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Chapter 17: Pharmacology, Drugs and Sports

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Title: Chapter 17: Pharmacology, Drugs and Sports


1
Chapter 17 Pharmacology, Drugs and Sports
2
  • 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

3
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

4
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

5
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)

6
  • Intravenous (into a vein)
  • Oral (most common form)
  • Rectal (limited due to dosage regulation)
  • Sublingual/buccal (dissolvable agents placed
    under tongue
  • 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 (adhesive bandage with slow
    release medication)
  • Solutions (administered externally- antiseptics,
    disinfectants)

7
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)

8
  • Distribution
  • Once absorbed, drug is transported through blood
    to target tissue
  • Volume of distribution volume of fluid through
    which drug would have to be distributed to reach
    therapeutic level of concentration
  • 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

9
  • 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

10
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

11
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

12
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
  • ATCs are not allowed to dispense medication
    unless allowed by state licensure

13
  • 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

14
  • Record Keeping
  • Must maintain accurate and up to date medical
    records
  • Should include the following in log
  • quantity of medication given
  • method of administration

15
Record Keeping -Must maintain accurate and up to
date medical records
  • Lot number
  • Expiration Date
  • Quantity of medication given
  • Method of administration
  • Date and time of administration
  • Name
  • Complaint
  • Current medications
  • Any known drug allergies
  • Name of medication

- 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
16
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

17
  • 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

18
  • 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
  • Athlete 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

19
  • Alcohol is a 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
  • ATC must know their athletes w/ whom they work
    to avoid potential adverse reactions

20
  • 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

21
  • Traveling with Medications
  • When traveling with a team or individually the
    athlete 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

22
Selected Therapeutic Drugs to Treat the Athlete
  • 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

23
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

24
  • 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

25
  • 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

26
  • 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

27
  • 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

28
  • 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

29
Drugs for Asthma
  • Used to treat chronic inflammatory lung disorder
  • National Asthma Education and Prevention Program
    has established guidelines for diagnosis and
    treatment
  • 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

30
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

31
  • 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)

32
  • 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)
  • 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)

33
  • 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

34
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, Reyes 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

35
  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
  • 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 NSAIDs
  • Can cause GI reactions, headache, dizziness,
    depression, tinnitus,
  • Taken in conjunction w/ heavy alcohol use can
    produce stomach bleeding

36
  • 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

37
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 analgesics or
    sedatives in either acute or chronic conditions

38
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

39
  • 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

40
  • 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 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

41
  • 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
    psuedomembranous colitis

42
  • 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)

43
Drugs Used to Treat Colds and Allergies
  • Nasal Decongestants
  • Number of topical nasal decongestants available
  • Prolonged use may cause rebound congestion and
    dependency
  • Antihistamines
  • Often added to decongestants
  • Opposes histamine actions, but have little
    effects on the common cold
  • Beneficial in allergies
  • Impair bodys ability to dissipate heat

44
  • Cough Medications
  • Suppress cough (antitussives) or produce fluid in
    respiratory system (expectorant)
  • Few side effects from nonnarcotic antitussives
    and are not addictive
  • Little evidence that expectorants are any more
    effective on reducing cough than simply drinking
    water
  • Sympathomimetics
  • May cause heat related problems
  • Epinephrine (Epipen)
  • ATCs can receive instruction on use
  • Used to treat anaphylaxis resulting from food or
    insect bites

45
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

46
  • 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

47
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

48
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

49
  • 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 athletes use

50
  • 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
  • Athlete may become irrational
  • chronic use causing individual to become hung
    up in state of repetitious behavioral sequences

51
  • 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

52
  • 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
  • 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

53
  • 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 -- sufferer 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)

54
  • 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

55
  • 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

56
  • 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

57
  • 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

58
  • 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

59
  • Blood Reinjection (Blood Doping, Packing or
    Boosting)
  • Endurance, acclimatization and altitude make
    increased metabolic demands for the body,
    requiring increased blood volume and RBCs
  • 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)

60
Recreational Substance Abuse Among Athletes
  • 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

61
  • 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

62
  • 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

63
  • 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

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  • 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

65
  • Metabolism can not be accelerated
  • Athlete 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

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  • 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

67
  • 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 judgement, slower thinking and
    short attention span

68
  • 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

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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

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  • 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

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  • 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

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  • 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
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