Transcript Pharmacology - Higley Unified School District

Pharmacology
PHARM BASICS
Pharmacology- the study of medicines
and their effects on the body
• Therapeutic Drugs- agents which have a
medicinal purpose
• Recreational Drugs- agents with no medicinal
purpose or being used in a non-medicinal
manner
5 Rights for Safety
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Right Patient
Right Medication
Right Route
Right Dose
Right Time/Date
What you should you understand
about medications?
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Drug Action
Drug Indications
Drug Contraindications
Side Effects
Dose
Route of Administration
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Oral
Sublingual
Inhalant
Injection
Topical
• IV
• Vaginal
• Rectal
Legal Issues
• Over the counter medications- anyone can
purchase; safe for public to use as directed
• Prescription medications- medications that
are recommended by a physician or
psychiatrist
Legal Issues
• Medications should be kept in well-labeled
containers
• Minors (those under age 18) cannot be given
OTC medication by anyone other than parent
or someone with written permission from
parent or physician
Administering vs. Dispensing
Medications
• Administering Medications: providing a
single dose to person
• Dispensing Medications: providing several
doses to a person
• An Athletic Trainer may administer a dose,
but cannot dispense any medication!
COMMON THERAPEUTIC MEDS
Infection Fighters
• Antibiotics: agents that fights bacterial
infections
– Prescription
– Penicillins, Erythromycins, Sulfa Drugs,
Tetracycline
• Antifungals: agents that fight tineas
(fungal infections)
– OTC or prescription
– Lamisil, Tinactin, Desenex, Micatin
Analgesics- Pain Relievers
• Can be OTC or prescription
• Narcotics: depress pain impulse and
respirations; mainly opiates
– Oxycontin, codeine, vicodin
• Topical Analgesics: counter irritants or
local anesthetics
– Flexall, Ben Gay, Icy Hot, Aspercreme, Tiger
Balm, Theragesic
– Injectables like Lidocaine, Novocain
Pain Relievers: Acetaminophen vs.
Aspirin
Tylenol
Aspirin
• Pain reliever
• Antipyretic: fever
reducer
• More tolerable than
aspirin
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Pain reliever
Antipyretic
Anti-inflammatory
Anti-coagulant
GI irritating
Should not be used by
minors
• Higher risk of allergic
reaction
NSAID- Non-steroidal Antiinflammatory Drugs
• Analgesic
• Antipyretic
• Anti-inflammatory
• Can cause GI upset,
headaches, tinnitus
• Advil, Motrin,
Ibuprofen,
Naproxen Sodium,
Aleve
Stomach Medications
• Antacids: reduce
stomach acid
– Relief of heartburn,
ulcers, indigestion
– Tums, Rolaids, AlkaSeltzer
• Laxatives
– Poor diet can cause
constipation
(Could be
symptom of disease)
– Can cause
electrolyte
imbalance
– ExLax, Dulcolax
• Anti-diarrheals
– Diarrhea is
symptom of
problem-infection?
– Imodium, Lomotol,
Kaopectate
ASTHMA
Asthma
• Air passages swell and
narrow
• Signs/Symptoms:
Emergency Symptoms:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PM
H0001196/
– Coughing
– Wheezing
– Shortness of Breath
– Tingling/chest
tightness
Cyanosis
Rapid pulse
Rapid heart rate
Sweating
Extreme breathing
difficulty
Medicinal Care
• Control
Medications
– Prevent the attack
from occurring
• Quick Relief
Medications
http://www.momsteam.com/health-safety/common-mythsabout-asthma-tips-for-parents-to-prevent-asthma-attacks
– Rescue drugs used
during attacks
Control Medications
• Long acting Beta2-agonists
– Symbicort
• Inhaled corticosteroids
– Flovent, Pulmicort
• Leukotriene inhibitors
– Singular
Quick Relief Meds
• Short acting Beta2agonists
(bronchodilators)
– Advair, Albuterol,
Proventil, Ventolin
• Oral (cortico) steroids
“What You and Your Family Can Do About
Asthma” by the Global Initiative for
Asthma Created and funded by
NIH/NHLBI
– Prednisone
– Pills, liquid, capsules
How do you know an asthma attack is
coming?
