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Pharmacology in Athletic Medicine

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Title: Pharmacology in Athletic Medicine


1
Chapter 5
  • Pharmacology in Athletic Medicine

2
Overview
  • PART I General Information
  • Medication basics
  • Legal aspects
  • Practical aspects
  • PART II Specific Information
  • Anti-inflammatory drugs
  • Analgesics
  • Antihistamines decongestants
  • Cough cold preparations
  • Other related medications
  • PART III Test your knowledge

3
PART I
  • General Information

4
Medication Basics
  • Pharmacology
  • Study of drugs
  • Pharmacotherapeutics
  • Study of the therapeutic uses and effects of drugs

5
Medication Basics
  • Pharmacokinetics
  • Study of the bodily absorption, distribution,
    metabolism, and excretion of drugs
  • Pharmacodynamics
  • Branch of pharmacology dealing with the reactions
    between drugs and living systems

6
Drug Basics
  • Whats in a name?
  • Chemical (example 2-naphthaleneacetic acid,
    6-methoxy-a-methyl-sodium salt)
  • Generic (example naproxen sodium)
  • Trade (example Aleve)
  • Prescription or over the counter (OTC)?
  • Even OTCs require strict legal adherence

7
Drug Basics
  • Prescription drugs
  • May only be prescribed by physician
  • Classified according to potential for abuse
  • Schedule I-V, Schedule I most potential for abuse
  • Pharmacology the study of drugs
  • Pharmacokinetics how drugs are absorbed,
    distributed, metabolized, and eliminated
  • Enteral administration through the digestive
    system
  • Parenteral administration through other means

8
Drug Basics
  • Pharmacodynamics how drugs work within the body
  • Side effects
  • May be therapeutic, may be detrimental
  • Allergies
  • NKDA no known drug allergies
  • May be toxic or allergic

9
Drug Basics
  • Drug interactions
  • May agonistic or antagonistic
  • The Physicians Desk Reference (PDR)
  • Comprehensive for trade names, but generics not
    listed
  • USOC and USADA banned substance lists
  • Valuable resource for drugs, but not supplements

10
Medication Basics
  • Drug names
  • Chemical name defines chemical structure
  • Example 2-naphthaleneacetic acid, 5 methoxy-
    a-methyl-,()
  • Generic or non-proprietary name issued by US
    Adopted Names Council
  • Example Naproxen
  • Trademark or proprietary name given by specific
    pharmaceutical company
  • Example Naprosyn

11
Medication Basics
  • Administration
  • Oral
  • First-pass hepatic degradation
  • Timed or sustained release
  • Enteric coating
  • Intravenous
  • Sublingual
  • Topical

12
Legal Aspects
  • Dispensation
  • Providing prescription and/or OTC medication in
    amounts greater than a single dose
  • Most states only allow dispensation by
    physicians, pharmacists, physician assistants
    (varies), and nurse practitioners (varies)

13
Legal Aspects
  • Dispensation (cont.)
  • ILLEGAL for the athletic trainer, even under a
    physicians direction/order
  • Administration
  • Providing a single dose of medication for
    immediate use

14
Legal Aspects
  • Storage
  • Keep all OTC meds in locked cabinets with strict
    key control
  • Only store prescription medications if absolutely
    necessary
  • If so, store in separate locked cabinet and/or
    with physicians medical bag

15
Legal Aspects
  • Storage (cont.)
  • Rotate stock periodically
  • Observe expiration dates and destroy expired meds
  • Be sure to check travel kits during routine
    inventory
  • Do not consolidate single dose packs into
    containers without packaging (keep in original
    packaging until used)

16
Legal Aspects
  • Labeling requirements
  • Product name
  • Manufacturer name and address
  • Net contents
  • Name and quantity of active ingredients
  • Name of habit forming drugs
  • Cautions and warnings
  • Directions for safe use
  • Martin Yates, Jr. (1998)

17
Legal Aspects
  • Record keeping
  • Record EVERY OTC and prescription drug
    administration in your facility
  • OTC administration
  • Athlete name team
  • Date
  • Drug name and dose
  • Lot number
  • Expiration date
  • Name and signature of ATC

