Pharmacology for Nurses: A Pathophysiologic Approach

970 Pages·2020·52.979 MB·English

by  Michael P. Adams, Norman Holland, Carol Quam Urban

Pharmacology
for Nurses
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Sixth Edition
Pharmacology
for Nurses
A Pathophysiologic Approach
Michael Patrick Adams
Adjunct Professor of Anatomy and Physiology
Hillsborough Community College
Formerly Dean of Health Professions
Pasco-Hernando State College
Leland Norman Holland, Jr.
Professor
Hillsborough Community College
Polk State College
Carol Quam Urban
Associate Dean for Practice and Strategic Initiatives
Associate Professor
College of Health and Human Services
George Mason University
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Library of Congress Cataloging-in-Publication Data
Names: Adams, Michael, 1951- , author. | Holland, Leland Norman, 1957- ,
author. | Urban, Carol Q. (Carol Quam), author.
Title: Pharmacology for nurses : a pathophysiologic approach / Michael
Patrick Adams, Leland Norman Holland, Jr., Carol Quam Urban.
Description: Sixth edition. | Hoboken, N.J. : Pearson, [2020] | Includes
bibliographical references and index.
Identifiers: LCCN 2019000512| ISBN 9780135218334 | ISBN 0135218330
Subjects: | MESH: Drug Therapy | Pharmacological Phenomena | Pharmacology |
Nurses Instruction
Classification: LCC RM301 | NLM WB 330 | DDC 615/.1--dc23 LC record available at https://
lccn.loc.gov/2019000512
ISBN-10: 0-13-521833-0
1 19 ISBN-13: 978-0-13-521833-4
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About the Authors
MICHAEL PATRICK ADAMS, PHD, is an accomplished ed- was on the faculty of Lansing Community College and
ucator, author, and national speaker. The National Institute St. Petersburg College, and served as Dean of Health Pro-
for Staff and Organizational Development in Austin, Texas, fessions at Pasco-Hernando State College for 15 years. He
named Dr. Adams a Master Teacher. He has published two is currently Adjunct Professor of Biological Sciences at
other textbooks with Pearson Publishing: Core Concepts in Hillsborough Community College.
Pharmacology and Pharmacology: Connections to Nursing Practice.
Dr. Adams obtained his master’s degree in pharmacol- I dedicate this book to nursing educators, who contribute every
ogy from Michigan State University and his doctorate in day to making the world a better and more caring place.
education from the University of South Florida. Dr. Adams —MPA
LELAND NORMAN HOLLAND, JR., PHD (NORM), over subjects, such as microbiology, biological chemistry, and
25 years ago, started out like many scientists, planning for pharmacology. Dr. Holland’s doctoral degree is in medical
a career in basic science research. He was quickly drawn to pharmacology. He is very much dedicated to the success of
the field of teaching in higher medical education, where he students and their preparation for careers in health care.
has spent most of his career. Among the areas where he has He continues to motivate students in the lifelong pursuit
been particularly effective are preparatory programs in of learning.
nursing, medicine, dentistry, pharmacy, and allied health.
Dr. Holland is both a professor and supporter in nursing To the greatest family in the world: Karen, Alexandria, Caleb,
education nationwide. He brings to the profession a depth and Joshua.
of knowledge in biology, chemistry, and medically related —LNHII
CAROL QUAM URBAN, PHD, RN, Associate Professor, is interdisciplinary teamwork. She has co-authored the
the Associate Dean for Practice and Strategic Initiatives in Pearson textbook Pharmacology: Connections to Nursing
the College of Health and Human Services at George Mason Practice with Dr. Adams.
University in Fairfax, Virginia. Teaching in the School of
Nursing for over 25 years, and most recently in the position To my daughter, Joy, an extraordinary pediatric hematology-oncology
of Director of the School, she considers pharmacology to be nurse, and in memory of my son, Keith, and husband, Michael.
a course that truly integrates nursing knowledge, skills, and —CQU
v
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Thank You
Our heartfelt thanks go out to our colleagues from Approach, sixth edition, has reaped the benefit of your col-
schools of nursing across the country who have given lective knowledge and experience as nurses and teachers,
their time generously to help create this exciting new edi- and we have improved the materials due to your efforts,
tion. These individuals helped us plan and shape our suggestions, objections, endorsements, and inspiration.