• Allergens and pollution
exposure
• Use Peak Flow Meter
http://www.pamf.org/asthma/selfcare/peakflow.html
– Can be used prior to
symptoms
– Should be used daily
morning and evening to
determine averages
How to use a Peak Flow Meter
Set measuring arrow at zero
• Inhale deeply
• Place mouthpiece in mouth
sealing lips tightly
• Exhale as strongly as possible
• Record reading
• Repeat for a total of 3 times, keeping the best
reading
http://www.tree.com/health/asthma-symptoms.aspx
• http://www.mayoclinic.com/health/asthma/MM00399 video demonstration
Interpreting the
Results
• Green zone- good
breathing
• Yellow zonemoderate asthma
attack
– Use rescue drugs
• Red zone- severe
asthma attack
– May need EMS
activation
http://www.bcbsks.com/behealthy/DiseaseMgmt/Asthma/peak
Flow.htm
COLD & ALLERGY MEDS
Colds and Flu
• Most are viruses
– Antibiotics do not work well!
– Increase chance of developing allergies/tolerance
to antibiotics
• Treat the symptoms with OTC meds
– Analgesics, antipyretics
Runny Nose and Cough
• Decongestants: stop runny nose
– Sudafed, pseudoephedrine
• Antitussive: stops cough
– Robitussin
• Expectorants: makes productive coughs
– Delsym
Allergies: Seasonal and Minor
Reactions
• Local reaction to the body
• Antihistamines: decrease immune system
response to itching and nasal swelling
– Benadryl, Claritin, Allegra
– Can cause drowsiness, dizziness, headache
Skin Allergic Responses
• Hives, itching, swelling
• Antipruritics: anti-itch
– Benadryl, hydrocortisone cream, topical
corticosteroids
• Ice can reduce itch, swelling
Anaphylaxis: severe allergic reaction
• Systemic reaction to body-all over body
response
• Body releases histamine and airways
begin to swell shut
• Breathing difficulty, anxiety, hives,
swelling, cough, vomiting, congestion,
wheezing
• Activate EMS
Epipen
• Epinephrine: sympathomimetic drug that
relaxes airway muscles and constricts blood
vessels
• Injected into large muscle mass (thigh)
• Can be injected through clothing
Epipen Instructions
1. Hold the device firmly in your fist with the black tip
pointing down. Do not touch the black tip; hold only
the cylinder.
2. Remove the gray activation cap.
3. Move your hand so the black tip is near your outer
thigh.
4. Swing your hand away from your body, then jab the
black tip firmly into your outer thigh at a 90-degree
angle. You may inject the needle through clothing
that is covering your thigh.
5. Keep the device firmly in this position for ten
seconds.
Epipen
Instructions
6. Remove the device from your thigh and
rub the area with your fingers.
7. Look at the black tip to see if the needle is showing. If
the needle is not showing, repeat steps 3-6.
8. If the needle is showing, you have received the full
dose of epinephrine. You will notice that most of the
liquid remains in the device. This is extra liquid that
cannot be used.
9. Press the needle against a hard surface to retract.
10. Replace the device in the carrying tube (without the
activation cap) and cover with the cap.
ACTIVE INGREDIENTS IN OTC
Active Ingredients: Purpose
• Over the counter medications are easy
method to treat colds, flu and illness
without intervention of a physician. It is
important to understand the role of
active ingredients in these medications
and the link between these medications
with side effects and medicinal purpose.
Terminology
• Active Ingredient: the substance in a
pharmaceutical drug or a pesticide that is
biologically active
STIMULANTS
Terminology
• Ergogenic Aid: performance enhancer
Purpose of most Ergogenic Aids
• Increase alertness
• Increase blood
pressure
• Increase tissue
temperature
• Increase
competitiveness
• Increase heart rate
• Increase
metabolism
• Increase power or
endurance
• Delay fatigue
• Speed up protein
synthesis
• Help them feel
better
Claims vs. Actual Actions
• Most performance enhancers are not
regulated by the FDA!
– Ingredients not regulated
– Claims are not always true
• Most important thing is to read the ingredient
label and learn the actions of the ingredients!
