapter 59
Chapter 8

Chisholm_FM_pi-xxviii.indd 20 05/09/18 5:00 PM

 CONTRIBUTORS xxi

James E. Tisdale, PharmD, BCPS, FCCP, FAPhA, FNAP, Ya-Feng Wen, PharmD
FAHA, FACC PhD Student, Department of Experimental and Clinical
Professor, College of Pharmacy, Purdue University; Adjunct Pharmacology, College of Pharmacy, University of Minnesota,
Professor, School of Medicine, Indiana University, Minneapolis, Minnesota
Indianapolis, Indiana Chapter 5
Chapter 9
Tara R. Whetsel, PharmD, BCACP, BC-ADM
Mary A. Ullman, PharmD Clinical Associate Professor, West Virginia University School of
Pharmacist, Regions Hospital, St. Paul, Minnesota Pharmacy, Morgantown, West Virginia
Chapter 85 Chapter 15

Sandeep Vansal, PharmD Jon P. Wietholter, PharmD, BCPS

Associate Professor and Director, Pharmaceutical Sciences, Clinical Associate Professor, West Virginia University School
School of Pharmacy, Fairleigh Dickinson University, of Pharmacy; Internal Medicine Clinical Pharmacist, WVU
Florham Park, New Jersey Medicine Ruby Memorial Hospital, Morgantown, West
Chapter 67 Virginia
Chapter 15
Orly Vardeny, PharmD, MS, BCACP
Associate Professor, School of Medicine, University of Sheila Wilhelm, PharmD, BCPS
Minnesota, Minneapolis, Minnesota Clinical Associate Professor, Department of Pharmacy
Chapter 6 Practice, Eugene Applebaum College of Pharmacy and
Health Sciences, Wayne State University; Clinical Pharmacy
Mary L. Wagner, PharmD, MS Specialist, Internal Medicine, Harper University Hospital,
Associate Professor, Department of Pharmacy Practice and Detroit, Michigan
Administration, Ernest Mario School of Pharmacy, Rutgers Chapter 20
University, Piscataway, New Jersey
Chapter 33 Lori Wilken, PharmD
Clinical Pharmacist, University of Illinois Hospital and Health
Heidi J. Wehring, PharmD, BCPP Sciences System; Clinical Assistant Professor, Pharmacy
Assistant Professor, Department of Psychiatry, Maryland Practice, University of Illinois at Chicago College of
Psychiatric Research Center, University of Maryland School Pharmacy, Chicago, Illinois
of Medicine, Washington, DC Chapter 14
Chapter 37
Susan R. Winkler, PharmD, BCPS
Lydia E. Weisser, DO, MBA Professor and Chair, Department of Pharmacy Practice, College
Medical Director, Bryan Psychiatric Hospital, Columbia, of Pharmacy, Midwestern University Chicago, Downers
South Carolina Grove, Illinois
Chapter 39 Chapter 11
Timothy E. Welty, PharmD, MA, BCPS G. Christopher Wood, PharmD, BCPS AQ-ID, BCCCP
Professor and Chair, Department of Clinical Sciences, College Associate Professor, Department of Clinical Pharmacy, College
of Pharmacy and Health Sciences, Drake University, Des of Pharmacy, University of Tennessee, Memphis, Tennessee
Moines, Iowa Chapter 13
Chapter 31

