© 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 17: Pharmacology, Drugs and...

© 2011 McGraw-Hill Higher Education. All rights reserved.

Chapter 17: Pharmacology, Drugs and Sports


• Pharmacology is the branch of science that deals with the action of drugs on the biological systems

• Specifically those that are used in medicine for diagnostic and therapeutic purposes

• Used to achieve definite outcomes that improve quality of life

• Various drugs and other substances are being used widely for performance enhancement or mood alteration


What is a drug?

• Chemical agent used in prevention, treatment, & diagnosis of disease

• Ancient practice dating back to the Egyptians• Many are derived from natural sources• Drugs which have in the past come from nature

are now produced synthetically


Pharmacokinetics

• Method by which drugs are absorbed, distributed, metabolized and eliminated from the body

• Pharmacodynamics is the actions or effects of drugs on the body


Administration of Drugs• Must first enter the system and reach receptor

tissue to be effective• Drug vehicles

– Therapeutically inactive substance used to transport drug (solid or liquid)

• Internal administration– Inhalation (medication through respiratory tract)– Intradermal (into the skin)– Intramuscular (medication directly into muscle)– Intranasal – Intraspinal (medication injected into the spine)


– Intravenous (into a vein)– Oral (most common form)– Rectal (limited due to dosage regulation)– Sublingual/buccal (dissolvable agents placed under tongue– Intravaginal (placing drug device inside vagina)

• External Administration– Inunctions (oil based medication rubbed into skin)– Ointments (long lasting topical medication)– Pastes (ointments with nonfat base)– Plasters (thick ointment, counterirritant for pain &

inflammation relief, increasing circulation) – Transdermal patches (patch with slow release mechanism)– Solutions (administered externally)


Absorption of Drugs• Drug must dissolve before absorption• Rate and extent determined by chemical

characteristics of drug, dosage, and gastric emptying

• Bioavailability– How completely a drug is absorbed by the system– Dependent on characteristics not dosage– (Absorption rate dependent on dosage form)


• Distribution– Once absorbed, drug is transported through blood to target

tissue– Volume of distribution: volume of fluid/plasma in which drug is

dissolved and indicates extent of distribution of that drug – Efficacy: capability of producing therapeutic effect– Potency: dose of the drug required to produce a desired

therapeutic effect• Metabolism

– Biotransformation of drug to water soluble compounds that can be excreted

– Most takes place in liver, rest in blood and kidneys– Liver detoxifies active agents– Metabolites may be toxic


• Excretion– Excretion of drug or its metabolites is controlled by

kidneys– Filtered through kidneys and usually excreted in the

urine (some is reabsorbed)– May also be excreted in saliva, sweat and feces

Drug Half-Life

• The amount of time required for the plasma drug level to be reduced by one half

• It is either measured in minutes, hours, or days depending on the drug

• Critical information in determining how much of what drug to utilize

• Drug steady state– The amount taken is equal to the amount excreted– Drugs with long half-lives may take days or weeks to

reach steady state© 2011 McGraw-Hill Higher Education. All rights reserved.

Effects of Physical Activity on Pharmokinetics

• Exercise decreases the absorption after oral administration

• Exercise increases absorption after intramuscular or subcutaneous administration due to the increased rate of blood flow

• Exercise has an influence on the amount of a drug that reaches the receptor site


Legal Concerns in Administering Versus Dispensing Drugs

• Defined as a single dose of medication to be used by a patient

• Dispensing constitutes providing a sufficient quantity to be used for multiple doses– By law, only licensed persons may prescribe or

dispense prescription drugs for an athlete– Athletic trainers are not allowed to dispense

medication unless allowed by state licensure


• Administering Over the Counter Drugs– Athletic trainer may be allowed to administer a single

dose of nonprescription medication– Rules relative to secondary schools

• Oral medications vs. wound medication– College and professional athletes

• Most are of legal age and are allowed to use whatever nonprescription drugs they choose

• Athletic trainer must still use reasonable care and be prudent about types of medication provided

