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Pharmacology
for Nurses
A01_ADAM8334_06_SE_FM.indd 1
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A01_ADAM8334_06_SE_FM.indd 2
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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
A01_ADAM8334_06_SE_FM.indd 3
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Cover, Pearson Education
Drug icon used throughout, tassel78/123RF.
Copyright © 2020, 2017, 2014, 2011, and 2008 by Pearson Education, Inc., or its affiliates. 221 River Street,
Hoboken, NJ 07030. All Rights Reserved. Printed in the United States of America. This publication is protected by
copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage
in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms and the appropriate contacts within the
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Unless otherwise indicated herein, any third-party trademarks that may appear in this work are the property of
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authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the
owner and Pearson Education, Inc. or its affiliates, authors, licensees, or distributors.
Notice: Care has been taken to confirm the accuracy of information presented in this book. The authors, editors,
and the publisher, however, cannot accept any responsibility for errors or omissions or for consequences from
application of the information in this book and make no warranty, express or implied, with respect to its contents.
The authors and publisher have exerted every effort to ensure that drug selections and dosages set forth in this
text are in accord with current recommendations and practice at the time of publication. However, in view of
ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package inserts of all drugs for any change in indications
of dosage and for added warnings and precautions. This is particularly important when the recommended agent
is a new or infrequently employed drug.
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 20
ISBN-13:978-0-13-521833-4
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About the Authors
MICHAEL PATRICK ADAMS, PHD, is an accomplished ed-
ucator, author, and national speaker. The National Institute
for Staff and Organizational Development in Austin, Texas,
named Dr. Adams a Master Teacher. He has published two
other textbooks with Pearson Publishing: Core Concepts in
Pharmacology and Pharmacology: Connections to Nursing Practice.
Dr. Adams obtained his master’s degree in pharmacology from Michigan State University and his doctorate in
education from the University of South Florida. Dr. Adams
LELAND NORMAN HOLLAND, JR., PHD (NORM), over
25 years ago, started out like many scientists, planning for
a career in basic science research. He was quickly drawn to
the field of teaching in higher medical education, where he
has spent most of his career. Among the areas where he has
been particularly effective are preparatory programs in
nursing, medicine, dentistry, pharmacy, and allied health.
Dr. Holland is both a professor and supporter in nursing
education nationwide. He brings to the profession a depth
of knowledge in biology, chemistry, and medically related
CAROL QUAM URBAN, PHD, RN, Associate Professor, is
the Associate Dean for Practice and Strategic Initiatives in
the College of Health and Human Services at George Mason
University in Fairfax, Virginia. Teaching in the School of
Nursing for over 25 years, and most recently in the position
of Director of the School, she considers pharmacology to be
a course that truly integrates nursing knowledge, skills, and
was on the faculty of Lansing Community College and
St. Petersburg College, and served as Dean of Health Professions at Pasco-Hernando State College for 15 years. He
is currently Adjunct Professor of Biological Sciences at
Hillsborough Community College.
I dedicate this book to nursing educators, who contribute every
day to making the world a better and more caring place.
—MPA
subjects, such as microbiology, biological chemistry, and
pharmacology. Dr. Holland’s doctoral degree is in medical
pharmacology. He is very much dedicated to the success of
students and their preparation for careers in health care.
He continues to motivate students in the lifelong pursuit
of learning.
To the greatest family in the world: Karen, Alexandria, Caleb,
and Joshua.
—LNHII
interdisciplinary teamwork. She has co-authored the
Pearson textbook Pharmacology: Connections to Nursing
Practice with Dr. Adams.
To my daughter, Joy, an extraordinary pediatric hematology-oncology
nurse, and in memory of my son, Keith, and husband, Michael.