book and resources by reviewing chapters, art, design, Among those who gave their time generously are the
and more. Pharmacology for Nurses: A Pathophysiologic following:
Beatrice Adams, PharmD Marcus W. Campbell, PharmD, Adina C. Hirsch, PharmD, BCNSP
Critical Care Clinical Pharmacist BC-ADM Assistant Professor of Pharmacy
Tampa General Hospital Assistant Professor Pharmacy Practice Practice
Department of Pharmacy Director, Center for Drug Information Philadelphia College of Osteopathic
Tampa, Florida & Research Medicine
LECOM School of Pharmacy Philadelphia, Pennsylvania
Shannon Allen, CRNA, MSNA
Bradenton, Florida
Professor Linda Howe, PhD, RN, CNS, CNE
New Mexico Junior College Rachel Choudhury, MSN, MS, RN, CNE Associate Professor
Hobbs, New Mexico Associate Dean and Program Director, University of Central Florida
Candyce Antley, RN, MN ABSN Orlando, Florida
Instructor Musco School of Nursing and Health
Anne L. Hume, PharmD, FCCP,
Midlands Technical College Professions
BCPS
Columbia, South Carolina Brandman University
Professor of Pharmacy
Irvine, California
Culeta Armstrong, MSN, RN University of Rhode Island
Clinical Assistant Professor Darlene Clark, MS, RN Kingston, Rhode Island
University of Memphis Senior Lecturer in Nursing
Ragan Johnson, DNP, APRN-BC
Memphis, Tennessee Pennsylvania State University
University Park, Pennsylvania Assistant Professor
Wanda Barlow, MSN, RN, University of Tennessee
FNP-BC Janice DiFalco, RN, MSN, CNS, Memphis, Tennessee
Instructor CMSRN, FAACVPR
Winston-Salem State University Professor Vinh Kieu, PharmD
Winston-Salem, North Carolina San Jacinto College Assistant Professor
Pasadena, Texas George Mason University
Sophia Beydoun, RN, BSN, MSN,
Fairfax, Virginia
AA-AND Deepali Dixit, PharmD, BCPS
Professor Clinical Assistant Professor Dorothy Lee, PhD, RN, ANP-BC
Henry Ford Community College Rutgers University Associate Professor of Nursing
Dearborn, Michigan Piscataway, New Jersey Saginaw Valley State University
University Center, Michigan
Staci Boruff, PhD, RN Rachael Durie, PharmD, BCPS
Assistant Academic Dean of Health Cardiology Clinical Pharmacist Toby Ann Nishikawa, MSN, RN
Programs Assistant Professor of Clinical Assistant Professor
Professor of Nursing Pharmacy Weber State University
Walters State Community College Rutgers University Ogden, Utah
Morristown, Tennessee Neptune, New Jersey
Dr. Diana Rangaves, PharmD, RPh
Bridget Bradley, PharmD, BCPP Deborah Dye, RN, MSN Director, Pharmacy Technology
Assistant Professor Assistant Professor/Nursing Program
Pacific University Department Chair Santa Rosa Junior College
Hillsboro, Oregon Ivy Tech Community College Santa Rosa, California
Lafayette, Indiana
Mary M. Bridgeman, PharmD, Timothy Reilly, PharmD, BCPS,
BCPS, CGP Jacqueline Frock, RN, MSN CGP, FASCP
Clinical Assistant Professor Professor of Nursing Clinical Assistant Professor
Rutgers University Oklahoma City Community College Rutgers University
Piscataway, New Jersey Oklahoma City, Oklahoma Piscataway, New Jersey
Reamer L. Bushardt, PharmD, Jasmine D. Gonzalvo, PharmD, Janet Czermak Russell, MS, MA,
P.A.-C BCPS, BC-ADM, CDE APN-BC
Professor Clinical Associate Professor Associate Professor
Wake Forest Baptist Health Purdue University Essex County College
Winston-Salem, North Carolina West Lafayette, Indiana Newark, New Jersey
vi
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Pooja Shah, PharmD Dustin Spencer, DNP, NP-C, ENP-BC Suzanne Tang, MSN, APRN, FNP-BC
Clinical Assistant Professor Assistant Professor of Nursing Instructor
Rutgers University Saginaw Valley State University Rio Hondo College
Piscataway, New Jersey University Center, Michigan Whittier, California
Samantha Smeltzer, RN Dr. Jacqueline Stewart, DNP, CEN, Ryan Wargo, PharmD, BCACP
Professor of Nursing CCRN Assistant Professor of Pharmacy
Mount Aloysius College Associate Professor of Nursing Practice
Cresson, Pennsylvania Wilkes University Director of Admissions
Wilkes-Barre, Pennsylvania LECOM School of Pharmacy
Rose Marie Smith, RN, MS, CNE
Bradenton, Florida
Division Dean of Nursing, Liberal Rebecca E. Sutter, DNP, APRN,
Arts, Social and Behavioral FNP-BC Timothy Voytilla, MSN, ARNP
Sciences Associate Professor Nursing Program Director
Redlands Community College George Mason University Keiser University
El Reno, Oklahoma Fairfax, Virginia Tampa, Florida
vii
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Preface
When students are asked which subject in their nursing • NEW! Key terms are listed at the beginning of each
program is the most challenging, pharmacology always chapter along with corresponding page numbers that
appears near the top of the list. The study of pharmacology indicate where their definitions may be found within
demands that students apply knowledge from a wide vari- the chapter.