Chisholm_FM_pi-xxviii.indd 21 05/09/18 5:00 PM

 This page intentionally left blank

Chisholm_FM_pi-xxviii.indd 22 05/09/18 5:00 PM

 REVIEWERS
Nelly Adell, PharmD, BCOP, BCPS
Chair, Pharmacy Practice, Associate Professor in Oncology,
Touro College of Pharmacy, New York, New York
Rita R. Alloway, PharmD, FCCP
Research Professor of Medicine; Director, Transplant Clinical
Research; Director, Transplant Pharmacy Residency and
Fellowship, University of Cincinnati, Cincinnati, Ohio
Carmela Avena-Woods, BS Pharm, PharmD, CGP
Associate Clinical Professor, Department of Clinical Health
Professions, College of Pharmacy and Health Sciences, St.
John’s University, Queens, New York
Katie E. Barber, PharmD, RPh
Assistant Professor, Department of Pharmacy Practice,
University of Mississippi School of Pharmacy, Jackson,
Mississippi
Kimberley Begley, PharmD, RPh
Associate Professor, Director of Distance Pharmacy Education,
School of Pharmacy and Health Professions, Creighton
University, Omaha, Nebraska
Deborah Berlekamp, PharmD, BCPS
Assistant Professor of Pharmacy Practice, University of Findlay,
Findlay, Ohio
Martha Blackford, PharmD, BCPS
Assistant Professor of Pediatrics; Clinical Assistant Professor
of Pharmacy Practice, Northeast Ohio Medical University,
Rootstown, Ohio; Clinical Pharmacologist & Toxicologist,
Akron Children’s Hospital, Akron, Ohio
Betsy Blake, PharmD, BCPS
Director, Interprofessional Education; Clinical Associate
Professor, Department of Clinical Pharmacy and Outcomes
Sciences, College of Pharmacy, University of South Carolina,
Columbia, South Carolina
Mary Bridgeman, PharmD, BCPS, BCGP
Clinical Associate Professor, Department of Pharmacy Practice
and Administration, Ernest Mario School of Pharmacy,
Rutgers, The State University of New Jersey, Piscataway,
New Jersey
Denise Buonocore, MSN, ACNPC, CCNS, CCRN, CHFN
Acute Care Nurse Practitioner for HF Services, St. Vincent’s
Multispecialty Group, Bridgeport, Connecticut
Jamal A. Brown, PharmD, BCGP
Assistant Professor, Department of Pharmacy Practice, College
of Pharmacy and Pharmaceutical Sciences, Florida A&M
University, Tampa, Florida
Katie E. Cardone, PharmD, BCACP, FNKF, FASN, FCCP
Associate Professor of Pharmacy Practice, Albany College of
Pharmacy and Health Sciences, Albany, New York
Katherine Carey, PharmD, BCACP
Associate Professor of Pharmacy Practice, School of Pharmacy,
MCPHS University, Worcester, Massachusetts
Chisholm_FM_pi-xxviii.indd 23
Manouchkathe Cassagnol, PharmD, BCPS, CGP
Associate Clinical Professor, College of Pharmacy and Allied
Health Professions, St. John’s University, Queens, New York
Daniel B. Chastain, PharmD, AAHIVP
Clinical Assistant Professor; Clinical Pharmacy Specialist,
Infectious Diseases, Department of Clinical and
Administrative Pharmacy, College of Pharmacy, University of
Georgia, Albany, Georgia
Julie Cooper, PharmD, BCPS AQ Cardiology
Associate Professor, Department of Clinical Sciences, Fred
Wilson School of Pharmacy, High Point University, High
Point, North Carolina
Kelli Coover, PharmD, BCGP
Associate Professor and Vice-Chair of Pharmacy Practice,
School of Pharmacy and Health Professions, Creighton
University, Omaha, Nebraska
Bonnie A. Dadig, EdD, PA-C
Professor Emeritus, Physician Assistant Department, College
of Allied Health Sciences, Augusta University; Physician
Assistant, Department of Family Medicine, Medical College
of Georgia, Augusta, Georgia
David Dadiomov, PharmD
Assistant Professor, Larkin University, Miami, Florida
Lawrence W. Davidow, PhD, RPh
Director, Pharmacy Skills Laboratory, University of Kansas
School of Pharmacy, Lawrence, Kansas
Joseph M. Davis, PharmD, BCPS
Nephrology Clinical Pharmacist, Vidant Medical Center,
Greenville, North Carolina
Emily Dornblaser, PharmD, MS, BCPS
Associate Professor, Department of Pharmacy Practice, Critical
Care Specialist, College of Pharmacy, University of New
England, Portland, Maine
Thomas Dowling, PharmD, PhD
Assistant Dean and Professor of Pharmacy Practice, College of
Pharmacy, Ferris State University, Grand Rapids, Michigan
Alicia Elam, PharmD
Associate Professor, Physician Assistant Department, College of
Allied Health Sciences, Augusta University, Augusta, Georgia
David P. Elliott, PharmD, CGP
Professor and Associate Chair of Clinical Pharmacy, School
of Pharmacy, West Virginia University, Charleston, West
Virginia
Jingyang Fan, PharmD, BCPS
Assistant Dean, Academic Affairs; Clinical Associate
Professor, School of Pharmacy, Southern Illinois University,
Edwardsville, Illinois
xxiii
05/09/18 5:00 PM
 xxiv REVIEWERS
Karen M. Fancher, PharmD, BCOP
Assistant Professor of Pharmacy Practice, School of Pharmacy,