—CQU
v
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Thank You
Our heartfelt thanks go out to our colleagues from
schools of nursing across the country who have given
their time generously to help create this exciting new edition. These individuals helped us plan and shape our
book and resources by reviewing chapters, art, design,
and more. Pharmacology for Nurses: A Pathophysiologic
Beatrice Adams, PharmD
Critical Care Clinical Pharmacist
Tampa General Hospital
Department of Pharmacy
Tampa, Florida
Shannon Allen, CRNA, MSNA
Professor
New Mexico Junior College
Hobbs, New Mexico
Candyce Antley, RN, MN
Instructor
Midlands Technical College
Columbia, South Carolina
Culeta Armstrong, MSN, RN
Clinical Assistant Professor
University of Memphis
Memphis, Tennessee
Wanda Barlow, MSN, RN,
FNP-BC
Instructor
Winston-Salem State University
Winston-Salem, North Carolina
Sophia Beydoun, RN, BSN, MSN,
AA-AND
Professor
Henry Ford Community College
Dearborn, Michigan
Approach, sixth edition, has reaped the benefit of your collective knowledge and experience as nurses and teachers,
and we have improved the materials due to your efforts,
suggestions, objections, endorsements, and inspiration.
Among those who gave their time generously are the
following:
Marcus W. Campbell, PharmD,
BC-ADM
Assistant Professor Pharmacy Practice
Director, Center for Drug Information
& Research
LECOM School of Pharmacy
Bradenton, Florida
Rachel Choudhury, MSN, MS, RN, CNE
Associate Dean and Program Director,
ABSN
Musco School of Nursing and Health
Professions
Brandman University
Irvine, California
Darlene Clark, MS, RN
Senior Lecturer in Nursing
Pennsylvania State University
University Park, Pennsylvania
Janice DiFalco, RN, MSN, CNS,
CMSRN, FAACVPR
Professor
San Jacinto College
Pasadena, Texas
Deepali Dixit, PharmD, BCPS
Clinical Assistant Professor
Rutgers University
Piscataway, New Jersey
Staci Boruff, PhD, RN
Assistant Academic Dean of Health
Programs
Professor of Nursing
Walters State Community College
Morristown, Tennessee
Rachael Durie, PharmD, BCPS
Cardiology Clinical Pharmacist
Assistant Professor of Clinical
Pharmacy
Rutgers University
Neptune, New Jersey
Bridget Bradley, PharmD, BCPP
Assistant Professor
Pacific University
Hillsboro, Oregon
Deborah Dye, RN, MSN
Assistant Professor/Nursing
Department Chair
Ivy Tech Community College
Lafayette, Indiana
Mary M. Bridgeman, PharmD,
BCPS, CGP
Clinical Assistant Professor
Rutgers University
Piscataway, New Jersey
Reamer L. Bushardt, PharmD,
P.A.-C
Professor
Wake Forest Baptist Health
Winston-Salem, North Carolina
Adina C. Hirsch, PharmD, BCNSP
Assistant Professor of Pharmacy
Practice
Philadelphia College of Osteopathic
Medicine
Philadelphia, Pennsylvania
Linda Howe, PhD, RN, CNS, CNE
Associate Professor
University of Central Florida
Orlando, Florida
Anne L. Hume, PharmD, FCCP,
BCPS
Professor of Pharmacy
University of Rhode Island
Kingston, Rhode Island
Ragan Johnson, DNP, APRN-BC
Assistant Professor
University of Tennessee
Memphis, Tennessee
Vinh Kieu, PharmD
Assistant Professor
George Mason University
Fairfax, Virginia
Dorothy Lee, PhD, RN, ANP-BC
Associate Professor of Nursing
Saginaw Valley State University
University Center, Michigan
Toby Ann Nishikawa, MSN, RN
Assistant Professor
Weber State University
Ogden, Utah
Dr. Diana Rangaves, PharmD, RPh
Director, Pharmacy Technology
Program
Santa Rosa Junior College
Santa Rosa, California
Jacqueline Frock, RN, MSN
Professor of Nursing
Oklahoma City Community College
Oklahoma City, Oklahoma
Timothy Reilly, PharmD, BCPS,
CGP, FASCP
Clinical Assistant Professor
Rutgers University
Piscataway, New Jersey
Jasmine D. Gonzalvo, PharmD,
BCPS, BC-ADM, CDE
Clinical Associate Professor
Purdue University
West Lafayette, Indiana
Janet Czermak Russell, MS, MA,
APN-BC
Associate Professor
Essex County College
Newark, New Jersey
vi
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Pooja Shah, PharmD
Clinical Assistant Professor
Rutgers University
