Managing Medications Workshop presentation

Managing Medication Managing

Health DR MICHELLE RUSSELLPharmD

History of Medicines

• God, demons, witches or the stars

• No record of first herbs used

• Shamans and apothocaries (herbalists) these

made simple drugs from crushing etc powders,

teas, pastes

• Folk medicine i.e. word of mouth

• 1800s advances in chemistry and extraction

• 1900s synthetic compounds

Basic Medication Design

Taken by mouth• Tablets coated and uncoated• Capsules• Softgels• Liquigels• Sub Lingual• Slow and extended

release

Liquids

• Syrups• Elixirs• Suspensions• Drops

Injections

Intra muscular InjectionSubcutaneous

injection

Intravenous Injections

Topical Applications

Tran dermal patch Creams, Ointments, Gels, Paints, Sprays & eyedrops

Inhalers – Metered Dose/nasal

Suppositories

How Medications Work

•Absorption

•Distribution

•Metabolism

•Excretion

AbsorptionIt can be absorbed :

• Through And Under Your Skin

• In Your Heart

• Into Your Stomach

• In Your Intestines

• In Your Kidneys Or Liver

• In Your Nose

• Under Your Tongue

• Through Your Eye

Absorption

Distribution

• Point of absorption to site of action• Blood flow - rate and amount• Size of molecule• Attraction to other components in

the blood• Crossing natural barriers e.g. blood

brain barrier

Metabolism

How the body changes what goes in to what comes out

• Enzymes

• Changing charges

• Breaking down

• Alcohol and insulin

• Toxification and Detoxification

Elimination

• The removal of drugs from the

body

• Water soluble through the kidneys

• Gall bladder

• Skin

Generics and Equivalents

• Identical or within an acceptable bioequivalent range to the brand name counterpart – In dose– Strength– Route of administration– Safety– Efficacy– and intended use

Generics and Brands

• Branded products usually do not have the drugs chemical name .

• Some generics have chemical name as product name

• Newer generics often have a “brand name” that does not include the chemical name.

• A drug may have several brand names

Therapeutic Equivalents

• A drug that has essentially the same effect in the treatment of a disease or condition as one or more other drugs.

• A drug that is a therapeutic equivalent may or may not be chemically equivalent, bioequivalent, or generically equivalent.

Over The Counter – OTC

List One

• Free sale

• Patient makes

choice

• Package sizes

limited

• No intervention

may occur

List Two

• Patient must

request item

• Some

intervention

• Package size

limited

Meds & Athletic Performance

Ergogenic Actions improves performance

• Performance enhancing

• Stimulants • Pain killers• Anti-inflammatory

Ergolytic Actions decreases

performance

• Alcohol and Marijuana• cocaine• Some blood pressure

meds• eye drops, and

diuretics.• Some

antidepressants• some antihistamines • even caffeine--

Ergogenic Drugs

Caffeine

• Improves athletic performance

• Increases energy and delays fatigue – (T)

• Improves fat burning by increasing fat metabolism (F)

• Spares muscle glycogen ( slightly)

• Enhances body fat loss (F)

• Acts as a central nervous system (CNS) stimulant (T)

• Raises epinephrine levels (T)

• Increases alertness (T)

• Ephedrine Claims – Increases body fat loss – Improves athletic performance – Improves concentration

• Research Shows

– Research has found no effect of ephedrine on

strength, endurance, reaction time, anaerobic

capacity, or recovery time after prolonged exercise

– Caffeine potentiates the effect of Ephedrine and

the combination can be dangerous

Ergogenic Drugs

Ergolytic Drugs in Sports

Alcohol

Impairs motor skills including :

• reaction time, balance, accuracy,

hand-eye coordination and complex

coordination

• may impair strength, power, speed

and both muscular and cardiovascular

endurance as it reduces the force of

hearts contraction

Ergolytics Con’tCocaine and Marijuana.• Both increases the work

of the heart• Decreases performance. • Cocaine can also lead to

more serious complications, including – Heart attack– Cardiac arrhythmia

(heart rate changes)– Seizure (fits)– Stroke and death.

Ergolytics Con’t

Nicotine

• While nicotine will give

athletes a "high" and they may

feel more alert, their

performance decreases.

• Negative changes in the hearts

performance that impair heart

function.

Ergolytics Cont’t

Diuretics (water tablets)

• Throw off the body's electrolyte balance

• Causes muscle cramps

• Reductions in strength and power

• They also affect hydration

• Cardiovascular performance decreases Diuretic use has played a role in the

collapse of runners during hot-weather races .

Blood pressure pills and eye drops

• Beta-blocker reduces the heart's ability to respond to

exercise stress.

• It can reduce maximal oxygen uptake by up to 15

percent among elite athletes.

• The same thing happens to performance capacity

during exercise.

• Competitive athletes should avoid beta-blockers;

calcium channel blockers, seem to have very little

negative effect on exercise capacity.

Ergolytics Cont’t

Ergolythics Con’t

Other drugs• Sleeping tablets-

hangover effect• Tranquilizers • Most anti allergy –

cause drowsiness and listlessness

• Caffeine high then low, sleep disruption

Ergolytics Cont’t

Storing Medications

Factors affecting medication stability

• Heat• Cold• Dampness• Drying out because left open• Keep out of the reach of children

How to take Medications

• Route, frequency, and

duration

• Before , during or after meals

• Breaking and crushing and

dissolving tablets

ANY QUESTIONS?

Exercise because…

• Sufficient Flexibility

• Adequate Muscular

Endurance

• Adequate Strength

• Cardiovascular

Endurance

• Healthy Body

Composition

What & How Much To Eat?

• Learn the body’s nutrient needs

• Categorize the body’s nutrient

needs

• Learn the foods that meet these

needs

• Learn how to think critically about

food choices, read labels, and

evaluate foods

• Apply the above information to

create a personalized food plan

Causes of Athlete’s Fatigue

• Glycogen depletion (stored

carbohydrate )

• Hypoglycemia

• Dehydration

• Lactic acid accumulation

• Electrolyte imbalances

• Amino acid imbalances

• Muscle overuse

• Lack of muscle recovery

How much do you need

• Active people and athletes should consume a

majority (65-75%) of their Calories from

Carbohydrates. Average person 55% may be

enough

• The government recommends less that 30% of

Calories come from Lipids, but many nutritionists

recommend less than 20%.

• Proteins should be approximately 10-15% of one’s

Calories

Functions of Carbohydrates

• Blood glucose maintenance (80 Calories)

• Glycogen storage in the liver (400 Calories)

• Glycogen storage in the muscle (1400-1800 Calories)

• Primary brain fuel

• Protein-sparing; prevents ketosis

• Essential for athletes, especially endurance athletes

Wholesome Unrefined Complex Carbohydrates

• Whole-grain cereals, waffles, and

breads

• Beans and legumes

• Pastas

• Brown rice

• Barley, quinoa, oats

• Fresh veggies

• Fresh fruits

• Polenta (coarse cornmeal)

Functions of Fat

• Stores energy

• Cushions vital organs

• Insulates the body and maintain body temperature

• Transports essential fatty acids and fat soluble vitamins

• Part of cell membrane structure

• Offers satiety in meals

• Enhances food flavor and aroma

Water

• Vital to life

• Is a solvent, lubricant, medium for transport, and temperature regulator

• Makes up majority (2/3) of our body

• Yields no energy

Dehydration Causes Fatigue

Hydration

• Thirst is not a reliable indicator of fluid

needs

• General guideline: 2-3 Cups of fluids per

each pound of weight loss during activity

• Drink fluid freely 24 hours before the event

• Drink 1.5-2.5 Cups two-three hours before

the event

• Consume 3-8 ounces every 15 minutes for

events lasting longer than 30 min.

• At 3% water loss, performance shown to

decrease 10%

Rehydration

• Water good for first 90 minutes

• >90 mins blood sugar falls

• Sodium and potassium lost

through sweat

• Sports drink can raise blood sugar

levels

• Not all sports drinks are created

equal

• Juice and sodas too sugary need to

be diluted

Supplements

• Something added to the diet, to make up for a nutritional deficiency.

• Supplements include the following: – Vitamins – Amino Acids –Minerals –Herbs – Other Botanicals

Supplements are not

• Required to meet the same safety requirements as over-

the-counter or prescription drugs or food ingredients

• Held to specific manufacturing standards

• Guaranteed to meet product potency or purity ratings

• Required to prove the effectiveness of any health claim

they make

• Required to meet safety or efficacy testing prior to

going to the market

Supplement FactsServing Size 1 Tablet Amount Per Serving % Daily Value

Thiamin (Vitamin B-1)(as Thiamin Hydrochloride and Brewer’s

Yeast) 7 mg 467%

Riboflavin (Vitamin B-2)(as Riboflavin and Brewer’s

Yeast) 14 mg 824%

Niacin (as Niacin and Brewer’s Yeast) 4.5 mg 23%

Vitamin B-12 (as Cyanocobalamin and Brewer’s

Yeast) 25 mcg 417%

Protease (as Papain Powder) 10 mg * *

Supplement Facts Sheet

Supplements

Vitamin Bs

• May be a link between the B-

vitamins (thiamin, riboflavin,

vitamin B-6, B-12 and folate) and

performance in high-level athletes

• Even a small B-vitamin deficiency

can result in reduced

performance and recovery.

Essential Fatty Acids

Omega 3, 6 and 9

• Body can’t make it

• Needed for immune function

• Vision

• Cell membrane

• Production of hormone-like

compounds

Nutrient needs

Adequate nutrients can

mean

• Quicker recovery time

• Lower infection rates

• Less fatigue

• Ultimately, can help

athletes reach their desired

performance levels.

The Female Athlete Triad (or Triple Threat to Female Athletes

1. Eating Disorders

2. Cessation of

Menstruation

(Amennorhea)

3. Bone Fractures (and

ultimately

osteoporosis

Supplements –The Good

Antioxidants

• A • C• E• Co-enzyme Q 10

Anti -Inflammatory • Omega 3• Turmeric• Bromelian • Capsaicin • Pycnogenol • Glucosamine and

chondrotin & MSM

Supplements –the good

• Calcium 1000 - 1500/d

• Iron > 6 hours/week

10- 15mg/d

• Magnesium 500-800mg/d

• Potassium

• Selenium 100-200mcg

• Sodium

• Zinc

Minerals

Supplements –The Good

May 1999 Issue of Nutrition Science News

Health ,Harm or Rip Off?

• Energy drinks — which are often loaded with caffeine, sugar and herbal stimulants may pose various health risks, including:– Restlessness and irritability head aches n&v– Increased blood pressure– Possible dehydration – Weight gain– Excessive amounts of energy drinks have been

associated with manic episodes, seizures, chest pain, heart attacks and sudden cardiac death

Mayo clinic

Supplements – The Dangerous

• All athletes need to be proactive in asking questions so they don’t jeopardize their sporting careers.

• If you have a question - ASK! • If you cannot be 100% sure of the

ingredients or don’t know the status of a substance – DON’T TAKE IT!

WADA

www .easy access. com

We sell only the highest quality pharmaceutical grade anabolics.

** Warning: Deca-Durabolan, Dianabol, Winstrol, Clenbuteral, Anavar, and Trenbolone are toxic Anabolic Steroids

Too good to be True

• Performance enhancing

• Bulk and cut• Extreme muscle

development• Quicker recovery time• Less injury• More power• Muscular

development

ANABOLIC ANDROGENIC STEROIDS

• They increase protein synthesis

within cells

• They reduce the rate of muscle

breakdown

• Muscle cells formed

preferentially over fat cells

• Increase of Basal Metabolic Rate

( BMR) burning fat stores

MEDICINAL USES

• Replace testosterone after surgery or cancer

• Adolescent males with pituitary malfunction

• After certain kinds of surgery and cancer.

Anabolic steroids are used , with exercise and

diet, to build up lost muscle tissue.

• AAS are given by mouth, via injections or by

adhesive patches.

SPECIFIC USES OF AAS

• Danazol –Endometriosis• Mesterolone (Proviron) – low

sperm count• Stanozolol - anemia and

hereditary angioedema• Oxymetholone (Anadrol) –anemia

osteoporosis

Beta Blockers

• Asthma• High blood pressure• Glaucoma in the eye• Racing heart

Beta blocker widen blood vessels and reduce muscle

spasms.

Aromatase Inhibitors

EstroBlock

Anti-Estrogen/Aromatase Inhibitor

� Conquers Estrogen

Bodybuilders and strength athletes are well aware that the female hormone estrogen can seriously harm their attempts to build muscle and strength. Estrogen MUST be kept under control or some pretty undesirable conditions may arise in the body.

Hormone Antagonists and Modulators

• Many used to treat various forms

of breast cancer

• Low sperm count

• Infertility in both men and women

Stimulants

• Appetite suppression

• Attention deficit disorder with

hyperactivity

• Narcolepsy

• May 1999 Issue of Nutrition Science News