ety of the natural and applied sciences. Successfully pre- • UPDATED! Check Your Understanding questions
dicting drug action requires a thorough knowledge of
appear throughout the drug chapters to reinforce
anatomy, physiology, chemistry, and pathology as well as
student knowledge.
the social sciences of psychology and sociology. Lack of
• EXPANDED! Includes more than 40 new drugs, drug
adequate pharmacology knowledge can result in immedi-
classes, indications, and therapies that have been ap-
ate and direct harm to the patient; thus, the stakes in learn-
proved since the last edition.
ing the subject are high.
• UPDATED! Black Box Warnings issued by the FDA are
Pharmacology cannot be made easy, but it can be
included for all appropriate drug prototypes.
made understandable when the proper connections are
made to knowledge learned in these other disciplines. The • UPDATED! Pharmacotherapy Illustrated diagrams
vast majority of drugs in clinical practice are prescribed for help students visualize the connection between phar-
specific diseases, yet many pharmacology textbooks fail to macology and the patient.
recognize the complex interrelationships between pharma- • UPDATED! Nursing Practice Application charts have
cology and pathophysiology. When drugs are learned in been revised to contain current applications to clinical
isolation from their associated diseases or conditions, stu- practice with key lifespan, safety, collaboration, and di-
dents have difficulty connecting pharmacotherapy to ther- versity considerations noted.
apeutic goals and patient wellness. The pathophysiology
focus of this textbook gives the student a clearer picture of
Organization and Structure—A Body
the importance of pharmacology to disease and, ulti-
System and Disease Approach
mately, to patient care. The approach and rationale of this
textbook focus on a holistic perspective to patient care
Pharmacology for Nurses: A Pathophysiologic Approach is orga-
which clearly shows the benefits and limitations of phar-
nized according to body systems (units) and diseases
macotherapy in curing or preventing illness. In addition to
(chapters). Each chapter provides the complete information
its pathophysiology focus, medication safety and interdis-
on the drug classifications used to treat the diseases. Spe-
ciplinary teamwork are consistently emphasized through-
cially designed numbered headings describe key concepts
out the text. Although difficult and challenging, the study
and cue students to each drug classification discussion.
of pharmacology is truly a fascinating, lifelong journey.
The pathophysiologic approach clearly places the
drugs in context with how they are used therapeutically.
New to This Edition The student is able to locate easily all relevant anatomy,
physiology, pathology, and pharmacology in the same
The sixth edition of Pharmacology for Nurses: A Pathophysi-
chapter in which the drugs are discussed. This approach
ologic Approach has been thoroughly updated to reflect
provides the student with a clear view of the connection
current pharmacotherapeutics and advances in under-
among pharmacology, pathophysiology, and the nursing
standing disease.
care learned in other clinical courses.
• NEW! Applying Research to Nursing Practice feature The vast number of drugs available in clinical practice
illustrates how current medical research is used to im- is staggering. To facilitate learning, this text uses drug pro-
prove patient teaching. Books, journals, or websites totypes in which the most representative drugs in each
may be cited, and the complete source information classification are introduced in detail. Students are less in-
provided in the References section at the end of timidated when they can focus their learning on one repre-
the chapter. sentative drug in each class.
viii
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Preface ix
Chapter 15 Drugs for Seizures 179
This text uses several strategies to
Prototype Drug Valproic Acid (Depakene, others)
connect pharmacology to nursing practice.