Piscataway, New Jersey
Dustin Spencer, DNP, NP-C, ENP-BC
Assistant Professor of Nursing
Saginaw Valley State University
University Center, Michigan
Suzanne Tang, MSN, APRN, FNP-BC
Instructor
Rio Hondo College
Whittier, California
Samantha Smeltzer, RN
Professor of Nursing
Mount Aloysius College
Cresson, Pennsylvania
Dr. Jacqueline Stewart, DNP, CEN,
CCRN
Associate Professor of Nursing
Wilkes University
Wilkes-Barre, Pennsylvania
Ryan Wargo, PharmD, BCACP
Assistant Professor of Pharmacy
Practice
Director of Admissions
LECOM School of Pharmacy
Bradenton, Florida
Rose Marie Smith, RN, MS, CNE
Division Dean of Nursing, Liberal
Arts, Social and Behavioral
Sciences
Redlands Community College
El Reno, Oklahoma
Rebecca E. Sutter, DNP, APRN,
FNP-BC
Associate Professor
George Mason University
Fairfax, Virginia
Timothy Voytilla, MSN, ARNP
Nursing Program Director
Keiser University
Tampa, Florida
vii
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Preface
When students are asked which subject in their nursing
program is the most challenging, pharmacology always
appears near the top of the list. The study of pharmacology
demands that students apply knowledge from a wide variety of the natural and applied sciences. Successfully predicting drug action requires a thorough knowledge of
anatomy, physiology, chemistry, and pathology as well as
the social sciences of psychology and sociology. Lack of
adequate pharmacology knowledge can result in immediate and direct harm to the patient; thus, the stakes in learning the subject are high.
Pharmacology cannot be made easy, but it can be
made understandable when the proper connections are
made to knowledge learned in these other disciplines. The
vast majority of drugs in clinical practice are prescribed for
specific diseases, yet many pharmacology textbooks fail to
recognize the complex interrelationships between pharmacology and pathophysiology. When drugs are learned in
isolation from their associated diseases or conditions, students have difficulty connecting pharmacotherapy to therapeutic goals and patient wellness. The pathophysiology
focus of this textbook gives the student a clearer picture of
the importance of pharmacology to disease and, ultimately, to patient care. The approach and rationale of this
textbook focus on a holistic perspective to patient care
which clearly shows the benefits and limitations of pharmacotherapy in curing or preventing illness. In addition to
its pathophysiology focus, medication safety and interdisciplinary teamwork are consistently emphasized throughout the text. Although difficult and challenging, the study
of pharmacology is truly a fascinating, lifelong journey.
New to This Edition
The sixth edition of Pharmacology for Nurses: A Pathophysiologic Approach has been thoroughly updated to reflect
current pharmacotherapeutics and advances in understanding disease.
• NEW! Applying Research to Nursing Practice feature
illustrates how current medical research is used to improve patient teaching. Books, journals, or websites
may be cited, and the complete source information
provided in the References section at the end of
the chapter.
• NEW! Key terms are listed at the beginning of each
chapter along with corresponding page numbers that
indicate where their definitions may be found within
the chapter.
• UPDATED! Check Your Understanding questions
appear throughout the drug chapters to reinforce
student knowledge.
• EXPANDED! Includes more than 40 new drugs, drug
classes, indications, and therapies that have been approved since the last edition.
• UPDATED! Black Box Warnings issued by the FDA are
included for all appropriate drug prototypes.
• UPDATED! Pharmacotherapy Illustrated diagrams
help students visualize the connection between pharmacology and the patient.
• UPDATED! Nursing Practice Application charts have
been revised to contain current applications to clinical
practice with key lifespan, safety, collaboration, and diversity considerations noted.
