Pharmacology

PHARM BASICS

• Therapeutic Drugs- agents which have a medicinal purpose

• Recreational Drugs- agents with no medicinal purpose or being used in a non-medicinal manner

Pharmacology- the study of medicines and their effects on the body

• Right Patient• Right Medication• Right Route• Right Dose• Right Time/Date

5 Rights for Safety

• Drug Action• Drug Indications• Drug Contraindications• Side Effects• Dose

What you should you understand about medications?

Route of Administration

• Oral• Sublingual• Inhalant• Injection• Topical

• IV• Vaginal• Rectal

• Over the counter medications- anyone can purchase; safe for public to use as directed

• Prescription medications- medications that are recommended by a physician or psychiatrist

Legal Issues

• Medications should be kept in well-labeled containers

• Minors (those under age 18) cannot be given OTC medication by anyone other than parent or someone with written permission from parent or physician

Legal Issues

• Administering Medications: providing a single dose to person

• Dispensing Medications: providing several doses to a person

• An Athletic Trainer may administer a dose, but cannot dispense any medication!

Administering vs. Dispensing Medications

COMMON THERAPEUTIC MEDS

• Antibiotics: agents that fights bacterial infections– Prescription– Penicillins, Erythromycins, Sulfa Drugs,

Tetracycline• Antifungals: agents that fight tineas (fungal

infections)– OTC or prescription – Lamisil, Tinactin, Desenex, Micatin

Infection Fighters

• Can be OTC or prescription• Narcotics: depress pain impulse and

respirations; mainly opiates– Oxycontin, codeine, vicodin

• Topical Analgesics: counter irritants or local anesthetics– Flexall, Ben Gay, Icy Hot, Aspercreme, Tiger

Balm, Theragesic– Injectables like Lidocaine, Novocain

Analgesics- Pain Relievers

Pain Relievers: Acetaminophen vs. Aspirin

Tylenol

• Pain reliever• Antipyretic: fever

reducer• More tolerable than

aspirin

Aspirin• Pain reliever• Antipyretic• Anti-inflammatory• Anti-coagulant• GI irritating• Should not be used by

minors • Higher risk of allergic

reaction

NSAID- Non-steroidal Anti-inflammatory Drugs

• Analgesic• Antipyretic• Anti-inflammatory

• Can cause GI upset, headaches, tinnitus

• Advil, Motrin, Ibuprofen, Naproxen Sodium, Aleve

Stomach Medications• Antacids: reduce

stomach acid– Relief of heartburn,

ulcers, indigestion– Tums, Rolaids, Alka-

Seltzer

• Laxatives– Poor diet can cause

constipation(Could be symptom

of disease)

– Can cause electrolyte imbalance

– ExLax, Dulcolax

• Anti-diarrheals– Diarrhea is

symptom of problem-infection?

– Imodium, Lomotol, Kaopectate

ASTHMA

Asthma

• Air passages swell and narrow

• Signs/Symptoms:– Coughing– Wheezing– Shortness of Breath– Tingling/chest tightness

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001196/

Emergency Symptoms:CyanosisRapid pulseRapid heart rateSweatingExtreme breathing

difficulty

Medicinal Care

http://www.momsteam.com/health-safety/common-myths-about-asthma-tips-for-parents-to-prevent-asthma-attacks

• Control Medications– Prevent the attack

from occurring

• Quick Relief Medications– Rescue drugs used

during attacks

• Long acting Beta2-agonists– Symbicort

• Inhaled corticosteroids– Flovent, Pulmicort

• Leukotriene inhibitors– Singular

Control Medications

Quick Relief Meds

“What You and Your Family Can Do About Asthma” by the Global Initiative for Asthma Created and funded by NIH/NHLBI

• Short acting Beta2-agonists (bronchodilators)– Advair, Albuterol,

Proventil, Ventolin

• Oral (cortico) steroids– Prednisone– Pills, liquid, capsules

How do you know an asthma attack is coming?