Therapeutic Class: Antiseizure drug Pharmacologic Class: Valproate
Throughout the text the student will find
Actions and Uses PHARMACOKINETICS (PO CAPSULES)
interesting features, such as Complemen- Valproic acid has become a preferred drug for treating manyC hapter O1n5s e Dtrugs for SeizPueraeks 175 Duration
tary and Alternative Therapies, Treating tfoyprmesu loaft ioepnsile, pwshyi.c Thh cisa nm ceaduicsaet icoonn hfuassi osne vwerhael ntr satdued ynianmg eits. and 2–4 days 1–4 h 6–24 h
the Diverse Patient, CoPmrmotuontyitpye-O Drrieungt e d Phenoba•r bVgaiviletpnaro Plic O (aL.ciud m(Deipnakaeln)e) is the standard form of the drug ASiddvee erfsfeec Etsf fienccltusde sedation, drowsiness, GI upset, and pro-
Practice, and Lifespan Considerations, • Valproate sodium (Depacon) is the sodium salt of valproic longed bleeding time. Other effects include visual disturbances,
Therapeutic Class: Antiseizure drug; sedative Pachida grmivean cPoOl oorg IVi.c Class: Barbiturate; GABAA receptomru sacgleo wneisatkness, tremor, psychomotor agitation, bone
that clearly place the drugs in context with • Divalproex sodium (Depakote ER) is a sustained release marrow suppression, weight gain, abdominal cramps, rash,
Actions and Uses combination of vaWlpriothic oacvide radnods ites, s podhieumno sbalat rinb ait a l may caualsoepe sceiav, eprruer itruess, ppihraottoosreyn sitivity, erythema multiforme, and
their clinical apPphleincoabatriboitanl iss .a Alonpg-pacltyingi nbagrb iRtureat-e used for the m1:a1n maigxteu-re. It is gdiveepn rPeOs sainodn i,s CavNaiSlab dlee inp raens esniotenric, -coma, afantdal hdeepaatthot.oxicity. Black Box Warning: May result in fatal
search to Nursinmgen tP orf aa cvatriiectye o ff eseaiztuurers.e Its i si alllsuo sus-ed to produce scoeadtead- form. hepatic failure, especially in children under the age of 2 years.
All three formulatioCnos noft rthaei ndrduigc faortmio tnhes :c hAedmmi-inistration ofN ponhsepneocibfica srbymitaptl oism sin oaftdevn ispr-ecede hepatotoxicity: weakness,
trate how currenttio nm. Pehdeniocbaalrb riteal ssehoaurldc hno ti bse u usseedd fo r pain reliecf abl veaclparuosatee iat fter absaorbplteio nin o cr aons eesnt eorfin hg ythpee brsraeinn.s Tithiev ity to barfbacitiaul readteems,a ,s aenvoererxeia u, nancdo vno-miting. Liver function tests should
may increase a patient’s sensitivity to pain. pharmacokinetics of each form varies, and doses are not be performed prior to treatment and at specific intervals dur-
tilol uimstprarotevse ppoatt1ei7en0tnht eit aU GtnPleA ihtBap e3Acni Tohtnhbfeieauan rrNblogilettrasr.avl noaPtsuchmatss iatS tbtieytieors ,c tncwehamthe imncShi ca liasfel leyrae tbsdypy o ennshibanlec finogr sitotnohutt heepdere pcraswhrcceaisrtnsieibogs.eeni naa bgoll l ffeo .r Imn st hoisftro rettrohes elpxpl etrd,i odrrtauhs gpteto ,aan rutaiynincm l,ed ehspi ssvyr eaepslpaepeesrxrocetisirifc oitcw iapaniclthlgyihdy s C .ditsaN ytuesSsdpe dnd eeap roers soibi lsonifpesgni-nt ,ttr ahhup rebeco iafftirirtidpsoeatnhn .6iny, gmrai apnosandn,t h cgssree laoavfut eittcriresoe aa mtnmdae tnetr. aVtaolgperoniicc aecffiedc ctsa,n in pcrloudduincge
abnormal neuronal discharges that can cause epilepsy. Valproic acid is administered as monotherapy or in combi-
to medication errpoorisso.n Pinhg—aramndF cahcatnsg ecso inn tpaerifnu sion—suncahti oan sw itthh oothseer AEDsi tmo tprelaet mabseennctien sgeiz unreese adnedd co smapfleext y preCcoanutratiinodnicsa.t iIonns c: oHylplaerbseonrsaititviitoy nm ay occur. This