Organization and Structure—A Body
System and Disease Approach
Pharmacology for Nurses: A Pathophysiologic Approach is organized according to body systems (units) and diseases
(chapters). Each chapter provides the complete information
on the drug classifications used to treat the diseases. Specially designed numbered headings describe key concepts
and cue students to each drug classification discussion.
The pathophysiologic approach clearly places the
drugs in context with how they are used therapeutically.
The student is able to locate easily all relevant anatomy,
physiology, pathology, and pharmacology in the same
chapter in which the drugs are discussed. This approach
provides the student with a clear view of the connection
among pharmacology, pathophysiology, and the nursing
care learned in other clinical courses.
The vast number of drugs available in clinical practice
is staggering. To facilitate learning, this text uses drug prototypes in which the most representative drugs in each
classification are introduced in detail. Students are less intimidated when they can focus their learning on one representative drug in each class.
viii
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Preface
Chapter 15 Drugs for Seizures
ix
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
PHARMACOKINETICS (PO CAPSULES)
Actions and Uses
15 Drugs for Seizures
175
Valproic acid has become a preferred drug for treating manyChapter Onset
Peak
Duration
interesting features, such as Complementypes of epilepsy. This medication has several trade names and
2–4 days
1–4 h
6–24 h
formulations, which can cause confusion when studying it.
tary and Alternative Therapies, Treating
• Valproic acid (Depakene) is the standard form of the drug
Adverse Effects
the Diverse Patient, Community-Oriented
given PO.
Prototype Drug
Phenobarbital
(Luminal)
Side effects include sedation, drowsiness, GI upset, and pro• Valproate sodium (Depacon) is the sodium salt of valproic
longed bleeding time. Other effects include visual disturbances,
Practice, and Lifespan
Considerations,
Therapeutic
Class: Antiseizure drug; sedative
Pharmacologic
agonist
acid given PO or IV. Class: Barbiturate; GABAA receptor
muscle
weakness, tremor, psychomotor agitation, bone
• Divalproex sodium (Depakote ER) is a sustained release
marrow suppression, weight gain, abdominal cramps, rash,
that clearly place the drugs in context with
combination of valproic acid and its sodium salt in a
alopecia,
pruritus,
photosensitivity, erythema multiforme, and
Actions and Uses
With overdose, phenobarbital may cause
severe
respiratory
1:1 mixture. It is given PO and is available in an enterictheir clinical applications.
Re- used for the managefatal hepatotoxicity.
Black Box Warning: May result in fatal
Phenobarbital is a Applying
long-acting barbiturate
depression, CNS depression, coma, and
death.
coated form.
hepatic failure, especially in children under the age of 2 years.
mentPractice
of a variety offeatures
seizures. It isillusalso used to produce sedasearch to Nursing
All three formulations
of
the
drug
form
the
chemiNonspecific
symptoms
often precede hepatotoxicity: weakness,
Contraindications: Administration of phenobarbital is inadvistion. Phenobarbital should not be used for pain reliefcalbecause
valproate itafter absorption or on entering the brain. The
facial edema, anorexia, and vomiting. Liver function tests should
able
in
cases
of
hypersensitivity
to
barbiturates,
severe
uncontrate how currentmay
medical
research
is
used
pharmacokinetics of each form varies, and doses are not
be performed prior to treatment and at specific intervals durincrease a patient’s sensitivity to pain.
trolled pain, preexisting CNS depression,
porphyrias,
severe
ing the
first 6 months
of treatment. Valproic acid can produce
Phenobarbital acts
biochemically
by enhancing interchangeable.
the action of In this text, the name valproic acid is used
to improve patient
teaching.
Patient
Safety
170 Unit
3 The Nervous System
to describe all forms ofrespiratory
the drug, unless
specifically
stated
disease with dyspnea or obstruction,
glaucoma
life-threateningand
pancreatitis
and teratogenic effects, including
the GABA neurotransmitter, which is responsible for suppressing
otherwise.
spina
bifida.
illustrates potential
pitfalls that can lead
or prostatic hypertrophy.
abnormal neuronal discharges that can cause epilepsy. Valproic acid is administered as monotherapy or in combiContraindications:
Hypersensitivity may occur. This
needed
safety precautions.