• In all cases, actions should be performed under the supervision of a physician


General Guidelines for Administration (Focus 17-1)

• Should be taken as directed• Should not be used in

combination without direction of physician

• Do not use past expiration• Labels should not be

removed• Take medications with water

unless directed otherwise• Take with food or as directed• Containers should be child-

proof

• Provide verbal and written instructions

• Patient should read label information and know dosage schedule

• Medications should not be shared with other individuals

• Ensure that the patient is aware of side effects and possible addictions

• Be aware of interaction between meds and exercise


• Record Keeping– Must maintain accurate and up to date medical

records– Should include the following in log

• quantity of medication given• method of administration

– Should be aware of state regulations relative to ordering, prescribing, distributing, storing and dispensing of the medications

– Obtaining legal counsel, working w/ state boards of pharmacy, student health clinic, physicians and establishing policies to minimize violating state laws


•Record Keeping-ATCs must maintain accurate and up to date medical records

• Name• Complaint • Current medications • Any known drug

allergies• Name of medication

• Lot number• Expiration Date• Quantity of medication given• Method of administration• Date and time of

administration


•Labeling Requirements (federally mandated)

• Name of product• Name and address of

manufacturer, packer or distributor

• Net contents of package• Name of active

ingredients and quantity of certain other ingredients

• Name of any habit forming drug contained

• Cautions and warnings to protect consumer

• Adequate directions for safe, effective use

• Expiration date and lot number


– Nonprescription drugs should not be repackaged w/out meeting labeling criteria

– All drugs dispensed from the athletic training room must be properly labeled

– Legal liability if drugs removed from original packaging and dispensed

• Unable to review contents, dosage, directions and precautions (information needed for safe use)

• Same liability associated with providing prescription medication


• Safety in Use of Pharmaceuticals– No drug is completely safe and harmless– Any drug under the correct conditions can be potent

and dangerous, w/ every individual reacting differently– Patient must be instructed on specifics of medications

(when to, how to and w/ what medication should be taken with)

– Drug Responses• Individuals react differently to the same medications, w/

different conditions causing altered effects of drugs• Drugs can change with aging and relative to how they are

administered• Alcohol ingestion w/ medications should be avoided


• Alcohol is a CNS depressant and can increase or decrease effects of other drugs

• Also used in many liquid preparations• Medication can potentially effect certain physiologic functions

related to dehydration (sweating, urination, and the ability to control and regulate body temperature)

• Can cause fluid depletion, further complicating illness, or make individuals sensitive to sunlight increasing risk of sunburn and allergic reactions

• Different diets may impact absorption rate• Consumption of acidic foods such as fruit, carbonated drinks

and vegetable juice may cause adverse reactions• Athletic trainer must know their patient’s in order to avoid

potential adverse reactions


• Buying Medication– Pharmacist is a vital resource, assisting in selection and

purchase of nonprescription drugs, suggesting less expensive generic drugs, and acting as a general advisor

– Properly storing medication is critical• Keep in locked cabinet• Maintain original container• Store away from direct light, heat, damp places and extreme

cold


• Traveling with Medications– When traveling with a team or individually the

individual should be advised to do the following relative to medications

• Medication should not be stored in a bag/luggage but carried by the athlete taking it

• Sufficient supply should be packaged in case of emergency

• Make sure there is a source of medication while traveling• Take copies of written prescriptions• Keep medication in original container• If traveling internationally, understand restrictions of

individual boundaries


Selected Therapeutic

• Widespread use in athletics and general society• Pharmaceutical labs develop compounds in vitro

and then test, retest, and refine drugs in vivo before submitting it to the Food and Drug Administration (FDA)

• Number of texts and databases are available for reference to determine appropriateness and effectiveness of medications for different conditions


