Pharmacology in Athletic Training
SEATA Student Symposium 2012
Dr. Jason Bennett, DA, ATC
Chapman University
Where to Focus Your
Attention When Preparing for
the BOC Exam?
Pharmacology
Class?
Pass the BOC
Patient
Care
Exam
!!Gen Med
O&A
Class ?
Clinical
Experience?
Class?
BOC Candidate Handbook for 20122013
% of Questions on
Exam
Injury/Illness Prevention and
Wellness Protection
Clinical Evaluation & Diagnosis
Immediate and Emergency Care
25%
22%
19%
Treatment and Rehabilitation
22%
Organizational and Professional
Health and Well-Being
12%
Areas of Review
• Legal Requirements
• Indications & Side Effects for Drugs:
– Pain, NSAIDs, Asthma, Cold/Cough/Allergy,
Performance Enhancing Substances
• Emergency Medications
– E.g., Epi-pen, Rescue Inhalers
• Drug Testing & Substance Abuse Issues
• Basic Pharmacology
– E.g., Pharmacokinetics, Pharmacodynamics
Review Plan
Course Notes
Course Textbooks
Clinical Experiences
Current Literature
Additional Items Available
• Pharmacology Podcasts
– Drug History; Pharmacokinetics;
Pharmacodynamics; NSAIDs; Opiates
BOC References for Pharmacology
2011-2012
1. Mangus & Miller. Pharmacology
Application in Athletic Training
2. Houghlum & Harrelson.
Principles of Pharmacology for
Athletic Trainers.
3. Gladson. Pharmacology for
Physical Therapists
4. Koester. Therapeutic
Medications in Athletic Training.
Scenario #1
• A 22-year old linebacker had a mild
concussion during practice 10 days ago.
After 1 week without symptoms he was
cleared to resume playing.
• He received another mild concussion in
the first half of tonight’s game. He was
withheld from competition for the
remainder of the game.
• At the conclusion of the game his only
complaint is a headache. What, if any,
medication do you recommend?
Scenario #1
Options
1.No medication
– 2nd concussion in last 2 weeks, want to
observe for increased symptoms
2.Tylenol
– No ibuprofen  slight anti-coagulant so could
increase bleeding if there is a subdural
hematoma present
Scenario #2
• A 20-year old female basketball player asks your
advice about using different medications.
• She is currently taking Azmacort and Albuterol for
her asthma. Since she sprained her ankle 2
weeks ago, her coach has recommended her
taking 2-200 mg tablets of ibuprofen each day to
reduce the swelling.
• She was also prescribed Serevent for her asthma
but hasn’t started using it. Is it safe for her to also
begin taking her Serevent with these other
medications?
Review Scenario #2
• Drugs currently taking:
– Azmacort – Inhaled corticosteroid  decreases
inflammation
– Albuterol – Short acting B2-agonist (rescue
medication)
– Ibuprofen – not taking enough for anti-inflammatory
effect
– Serevent ?? – A long acting B2-agonist 
bronchodilator
• What should she do?
– Discontinue Ibuprofen
– Only use Albuterol for “asthma attacks”
– Serevent & Azmacort work synergistically
NATA Consensus Statement:
Managing Prescriptions and
Non-Prescription Medications
in the Athletic Training Facility
Consensus Recommendations
• Create document: Policy & Procedure of
Medication Use
• Outlines:
– Storage; Documentation; Team Travel
– Verification (prescription only); Distribution
– Packaging/Labeling; Emergency
Medications
– Disposal; Samples
Administration of Medication
• Administration of Medication
– 1 dose pack
– Each individual receiving the medication
should be informed of the medication and how
s/he should take it
• Use Dose Packs
– Should not repackage medications  FDA 7point label guideline
Storage
– “All OTC and prescription medications should
be stored in a locked metal cabinet that is
environmentally controlled (dry temperature
between 59-86 degrees) and secured by
tamper-proof locks”
– “Storage should be inaccessible to athletes
(and other unauthorized individuals), with
access (keys) limited to the facility’s
authorized personnel (certified athletic
trainers and physician).”
Documentation
• Log Sheet
– Patient’s name
– Injury/Illness
– Medication given
– Dose (e.g., 200mg tablet)
– Quantity
– Lot Number (if possible)
– Date Administered
• Transfer patient information to individual
chart
Travel
• Domestic Travel
– Carry a formulary signed by an advising
physician that identifies each OTC and
prescription medication managed by the AT
• Preferred means of communication between the
AT and the physician while traveling.