In collaboration
poisoning—and
changes
in perfusion—such
aswith
those
nation
other AEDsimplementing
to treat absence seizures
and complex
to medication errors.
PharmFacts
contain
medication should not be administered to patients with liver
Interactions
partial seizures.
ER isthe
alsopatient,
approved for
the healthcare
prevenwith
the
provider, pharmacist, and
caused by hypotension, stroke, shock, and cardiac
dys-Depakote
disease, bleeding dysfunction, pancreatitis, and congenital
Administration
statistics and facts
that are Alerts
relevant
to the
tion of migraine headaches
and mania
associated
with bipolar
Drug–Drug:
Phenobarbital
interacts
with
many other drugs.
nurse
are instrumental
in achieving
rhythmias—may
be causes.
metabolicpositive
disorders. therapeutic
Off-label indications
include
behavioral
distur• Parenteral
phenobarbital is a soft-tissue
irritant.disorder.
IntramusItoutcomes.
should
notsevere
be
taken
with
alcohol
or other of
CNS
depressants
Through
a
combination
pharmacotherapy,
chapter. Check Your
Understanding
feabances,
such as agitation due to dementia, Alzheimer’s disease,
Pregnancy
planning
is
a
major
concern
for
women
cular (IM) injections may produce a local inflammatory
reacbecause
these substances
potentiate
barbiturateeffective
action,
Interactions
patient–family
support,
and education,
seizure
or explosive temper in patients
with ADHD; persistent
hiccups;
with students
epilepsy.
Because
several
AEDs
effectivetures encourage
to apply
what
Drug–Drug: depression
Valproic acid interacts
with many drugs. For
tion. IV administration
is rarely
useddecrease
because the
extravasation
the
riskachieved
of life-threatening
respiratory
or
and status epilepticus increasing
refractory
IV
diazepam.
controltocan
be
in a majority
of patients.
example, aspirin, cimetidine, chlorpromazine, erythromycin, and
ness of may
hormonal
contraceptives,
produce
tissue
necrosis. additional barrier methcardiac arrest. Phenobarbital increases
the metabolism of many
they have already
read
in the
chapter.
felbamate may increase valproic acid toxicity. Concomitant warAdministration Alerts
ods of birth control should be used to avoid unintended
drugs, (GI)
reducing
their effectiveness.
• Controlled substance: Schedule IV.
farin, aspirin, or alcohol use can cause severe bleeding. Alcohol,
• Valproic acid is a other
gastrointestinal
irritant. Advise
Students learn
better
supplied
pregnancy.
Prior when
to pregnancy
and considering thepatients
serious
15.2
Types
of
Seizures
benzodiazepines, and other CNS depressants potentiate CNS
not
to
chew
extended-release
tablets
because
• Pregnancy category D.
Lab
Tests:
Barbiturates
may
affect
bromsulphalein
tests and
of seizures,
patients should
consult with theirmouth
healthdepressant action. Use of clonazepam concurrently with valsoreness will occur.
with accurate, nature
attractive
graphics
and rich
The differing
presentation of seizures
relates to their signs
increase
serum
phosphatase.
proic acid may induce absence seizures. Valproic acid increases
• Do
not mix
care provider to determine the most appropriate
plan
ofvalproic acid syrup with carbonated beverages
and
symptoms.
Symptoms
may range
from sudden,
violent
serum phenobarbital
and phenytoin
levels. Lamotrigine, pheit will trigger
immediate
release of
the drug, which
media resources.
Pharmacology
for Nurses:
A
action
for seizure control.
When pregnancy
occurs,because
caution
PHARMACOKINETICS
Herbal/Food:
Kava,
chamomile
potentiate
nytoin, andmay
rifampin
lower valproic
acid levels.
shaking
and
total valerian,
loss of and
consciousness
to muscle
twitchcauses severe mouth
and throat
irritation.
is necessary
because
many
are pregnancy
D.
Pathophysiologic
AOnset
pproach
contains
a genersedation.