18
Legal Aspects
  • Record keeping
  • Record EVERY OTC and prescription drug
    administration in your facility
  • OTC administration
  • Athlete name team
  • Date
  • Drug name and dose
  • Lot number
  • Expiration date
  • Name and signature of ATC

19
Legal Aspects
  • Record keeping
  • Periodically review medication logs to identify
    potential abuse
  • Electronic databases may be particularly helpful
    in this respect

20
Practical Aspects
  • Travel
  • Do not check medication bag with other baggage
  • Be certain to travel with copies of any written
    prescriptions if necessary
  • Maintain all prescription medications in secure
    location in original containers with label(s)
    intact

21
Practical Aspects
  • Administration
  • Utilize confidential area to administer
    medications if possible
  • One-on-one preferred
  • Avoid whole-team distribution in team meetings,
    on aircraft, etc.
  • Be certain to keep record of medications
    administered while traveling as well
  • PocketPC/PalmPilot particularly handy in this
    regard

22
PART II
  • Specific Information

23
Anti-inflammatory Drugs
  • Most commonly used OTC in athletic training
  • OTC does not mean harmless
  • 103,000 hospitalized and 16,500 die annually from
    side effects of NSAIDs (Pallarito, 2004)

24
Anti-inflammatory Drugs
  • NSAIDs
  • Non-steroidal anti-inflammatory drugs
  • Analgesic, antipyretic, anticoagulant effects
  • Do not use immediately following trauma
    (increases bleeding)
  • Irritate the stomach
  • Propionic acids
  • Most common NSAIDs used in AT
  • Advil, Motrin, Ibuprofen, Ketoprofen
  • Carboxylic acids
  • Asprin

25
Anti-inflammatory Drugs
  • Adrenal steroids
  • Glucocorticoids
  • Very effective when injected, but may damage
    connective tissue if administered repeatedly
  • May also be administered through iontophoresis,
    phonophoresis, and other mechanisms
  • Cortisone, dexamethasone, hydrocortisone

26
Analgesics
  • Non-narcotics
  • Salicylates
  • Aspirin
  • Ibuprofen
  • Acetaminophen
  • Tylenol
  • May be coupled w/ narcotic (usually codeine) for
    potent analgesic effect

27
Analgesics
  • Narcotics
  • Not typically employed in athletics
  • Exception temporary use post-surgically
  • Opioids are potent analgesics, but are usually
    addictive
  • Endogenous endorphins
  • Exogenous morphine, codeine, heroin

28
Antihistamines Decongestants
  • Decongestants
  • Commonly used for allergies
  • May cause drowsiness or buzz
  • Sudafed
  • Antihistamines
  • Allergies and hay fever
  • Helpful as a sleep aid
  • Claritin, Benadryl

29
Cough Cold Preparations
  • Expectorants
  • Cough syrups
  • Humidity often as effective
  • Guifenesin
  • Antitussives
  • Cough suppressants
  • Tessalon
  • Many preparations (Nyquil, etc.) have multiple
    drugs of different categories

30
Anesthetics and Muscle Relaxants
  • Succinylcholine
  • Used for general anesthesia (IV)
  • Depolarizing drug
  • Works like acetylcholine
  • Must use respirator
  • Tubocurarine
  • Non-depolarizing drug used for general anesthesia
  • Respirator required

31
Anesthetics and Muscle Relaxants
  • Muscle relaxants
  • CNS depressant
  • Flexeril
  • May cause drowsiness and dizziness

32
Anesthetics and Muscle Relaxants
  • Local anesthetics
  • May be injected
  • Novocain
  • Injections take many forms
  • Small nerve (localized)
  • Major nerve trunk (larger)
  • Epidural

33
Other Related Medications
  • Inhalers
  • Beta-adrenergic agonists
  • Potent bronchodilators
  • Albuterol, Proventil, Ventolin
  • May cause heart palpitations
  • Often used improperly
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