http://www.pamf.org/asthma/selfcare/peakflow.html

• Allergens and pollution exposure

• Use Peak Flow Meter– Can be used prior to

symptoms– Should be used daily

morning and evening to determine averages

How to use a Peak Flow Meter

http://www.tree.com/health/asthma-symptoms.aspx

Set measuring arrow at zero• Inhale deeply• Place mouthpiece in mouth sealing lips tightly• Exhale as strongly as possible• Record reading• Repeat for a total of 3 times, keeping the best

reading• http://www.mayoclinic.com/health/asthma/MM00399 - video

demonstration

Interpreting the Results

• Green zone- good breathing

• Yellow zone- moderate asthma attack– Use rescue drugs

• Red zone- severe asthma attack– May need EMS

activation

http://www.bcbsks.com/behealthy/DiseaseMgmt/Asthma/peakFlow.htm

COLD & ALLERGY MEDS

• Most are viruses– Antibiotics do not work well!– Increase chance of developing allergies/tolerance

to antibiotics• Treat the symptoms with OTC meds

– Analgesics, antipyretics

Colds and Flu

• Decongestants: stop runny nose– Sudafed, pseudoephedrine

• Antitussive: stops cough– Robitussin

• Expectorants: makes productive coughs– Delsym

Runny Nose and Cough

• Local reaction to the body• Antihistamines: decrease immune system

response to itching and nasal swelling– Benadryl, Claritin, Allegra– Can cause drowsiness, dizziness, headache

Allergies: Seasonal and Minor Reactions

• Hives, itching, swelling• Antipruritics: anti-itch

– Benadryl, hydrocortisone cream, topical corticosteroids

• Ice can reduce itch, swelling

Skin Allergic Responses

• Systemic reaction to body-all over body response

• Body releases histamine and airways begin to swell shut

• Breathing difficulty, anxiety, hives, swelling, cough, vomiting, congestion, wheezing

• Activate EMS

Anaphylaxis: severe allergic reaction

• Epinephrine: sympathomimetic drug that relaxes airway muscles and constricts blood vessels

• Injected into large muscle mass (thigh)• Can be injected through clothing

Epipen

Epipen Instructions1. Hold the device firmly in your fist with the black tip

pointing down. Do not touch the black tip; hold only the cylinder.

2. Remove the gray activation cap.3. Move your hand so the black tip is near your outer

thigh.4. Swing your hand away from your body, then jab the

black tip firmly into your outer thigh at a 90-degree angle. You may inject the needle through clothing that is covering your thigh.

5. Keep the device firmly in this position for ten seconds.

6. Remove the device from your thigh and rub the area with your fingers.

7. Look at the black tip to see if the needle is showing. If the needle is not showing, repeat steps 3-6.

8. If the needle is showing, you have received the full dose of epinephrine. You will notice that most of the liquid remains in the device. This is extra liquid that cannot be used.

9. Press the needle against a hard surface to retract.10. Replace the device in the carrying tube (without the

activation cap) and cover with the cap.

Epipen Instructions

ACTIVE INGREDIENTS IN OTC

• Over the counter medications are easy method to treat colds, flu and illness without intervention of a physician. It is important to understand the role of active ingredients in these medications and the link between these medications with side effects and medicinal purpose.

Active Ingredients: Purpose

Terminology

• Active Ingredient: the substance in a pharmaceutical drug or a pesticide that is biologically active

STIMULANTS

• Ergogenic Aid: performance enhancer

Terminology

Purpose of most Ergogenic Aids• Increase alertness• Increase blood

pressure• Increase tissue

temperature• Increase

competitiveness• Increase heart rate

• Increase metabolism• Increase power or

endurance• Delay fatigue• Speed up protein

synthesis• Help them feel better

• Most performance enhancers are not regulated by the FDA!– Ingredients not regulated– Claims are not always true

• Most important thing is to read the ingredient label and learn the actions of the ingredients!