• Open capsules and
sprinkle
on
soft
foods
if
the
patient
Peak AEDs
Duration category
ing or slight tremor of a limb. Staring
space, altered
Lab Tests: into
Unknown.
AEDs such as lamotrigine, gabapentin, and zonisamide
cannot swallow them.
20–60 minwith an
4–12uhnequaled
PO; 30 min IV 10–16 h PO; 4–10 h IV
vision, and
are
other treatment
behaviors
ous number ofmay
figures,
Treatment
ofdifficulty
Overdose:speaking
There is no
specific
fora person
Herbal/Food:
Unknown.
• Pregnancy
category
D.
be
considered
because
they
appear
to
have
a
lower
risk
PO; 5 min IV
may exhibit.
Determining
cause of recurrent
seizures
overdose.
Drug removal
may bethe
accomplished
by gastric lavage
of teratogenicity. Some AEDs
may cause folate deficiency,
art program. Pharmacotherapy
Illustrated
is use
essential
for proper
diagnosis
andmay
selection
of the
or
of
activated
charcoal.
Hemodialysis
be
effective
in most
condition correlated with fetal neural tube defects. Vitafeatures appearamin
throughout
effective removal
treatment
options. from the body. Treatment is
Adverse Effects the text, breakfacilitating
of
phenobarbital
supplements may be necessary. Eclampsia is a severe
Methods
of classifying
epilepsy
have
changed
Phenobarbital
is ainto
Schedule
IV drugunthat may cause depensupportive
and consists
mainly of endotracheal
intubation
and over
such as lamotrigine
(Lamictal)
and zonisamide (Zonegran),
ing down complex
topics
easily
hypertensive
disorder
that
continues
to worsen
preg- Seizures
15.8 as
Treating
time. For example,
terms grand
and
petithypotenmalfor
epilepsy
aremal
being
investigated
their roles in treating absence seidence. Common side effects include drowsiness, vitamin defimechanical
ventilation.the
Treatment
of bradycardia
and
nancy
progresses.
It
is
characterized
by
seizures,
coma,
and
with
Succinimides
derstood formats.
Animations
of
drug
zures.
Lamotrigine
has
also
been
have,
forbethe
most part, been replaced by more descriptive found to be effective in
ciencies (vitamin D; folate 3B9 4; and B12), and laryngospasms.
sion
may
necessary.
perinatal
mortality. Eclampsia is likely to occurSuccinimides
from around
patients with partial seizures, usually in combination with
are medications
that suppress
by are
and detailed
labels.seizures
Epilepsies
typically identified using
mechanisms show
the
student
step-by-step
other antiseizure medications.
the 20th week of gestation until at least 1 weekdelaying
after delivery
calcium influx into neurons. By raising the seithe
International
Classification
of
Epileptic Seizures nomenzure eclampsia
threshold, succinimides keep neurons from firing too
of
the
baby.
Approximately
25%
of
women
with
how drugs act.
clature.
These
are are
termed
partial (focal), generalized, and
quickly, thus suppressing
abnormal
foci. They
generally
experience seizures within 72 hours postpartum.
For years,
only effective against absence
Thesyndromes
succinimides (Table 15.1). Types of partial
specialseizures.
epileptic
one of the approaches used to prevent or treat
eclamptic
are listed
in Table 15.5.(focal) seizures or generalized seizures may be recognized
Ethosuximide
Check Your Understanding 15.1
seizures was magnesium sulfate. The mechanism
for this (Zarontin) is the most commonly prebased
on symptoms
observed
during a seizure episode.
scribed drug inA
this class.
It remains
a preferred choice
for
If an antiseizure drug must be discontinued, how will this be accomComplementary
and Alternative
Therapies
substance’s
antiseizure
activity is not
well understood.
Some
symptoms
are
subtle
and
reflect
thewhy
specific
nature
of
absence seizures, although valproic acid is also effective for
plished, and
is this method
necessary?