Downfall: Side Effects
• Can have dangerous outcomes with usage
• Can have short term effects
– Headache, tremors, heart arrhythmia
• Can have long term effects
– Tumors, cancers, needle diseases, changes to sex
organs
Stimulants: Actions on the body
• Increase alertness
• Increase heart rate
• Increase blood
pressure
• Increase
competitiveness
• Increase hostility
• Delay fatigue
• Increase
metabolism
• Increase body
temperature
• Promote quickness
and agility
Types of Stimulants
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Amphetamines
Sudafed
Beta2-agonists
Cocaine/crack
Methamphetamine
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Tobacco
Caffeine
Ephedra
Guanara
Willow Bark
Bitter Orange
Stimulant Side Effects
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Tremors
Nervousness
Headaches
Heart arrhythmia
Insomnia
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Tinnitus
Dilated pupils
Increased tolerance
Withdrawal
symptoms
Terminology
• Anabolic: muscle-building
• Androgenic: increases masculine
characteristics
• Cycling: taken over a short period of time
then stopped
• Stacking: taking multiple substances to
enhance desired effect
STEROIDS
Anabolic and Androgenic Steroids
• Natural or synthetic hormones
– Oral or injected
• Increase protein synthesis
– Increase lean tissue and weight
• Intended use with people who:
– Produce low levels of testosterone
– Need to battle muscle wasting issues/diseases
• Increase or exaggerate secondary sex
characteristics
Steroid Use Patterns
• Cycling: taken over a short period of time
then stopped
• Stacking: using multiple types of steroids
to maximize effectiveness
• Athletes use to maximize strength and
power
• Non-athletes use to look good
Types of secondary effects of AnabolicAndrogenic Steroids
• Deep voice
• Acne
• Possible increase in
chance of
cancers/tumors
• Joint pain
• Increased
aggressiveness
• Stunted growth
• Needle-related
diseases
• Increased blood
pressure
• Increase in LDL
(bad cholesterol)
• Increased mood
swings
Gender-specific Side Effects
Males
• Shrunken testes
• Decreased sperm
count
• Increased breast
tissue
• Baldness
http://www.ehd.org/health_steroids_5.php
Females
• Enlarged clitoris
• Male-pattern baldness
• Increased body hair
Steroids can be hidden in non-FDA
regulated products
• Steroids get disguised in
supplements
• Store-Bought Steroid Scandal:
http://www.youtube.com/watc
h?v=pEo2YMil5Sc Tren Xtreme
supplement sold at retail stores
contained anabolic steroids
http://www.dipity.com/timeline/Tren-Xtreme/
Most famous user
was Mark McGwire.
The year he
surpassed Roger
Maris’ home run
record, he gladly
admitted using Andro
to increase his mass
and power.
Before and After:
http://www.steroidsinmlb.com/wp-content/uploads/2009/12/roids_mcgwire.jpg
Androstenedione
Androstenedione
• Precursor to testosterone BUT can
convert to estrogen in some
– High level testosterone= testosterone
produced
– High level estrogen= estrogen produced
• Effects on body can be similar to steroids
including side effects
• Popular supplement in late 1990s but
made illegal to possess in 2005
Human Growth Hormone (HGH)
• Naturally produced in pituitary gland
• Now synthetically produced
• Increases conversion of amino acids into
proteins
– Increases protein synthesis
• Increases fat burn
HGH Side Effects
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Abnormal body growth
Increased chance of heart disease
Impotence
Osteoporosis/premature growth plate
closure
• Pancreatic issues (cancer, diabetes)
• Death
Steroids, Andro and HGH…
• All banned in sport
– Steroids, andro easier to detect
– HGH more difficult to detect because
produced naturally in body
NATURAL STIMULANTS
Terminology
• Doping: unnatural use of any substance to
gain an unfair advantage
Endurance: Specific Aids
• Methods to increase oxygen delivery to
tissues
• Altitude Training
• Blood Doping: remove pint of blood, wait 6-8
weeks then reinject into body
• Erythropoietin (EPO): natural and synthetic
method of increasing red blood cell count
– Anemic athletes may be prescribed EPO
Blood Doping and EPO: Actions
• Increase RBC count so more oxygen can be
carried/utilized by muscles
• Delays fatigue thus improving performance
• Found in endurance sports- cycling, distance
