Focusing on Concussion

US Pharm. 2017;42(1):1.

 As the nation looks forward to gathering to watch the most anticipated sporting event of the year in a couple of weeks, the Super Bowl, few have the issue of concussions in the forefront of their minds. The National Football League, however, just might. Last year, the league instituted revised rules to address the issue, and the league and players’ union will each appoint a person to monitor games to ensure that players are tested for concussions when warranted.

The NFL concussion protocol requires that a player suspected of having sustained a concussion be removed from the field. Following an examination, a player diagnosed with a concussion cannot return to the game the same day. If he passes this exam, he must be monitored for symptoms the rest of the game. Teams found guilty of avoiding the rules are subject to a fine of up to $150,000 for a first violation, and a minimum of $100,000 for subsequent infractions. If the NFL commissioner concludes that a team’s medical staff did not follow the concussion protocol for “competitive reasons,” the team could be forced to forfeit one or more draft picks. In addition, the league and the union agreed to review injury data each year to see if game rules needed to be changed to improve player safety.

Pharmacists are well positioned to convey information about concussions from everyday patients. Most often originating from a blow or jolt to the head, causing the brain to collide with the skull, the most common causes are falls, motor vehicle accidents, and sports-related injuries. Sports-caused injuries are more common in younger patients, while falls are seen more often in geriatric patients. When the brain bangs against the skull, axonal stretching causes neuronal dysfunction, and multiple ionic, metabolic, and physiologic changes happen. Following the flux of ions, more neurotransmitters are released, namely, glutamate.

As Todd J. Woodard, PharmD, BCPP, BCPS, BCGP and Shari N. Allen, PharmD, BCPP write in this issue’s article, “An Overview of the Management of Concussion,” “Glutamate release leads to the influx of calcium ions into the cells and the efflux of potassium ions out of the cells. As a result, they add, and to restore membrane potential, the sodium-potassium pump begins to work overtime. The sodium-potassium pump requires energy via adenosine triphosphate, leading to an increase in glucose metabolism. The resulting sequence of events causes an imbalance between oxygen supply and demand…causing oxidative stress.”

Some of the more oblique concussion symptoms include headache or neck pain, nausea, ringing in the ears, dizziness, light sensitivity, and tiredness. Pharmacists can adeptly counsel patients on the management of concussion and concussion-related sequelae. Specifically, they can educate patients and/or their parents regarding current guidelines for sports-related concussion in school-age children and adolescents. Pharmacists, the authors write, who are members of hospitals as well as ambulatory interdisciplinary teams can posit well-founded recommendations on pharmacotherapy for concussion-related comorbidities.

The authors add that community pharmacists are the most accessible healthcare contacts by virtue of regularly filling prescriptions and counseling on basic healthcare needs. As such, they argue, pharmacists have a responsibility to stay current on strategies for common conditions that may affect their patients. “It has been well documented that pharmacists can assist in the management of other common conditions, such as diabetes, asthma, and mental health disorders,” they write. “Therefore, pharmacists who are quite familiar with common neurologic disorders, such as concussions and brain-related injuries, can provide additional support to other healthcare providers and, more importantly, the patients they serve.”

So as they enjoy the big game, pharmacists might do well to consider the potential health impact that concussions can have on the lives of their patients, young or old.