Duquesne University; Clinical Pharmacy Specialist,
University of Pittsburgh Medical Center at Passavant
Hospital, Pittsburgh, Pennsylvania
Sarah Jane E. Faro, PharmD, BCPS, BCOP
Assistant Professor, School of Pharmacy, College of Health
Professions, Pacific University, Forest Grove, Oregon
Maisha Freeman, PharmD, BCPS
Professor and Director, Center for Healthcare Innovation
and Patient Outcomes Research, Department of Pharmacy
Practice, McWhorter School of Pharmacy, Samford
University, Birmingham, Alabama
Lisa R. Garavaglia, PharmD, BCPS
Pediatric Clinical Pharmacist, WVU Medicine; Adjunct
Assistant Professor, West Virginia University School of
Pharmacy, Morgantown, West Virginia
Brooke L. Griffin, PharmD, BCACP
Professor, Department of Pharmacy Practice, Chicago College
of Pharmacy, Midwestern University, Downers Grove, Illinois
Ben Gross, PharmD, MBA, BCPS, BCACP, CDE, BC-ADM,
ASH-CHC
Associate Professor, College of Pharmacy and Health Sciences,
Lipscomb University, Nashville, Tennessee
Leslie Hamilton, PharmD, BCPS, BCCCP, FCCP, FCCM
Associate Professor, Department of Clinical Pharmacy and
Translational Science, College of Pharmacy, University of
Tennessee Health Science Center, Knoxville, Tennessee
Jin Han, PharmD, PhD, BCPS
Clinical Pharmacist and Clinical Assistant Professor,
Department of Pharmacy Practice, University of Illinois at
Chicago College of Pharmacy, Chicago, Illinois
Christy S. Harris, PharmD, BCPS, BCOP
Associate Professor of Pharmacy Practice, School of Pharmacy,
Massachusetts College of Pharmacy and Health Sciences,
Boston, Massachusetts
Cara A. Harshberger, PharmD, BCOP
Clinical Assistant Professor of Pharmacy Practice, School of
Pharmacy, University of Wyoming, Laramie, Wyoming
Deborah A. Hass, PharmD, BCOP, BCPS
Associate Professor of Pharmacy Practice, West Coast
University, Los Angeles, California
Dawn E. Havrda, PharmD, BCPS, FCCP
Associate Professor, Department of Clinical Pharmacy and
Translational Science; Associate Dean for Academic Affairs
and Assessment, College of Pharmacy, University of
Tennessee Health Science Center, Memphis, Tennessee
Crystal Howell, PharmD, FCCP, BCPS
Assistant Professor, Department of Infectious Diseases,
Department of Pharmacotherapy; Infectious Diseases
Pharmacist, UNT Health Science Center, Fort Worth, Texas
Chisholm_FM_pi-xxviii.indd 24
Stephanie Hsia, PharmD, BCPP
Assistant Professor, Department of Clinical Pharmacy, School of
Pharmacy, University of California, San Francisco, California
Michelle Hughes, PharmD, BCPS, BCACP
Clinical Pharmacist, Neighborhood Healthcare, Escondido,
California, Palomar Health, Escondido, California
John Hurt, MSPAS, PA-C
Assistant Professor, Department of Clinical and Diagnostic
Sciences, School of Health Professions, University of Alabama
at Birmingham, Birmingham, Alabama
Meghan Jeffres, PharmD
Assistant Professor, Department of Clinical Pharmacy, Skaggs
School of Pharmacy and Pharmaceutical Sciences, University
of Colorado, Aurora, Colorado
Melissa D. Johnson, PharmD, MHS, AAHIVP
Associate Professor of Medicine, Division of Infectious Diseases
& International Health, Duke University Medical Center,
Liaison Clinical Pharmacist, Duke Antimicrobial Stewardship
Outreach Network (DASON) Durham. North Carolina
Julie Ann Justo, PharmD, MS, BCPS AQ-ID
Assistant Professor, Department of Clinical Pharmacy and
Outcomes Sciences, College of Pharmacy, University of South
Carolina, Columbia, South Carolina
Jason Kielly, PharmD
Assistant Professor, School of Pharmacy, Memorial University,
St John’s, Newfoundland and Labrador, Canada
Justin Kinney, PharmD, MA, BCCCP
Assistant Professor, Department of Pharmacy Practice, School
of Pharmacy, Loma Linda University, Loma Linda, California
Kenneth P. Klinker, PharmD
Clinical Associate Professor, Department of Pharmacotherapy
and Translational Research, College of Pharmacy, University
of Florida, Gainesville, Florida
Jessa Koch, PharmD, BCPP
Assistant Professor, Department of Pharmacy Practice, School
of Pharmacy, Loma Linda University, Loma Linda, California
Jerika Lam, PharmD, AAHIVP
Associate Professor, Department of Pharmacy Practice, School
of Pharmacy, Chapman University, Irvine, California
Michelle D. Lesé, PharmD, BCPS
Assistant Professor of Pharmacy Practice, Lloyd L. Gregory
School of Pharmacy, Palm Beach Atlantic University, West
Palm Beach, Florida
Michelle L. Litchman, PhD, FNP-BC
Assistant Professor, College of Nursing, University of Utah,
Salt Lake City, Utah
Benjamin J. Malcolm, PharmD, MPH, BCPP
Assistant Professor, Pharmacy Practice and Administration,
College of Pharmacy, Western University of the Health
Sciences, Pomona, California
05/09/18 5:00 PM