caused by hypotension, stroke, shock, and cpaarrtdiail aseciz duryess. -DepakIownteti eEtrhRa icsth taileoso np asapptiroevnedt, f otrh thee hpreeavelnth-care mperdoicvatiiodne srh, opuldh anortm bea acdimstin, isatenredd to patients with liver
statistics and facAtrdshm ytithnhiasmttri aaatsi—roenm Araleeyrl tbesev caanuste st.o the tion of migraine headacDnhreuusr gasn–edD maruraengi a:i aPnshssoetrcniuaotmbeda erwbnitihtta abll ipi noitnlaer r aaccthsi ewdviistiehna smge, a pbnleoye sodiitnthgiev drey ds ftruuhngcetsrio.a np, peaunctrieca titis, and congenital
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they have alreandesys orfe mhaaodyr mp iroondn uatchl ece toi sncstuhreaa cnpeepctrteoivsrie.ss., additional barrier meth- cardiac arrest. Phenobarbital increaseesx athmep lem, eastpaibrino,l icsimme toidfi nme,a cnhylo rpromazine, erythromycin, and
Students lopedraesg ronn•fa nbCbcioryent.ht trPot rclelieoordnr t swtruoob lhps tsreahenngocnue a:sl dnSu ccbphyee pa dunulsdlieee dcIVdo .tn os iadveoriindg u Atndh•mi enVi nastielespntrrroiadioct ieuaodcnsi d A ilse rat sog1aths5teror.i n2dter usTtginsya,l (rpGeId)e iurrsictai nnotg. fAth dSveisiree eifzfecutivreenseffsealrsbin.a,m aaspteir imn,a oyr i naclcroeahsoel uvsaelp croainc caacuids eto sxeicvietyr.e Cbolenecdoinmgit.a Anltc owhaor-l,
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media resourceasct.i oPnh faorr mseaizcuorleo cgoynP tfHrooArlR. NMWAuhCerOnsK epIsNr:eE gATnI CaSncy occurs,bc caeaucsaueutssi eso eitnv we riell tmrigoHgasuehtenhr ra diambkn masdiynl et/hdmFgriaoo tpaaeot tn rdiorerdl:imet a Kattsisaooe.nv toS.aaf y,lt h vmleao dlpesrurstigo a,omn wf, hsacic nmohd na scych iarsnoaemyurtnouosmignmn, e paei lhnfesedr snom ro imftbaaoamy r sbpmpuiitnoa dullt oaedswnncedetlr inp eavh,t a eetlvpwn riyootiioctli enca hncleid-tv e lelsv.e Llsa.motrigine, phe-
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features appeaamr citnoAh ndsrdvuoeipturipsogelne hE mcfoofeernucrtettssl atmtheadey wtbeeitx hnt e,fc ebetasrsle anareyku. Er-acll atumbpes diae fies cats s. eVvietrae- ofieasrfc fuieelistscaestt eiionvnfg eta irctaertlmiev afaoottvemrad lp e ocnrfho tpa porhceepornta iodlo.b inHaasrgeb.mnitoaolsd fiiraso lymasn istdh me s abeyol edbcyet. ieTofrfneea cottmifv eethn inte i sm ost
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dmeercshtaonoidsm fso srhmnpoaearnwdcictnieeys nant ct. pchae irel.Aeo smC g (sonvroimettriaustmmmasdeloiinsntae .y D sIn.t t;iEdi tfioecos l sl aeacnttfhmfeeesa cpp rtBasos-ic 9baiftn e iy;c srladu i-lnzdsirdkeet due eBdl y1pbrgo2 y)t w ,o sas eoninidcezc suluasrrr,wSye uvnfsricigt,oct aocihmmnos ipimmS naa uirsaddom,ece uafscsi- nn.ia nddrei mmeiddmsthaiiicoeneamanscdvt iehmeo d.an, aFnesfyio otct arbhrai aleel tetv hx nedsaeenu m cltpmaielpapbsortsleieoseasltn,ssr y .t.p s.hETeaeriperz ttauie,ltr emrbepmsee sebnsinyte g so rr faae bnrpazpredlarua a etdtrm yicebyeseaepnc.idl tain Lsac rg abdawn miiylnadiltov yh matpe rnpiseidotgdtaiiigrer tnhtean iemyat etdplhi dasfoeal eifts seioee zcdarpnur lt- sriihuleopeess itb,pri iuen vsresogyenul e afslo liyun n itnrde catootmi nbbgei anebaffsteieocntnci vew es ietiihn-
the 20th week of gestation 3unt4il at least 1 weekd aefltaeyrin dge claivlceiurym influx into neurons. By raising the sei- other antiseizure medications.
