1. Chapter 17: Pharmacology, Drugs and Sports

2. 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

3. 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

4. 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

5. 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)

6. External Administration
Intravenous (into a vein)
Oral (most common form)
Rectal (limited due to dosage regulation)
Sublingual/buccal (dissolvable agents placed under tongue
Intravaginal (placing drug device inside vagina)
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 (patch with slow release mechanism)
Solutions (administered externally)

7. 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)

8. Distribution Metabolism
Once absorbed, drug is transported through blood to target tissue
Volume of distribution: volume of fluid/plasma in which drug is dissolved and indicates extent of distribution of that drug
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

9. 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

10. 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

11. Effects of Physical Activity on Pharmokinetics
Exercise decreases the absorption after oral administration
Exercise increases 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

12. 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

13. Administering Over the Counter Drugs
ATC may be allowed to administer a single dose of nonprescription medication
Rules relative to secondary schools
Oral medications vs. wound medication
College and professional athletes
Most are of legal age and are allowed to use 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

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

15. Record Keeping -ATC’s 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

16. 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

17. Legal liability if drugs removed from original packaging and dispensed
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

18. 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

19. Alcohol is a CNS 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 in order to avoid potential adverse reactions

20. 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

21. 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

22. 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

23. 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

24. Alcohol Phenol 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 to 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
Used to control disease organisms
Found in various concentrations and emollients
Derivatives include, resorcinol, thymol, and common house cleaner Lysol

25. Halogens Oxidizing agent
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

26. Antifungal Agents Antibiotics
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
Interferes w/ necessary metabolic processes of pathogenic microorganisms

27. 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

28. Erythromycin Sulfonamides Quinolones
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

29. 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

30. 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

31. 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)

32. 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)

33. 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

34. 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

35. Nonsteroidal Anti-inflammatory Drugs (NSAID’s)
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

36. 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

37. 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

38. 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

39. 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

40. Antiemetics 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

41. Cathartics (laxatives)
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

42. 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

43. 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)

44. 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
Impairs body’s ability to dissipate heat

45. Cough Medications Sympathomimetics
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

46. 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

47. Anticoagulants Heparin Coumarin derivatives
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

48. Drugs that Can Increase the Rate of Heat Illness
Some drugs may alter the body’s ability to thermoregulate
Anticholinergics and antihistamines (decrease sweating mechanism)
Sympathomimetic amines (may predispose athlete to heat stroke)
Phenothiazines (impacts hot/cold temp. regulation)
Diuretics (alters volume expansion and cutaneous vasodilation)
ATC must be aware of potential risk of medications relative to heat illnesses

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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

55. Habitual user that ceases use may go through withdrawal
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
Suffer 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)

56. 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

57. 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

58. 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

59. Tetrahydrogestrinone (THG)
Believed to be undetectable
Designer steroid that is structurally similar to gestrinone and trenbolone
Derived from other anabolic steroids
Banned by USADA
Cannot be legally marketed without FDA approval

60. 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
Banned by IOC, NFL, NCAA, and minor league baseball
Contains steroid hormones
May result in breast enlargement, testicular shrinkage (males) or facial/body hair, voice deepening, and clitoral enlargement (females)

61. 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 %

62. 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

63. 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)

64. 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

65. 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

66. Smoking
Seriously impacts 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

67. 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

68. 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

69. 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

70. 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

71. Marijuana (carcinogenic drug)
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

72. Managing a Drug Overdose
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

73. 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

74. 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

75. 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 3 months - 24 months depending on the drug for a first time offense
Lifetime ban for subsequent positive tests

76. 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