Jennifer M. Malinowski, PharmD
Associate Professor, Pharmacy Practice, Nesbitt School of
Pharmacy, Wilkes University, Wilkes-Barre, Pennsylvania;
Director, Clinical Pharmacy Services Integration, The Wright
Center for Primary Care, Jermyn, Pennsylvania
Michael A. Mancano, PharmD
Chair, Department of Pharmacy Practice; Clinical Professor of
Pharmacy Practice, Temple University School of Pharmacy,
Philadelphia, Pennsylvania
Jay Martello, PharmD, BCPS
Clinical Associate Professor, School of Pharmacy, West Virginia
University, Clinical Specialist in Internal Medicine, WVU
Medicine, Morgantown, West Virginia
Craig Martin, PharmD, MBA
Professor, Department of Pharmacy Practice and Science;
Director, Practice and Residency Advancement, College of
Pharmacy, University of Kentucky, Lexington, Kentucky
Lena Maynor, PharmD, BCPS
Clinical Associate Professor, School of Pharmacy, West Virginia
University, Morgantown, West Virginia
Ziemowit Mazur, EdM, MS, PA-C
Assistant Professor and Associate Director, Physician Assistant
Program, College of Health Professions, Rosalind Franklin
University of Medicine and Science, North Chicago, Illinois
Milena M. McLaughlin, PharmD, MSc, BCPS-AQ ID, AAHIVP
Associate Professor, Department of Pharmacy Practice, Chicago
College of Pharmacy, Midwestern University, Downers Grove,
Illinois
Mary Mihalyo, PharmD, BCPS, CDE
Assistant Professor, Pharmacy Practice, Division of Clinical,
Social and Administrative Science, School of Pharmacy,
Duquesne University, Pittsburgh, Pennsylvania
Kimberly Miller, PharmD
Assistant Professor of Pharmacy Practice, Nesbitt School of
Pharmacy, Wilkes University, Wilkes-Barre, Pennsylvania
Rima A. Mohammad, PharmD, BCPS
Clinical Associate Professor, Department of Clinical Pharmacy,
College of Pharmacy and Health System, University of
Michigan, Ann Arbor, Michigan
Anne Moore, DNP, APN, FAANP
Nurse Practitioner, Women’s Health and Adult Certification,
Division of Family Health and Wellness, Tennessee
Department of Health, Nashville, Tennessee
Candis M. Morello, PharmD, CDE, FCSHP, FASHP
Professor of Clinical Pharmacy, Skaggs School of Pharmacy,
University of California, San Diego, La Jolla, California
Whitney Narramore, PharmD, BCACP, BCGP
Assistant Professor, College of Pharmacy and Health Sciences,
Lipscomb University, Nashville, Tennessee
Dan Nichols, PharmD
Clinical Pharmacy Specialist, Adult Leukemia, University of
Texas MD Anderson Cancer Center, Houston, Texas
Chisholm_FM_pi-xxviii.indd 25
REVIEWERS xxv
Viet-Huong Nguyen, PharmD
Assistant Professor, Department of Pharmacy Practice, School
of Pharmacy, Chapman University, Irvine, California
Christine O’Neil, BS, PharmD, BCPS, BCGP, FCCP, CTTS
Professor of Pharmacy Practice, Assistant Dean, Curriculum
Development & Interprofessional Education School of
Pharmacy, Duquesne University, Pittsburgh, Pennsylvania
Stephen Orr, MD
Ophthalmologist, Spectrum Eye Care, Inc., Findlay, Ohio
Robert B. Parker, PharmD, FCCP
Professor, Department of Clinical Pharmacy and Translational
Science, University of Tennessee Health Science Center,
College of Pharmacy, Memphis, Tennessee
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP
Associate Professor of Pharmacy Practice, School of Pharmacy,
Massachusetts College of Pharmacy and Health Sciences,
Boston, Massachusetts
Alyssa Peckham, PharmD, BCPP
Assistant Professor, Department of Pharmacy Practice, College
of Pharmacy, Midwestern University, Glendale, Arizona
Patricia Pepa, PharmD, MS, BCPP
Clinical Pharmacy Specialist, Psychiatry, Kaiser Permanente,
Oakland, California
Kelly M. Percival, PharmD, BCPS AQ-ID
Assistant Professor of Pharmacy Practice, College of Pharmacy
and Health Sciences, Drake University, Des Moines, Iowa
Maribel A. Pereiras, PharmD, BCPS, BCOP
Clinical Oncology Specialist, Hackensack University Medical
Center, Hackensack, New Jersey
Golden L. Peters, PharmD
Associate Professor, Pharmacy Practice, Division of Ambulatory
Care Pharmacy, St. Louis College of Pharmacy, St. Louis,
Missouri
Kara Piechowski, PharmD, BCPS
Internal Medicine Clinical Pharmacist, WVU Medicine,
School of Pharmacy, West Virginia University, Morgantown,
West Virginia
Leesa Prunty, PharmD, BCPS, BCPPS
Clinical Pharmacy Specialist—Cystic Fibrosis, University
Hospitals Home Care Services & Rainbow Babies and
Children’s Hospital, Cleveland, Ohio
Sandra Cuellar Puri, PharmD, BCOP
Clinical Assistant Professor, Department of Pharmacy Practice,
University of Illinois at Chicago College of Pharmacy,
Chicago, Illinois
Talia Puzantian, PharmD, BCPP
Associate Professor of Clinical Sciences, School of Pharmacy
and Health Sciences, Keck Graduate Institute, Claremont,
California
05/09/18 5:00 PM
 xxvi REVIEWERS
Hana Rac, PharmD
Clinical Instructor, College of Pharmacy, University of South
Carolina, Columbia, South Carolina
Meenakshi R. Ramanathan, PharmD, BCPS
Assistant Professor, Infectious Diseases, Department of
Pharmacotherapy; Antimicrobial Stewardship Pharmacist,
UNT Health Science Center, Fort Worth, Texas
Erin Raney, PharmD, BCPS, BC-ADM
Professor, Department of Pharmacy Practice, College of
Pharmacy, Midwestern University, Glendale, Arizona
Michael Reed, PharmD, FCCP, FCP
Adjunct Professor, Department of Pharmacology; Director
Division of Clinical Pharmacology and Toxicology, Case
Western Reserve University, Cleveland, Ohio
Carol J. Rollins, MS, RD, PharmD, BCNSP, FASPEN, FASHP
Clinical Professor, University of Arizona, College of Pharmacy,
Tucson, Arizona
Aline Saad, PharmD
Clinical Associate Professor, Pharmacy Practice, School of
Pharmacy, Lebanese American University, Byblos, Lebanon
Maha Saad, PharmD, CGP, BCPS
Associate Clinical Professor, St. John’s University College of
Pharmacy and Health Sciences, Queens, New York
Claire Saadeh, PharmD, BCOP
Professor, Pharmacy Practice, Oncology, Pain Management,
Palliative Care, Ferris State University, Sparrow Health
System, Department of Pharmacy, Lansing, MI
Melissa Santibanez, PharmD
Assistant Professor, Department of Clinical and Administrative
Sciences, College of Pharmacy, Larkin University, Miami,
Florida
JoAnne M. Saxe, DNP, RN, ANP-BC, MS
Health Sciences Clinical Professor, Department of Community
Health Systems, School of Nursing, University of California
San Francisco, San Francisco, California
Jordan Sedlacek, PharmD, BCACP
Assistant Professor, Department of Clinical and Administrative
Sciences, College of Pharmacy, Larkin University, Miami,
Florida
Catherine N. Shull, PA-C, MPAS
Assistant Professor, Department of Physician Assistant Studies,
Department of Family and Community Medicine, Wake
Forest School of Medicine, Winston-Salem, North Carolina
Rebecca Stone, PharmD, BCACP, BCPS
Clinical Assistant Professor, Department of Clinical and
Administrative Pharmacy, College of Pharmacy, University of
Georgia, Athens, Georgia
Chisholm_FM_pi-xxviii.indd 26
Kimberly Tallian, PharmD, BCPP, APH
Advanced Practice Pharmacist—Psychiatry and PGY2
Residency Program Director, Psychiatry Scripps Mercy
Hospital, San Diego, California
Eglis Tellez, PharmD
Assistant Professor, College of Pharmacy, Marshall B. Ketchum
