Download Chapter 17: Pharmacology, Drugs and Sports

Chapter 17: Pharmacology,
Drugs and Sports
• 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
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
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
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
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Inhalation (medication through respiratory tract)
Intradermal (into the skin)
Intramuscular (medication directly into muscle)
Intranasal
Intraspinal (medication injected into the spine)
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Intravenous (into a vein)
Oral (most common form)
Rectal (limited due to dosage regulation)
Sublingual/buccal (dissolvable agents placed under
tongue
• External Administration
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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)
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)
• 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
• 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
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
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
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
– ATC’s are not allowed to dispense medication
unless allowed by state licensure
• 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
• Record Keeping
– Must maintain accurate and up to date medical
records
– Should include the following in log
• quantity of medication given
• method of administration
•Record Keeping
-Must maintain accurate and up to date
medical records
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Name
Complaint
Current medications
Any known drug
allergies
• Name of
medication
• Lot number
• Expiration Date
• Quantity of medication
given
• Method of administration
• Date and time of
administration
- 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
•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
– 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
• 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
• 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 athlete’s w/ whom they work to
avoid potential adverse reactions
• 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
• 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
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
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 nonliving objects
– Germicides (generic name) designed to destroy
bacteria, fungicides, sporicides and sanitizers
– 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
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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
– 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
• 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
– 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
– 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
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
Drugs that Inhibit Pain and
Inflammation
• Pain Relievers
– Numerous drugs and procedures can be used
– Reasons for effectiveness
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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
• 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
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Liniments
Analgesic balms
Spray coolants
Alcohol
Menthol
Cold
Local anesthetics (injected by physician)
• 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)
• 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
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, Reye’s 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
• Nonsteroidal Anti-inflammatory Drugs (NSAID’s)
– Anti-inflammatory, antipyretic and analgesic properties
– Inhibit prostaglandin synthesis and effective for osteoand 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 NSAID’s
– Can cause GI reactions, headache, dizziness,
depression, tinnitus,
– Taken in conjunction w/ heavy alcohol use can produce
stomach bleeding
• Corticosteroids
– Used primarily for chronic inflammation of
musculoskeletal and joint problems
– Prolonged use can create complications
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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
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
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
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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
• 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
• 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
• 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)
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 body’s ability to dissipate heat
• 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)
• ATC’s can receive instruction on use
• Used to treat anaphylaxis resulting from food or
insect bites
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
• 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
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
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
– 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 athlete’s use
• 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
– 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
• 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
– 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)
• 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
• 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
• 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
• 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
– 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
• Blood Reinjection (Blood Doping, Packing
or Boosting)
– Endurance, acclimatization and altitude make
increased metabolic demands for the body,
requiring increased blood volume and RBC’s
– 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)
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
• 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
– 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
– Nicotine is the addictive chemical in tobaccoone 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
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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
• 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
– Metabolism can not be accelerated
– Athlete abusing alcohol may exhibit the
following
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Mood and attitude changes
Missed practices
Isolation
Fighting or inappropriate outburst of violence
Changes in appearance
Hostility
Complaints from family
Changes in peer group
• 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
• 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
• 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
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
• 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
• 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
• 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