the International Classification of Epileptic Seizures nomen-
how drugs act.of the baby. Approximately 25% of women wziuthre ethcrleasmhoplds,i asu ccinimides keep neurons from firing too
experience seizures within 72 hours postpartuqmuic.k Flyo, rth yues asursp,p ressincgla atbunroerm. Talh foecsie. T ahreey atreer gmeneedra lplya rtial (focal), generalized, and
only effective against asbpseecnicae ls eeipzuilreesp. tTich es syunccdinriommideess (Table 15.1). Types of partial
one of the approaches used to prevent or traeraet l iestcelda imn Tpatbilce 15.5.(focal) seizures or generalized seizures may be recognized
seizures was magnesium sulfate. The mechanisEmth ofosurx timhiisd e (Zarontin) is the most commonly pre- Check Your Understanding 15.1
based on symptoms observed during a seizure episode.
sCuobmstpanlecme’se natnatrisye aiznudr eA altcetirvniatyti vise nTohte wraeplli eussncrdibeerds tdoruogd i.n A th is class. It remains a preferred choice for If an antiseizure drug must be discontinued, how will this be accom-
pTHroEt oKtEyTpOeG fEeNaItCu rDeI EfTo rF OmRa EgPnIeLsEiPuSmY sulfate is athpbesrseeen stcyeep nseetsie zoduf rs eeisniz, ualrtehso. uSSnogoemhum ver aeool fpns tryhaoemli cnm paecwitisodefrm ii sra insant lasigsore; eie zof usfteurhcetbe idvtrrlesue fg aoasrr,n ed m rpaoenlifsrslhewee ecdcr.,to atmnhdep w lshepyx ies. cthifisi cm netahotdu nreec oesfs ary? See Appendix A for the
Chapter 43.
The Skeetiozguerneisc cdaient hisa mveo sat soifgtenni fuicsaedn tw ihmepn asceti zounre sth cea nqnuoatl ibtey has a ketogenic ratio of 3 or 4 g of fat to 1 g of protein and carbohy-
ocof nlitfroel.l eTdh tehyro umgah yp hcaarumsaec soethreioraupsy ionrj uwrhye nif tthheerey aorec cuunra cwcehpilte- d1ra5te. 3(A zGeveedno deer Laiml aC eto aln., c20e1p7).t Bse ocafu sAe onf tthies heigihz ruatiroe o f fat
aa bplee rasdovner sise defrfeivcitsn gto a t hvee mhiecdleic aotrio npse.r Bfoerfomrei nagn tais edizaunreg edrrouguss iPn thhea driemt, caocmopltichateiornsa psuych as hyperlipidemia and hepatotoxic-
awcetriev idtye.v Aelolmpeods,t tahlils sdtaiette sw awsi lal nporitm garrMya1 5n_tArteD, AaoMt8rm3 3w4e_n0i6tl_ lS fEot_aCr 1k5e.einp daidl e w 1p79asyy., ity may occur, and patients on this diet need to be monitored long 08/12/2018 14:27
aR edcreinvte srt’usd lieicse hnasvee aexnadm rineeqdu tihree pao ssesiibziulitrye t-hfarte teh ep keertioogde nbiec fdoireet tTerhme tcoh doeitceec to tfh AesEeD ad ivse hrsieg heflfye citns d(Aivzeidveudaoli dzee Lfoimr ae eatc hal .p, 2a0ti1e7n; t
gcoraunldt ipnrogv iad ed brievneerfi’ts f olri cpeantiseen.t sW wiitthh oAulzth esuimcecre’ss,s Pfuarlk pinhsoanrm’s, aacnod- Aarnsdla nd eetp ael.n, 2d0s1 o6,n). the type of seizures, the patient’s previ-
tohtheerar pnye,u eropdileegpesnye rcaatinve s edviseeraesleys l i(mRaijta gpoaprtailc, iSpaantigoanm i,n S sincghho,o &l, ous Rmeesdeaicrcahl hsuisgtgoersyt,s EthEaGt t hdea tdaie, ta pnrdod auscseosc iaa hteigdh psuacthceoslos graietes .