University, Fullerton, California
Jyothi Tirumalasetty, MD
Assistant Professor of Medicine, School of Medicine; Director
of Allergy Clinic, UI Health, University of Illinois at Chicago,
Chicago, Illinois
Shawn Turner, PharmD, BCPS, MBA
Assistant Professor of Pharmacy Practice, College of Pharmacy,
Harding University, Searcy, Arkansas
Cory M. Vela, PharmD, BCOP
Clinical Pharmacy Specialist, Precision Medicine
Adjunct Assistant Professor, College of Pharmacy
University of Kentucky Markey Cancer Center
Lexington, Kentucky
Kurt Wargo, PharmD, FCCP, BCPS
Regional Dean and Associate Professor of Pharmacy,
Hendersonville Health Sciences Center, Wingate University,
Hendersonville, North Carolina
Sarah Westberg, PharmD, FCCP, BCPS
Associate Professor, Department of Pharmaceutical Care
and Health Systems, College of Pharmacy, University of
Minnesota, Minneapolis, Minnesota
Thomas White, JD, PA-C
Associate Professor, Physician Assistant Program, Westbrook
College of Health Professions, University of New England,
Portland, Maine
Monty Yoder, PharmD, BCPS
Clinical Coordinator, Department of Pharmacy, Wake Forest
Baptist Health; Assistant Clinical Professor, Wake Forest
School of Medicine, Winston-Salem, North Carolina
W. Cheng Yuet, PharmD
Assistant Professor of Pharmacotherapy, College of Pharmacy,
University of North Texas Health Science Center, Fort Worth,
Texas
Mary Ann Zagaria, PharmD, MS
Clinical Consultant Pharmacist in Geriatrics, MZ Associates
Inc, Portland, Maine
Yasmine Zeid, PharmD
Pharmacist, Mercy Hospital, St. Louis College of Pharmacy,
St. Louis, Missouri
David Zimmerman, PharmD, BCPS, BCCCP
Assistant Professor, Division of Pharmacy Practice, School of
Pharmacy, Duquesne University, Pittsburgh, Pennsylvania
05/09/18 5:00 PM
 PREFACE
E
ffective use of pharmacotherapy is vital for preventing and
treating acute and chronic medical conditions. Although
biomedical research continues to develop and provide
medications with enormous potential to improve health, these
same medications are often overused, underused, or misused,
leading to suboptimal or unsafe results. It is our responsibility
as health care practitioners to optimize positive health outcomes
and limit adverse pharmacotherapeutic effects.
Provision of high quality, cost-effective pharmacotherapy
requires an integration of scientific knowledge and clinical practice
skills combined with a fiduciary responsibility to put the patient’s
needs first. The development of mature pharmacotherapists
occurs through structured learning processes that include formal
coursework, independent study, mentorship, interprofessional
experiences, and direct involvement in the care of actual patients.
The fifth edition of Pharmacotherapy Principles & Practice
is designed to provide student learners and health care
practitioners with essential knowledge of the pathophysiology
and pharmacotherapeutics of disease states likely to be
encountered in routine practice. Chapters are written by content
experts and peer reviewed by pharmacists, nurse practitioners,
physician assistants, and physicians who are authorities in their
professional disciplines.
Pharmacotherapy Principles & Practice, fifth edition, opens
with an introductory chapter followed by chapters on pediatrics,
geriatrics, and palliative care. Most of the remainder of the
book consists of disease-based chapters that review disease
epidemiology, etiology, pathophysiology, clinical presentation
and diagnosis, and nonpharmacologic therapy, followed
by an emphasis on clear therapeutic recommendations for
medication selection, desired outcomes expected, dosing, and
patient monitoring. The following features were designed in
collaboration with educational design specialists to enhance
learning and retention:
• Structured learning objectives at the beginning of each
chapter, with information in the text that corresponds to
each learning objective identified by a vertical rule in the
margin, allowing the reader to quickly find content related to
each objective.
• Key concepts related to the disease, patient assessment,
and treatment highlighted with an easily identifiable icon
throughout the chapter.
• Patient encounters that facilitate development of critical
thinking skills and lend clinical relevance to the scientific
foundation provided.
• A newly designed patient care process section modeling
the Joint Commission of Pharmacy Practitioners (JCPP)
Pharmacists’ Patient Care Process that provides specific
recommendations about the process of care for an individual
Chisholm_FM_pi-xxviii.indd 27
patient involving five steps: collecting information, assessing
information, developing a care plan, implementing the care
plan, and following-up: monitor and evaluate.
• Up-to-date literature citations for each chapter to support
treatment recommendations.
• Tables, figures, and algorithms that enhance understanding of
pathophysiology, clinical presentation, medication selection,
pharmacokinetics, and patient monitoring.
• Medical abbreviations and their meanings at the end of each
chapter to facilitate learning the accepted shorthand used in
real-world health care settings.
• Self-assessment questions and answers for each chapter in
the Online Learning Center to facilitate self-evaluation of
learning.
• Laboratory values expressed as both conventional units and
Système International (SI) units.
• Appendices that contain: (1) conversion factors and
anthropometrics; (2) common medical abbreviations; (3)
glossary of medical terms (the first use of each term in a
chapter appears in bold, colored font); and (4) prescription
writing principles.
• A table of common laboratory tests and reference ranges
appears on the inside covers of the book.
A companion textbook, Pharmacotherapy Principles and
Practice Study Guide: A Case-Based Care Plan Approach, is
available to further enhance learning by guiding students
through the process of applying knowledge of pharmacotherapy
to specific patient cases. This study guide contains approximately
100 patient cases that correspond to chapters published in the
textbook.
The Online Learning Center at www.ChisholmPharmaco
therapy.com provides self-assessment questions, grading and
immediate feedback on the questions, and reporting capabilities.
The complete textbook and study guide are available to subscribers
of the publisher’s AccessPharmacy site (www.accesspharmacy.
com), an online educational resource for faculty and students of
the health professions.
We are extremely grateful for the commitment and dedication
of more than 190 contributing authors and more than 100 peer
reviewers of the chapters in this new edition. We also thank the
many educators, schools/colleges, and health care institutions
that have adopted this textbook in courses or use it as a reference
in practice settings. In closing, we extend our sincere thanks to
the McGraw-Hill Education editorial team for their hard work
and commitment to bringing this new edition to our readership.
The Editors
August 2018
xx vii
05/09/18 5:00 PM
 ACKNOWLEDGMENTS