Drugs to Combat Infection

• Local Antiseptics and Disinfectants– Antiseptics are substances that can be placed on

living tissue for killing bacteria or inhibiting growth– Disinfectants are used to combat microorganisms

but should be applied to non-living objects– Germicides (generic name) designed to destroy

bacteria, fungicides, sporicides and sanitizers


– Alcohol• Most widely used skin disinfectant• Ethyl alcohol (70% by weight) and isopropyl alcohol (70% by

weight) are equally effective• Inexpensive and nonirritating, kill bacteria immediately with

the exception of spores• No long lasting germicidal action, can be used as an antiseptic

or astringent• 70% solution can be used to disinfect instruments• Also can be utilized as mild anesthetic and topical skin

dressing when combined with 20% Benzoin– Phenol

• Early antiseptic and disinfectant in medical profession• Used to control disease organisms• Found in various concentrations and emollients• Derivatives include, resorcinol, thymol, and common house

cleaner Lysol© 2011 McGraw-Hill Higher Education. All rights reserved.

– Halogens• Chlorine, bromine, fluoride (used for antiseptic effect)• Iodophor or halogenated compounds create a much less

irritating solution than tincture of iodine• Betadine solution- excellent germicide, very effective for skin

lesions, abrasions and lacerations– Oxidizing agent

• Hydrogen peroxide is commonly used in the athletic training • Readily decomposes in presence of organic substances and

has little use as an antiseptic• Cleanses infected cutaneous and mucous membranes• Dilute solution can be used to treat inflammatory mouth and

throat conditions


• Antifungal Agents– Medicine used to treat fungi (Epidermophyton,

Trichophyton, and candida albicans)– Numerous antifungal agents – Some can be used against deep seated fungal

infections– Others are administered orally

• Must be carefully monitored by physician

• Antibiotics– Chemical agents that are produced by

microorganisms – Interferes w/ necessary metabolic processes of

pathogenic microorganisms


– Used topically or as systemic medication– Indiscriminate use can produce hypersensitivity and prevent

development of natural immunity or resistance to subsequent infections

– Must be carefully controlled by physician– A number of antibiotics are available– Penicillin and Cephalosporins

• Most important antibiotic• Useful in skin and systemic infections• Interferes w/ metabolism of bacteria

– Bacitracin• Antibacterial agent

– Tetracycline• Wide group of antibiotics that have broad antibacterial spectrum• Usually oral, modifies infection rather than eradicating it completely


– Erythromycin• Used for streptococcal infection and mycoplasma pneumoniae• Same general spectrum as penicillin but can be used with

individuals allergic to penicillin– Sulfonamides

• Group of synthetic antibiotics• Make pathogens vulnerable to phagocytes and certain

enzymatic actions– Quinolones

• New group of antibiotics with broad spectrum of activity• Must be carefully monitored for adverse effects


Drugs for Asthma• Used to treat chronic inflammatory lung disorder• National Asthma Education and Prevention Program has

established guidelines for diagnosis and treatment; NATA also has position statement

• Goals of asthma therapy are to prevent chronic and troublesome symptoms, maintain normal lung function, prevent exacerbation and provide adequate pharmacotherapy with minimal adverse effects

• Portable hand-held inhalers are available– Meter dosed inhalers (pressurized canister)– Dry powder inhalers– Nebulizer

• Often individuals become dependent on inhalers• Treatment should not just be drug based


Drugs that Inhibit Pain and Inflammation

• Pain Relievers– Numerous drugs and procedures can be used– Reasons for effectiveness

• Excitatory effect on an individual impulse is depressed• Individual impulse is inhibited• Perceived impulse is decreased• Anxiety created by pain or impending pain is decreased


• Counterirritants and Local Anesthetics– Analgesics give relief by causing systemic and topical

analgesia– Application causes local increases in circulation, redness,

rise in skin temperature– Mild pain can often be reduced w/ counterirritants– Examples include

• Liniments• Analgesic balms• Spray coolants• Alcohol• Menthol• Cold• Local anesthetics (injected by physician)


• Narcotic Analgesics– Most derived from opium or are synthetic opiates

(morphine and codeine)– Depress pain impulse and respiratory center– Examples include

• Codeine (morphine like action, found in cough suppressants; Vicodin)