running, cross country skiing, endurance
swimming
Blood Doping/EPO: Side Effects
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Increase blood viscosity
Increase blood pressure
Kidney damage
Needle/blood diseases and infections
If using another’s blood, need to have same
blood type
Amino Acids
• Amino Acids (AA) chain together to form
proteins
– Proteins build/repair tissues
• Many AAs by themselves are speculated to
increase fat burning and enhance protein
synthesis for muscle production
Common AA Supplements:
• Leucine
– Slows atrophy in atrophied patients
– Inconclusive if increases muscle mass
• Taurine
– Claims that it will increase mental performance
Creatine Monohydrate
• Naturally made in liver/kidneys
• Increases energy production to allow for more
sustained strenuous exercise
• Shows most promise in untrained athletes
starting strength program
Creatine Use Side Effects
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Muscle cramping
GI distress
Muscle strains
Harms body ability to produce creatine
Kidney/liver damage? (no long term studies)
Herbal Supplements
• Medicinal use since ancient times
• Some herbs, taken in small amounts, can be
harmless
• Some can have negative interactions with
foods, medications
• Generally not FDA approved
Herbal Examples
• Ginseng: reduce stress, increase stamina,
prevent infections
• St. Johns Wort: decrease anxiety,
depression and assist with sleeping
• Wild Yam Extract: claim it can convert to
a steroid (in a lab only)
• Yohimbe bark: claim it aids in weight loss;
it does increase blood pressure
DRUG ABUSE
Medicines and Supplements…
• Can be abused
• Become habit forming
• Can become Recreational Drugs: used for
non-medical reasons with the intent of
getting high, or altering mood or
behavior
Causes for Drug Abuse
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Stress
Access to drugs
Peer pressure
Low self esteem
Increased
performance
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Painkiller
Experimentation
Copy role model
Escape from reality
Psychological vs. Physical Dependence
– Psychological dependence: the drive to continue
to medicate to produce pleasure or avoid
discomfort
– Physical dependence: state of drug adaptation in
the body
• Tolerance builds
• When consumption stops abruptly unpleasant
withdrawal occurs
Common Addictive Recreational Drugs
Seen in Athletics
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Cocaine
Caffeine
Tobacco
Narcotics-oxycontin
Alcohol
Marijuana
Abusive Behavior can lead to…
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Injury/illness associated with use
Behavior/personality change
Failed drug tests
Ban from sport
Alienation from teammates
Strained social relationships
Recognition of Abuse
The Clinician’s Role
• Identify signs
• Show concern/interest
• Be prepared to discuss
ethics/legal issues
• Provide emotional support
• Assist in finding the right
help
YOU CANNOT
SOLVE THEIR
PROBLEMS!
DRUG TESTING
Drug Testing
• Purpose is to find individuals who have
problems with drug abuse
• Controversial
• Where do they test?
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Some High Schools
NCAA
USOC/IOC
Some workplaces
Collegiate Level Testing
• Began in 1986
• About 11,000 athletes tested annually in
Division I and II
• Random testing and at some
championship events
• Many colleges conduct their own testing
in addition to NCAA standardized testing
Positive Tests
• 1st positive: Lose 1 year of eligibility (and
out for a full sport season)
• 2nd positive;
– Street drugs: another year eligibility lost
– Performance enhancing drugs: permanent
ineligibility
Olympic Committee
• 1968 testing at Olympics began in order to:
– Promote health
– Respect for medical and sport ethics
– Ensure equality for all athletes
Olympic Protocols
• Athlete provides A and B sample
• Sanctions range from 3months-24
months depending on the drug for a first
time offense
• Lifetime ban for subsequent positive
tests
• Banned drug list much more extensive
that NCAA
Professional Athletics
• Testing policies mainly based on
collective bargaining units
– Not uniform policies!
• Positive tests lead to treatment rather
than sport bans
• MLB, NBA, NFL, NHL, PGA, MLS,
Professional Tennis, Boxing