• International Travel
– Coordinate with the appropriate government
agencies
Basic Pharmacology
Pharmacokinetics
• Definition: The effect the body has on the
drug
• Administration
– Enteral – by mouth, sublingual, or rectal
– Parenteral – anything else
• Distribution – across membranes
• Metabolism - Liver
• Excretion – usually kidney
Pharmacodynamics
• Definition: The effect of the drug on the
body
• Drug Receptor Theory
– Lock & Key
• Agonist vs. Antagonist
• Therapeutic Index
– Higher is safer
• Steady-state and Half-life
NSAIDs
What is an NSAID?
• Non-steroidal Anti-inflammatory Drug
• Most Common NSAID OTCs
– Aspirin (Bayer, Excedrin)
– Ibuprofen (Advil, Motrin)
– Naproxen Sodium (Aleve)
– Ketoprofen (Orudis KT)
• Common Rx:
– Celebrex, Voltaren, Relafen, etc
Effects of NSAIDs
•
OTC NSAIDS have 4 effects:
1. Anti-pyretic (Reduces Fever)
2. Analgesia
3. Anti-platelet (anti-coagulant)
4. Anti-inflammatory
• How does an NSAID decrease
inflammation?
Arachidonic Acid (cell membrane)
Phospholipase A2
Arachidonic Acid
Lipoxygenase
enzyme
Cox enzyme
PGs
Prostaglandin
TXs
Thromboxane
PGI2
Prostacyclin
LTs
Leukotrienes
Role of Prostaglandin
• Prostaglandins
– Increases vascular permeability (edema);
induces pain
– Also protects gastric mucosa by decreasing
acid secretion (PGE2)
• NSAIDs are generally referred to as “antiprostaglandins”
Arachidonic Acid (cell membrane)
Phospholipase A2
Corticosteroids
Arachidonic Acid
Singulair,
Lipoxygenase
Zyfloenzyme
Cox
enzyme
NSAIDs
PGs
Prostaglandin
TXs
Thromboxane
PGI2
Prostacyclin
LTs
Leukotrienes
cause
Bronchoconstriction
Arachidonic Acid (cell membrane)
Phospholipase A2
Arachidonic Acid
Lipoxygenase
enzyme
Cox enzyme
PGs
Prostaglandin
TXs
Thromboxane
PGI2
Prostacyclin
LTs
Leukotrienes
Role of Cox Enzyme
• COX-1 produces TXA2,
platelet
aggregation
• COX-2 produces PGI2,
platelet
aggregation inhibition (anti-platelet)
• With injury - production of PGI2 is reduced
and TXA2 dominates
– Platelets aggregate and lead to blood clot
formation
Aspirin & Cox Enzyme
• Aspirin is primarily a Cox-1
INHIBITOR
– By inhibiting Cox-1 Enzyme
= Anti-coagulant
Cox 2 Enzyme =
Inhibits Platelet
Aggregation
Cox 1 Enzyme =
Causes Platelet
Aggregation
Ibuprofen & Cox Enzyme
• Ibuprofen inhibits both
Cox-1 & Cox-2, with a
slightly greater inhibition of
Cox-1 enzyme
– Slight anti-coagulant
• Similar Drugs: Aleve
(Naproxen sodium)
Cox 2 Enzyme =
Inhibits Platelet
Aggregation
Cox 1 Enzyme =
Causes Platelet
Aggregation
Celebrex & Cox Enzyme
• Celebrex inhibit only
Cox-2 enzyme
– Coagulant
Cox 2 Enzyme =
Inhibits Platelet
Aggregation
Cox 1 Enzyme =
Causes Platelet
Aggregation
NSAID Dosage for Pain
• Aspirin Dosage
– The antipyretic dose for aspirin and
ibuprofen is similar to the dose for relief
of mild to moderate pain
– Risk of Reye’s syndrome associated
with the use of aspirin in children with
fever and after viral infection
NSAIDs and Research
• Some research suggest that NSAID use
early after injury will have negative effect
on healing of tissues (Johnson & Stovitz,
Physician & Sports Medicine, 2003).
• Some “Tendonitis” injuries had no
inflammatory component
Review Plan
Course Notes
Course Textbooks
Clinical Experiences
Current Literature
Additional Items Available
• Pharmacology Podcasts
– Drug History; Pharmacokinetics;
Pharmacodynamics; NSAIDs; Opiates
Questions