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Chapter 17 Pharmacology, Drugs, and Sports
Chapter 17
Extended Lecture Outline
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Introduction:
o Pharmacology is the branch of science that deals with the actions of drugs on biological systems,
especially drugs that are used in medicine for diagnostic and therapeutic purposes
What is a Drug?
o Drug = a chemical agent used in the prevention, treatment or diagnosis of disease
Pharmacokinetics: The method by which drugs are absorbed, distributed, metabolized and
eliminated or excreted from the body
o Administration of Drugs
 Internal Administration
 Inhalation
 Intradermal or subcutaneous
 Intramuscular
 Intranasal
 Intraspinal
 Intravaginal
 Intravenous
 Oral
 Rectal
 Sublingual and buccal
 External Administration
 Inunctions
 Ointments
 Pastes
 Plasters
 Transdermal patches
 Solutions
 Drug vehicles (See Table 17-1)
 Therapeutically inactive substance that transports a drug – drug housed in either
solid or liquid
o Absorption of Drugs
 Bioavailability: How completely a particular drug is absorbed by the system
 Distribution
 The volume of distribution: volume of fluid or plasma in which the drug is
dissolved and indicates the extent of distribution of the drug
o Efficacy: Drugs capability of producing a specific therapeutic effect
once it reaches a particular receptor
o Potency: The dose of the drug that is required to produce a desired
therapeutic effect
 Metabolism
 Biotransformation: Transforming a drug so it can be metabolized in the liver
with some occurring in the kidneys and blood
 Excretion
 Controlled by the kidneys – Drugs are filtered by the kidneys and excreted in
urine, saliva, sweat and feces
o Drug Half-Life
 The rate at which a drug disappears from the body, either through metabolism or
excretion or combination of the two
 The rate is the amount of time required for the plasma drug level to be reduced by onehalf
 For most drugs the half-life is measured in hours
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Chapter 17 Pharmacology, Drugs, and Sports
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Steady-state: determines how often the drug will be administered – Steady state is
reached when the amount taken in is equal to the amount being excreted
o Effects of Physical Activity on Pharmacokinetics
 Exercise in general decreases the absorption after oral administration of a drug
 Exercise increases absorption after intramuscular or subcutaneous administration because
of increased blood flow in the muscle
Legal Concerns in Administering versus Dispensing Drugs
o Dispensing Prescription Drugs (See Table 17-2)
 At no time can anyone other that a person licensed by law legally prescribe or dispense
prescription drugs for athletes
o Administering Over-the-Counter Drugs (See Focus Box 17-1, “general guidelines for
administering medications to athletes”)
 Athletic trainer may administer a single dose of a nonprescription medication
 Most secondary schools do not allow the athletic trainer to administer nonprescription
drugs, including aspirin, and cold remedies
o Record Keeping
 Need to keep a medication administration log
 Labeling Requirements
 OTC drugs are required to have directions for use and precautions on the
product, Must have federal eight-point label
 All drugs dispensed from the athletic training room must be properly labeled
 In 2011, the FDA finalized a regulation requiring OTC drugs to have clear and
simple labeling. Standardized headings and subheadings make it easier for
consumers to understand information about products, benefits and risks, and
how the drugs should be used most effectively.
 The following "Drug Facts" must be included on the labels of prescription
drugs:
o 1. Name of Product
o 2. Active Ingredient(s)
o 3. Purpose
o 4. Use(s)
o 5. Warnings, such as contraindications to using the product and side
effects that could occur
o 6. Directions for use including dosage and when, how, or how often to
take
o 7. Other information
o 8. Inactive Ingredients
o 9. Questions (optional) followed by a telephone number.
o Safety in the Use of Pharmaceuticals
 Drug Responses (See Table 17-3)
o Buying Medications
 Always keep both prescription and OTC medications in a locked cabinet or secured place
 Keep them in the original containers
 Store them away from heat, direct light, damp places and extreme cold
 Keep OTC medications in single-dose-packs
o Traveling with Medications
 Meds should not be packed in luggage
 Pack a sufficient supply in case of emergency
 Take copies of written prescriptions
 Keep medications in original containers and in secure place
 Understand the restrictions of individual jurisdictions when traveling internationally
Selected Therapeutic Drugs Used to Treat the Athlete (See Table 17-4)
o Drugs to Combat Infection
 Local Antiseptics and Disinfectants
 Alcohol
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Chapter 17 Pharmacology, Drugs, and Sports
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Phenol
Halogens
Oxidizing Agents (hydrogen peroxide)
Antifungal Agents
o Terbinafine (Lamisil), miconazole (Micatin), clotrimazole (Lotrimin)
and tolnaftate (Tinactin – does not treat candida infections)
o Athlete’s taking oral antifungal agents must be carefully monitored by
a clinician
o Ketoconazole has been associated with hepatoxicity, including some
fatalities
o Concomitant use with cisapride is contraindicated due to the occurrence
of ventricular arrhythmias
 Antibiotics
 Penicillins and Cephalosporins
 Bacitracin
 Tetracycline
 Erythromycin
 Sulfonamides
 Quinolones
Drugs for Asthma (See Table 17-6)
 Using an inhaler
 Metered-dose inhalers
 Dry powder inhalers
 Nebulizer
Drugs that Inhibit Pain and Inflammation
 Pain relievers
 Counterirritants and Local Anesthetics
 Spray coolants
 Alcohol
 Menthol
 Cold
 Local anesthetics
 Narcotic Analgesics
 Codeine
 Propoxyphene hydrochloride (Darvon)
 Morphine
 Meperidine (Demerol)
 Nonnarcotic Analgesics and Antipyretics
o Designed to suppress all but the most severe pain, without the patient
losing consciousness
 Acetaminophen
Drugs to Reduce Inflammation
 Acetylsalicylic Acid (Aspirin)
 Nonsteroidal Antiinflammatory Drugs (See Table 17-7)
 NSAIDS are associated with an increased risk of adverse cardiovascular events,
including MI, stroke, and new onset or worsening of pre-existing hypertension
 NSAIDS may increase risk of gastrointestinal irritation, ulceration, bleeding and
perforation
 Corticosteroids
Drugs that Produce Skeletal Muscle Relaxation
Drugs Used to Treat Gastrointestinal Disorders
 Antacids
 Antiemetics (Pepto-Bismal, Phenergan)
 Carminatives (relief from gas – simethicone)
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Chapter 17 Pharmacology, Drugs, and Sports
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 Cathartics (laxatives)
 Antidiarrheals (Imodium AD)
 Histamine-2 Blockers [Tagamet (cimetidine), Zantac (ranitidine)]
 Protein Pump Inhibitors
o Drugs Used to Treat Cold and Allergies
 Nasal Decongestants (Afrin, Sudafed)
 Antihistamines (Benadryl, Chlor-Trimeton, Claritin)
 Cough Medicines (antitussives, expectorants)
 Sympathomimetics
 Epinephrine
o Drugs Used to Control Bleeding
 Vasoconstrictors (epinephrine)
 Hemostatic Agents
 Anticoagulants (heparin, coumarin)
Drugs that can increase the rate of heat illness (See Table 17-8)
Protocols for Using Over-The-Counter Medications (See Focus Box 17-2 “Protocols for the use of
over-the-counter drugs for athletic trainers”)
Substance Abuse Among Athletes (See Focus Box 17-3 “Identifying the substance abuser”)
o Performance-Enhancing Substances (Ergogenic Aids)
 Ergogenic aid – any method, legal or illegal used to enhance athletic
performance
 See NATA Official Statement on Drug and Performance Enhancement
Supplement Use in Athletics (Focus Box)
 Stimulants
o psychomotor-stimulant drugs
 Amphetamines
o Nonamphetamines
o Adrenergic (sympathomimetic) drugs
 Caffeine (See Table 17-9)
 Narcotic Analgesic Drugs (Morphine, and codeine)
 Beta Blockers
 Diuretics
 Anabolic Steroids (See Focus Box 17-5 “examples of deleterious effects of anabolic
steroids”)
 Tetrahydrogestrinone (THG)
 Androstenedione
 Human Growth Hormone
 Blood Reinjection (Blood doping, blood packing and blood boosting)
o Recreational Substance Abuse
 Psychological versus Physical Dependence
o Psychological dependence is the drive to repeat the ingestion of a drug
to produce pleasure or to avoid discomfort
o Physical dependence: the state of drug adaptation that manifests itself
as the development of tolerance and, when the drug is removed causes
withdrawal symptoms
 Tobacco Use
o Cigarette smoking
o Use of smokeless tobacco
o Passive smoke
 Alcohol Use
o Most widely used and abused substance among athletes
o Depresses the central nervous system
o Liver metabolizes the alcohol – no way to speed up the metabolism
process
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Chapter 17 Pharmacology, Drugs, and Sports
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Characteristics: Mood changes, missed practices, isolation, attitude
changes, fighting or inappropriate outbursts of violence, changes in
appearance, hostility toward authority figures, complaints from family
and changes in peer group
Drug Use
o Cocaine
o Crack
o Marijuana
o Managing a Drug Overdose (See Focus Box 17-6 “Contacting the
poison control center”)
Drug Testing in Athletes
 Began in 1968 – the Olympic Games
 1985 the USOC began drug testing athletes involved in both national and international
competitions
 January 1986 – NCAA voted overwhelmingly to expand the NCAA drug education
program to include mandatory random drug testing in specific sports throughout the year
and during and after NCAA championship events
o The Drug Test
 Slight differences between NCAA and USOC procedures and protocols
 NCAA requires all athletes to sign a consent form agreeing to participate in drug
testing program throughout the year
 USOC tests athletes on a random basis throughout the year and tests all athletes
before a USOC sanctioned competition
 Sanctions for positive tests
 First-time positive test: NCAA declares athlete ineligible for all regular and
postseason competitions for a minimum of one year
 During that year the athlete may be drug tested at any time
 Additional positive tests can result in lifetime disqualification from NCAA
competition
 USOC sanctions range from three to twenty-four months of disqualification,
depending on the drug – with minimum 2 year ban for first-time violation
o Banned Substances (See Focus Box 17-7 “banned drugs – common ground”) (See Table 17-10)
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