e Jmogpinlaopyamllye, n20t,1 a6n; dVe syoracti-aDlu arecbtievxi teiet sa la., n2d0 1c8a)n. Tdheef ienxiatcetl ym aefcfheac-t cOonmcpea are md etod isctaatnidoanr dis tsreealetmcteendt,, twhieth p baetitetenrt ciso nptlraocl eodf soeniz au rleosw.
sneislmf- ebsetheienmd t.h eC ehfrfeocntiivce ndeesps roef sthseio dnie tm isa uyn kancocwonm apnadn ayp ppeoaorsr tloy Iimnpitrioavle dmoesnet .m Tahye b aem nootuedn tr aips igdlrya adnuda tlhley diniect raepapseeadrs u ton tbiel seeqiuzaullrye
cinocnlutdreo lbloetdh dsireeicztu erffeesc.t fIrommp koerttoannet b ocdoyn isnicdreearsaetsi,o annsd mine tnabuorlsic- ecfofencttrivoel foisr eavcehriye sveeizdu,r eo rty upen.t Tilh de rmuogs ts ifrdeeq ueefnfetlcyt rse pporretvede natd vaedrsdei -
icnhga ncgaerse t hinatc loucdcuer , iidncernetaisfiynign Gg ApBaAt iaenndt sin ahtib ritiosrky nfeourr osteraiznusmreits-, etfifoenctasl iinncclurdeea sveosm iinti ndgo, sfaet.i gSueer,u cmon dstriupagt iloenv, edlisa rmrhaeya, baen do bhtuanigneer.d
dteorsc u(Rmhoe,n 2ti0n1g7 ).the pattern and type of seizure activity, and Ctoo sat sasnisdt ththe ed ihffeicaullttyh coaf rfoel lopwroinvgi dtheer diine t dloentge rtmermin imnagy tahlseo m limoist t
The ketogenic diet is a stringently calculated diet that is high its use (Wijnen et al., 2017). Those interested in trying the diet must
in fat and low in carbohydrates and protein. It limits water intake to consult with their healthcare provider to optimize the therapy. The
avoid ketone dilution and carefully controls caloric intake. Each meal long-term effects are not yet fully known.
Treating the Diverse Patient: Sports-Related Concussions
There is increased awareness and concern about sports-related Early detection and intervention is a key strategy in the appro-
concussions at all ages. Concussions are a form of traumatic priate treatment of a concussion, but not all patients, particularly
brain injury (TBI) and can range from mild to severe, with imme- children, seek treatment. Bryan, Rowhani-Rahbar, Comstock, &
diate and long-term consequences, including dementia and Rivara (2016) found that as many as 52% of high school sports
chronic traumatic encephalopathy (Thomas et al., 2018). Ban, and recreation-related concussions were not reported to a health-
Botros, Madden, and Batjer (2016) found a relatively low inci- care provider, and the authors recommend expanding research
M15_ADAM8334_06_SdE_eCn1c5.ein dodf s17p5orts-related TBI, but an estimated 13% of pediatric to include recreation-related injuries as a cause of TBI. For c0h8/i1l-2/2018 14:27
and 14% of adult injuries were considered moderate to severe. dren, parents play a key role in identifying and managing these
While headaches, dizziness, and visual disturbances were injuries. However, particularly among parents with low income,
common after a mild injury, seizures were more common with education is lacking (Lin et al., 2015). Because seizures and long-
severe sports-related concussions, and symptoms may persist term complications may occur after a moderate to severe injury,
and become chronic (Choe et al., 2016; Merritt, Rabinowitz, & education on prevention and early detection may help to decrease
Arnett, 2015). these consequences.
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