Claims vs. Actual Actions

• Can have dangerous outcomes with usage• Can have short term effects

– Headache, tremors, heart arrhythmia• Can have long term effects

– Tumors, cancers, needle diseases, changes to sex organs

Downfall: Side Effects

Stimulants: Actions on the body

• Increase alertness• Increase heart rate• Increase blood

pressure• Increase

competitiveness• Increase hostility

• Delay fatigue• Increase metabolism• Increase body

temperature• Promote quickness

and agility

Types of Stimulants

• Amphetamines• Sudafed • Beta2-agonists• Cocaine/crack• Methamphetamine

• Tobacco• Caffeine• Ephedra• Guanara• Willow Bark• Bitter Orange

Stimulant Side Effects

• Tremors• Nervousness• Headaches• Heart arrhythmia• Insomnia

• Tinnitus • Dilated pupils• Increased tolerance• Withdrawal symptoms

• Anabolic: muscle-building• Androgenic: increases masculine

characteristics• Cycling: taken over a short period of time

then stopped• Stacking: taking multiple substances to

enhance desired effect

Terminology

STEROIDS

• Natural or synthetic hormones– Oral or injected

• Increase protein synthesis– Increase lean tissue and weight

• Intended use with people who:– Produce low levels of testosterone– Need to battle muscle wasting issues/diseases

• Increase or exaggerate secondary sex characteristics

Anabolic and Androgenic Steroids

• Cycling: taken over a short period of time then stopped

• Stacking: using multiple types of steroids to maximize effectiveness

• Athletes use to maximize strength and power

• Non-athletes use to look good

Steroid Use Patterns

Types of secondary effects of Anabolic-Androgenic Steroids

• Deep voice• Acne• Possible increase in

chance of cancers/tumors

• Joint pain• Increased

aggressiveness• Stunted growth

• Needle-related diseases

• Increased blood pressure

• Increase in LDL (bad cholesterol)

• Increased mood swings

Gender-specific Side Effects

Males

http://www.ehd.org/health_steroids_5.php

Females• Enlarged clitoris• Male-pattern baldness• Increased body hair

• Shrunken testes• Decreased sperm

count• Increased breast

tissue• Baldness

• Steroids get disguised in supplements

• Store-Bought Steroid Scandal: http://www.youtube.com/watch?v=pEo2YMil5Sc Tren Xtreme supplement sold at retail stores contained anabolic steroids

Steroids can be hidden in non-FDA regulated products

http://www.dipity.com/timeline/Tren-Xtreme/

Androstenedione

Most famous user was Mark McGwire. The year he surpassed Roger Maris’ home run record, he gladly admitted using Andro to increase his mass and power.

Before and After: http://www.steroidsinmlb.com/wp-content/uploads/2009/12/roids_mcgwire.jpg

• Precursor to testosterone BUT can convert to estrogen in some– High level testosterone= testosterone

produced– High level estrogen= estrogen produced

• Effects on body can be similar to steroids including side effects

• Popular supplement in late 1990s but made illegal to possess in 2005

Androstenedione

• Naturally produced in pituitary gland• Now synthetically produced• Increases conversion of amino acids into

proteins– Increases protein synthesis

• Increases fat burn

Human Growth Hormone (HGH)

• Abnormal body growth• Increased chance of heart disease• Impotence• Osteoporosis/premature growth plate

closure• Pancreatic issues (cancer, diabetes)• Death

HGH Side Effects

• All banned in sport– Steroids, andro easier to detect– HGH more difficult to detect because

produced naturally in body

Steroids, Andro and HGH…

NATURAL STIMULANTS

• Doping: unnatural use of any substance to gain an unfair advantage

Terminology

• Methods to increase oxygen delivery to tissues

• Altitude Training• Blood Doping: remove pint of blood, wait 6-8

weeks then reinject into body• Erythropoietin (EPO): natural and synthetic

method of increasing red blood cell count– Anemic athletes may be prescribed EPO

Endurance: Specific Aids

• Increase RBC count so more oxygen can be carried/utilized by muscles

• Delays fatigue thus improving performance• Found in endurance sports- cycling, distance

running, cross country skiing, endurance swimming

Blood Doping and EPO: Actions

• Increase blood viscosity• Increase blood pressure• Kidney damage• Needle/blood diseases and infections• If using another’s blood, need to have same

blood type

Blood Doping/EPO: Side Effects

• Amino Acids (AA) chain together to form proteins– Proteins build/repair tissues