See Appendix A for the
prototype
feature
forFOR
magnesium
presented
in
THE KETOGENIC
DIET
EPILEPSY sulfate is these
types of seizures. Some
of the newer
antiseizure
drugs,
answer.
neuronal
misfiring;
others
are more
complex.
Chapter 43.
The Seizures
ketogenic can
diet have
is most
often used when
seizures
cannot
be
has a ketogenic ratio of 3 or 4 g of fat to 1 g of protein and carbohya significant
impact
on the
quality
controlled
through
or whenif there
unacceptdrate
de LimaConcepts
et al., 2017). Because
of the high ratio of fat
of
life. They
maypharmacotherapy
cause serious injury
they are
occur
while
15.3(Azevedo
General
of Antiseizure
adverse
effects toathe
medications.
Before antiseizure
drugs
in the diet, complications such as hyperlipidemia and hepatotoxicaable
person
is driving
vehicle
or performing
a dangerous
Pharmacotherapy
were developed,
diet was
primary
treatment
epilepsy.
ity
may occur, and patients on this diet need to be monitored long
M15_ADAM8334_06_SE_C15.indd
179
08/12/2018 14:27
activity.
Almost this
all states
willa not
grant,
or will for
take
away,
studies
have and
examined
the possibility
that theperiod
ketogenic
diet
term
detectofthese
effects
(Azevedo de Lima
et al.,patient
2017;
The to
choice
AEDadverse
is highly
individualize
for each
aRecent
driver’s
license
require
a seizure-free
before
could provide
benefit for
patientsWithout
with Alzheimer’s,
Parkinson’s,
and
Arslan
et al., 2016,).
and depends
on the type of seizures, the patient’s previgranting
a driver’s
license.
successful
pharmacoother neurodegenerative
diseaseslimit
(Rajagopal,
Sangam,inSingh,
&
suggests EEG
that the
dietand
produces
a high pathologies.
success rate
ous Research
medical history,
data,
associated
therapy,
epilepsy can severely
participation
school,
Joginapally, 2016;
Veyrat-Durebex
et al.,
2018).
exact mechacompared
to standardistreatment,
withpatient
better control
of seizures.
Once a medication
selected, the
is placed
on a low
employment,
and
social activities
and
can The
definitely
affect
nism behind theChronic
effectiveness
of the dietmay
is unknown
and appears
to
Improvement
noted rapidly
and the diet
appearsuntil
to be seizure
equally
initial dose.may
Thebe
amount
is gradually
increased
self-esteem.
depression
accompany
poorly
include both direct
effect from
ketone body
increases, and metabolic
effective
seizureortype.
The
mostside
frequently
reported
adverse
control for
is every
achieved,
until
drug
effects
prevent
addicontrolled
seizures.
Important
considerations
in nurschanges
occur, identifying
increasing GABA
and inhibitory
effects
vomiting,
fatigue,
constipation,
diarrhea,
andobtained
hunger.
tional include
increases
in dose.
Serum
drug levels
may be
ing
carethat
include
patients
at risk neurotransmitfor seizures,
ters (Rho, 2017).the pattern and type of seizure activity, and
Cost
and the
of following
the diet
long term may the
alsomost
limit
to assist
thedifficulty
healthcare
provider
in determining
documenting
The ketogenic diet is a stringently calculated diet that is high
in fat and low in carbohydrates and protein. It limits water intake to
avoid ketone dilution and carefully controls caloric intake. Each meal
its use (Wijnen et al., 2017). Those interested in trying the diet must
consult with their healthcare provider to optimize the therapy. The
long-term effects are not yet fully known.
Treating the Diverse Patient: Sports-Related Concussions
There is increased awareness and concern about sports-related
concussions at all ages. Concussions are a form of traumatic
brain injury (TBI) and can range from mild to severe, with immediate and long-term consequences, including dementia and
chronic traumatic encephalopathy (Thomas et al., 2018). Ban,
Botros, Madden, and Batjer (2016) found a relatively low inciM15_ADAM8334_06_SE_C15.indd
175
dence of sports-related
TBI, but an estimated 13% of pediatric
and 14% of adult injuries were considered moderate to seve