Editors Emeriti
The following individuals were founding editors and participated in the first four editions. Their
contributions have been invaluable and are greatly appreciated:
• Barbara G. Wells, PharmD, FASHP, FCCP
• Joseph T. DiPiro, PharmD, FCCP

Original Artwork
Title: The Art of Pharmacotherapy
Cover illustration and design copyright © 2018 by Obi-Tabot Tabe, PharmD. The image is taken from an
18’ × 24’ oil painting by Obi-Tabot Tabe, PharmD, a painter, graphic designer, scientific illustrator, and
pharmacist. The painting is housed at the University of Pittsburgh School of Pharmacy.
Dr. Tabe, originally from Cameroon, is a graduate of the University of Pittsburgh School of Pharmacy.
The pharmacist scope of practice is expanding, and pharmacists are taking on a greater patient care
role in collaborative drug therapy with physicians and other healthcare professionals. The painting
depicts the collaborative relationship between the disciplines of pharmacy and medicine in the art
of pharmacotherapy. Basic dispensing functions, drug information services, solutions to patient-
and medication-related problems, and decisions regarding drug prescribing, monitoring and drug
regimen adjustments are all collaborative efforts in pharmacotherapy. The intersecting circles represent
collaboration between pharmacists, physicians, and other healthcare professionals in the art of
pharmacotherapy. The subtle greens and blues in the painting, including carbon rings and molecular
structures, represent natural and synthetic medicines. The pills (tablets and capsules) in one of the
circles represent the knowledge and expertise of the pharmacist in drug information services and drug
therapy; the stethoscope represents the clinical environment; and the pharmacokinetic curves represent
the vitality to drug monitoring and adjustments.

