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 What�s 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 Physician�s 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 physician�s 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 physician�s 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