Chapter 17: Pharmacology, Drugs and Sports

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

What is a drug?

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

Internal administration

External Administration

Drug must dissolve before absorption

Rate and extent determined by chemical characteristics of drug, dosage, and gastric emptying

Distribution

Metabolism

Excretion

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

Effects of Physical Activity on Pharmokinetics

Exercise decreases the absorption after oral administration

Exercise increase 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

By law, only licensed persons may prescribe or dispense prescription drugs for an athlete

ATCπs are not allowed to dispense medication unless allowed by state licensure

Administering Over the Counter Drugs

ATC may be allowed to administer a single dose of nonprescription medication

Rules relative to secondary schools

Oral medications and wound medication

College and professional athletes

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

ATC 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

Important Aspects of Drug Adminstration

Record Keeping

Labeling

Safety - All drugs are potentially hazardous

must be instructed on specifics of medications (when to, how to and w/ what medication should be taken with)

Proper Storage

Proper Traveling with Drugs

Selected Therapeutic Drugs to Treat the Athlete

Widespread use in athletics and general society

Types of Drugs

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 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

Control disease organisms

Found in various concentrations and emollients

Derivatives include, resorcinol, thymol, and common house cleaner Lysol

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 room

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

Interfere 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

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

Sulfonamides

Quinolones

Drugs for Asthma

Meter dosed inhalers (pressurized canister)

Dry powder inhalers

Nebulizer

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:

Narcotic Analgesics

Most derived from opium or are synthetic opiates (morphine and codeine)

Depress pain impulse and respiratory center

Examples include

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, Reyeπs 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 (NSAIDπs)

Corticosteroids

Used primarily for chronic inflammation of musculoskeletal and joint problems

Prolonged use can create complications

Cortisone is primarily injected

Drugs that Produce Skeletal Muscle Relaxation

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

Cathartics (laxatives)

Must be under direct supervision of physician

Constipation may be symptomatic of serious disease

Indiscriminate use may render athlete unable to have normal bowel movements

May cause electrolyte imbalance

Antidiarrheals

Diarrhea tends to be a symptom, not a disease

Result of emotional stress, allergies, adverse drug reactions, or different intestinal problems

Acute diarrhea

Accompanied by chills, vomiting, intense abdominal cramps/pain

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

Chronic diarrhea

Histamine-2 Blockers

Drugs Used to Treat Colds and Allergies

Nasal Decongestants

Antihistamines

Cough Medications

Epinephrine (Epipen)

ATCπs can receive instruction on use

Used to treat anaphylaxis resulting from food or insect bites

Drugs to Control Bleeding

Vasoconstrictors

Hemostatic Agents

Anticoagulants

Prolongs clotting time but will not dissolve clot once formed

Given orally, they can be used to slow clotting time in certain vascular disorders

Substance Abuse Among Athletes

Performance Enhancing Substances (Ergogenic Aids)

Stimulants

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

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

Athlete 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 medular centers stimulation, causing wakefulness and mental alertness

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

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

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)

It occurs among athletes

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 impact 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 with athletes

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

Drug Use

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

Mandatory and random testing occurs at both levels

The Drug Test

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 3months-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