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