• Morphine (dangerous due to respiratory effects, habit forming qualities)

• Propoxyphene hydrochloride (slightly stronger than aspirin and can be fatal if mixed with sedatives or depressants)

• Meperidine (Demerol - substitute for morphine, effective when given intravenously or intramuscularly)


• Non-narcotic Analgesics and Antipyretics– Designed to suppress all but most serious pain w/out

losing consciousness– Acetaminophen

• Tylenol - effective analgesic and antipyretic but has no anti-inflammatory activity

• Does not irritate GI system and is often replacement for aspirin in non-inflammatory conditions

• Over-ingestion can lead to liver damage


Drugs to Reduce Inflammation• Acetylsalicylic Acid (Aspirin)

– Widely used analgesic, anti-inflammatory, antipyretic and abused drug

– Helps reduce pain, fever and inflammation– Adverse reactions generally GI related– Over-ingestion can lead to ear ringing and dizziness,

Reye’s syndrome (adolescents)– Allergic reactions result in anaphylaxis -- asthmatics may

be at risk for reactions– Should be avoided w/ contact sports as it prolongs

clotting time


• Nonsteroidal Anti-inflammatory Drugs (NSAID’s)– Anti-inflammatory, antipyretic and analgesic

properties– Inhibit prostaglandin synthesis and effective for

osteo- and rheumatoid arthritis– Used primarily to reduce pain, stiffness, swelling,

redness, fever associated w/ localized inflammation– Fewer side effects and longer duration than aspirin– Should not be used in place of acetaminophen or

aspirin for headaches or increased temperature– Individuals w/ nasal polyps, associated

bronchospasm or history of anaphylaxis should not receive NSAID’s


– Can cause GI reactions, headache, dizziness, depression, tinnitus,

– Taken in conjunction w/ heavy alcohol use can produce stomach bleeding

– NSAIDs are associated with increased risk of adverse cardiovascular events

• Myocardial infarction, stroke, new onset or worsening of existing hypertension

• If necessary - should use the lowest effective dose for shortest duration of time, consistent with patient goals

– NSAIDS may increase risk of GI bleeding, ulceration and perforation


• Corticosteroids– Used primarily for chronic inflammation of

musculoskeletal and joint problems– Prolonged use can create complications

• Fluid and electrolyte disturbances• Musculoskeletal and joint impairment• Dermatological problems• Neurological impairment• Endocrine dysfunction• Ophthalmic conditions• Metabolic impairment

– Cortisone is primarily injected• Can have negative effect on ligaments and tendons

– Also administered through iontophoresis and phonophoresis


Drugs that Produce Skeletal Muscle Relaxation

• Include methocarbamol (Robaxin) and carisoprodol (Soma)

• Due to overall relaxation effect, physicians believe these are less specific to muscle relaxation than once believed (also cause drowsiness)

• Used to eliminate muscle guarding and spasm• Do not appear to be superior to analgesics or sedatives

in either acute or chronic conditions


Drugs Used to Treat Gastrointestinal Disorders

• Includes stomach upset, gas formation due to food incompatibilities, acute or chronic hyperacidity

• Poor eating habits may lead to digestive dysfunction such as diarrhea or constipation

• Antacids– Neutralize acidity in upper GI, reducing pepsin

activity (particularly on mucosal nerve endings– Relief of acid indigestion, heart burn, peptic ulcers


– Sodium bicarbonate or baking soda are popular– Antacids w/ magnesium tend to have laxative effect– Those w/ aluminum and calcium cause constipation– Overuse can cause electrolyte imbalance

• Antiemetics– Used to treat nausea and vomiting– Working locally

• Work on mucosal lining of stomach (may be more placebo)– Working centrally

• Affect brain, making it less sensitive to nerve impulses from inner ear and stomach

– Variety of meds available, but may cause drowsiness


• Carminatives– Provide relief from flatulence (gas)– Inhibit gas formation and aid in expulsion