Special Acknowledgment
On the occasion of her retirement, we especially acknowledge the many years of dedicated service
provided by Ms. Laura Libretti, Administrative Assistant at McGraw-Hill Education.

xx viii

Chisholm_FM_pi-xxviii.indd 28 05/09/18 5:00 PM

 Part I

Basic Concepts of
Pharmacotherapy
Principles and Practices

Chisholm_Ch01_p0001-0006.indd 1 22/08/18 11:56 AM

 This page intentionally left blank

Chisholm_Ch01_p0001-0006.indd 2 22/08/18 11:56 AM

 1 Introduction
INTRODUCTION
H
ealth professionals are given significant responsibilities
in our health care system. These roles may be taken for
granted by patients until a pharmacist, nurse practitio-
ner, physician assistant, physician, or others perform assigned
tasks that make positive impacts upon patients and patients’
families lives in countless ways. The exemplary manner in which
health professionals provide necessary care to patients is a hall-
mark of health professional practice and delivery of US health
care. Patients are thus well served, and fellow health profession-
als share knowledge and expertise specific to their profession.
However, there are significant problems remaining in the US
health care system from a structural standpoint. In 2016, the
United States spent 17.2% of the gross domestic product (GDP)
on health care,1 yet the United States ranks 37th in the world
when considering outcomes of care. Comparing the United
States to similar industrialized countries, we rank 11th out of 11
comparator countries, and have poorer health outcomes.2 The
reasons for why the United States compares poorly with other
countries will be discussed in the following paragraphs.
Tremendous uncertainty surrounds the current health care
system in the United States. Efforts to repeal and replace the
Patient Protection and Affordable Care Act (ACA) have failed
at the US Congressional level. Bipartisan calls for improving the
current ACA have met with both encouragement and disdain,
depending upon the point of view of those speaking. Regardless
of the form of health care delivery and insurance for such, the
very bright note to point out is the realization of the excellence
of the delivery and outcomes of care provided by US health
care professionals. Health professionals improve the health of
Americans daily through many efforts and accomplishments.
A significant issue in the United States is that countless other
Americans in our midst are underinsured. They may have partial
coverage after a fashion, but, for these Americans, the high price of
deductibles, co-pays, and monthly payments for insurance create
an economic dilemma each time they seek care or pay premiums.
In a comprehensive report from Kalorama Information,3 it was
noted that consumer out-of-pocket health care costs have risen
from $250 per year in 1980 to over $1400 in 2016. It was also
noted in this report that those in less comprehensive health care
coverage insurance plans have delays in treatment, which lead to
increasing costs in the long term. Recently, Howard Bauchner,
MD, the editor-in-chief of JAMA and The JAMA Network, has
called for health professionals and professional organizations to
speak with one voice and support health care coverage as a right
for all.4
Recent US Center for Medicare and Medicaid (CMS) expenditure
data projections posit that, in 2025 in the United States, a total of
$4.72 trillion will be spent on health care.5 The projection for
spending on prescription drugs in 2025 is estimated to total
$1.7 billion.6
Chisholm_Ch01_p0001-0006.indd 3
Jack E. Fincham
There are tremendous opportunities for health professionals
due to the implementation of outcome measures (clinical,
economic, humanistic) via the ACA. For the first time in the
structure of the US health care system there is now a tangible,
significant effort to enhance the quality and outcomes of health
care delivered.
The use of medications in the health care system provides
enormous help to many; lives are saved or enhanced, and
lifespans are lengthened. Many other uses of medications lead to
significant side effects, worsening states of health, and premature
deaths. So, how to separate these disparate pictures of drug use
outcomes? You, within your practices and within your networks
in the health care workplace, can help to promote the former
and diminish the latter. The authors of the chapters in this book
have written informative, current, and superb chapters that can
empower you to positively influence medication use.
DRUG USE IN THE HEALTH CARE SYSTEM
Prescription medications are used daily; 48.5% of the population
uses one prescription drug daily, 21.7% use three or more drugs
daily, and 10.6% use five or more prescription drugs daily.7
Problems occurring with the use of drugs can include:
• Medication errors
• Suboptimal drug, dose, regimen, dosage form, and duration
of use
• Unnecessary drug therapy
• Therapeutic duplication
• Drug–drug, drug–disease, drug–food, or drug–nutrient
interactions
• Drug allergies
• Adverse drug effects, some of which are preventable.
Clinicians are often called upon to resolve problems that
occur due to undertreatment, overtreatment, or inappropriate
treatment. Individuals can purchase medications through
numerous outlets. Over-the-counter (OTC) medications can
be purchased virtually anywhere. OTCs are widely used by
all age groups. Prescription medications can be purchased
through traditional channels (community chain and independent
pharmacies), from mail-order pharmacies, through the Internet,
from physicians, from health care institutions, and elsewhere.
Herbal remedies are marketed and sold in numerous outlets. The
monitoring of the positive and negative outcomes of the use of
these drugs, both prescription and OTC, can be disjointed and
incomplete. Clinicians and health professionals need to take
ownership of these problems and improve patient outcomes
resulting from drug use.
Although clinicians are the gatekeepers for patients to obtain
prescription drugs, patients obtain prescription medications
from numerous sources. Patients may also borrow from friends,
3
22/08/18 11:56 AM
 4 PART I | BASIC CONCEPTS OF PHARMACOTHERAPY PRINCIPLES AND PRACTICES
relatives, or even casual acquaintances. In addition, patients obtain
OTC medications from physicians through prescriptions, on
advice from pharmacists and other health professionals, through
self-selection, or through the recommendations of friends or
acquaintances. Through all of this, it must be recognized that
there are both formal (structural) and informal (word-of-mouth)
components at play. Health professionals may or may not be
consulted regarding the use of medications, and, in some cases,
are unaware of the drugs patients are taking.
External variables may greatly influence patients and their
drug-taking behaviors. Coverage for prescribed drugs allows
those with coverage to obtain medications with varying cost
sharing requirements. However, many do not have insurance
coverage for drugs or other health-related needs.
Self-Medication
Self-medication can be broadly defined as a decision made by
a patient to consume a drug with or without the approval or
direction of a health professional. The self-medication activities
of patients have increased dramatically in the late 20th and early
21st centuries. Many factors affecting patients have continued
to fuel this increase in self-medication. There have been many
prescription items switched to OTC classification in the last
50 years, which is dramatically and significantly fueling the
rapid expansion of OTC drug usage. In addition, patients are
increasingly comfortable with self-diagnosing and self-selection
of OTC remedies.
Through the rational use of drugs, patients may avoid more
costly therapies or expenditures for other professional services.
Self-limiting conditions, and even some chronic health conditions
(eg, allergies and dermatologic conditions), if appropriately
treated through patient self-medication, allow the patient to have
a degree of autonomy in health care decisions.
Compliance Issues
Noncompliance with prescription regimens is one of the most
understated problems in the health care system. Approximately
10% of initial prescriptions written by physicians are never
filled.8 Reasons can include trying too soon to obtain a new
prescription, prior approval requirements, the prescribed drug
may not be covered under the patient’s insurance, and so on.
The effects of noncompliance have enormous ramifications for
patients, caregivers, and health professionals. Noncompliance
is a multifaceted problem with a need for interprofessional,
multidisciplinary solutions. Interventions that are organizational
(how clinics are structured), educational (patient counseling,
supportive approach), and behavioral (impacting health beliefs
and expectations) are necessary. Compliant behavior can be
enhanced through your actions with the patients for whom
you provide care. Sometimes what is necessary is referral to
specific clinicians for individualized treatment and monitoring
to enhance compliance. The case histories provided in this
textbook will allow you to follow what others have done in
similar situations to optimally help patients succeed in improving
compliance rates and subsequent positive health outcomes.
Drug Use by the Elderly
The major source of payment for prescription drugs for those
aged 65 years and older in the United States is the Medicare Part D
Drug Benefit. Seniors have benefitted tremendously from this
component. Estimates place the expenditure for Medicare Part D
to be $94 billion in 2017; this is 15.6% of Medicare expenditures.9
Chisholm_Ch01_p0001-0006.indd 4
Since the inception of Medicare Part D, recipients have had to pay
costs after initial minimum threshold amounts are reached, then
enter the so-called “donut hole” requiring payment out of pocket
until a certain amount would be paid, and then coverage for
payment would ensue. This so-called donut hole closes in 2020,
which will provide more benefits for more enrollees. Enhanced
use of pharmacoeconomic tenets to select appropriate therapy,
while considering cost and therapeutic benefits for seniors and
others, will become even more crucial for clinicians in the future.
Unnecessary drug therapy and over medication are problems
with drug use in the elderly. Cost estimates are projected to be
$1.3 billion per year for elderly patient polypharmacy alone.10 A
joint effort by health professionals working together is the best
approach to aiding seniors in achieving optimal drug therapy.
Evaluation of all medications taken by seniors at each patient visit
can help prevent polypharmacy from occurring.
IMPACTING THE PROBLEMS OF DRUG USE
Medication Errors
There is a tremendous opportunity in medication use and
monitoring for working to reduce medication errors. Untold
morbidity and mortality occur due to the many errors in medication
use. Studies have shown that reconciling the medications that
patients take, with coordination by various caregivers providing
care, can help reduce medication errors in patient populations.8
The incorporation of three key interventions—computerized
physician order entry (CPOE), additional staffing, and bar
coding—has been shown in an institutional setting to help reduce
medication errors.11
Avoiding Prescribing Cascades
Prescribing cascades occur in health care when the side effect
from a medication is interpreted as a new condition, and a second
drug is prescribed to “treat” the side effect. Prescribing cascades
are important because they can be prevented.12
Impacting the Opioid Crisis
The use and misuse of prescription opioid analgesic medications
are at an all-time high and are increasing, and the negative
consequences of this epidemic are many.13 According to the
Centers for Disease Control and Prevention (CDC), 91 Americans
die daily from an opioid overdose, including prescription opioids
and heroin.14 The opioid crisis is not limited to the United
States; it is a North American crisis as well, with the Canadian
government providing funding to address the problem.14,15 The
CDC has published and promoted prescribing guidelines to
help stem inappropriate prescribing of opioids for chronic
pain.16 Health professionals will play a vital role in reversing this
epidemic and enhancing the health of many and society as well.
SUMMARY
Health professionals are at a crucial juncture facing an uncertain,
yet promising future. The skills and knowledge that enable
effective practice have never been more daunting among the
numerous health professions. Technology can further empower
health professionals to play an effective role in helping patients
and fellow health professionals to practice safe and effective
medicine. Health care reform has the potential to dramatically
impact your practices in the health care system for the length of
your careers.
22/08/18 11:56 AM