• Many AAs by themselves are speculated to increase fat burning and enhance protein synthesis for muscle production

Amino Acids

• Leucine– Slows atrophy in atrophied patients– Inconclusive if increases muscle mass

• Taurine– Claims that it will increase mental performance

Common AA Supplements:

• Naturally made in liver/kidneys• Increases energy production to allow for more

sustained strenuous exercise• Shows most promise in untrained athletes

starting strength program

Creatine Monohydrate

• Muscle cramping• GI distress• Muscle strains• Harms body ability to produce creatine• Kidney/liver damage? (no long term studies)

Creatine Use Side Effects

• Medicinal use since ancient times• Some herbs, taken in small amounts, can be

harmless• Some can have negative interactions with

foods, medications• Generally not FDA approved

Herbal Supplements

• Ginseng: reduce stress, increase stamina, prevent infections

• St. Johns Wort: decrease anxiety, depression and assist with sleeping

• Wild Yam Extract: claim it can convert to a steroid (in a lab only)

• Yohimbe bark: claim it aids in weight loss; it does increase blood pressure

Herbal Examples

DRUG ABUSE

Medicines and Supplements…

• Can be abused • Become habit forming• Can become Recreational Drugs: used for

non-medical reasons with the intent of getting high, or altering mood or behavior

Causes for Drug Abuse

• Stress• Access to drugs• Peer pressure• Low self esteem• Increased

performance

• Painkiller• Experimentation• Copy role model• Escape from reality

– Psychological dependence: the drive to continue to medicate to produce pleasure or avoid discomfort

– Physical dependence: state of drug adaptation in the body

• Tolerance builds• When consumption stops abruptly unpleasant

withdrawal occurs

Psychological vs. Physical Dependence

• Cocaine• Caffeine• Tobacco • Narcotics-oxycontin• Alcohol• Marijuana

Common Addictive Recreational Drugs Seen in Athletics

• Injury/illness associated with use• Behavior/personality change• Failed drug tests• Ban from sport• Alienation from teammates• Strained social relationships

Abusive Behavior can lead to…

Recognition of Abuse

The Clinician’s Role

• Identify signs• Show concern/interest• Be prepared to discuss

ethics/legal issues• Provide emotional support• Assist in finding the right

helpYOU CANNOT SOLVE THEIR PROBLEMS!

DRUG TESTING

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

• Controversial• Where do they test?

– Some High Schools– NCAA– USOC/IOC– Some workplaces

Drug Testing

• Began in 1986• About 11,000 athletes tested annually in

Division I and II• Random testing and at some

championship events• Many colleges conduct their own testing

in addition to NCAA standardized testing

Collegiate Level Testing

• 1st positive: Lose 1 year of eligibility (and out for a full sport season)

• 2nd positive; – Street drugs: another year eligibility lost– Performance enhancing drugs: permanent

ineligibility

Positive Tests

• 1968 testing at Olympics began in order to:– Promote health– Respect for medical and sport ethics– Ensure equality for all athletes

Olympic Committee

• Athlete provides A and B sample• Sanctions range from 3months-24

months depending on the drug for a first time offense

• Lifetime ban for subsequent positive tests• Banned drug list much more extensive

that NCAA

Olympic Protocols

• Testing policies mainly based on collective bargaining units– Not uniform policies!

• Positive tests lead to treatment rather than sport bans

• MLB, NBA, NFL, NHL, PGA, MLS, Professional Tennis, Boxing

Professional Athletics