• Cathartics (laxatives)– Must be under direct supervision of physician

• Constipation may be symptomatic of serious disease– Indiscriminate use may render individual unable to

have normal bowel movements– May cause electrolyte imbalance

• Antidiarrhoeals– Diarrhea tends to be a symptom, not a disease– Result of emotional stress, allergies, adverse drug

reactions, or different intestinal problems


• Antidiarrheal (continued)– Acute diarrhea

• Accompanied by chills, vomiting, intense abdominal cramps/pain

• Will typically run course and stop when irritating agent removed from system

– Chronic diarrhea• May lasts for days or weeks and may be the result of more

serious disease states– Treat with Kaolin (absorb chemicals and pectin),

substances that add bulk to stool– Systemic agents (except Imodium AD) are prescription

drugs• Most are opiate derivatives and will cause drowsiness, dry

mouth, and constipation• Do not treat antibiotic induced diarrhea as it may be protective

symptom in antibiotic induced pseudomembranous colitis


• Histamine-2 Blockers– Reduce stomach acid output by blocking histamine on

certain stomach cells– Used to treat peptic and gastric ulcers and GI

hypersecretory conditions– Drug examples include Cimetidine (Tagamet) and

ranitidine (Zantac)• Protein Pump Inhibitors (Prilosec)

– Used to suppress gastric acid secretion– Treats erosive esophagitis, symptoms of

gastroesophageal reflux disease– Also used in prevention of gastric ulcers, part of

multidrug regimen for Helicobacter pylori in patients with duodenal ulcers


Drugs Used to Treat Colds and Allergies

• Nasal Decongestants– Number of topical nasal decongestants available– Prolonged use may cause rebound congestion and

dependency– Combat Methamphetamine Epidemic Act

• Bans over-the-counter retail sales of cold meds with pseudoephedrine

• Limits amount of pseudoephedrine that can be sold to an individual each month

• Regulated sellers also must go through federally mandated self-certification process

• Athletic trainers must be familiar with new state laws in order to remain compliant


• Cough Medications– Suppress cough (antitussives) or produce fluid in

respiratory system (expectorant)– Few side effects from nonnarcotic antitussives and

are not addictive– Narcotic antitussives contain codeine– Little evidence that expectorants are any more

effective on reducing cough than simply drinking water


• Antihistamines– Often added to decongestants– Opposes histamine actions, but have little effects on the

common cold– Beneficial in allergies– Impairs body’s ability to dissipate heat– Non-sedating antihistamines pose less risk for heat-related

illnesses

• Sympathomimetics– Often used to reduce spasm of bronchiole smooth muscle– May cause heat related problems– Epinephrine (EpiPen)

• Athletic trainers can receive instruction on use• Used to treat anaphylaxis resulting from food or insect bites


Drugs to Control Bleeding• Vasoconstrictors

– Most often administered externally at sites of profuse bleeding

– Epinephrine or adrenaline commonly used– Acts immediately, constricting vessels --very

valuable in instances of epistaxis (nosebleed)• Hemostatic Agents

– Drugs that immediately inhibit bleeding (under investigation)

– Thrombin© 2011 McGraw-Hill Higher Education. All rights reserved.

• Anticoagulants– Heparin

• Prolongs clotting time but will not dissolve clot once formed

• Controls extension of a thrombus already present– Coumarin derivatives

• Acts by suppressing formation of prothrombin in the liver– Given orally, they can be used to slow clotting time in

certain vascular disorders


Drugs that Can Increase the Rate of Heat Illness

• Some drugs may alter the body’s ability to thermoregulate– Anticholinergics and antihistamines (decrease sweating

mechanism)– Sympathomimetic amines (may predispose athlete to heat

stroke)– Phenothiazines (impacts hot/cold temp. regulation)– Diuretics (alters volume expansion and cutaneous

vasodilation)

• Athletic trainer must be aware of potential risk of medications relative to heat illnesses


Protocols for Using Over-the-Counter Medications

• Athletic trainers will be concerned only with nonprescription medications in most cases

• Does not include prescriptions medications• Prescription medications pose greater risk for

patient and require clinical skills and judgment of individuals that are trained and licensed


Substance Abuse Among Athletes

• Drug use and performance enhancing agents in athletics

• Substance abuse has no place in athletics• Use and abuse of substances can have a

profound effect on performance• Athletic trainer must be knowledgeable about

substance abuse in athletic population and should be able to recognize signs that athlete may be engaged in substance abuse– Focus Box 17-3


Performance Enhancing Substances (Ergogenic Aids)

• Stimulants– Used to increase alertness, reduce fatigue, increase

competitiveness and hostility– Psychomotor stimulant drugs

• Amphetamines and non-amphetamines• Produces rapid turnover of catecholamines, which have strong

effect on nervous and cardiovascular systems, metabolic rates, temperature and smooth muscle

– Sympathomimetic drugs• Work on adrenergic receptors (those that release catecholamines) • Cause mental stimulation and increased blood flow but can cause

elevated blood pressure, headache, increased and irregular heart beat, anxiety and tremors


– Amphetamines and cocaine are the two psychomotor drugs most commonly seen in athletics

– Sympathomimetic drugs are a difficult problem for the USOC as they are often found in cold remedies

– Some products have been approved for asthmatics (B2 agonists)

– Before engaging in competition a team physician must notify the USOC Medical Subcommission in writing about athlete’s use


• Amphetamines– Synthetic alkaloids (potent and dangerous)– Injected, inhaled, taken as tablets– Most widely used for performance enhancement– Can produce euphoria w/ heightened mental status

until fatigue sets in, accompanied by nervousness, insomnia, and anorexia

– In high doses, will reduce mental activity and decrease performance

– Patient may become irrational • chronic use causing individual to become “hung up” in

state of repetitious behavioral sequences


– Can lead to amphetamine psychosis, manifesting in auditory and visual hallucinations and delusions

– Physiologically, high doses can cause mydriasis (abnormal pupil dilation), increased blood pressure, hyperreflexia and hyperthermia

– Believed to improve performance - promote quickness and endurance, delay fatigue, increase confidence causing increased aggressiveness

– Studies indicate the opposite --create increased risk for injury, exhaustion and circulatory collapse


• Caffeine– Found in coffee, tea, cocoa and cola– CNS stimulant, diuretic and stimulates gastric

secretion– In moderation it will cause cerebral cortex and

medullar centers stimulation, causing wakefulness and mental alertness

– Large amounts will cause elevated blood pressure, changes in heart rate, increased plasma levels of epinephrine, norepinephrine and renin --impacting coordination, sleep, mood, behavior and thinking processes


– Adverse effects include, tremors, nervousness, headaches, diuresis, arrhythmia, restlessness, hyperactivity, irritability, dry mouth, tinnitus, ocular dyskinesia, scotomata, insomnia and depression

– Habitual user that ceases use may go through withdrawal

• Suffer headache, drowsiness, lethargy, rhinorrhea, irritability, nervousness, depression and lost interest in work

– Believed to act as ergogenic aid during prolonged activity

– Banned by USOC as stimulant in high doses (12 micrograms/milliliter)


• Narcotic Analgesic Drugs– Derived from opium or synthetic opiates– Morphine and codeine are made from alkaloid of

opium– Used for management of moderate/severe pain– Risk physical and psychological dependency

• Beta Blockers– Block of sympathetic nerve ending receptor– Primarily used for hypertension and heart disease.– Used for sports requiring steadiness– Adrenergic agent that inhibits catecholamines– Relax blood vessels, slows heart rate and decreases

cardiac output and heart contractility


• Diuretics– Increase kidney excretion by decreasing kidney

resorption of sodium– Excretion of potassium and bicarbonate may also

occur– Used for variety of cardiovascular and respiratory

conditions– In sports, misused for weight loss and decreasing

concentration in urine


• Anabolic Steroids– Synthetic chemical (structure resembles sex hormone,

testosterone)– Androgenic effects

• Growth, development and maintenance of reproductive tissues, masculinization

– Anabolic effects• Promote nitrogen retention leading to protein synthesis -

causing increased muscle mass and weight, general growth and bone maturation

• Goal is to maximize this effect– Can have deleterious and irreversible effects causing

major threats to health– Use most commonly seen in sports that involve strength

and power


• Tetrahydrogestrinone (THG)– Believed to be undetectable– Designer steroid that is structurally similar to

gestrinone and Trenbolone– Derived from other anabolic steroids– Banned by USADA– Cannot be legally marketed without FDA approval


• Androstenedione– Weak androgen produced primarily in testes and in

lesser amounts by adrenal cortex and ovaries– Increases testosterone in men and particularly

women– Effects last a few hours– No scientific evidence to support or rebuke efficacy

or safety of using this ergogenic aid– Banned by IOC, NFL, NCAA, and minor league

baseball– Contains steroid hormones

• May result in breast enlargement, testicular shrinkage (males) or facial/body hair, voice deepening, and clitoral enlargement (females)


• Human Growth Hormone (HGH)– Produced in somatotrophic cells of anterior pituitary

and released into circulatory system– Amount released varies with age– Can be produced synthetically– Results in increases muscle mass, skin thickness,

connective tissue in muscle, organ weight– Can produce lax muscles and ligaments during

periods of growth– Increases body length, weight and decreases body

fat %


– Difficult to detect so use is on the rise– Little current information on the effects of HGH– No proof that increased HGH and weight training

contributes to strength and muscle hypertrophy– Can cause premature closing of growth plates,

acromegaly which may also result in diabetes mellitus, cardiovascular disease, goiter, menstrual disorders, decreased sexual desire and impotence


• Blood Reinjection (Blood Doping, Packing or Boosting)– Endurance, acclimatization and altitude make

increased metabolic demands for the body, requiring increased blood volume and RBC’s

– Can replicate physiological responses by removing 900 ml of blood and reinfusing is after 6 weeks (allows time to replenish supply)

– Can significantly improve performance– While unethical, it can also prove to be dangerous– Risks involve allergic reactions, kidney damage,

fever, jaundice, infectious disease, blood overload (circulatory or metabolic shock)


Recreational Substance Abuse

• Part of the world of sports• Desire to experiment, temporarily escape, be

part of the group• Can be abused and habit forming• Drug used for non-medical reasons with the

intent of getting high, or altering mood or behavior


• Psychological vs. Physical Dependence– Psychological dependence is the drive to repeat the

ingestion to produce pleasure or avoid discomfort– Physical dependence is the state of drug adaptation

that manifests self in form of tolerance • When cease consumption abruptly unpleasant withdrawal

occurs – Tobacco Use

• Cigarettes, cigars & pipes are increasingly rare in athletics• Smokeless tobacco and passive exposure to others

continues to be an ongoing problem


– Smoking• Seriously impacts performance for those that are highly

sensitive• Associated with 4,700 different chemicals• 10 inhalations can cause average maximum decrease in

airway conductance of 50% (secondhand also)• Reduces oxygen carrying capacity of blood• Aggravates and accelerates heart muscle cell stimulation

through over-stimulation of sympathetic nervous system• Decreases lung capacity and maximum breathing

capacity, also decreases pulmonary diffusion• Accelerates thrombolic tendency• Carcinogenic factor in lung cancer and contributes to

heart disease


– Nicotine is the addictive chemical in tobacco- one of the most toxic drugs

• Causes elevated blood pressure, increased bowel activity, and antidiuretic action

– Smokeless Tobacco• Loose leaf, moist, dry powder, and compressed• Posses serious health risk

– Bad breath– Stained teeth– Tooth sensitivity to heat and cold– Cavities and gum recession– Tooth bone loss– Leukoplakia– Oral and throat cancer

• Major substance ingested is Nitrosonornicotine– Absorbed through mucous membranes

• More addictive habit w/out exposure to tar and carbon monoxide• Will increase heart rate


• Alcohol Use– Most widely used and abused substance– Depresses CNS– Absorbed from digestive tract into bloodstream– Absorption affected by drinks consumed, rate of

consumption, concentration and amount of food in stomach

– Can be oxidized by liver at 2/3 of an ounce per hour– If excess is in blood stream

• .1% - lose motor function• .2%-.5% symptoms become more profound and life

threatening


– Metabolism can not be accelerated– Individual abusing alcohol may exhibit the following

• Mood and attitude changes• Missed practices• Isolation• Fighting or inappropriate outburst of violence• Changes in appearance• Hostility • Complaints from family• Changes in peer group


• Drug Use– Cocaine

• CNS stimulant w/ short duration effects (intense)• Produces immediate feeling of euphoria, excitement,

decreased fatigue and heightened sexual drive• Long term use results in psychological tolerance and

dependence• Long term effects include

– Nasal congestion, damage to cartilage and mucous membranes of nose, bronchitis, loss of appetite, convulsions, impotence, cocaine psychosis w/ paranoia, depression, hallucinations, and disorganized mental function

• Overdose can lead to – Tachycardia, hypertension, extra heartbeats, coronary

vasoconstriction, strokes, pulmonary edema, aortic rupture and sudden death


• Can be taken in many forms including snorted, intravenously, or smoked (freebased)

• In form of crack - very short term rush, followed by depression

• Sudden stimulation w/ crack can cause cardiac or respiratory failure

– Marijuana (carcinogenic drug)• Formerly most abused drug in Western society• Similar components and cellular changes as tobacco• Can lead to respiratory disease, asthma, bronchitis, lowered

sperm count and testosterone levels, limited immune functioning and cell metabolism

• Causes increased pulse rate and can cause decrease in strength

• Psychologically causes diminution of self-awareness and judgment, slower thinking and short attention span


• Has also been found to alter the anatomical structures suggesting irreversible brain damage

• Contains cannabinoids (can store like fat cells) • May remain in the body and brain for weeks and months

resulting in cumulative deleterious effects

• Managing a Drug Overdose– In the event of an overdose, EMS should be

contacted as well as the poison control center immediately

– Athletic trainer should be certain that the correct steps have been taken either by phone or going to deal with the athlete in person


Drug Testing in Athletics

• Purpose is to identify individuals who have problems with drug abuse

• Controversial topic• NCAA and USOC routinely test

– Began at the Olympics in 1968 and has since expanded nationally (USOC and NCAA) and internationally

– Institution of testing and education– Performed to ensure health of athletes and fair practices– Mandatory and random testing occurs at both levels


• The Drug Test– Slight differences between NCAA and USOC,

mostly in area of selection• NCAA requires all athletes to sign consent form

agreeing to participate in testing throughout the year• USOC tests randomly throughout the year and

before USOC sanctioned events• During the test, athlete provides identification, and 2

samples under direct supervision– One for testing and confirmation, second for reconfirmation

• If positive, athlete is subject to sanctions


• Sanctions for Positive Tests– NCAA

• First time positive in NCAA results in minimum one year suspension; will undergo random testing throughout the year

• Must test negative prior to reinstatement• However, additional positives can result in lifetime

disqualification from NCAA– USOC

• Sanctions range from 3 months - 24 months depending on the drug for a first time offense

• Lifetime ban for subsequent positive tests


• Banned Substances– Both NCAA and USOC have a banned substance list

for athletes– Includes performance enhancing drugs and street or

recreational drugs, as well as OTC medications– Includes 4,600 different medications– USOC is more extensive than NCAA because it is

also subject to IOC rules – Athletic trainer working w/ athletes who may be

tested for drugs by NCAA or world-class or Olympic athletes governed by USOC should be familiar w/ the lists of banned drugs and substances


– In instances where an athlete has a diagnosed condition that requires use of a banned substance the athlete can apply for a Therapeutic Use Exemption (TUE) through USADA


© 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 17: Pharmacology, Drugs and...

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