The use of this text, which incorporates materials written
by the finest minds in pharmacy practice and education, can
enable the reader to play a crucial role in improving the drug use
process for patients, providers, payers, and society. The thorough
analysis of common disease states, discussion of therapies to treat
these conditions, and specific advice for patients will help you in
your practices. The purpose of this book is to help you make a
real improvement in the therapies you provide to your patients.
Current and future clinicians can rely on the information laid
out here to enhance your knowledge and allow you to assist your
patients with the sound advice that they expect you to provide.
Use the text, case histories, and numerous examples here to
expand your therapeutic skills and to help positively impact your
patients in the years to come.
You can help reverse medication-related problems, improve
outcomes of care both clinically and economically, and enable
drug use to meet stated goals and objectives. This text provides
a thorough analysis and summary of treatment options for
commonly occurring diseases and the medications or alternative
therapies used to successfully treat these conditions.
REFERENCES
1. Organization for Economic Cooperation and Development,
Paris, France; OECD Health Statistics. Available from: http://stats.
oecd.org/Index.aspx?DataSetCode=SHA. Updated June 2017.
Accessed November 3, 2017.
2. Schneider EC, Sarnak DO, Squires D, Shah A, Doty MM. Mirror,
Mirror 2017: International Comparison Reflects Flaws and
Opportunities for Better U.S. Health Care, The Commonwealth
Fund, August, 2017.
3. Out-of-Pocket Healthcare Expenditures in the United States.
Rockville, MD: Kalorama Information; April, 2017.
4. Bauchner H. Health care in the United States: a right or a
privilege. JAMA. 2017;317(1):29.
5. National Health Expenditure (NHE) Data. United States
Centers for Medicare and Medicaid Services. Available from:
https://www.cms.gov/research-statistics-data-and-systems/
statistics-trends-and-reports/nationalhealthexpenddata/nhe-
fact-sheet.html, Table 5. Updated June 14, 2017. Accessed
November 3, 2017.
Chisholm_Ch01_p0001-0006.indd 5
CHAPTER 1 | INTRODUCTION 5
6. National Health Expenditure (NHE) Data, Table 11. United
States Centers for Medicare and Medicaid Services. Available
from: https://www.cms.gov/research-statistics-data-and-systems/
statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-
sheet.html. Updated June 14, 2017. Accessed November 3, 2017.
7. National Center for Health Statistics. Health, United States, 2013:
With Special Feature on Prescription Drugs. Hyattsville, MD,
2014.
8. Aitken H, Valkova S. Exhibit 1: Avoidable U.S. healthcare costs
add up to $213 billion. Avoidable Costs in U.S. Healthcare:
The $200 Billion Opportunity from Using Medicines More
Responsibly. Report by the IMS Institute for Healthcare
Informatics, June, 2013: p. 3.
9. The Medicare Part D Prescription Drug Benefit. The Henry J.
Kaiser Family Foundation. Available from http://www.kff.org/
medicare/fact-sheet/the-medicare-prescription-drug-benefit-
fact-sheet. Accessed November 9, 2017.
10. Karnon J, McIntosh A, Dean J, et al. Modelling the expected net
benefits of interventions to reduce the burden of medication
errors. J Health Serv Res Policy. 2008;13:85–91.
11. Franklin BD, O’Grady K, Donyai P, Jacklin A, Barber N.
The impact of a closed-loop electronic prescribing and
administration system on prescribing errors, administration
errors and staff time: a before-and-after study. Qual Saf Health
Care. 2007;16:279–284.
12. Kalisch LM, Caughey GE, Roughead EE, Gilbert AL. The
prescribing cascade. Aust Prescr. 2011;34:162–166.
13. Fincham JE. The opioid epidemic: healthcare utilization and cost
considerations. Am Health Drug Benefits. 2017;10(2):79–86.
14. Drug overdose deaths in the United States continue to increase
in 2015. US Centers for Disease Control and Prevention.
Available from: www.cdc.gov/drugoverdose/epidemic. Updated
August 31, 2017. Accessed November 3, 2017.
15. Government of Canada announces $6 million in emergency
funding to combat opioid crisis in Alberta. Available from: www.
canada.ca/en/health-canada/news/2017/03/government_of_
canadaannounces6millioninemergencyfundingtocombato.html.
Accessed November 3, 2017.
16. CDC Guideline for Prescribing Opioids for Chronic Pain.
US Centers for Disease Control and Prevention. Available
from: www.cdc.gov/drugoverdose/prescribing/guideline.html.
Updated August 31, 2017. Accessed November 3, 2017.
22/08/18 11:56 AM
 This page intentionally left blank

Chisholm_Ch01_p0001-0006.indd 6 22/08/18 11:56 AM

Another random document with
no related content on Scribd:
 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN