Chapter 17: Pharmacology, Drugs and Sports

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Chapter 17 Pharmacology, Drugs and Sports
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• 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

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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

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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

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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)

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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
• 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)

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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)

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• 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

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• 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

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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

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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

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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

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• 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

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

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Record Keeping -Must maintain accurate and up to
date medical records

• 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
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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

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• 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

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• 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

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• 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

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• 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

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• 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

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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

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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

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• 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

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• 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

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• 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

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• 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

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• 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

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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

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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

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• 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)

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• 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)

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• 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

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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

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• 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

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• 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

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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

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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

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• 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

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• 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

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• 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)

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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

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• 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

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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

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• 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

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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

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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

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• 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

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• 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

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• 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

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• 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

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• 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)

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• 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

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• 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

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• 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

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• 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

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• 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

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• 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)

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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

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• 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

64

• 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

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• 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

66

• 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

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• 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