pharmacology in athletic training seata student symposium 2012 dr. jason bennett, da, atc chapman...
TRANSCRIPT
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Pharmacology in Athletic Training
SEATA Student Symposium 2012
Dr. Jason Bennett, DA, ATCChapman University
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Where to Focus Your Attention When Preparing for the BOC
Exam?
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Pass the BOC Exam !!
PharmacologyClass?
O & A Class ?
Gen Med Class?Clinical
Experience?
Patient Care
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BOC Candidate Handbook for 2012-2013
% of Questions on Exam
Injury/Illness Prevention and Wellness Protection
25%
Clinical Evaluation & Diagnosis 22%
Immediate and Emergency Care 19%
Treatment and Rehabilitation 22%
Organizational and Professional Health and Well-Being
12%
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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
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Course Notes
Course Textbooks
Current LiteratureClinical Experiences
Review Plan
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Additional Items Available
• Pharmacology Podcasts– Drug History; Pharmacokinetics;
Pharmacodynamics; NSAIDs; Opiates
![Page 9: Pharmacology in Athletic Training SEATA Student Symposium 2012 Dr. Jason Bennett, DA, ATC Chapman University](https://reader036.vdocument.in/reader036/viewer/2022062309/56649cef5503460f949bd06b/html5/thumbnails/9.jpg)
BOC References for Pharmacology2011-2012
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.
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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?
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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
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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?
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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
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NATA Consensus Statement: Managing Prescriptions and
Non-Prescription Medications in the Athletic Training Facility
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Consensus Recommendations
• Create document: Policy & Procedure of Medication Use
• Outlines:– Storage; Documentation; Team Travel– Verification (prescription only); Distribution– Packaging/Labeling; Emergency
Medications– Disposal; Samples
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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 7-
point label guideline
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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).”
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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
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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
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Basic Pharmacology
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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
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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
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NSAIDs
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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
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Effects of NSAIDs
• OTC NSAIDS have 4 effects:1. Anti-pyretic (Reduces Fever)2. Analgesia3. Anti-platelet (anti-coagulant)4. Anti-inflammatory
• How does an NSAID decrease inflammation?
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Arachidonic Acid (cell membrane)
Arachidonic Acid
PGsProstaglandin
PGI2
Prostacyclin
TXsThromboxane
LTsLeukotrienes
Cox enzyme
Phospholipase A2
Lipoxygenase enzyme
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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 “anti-prostaglandins”
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Arachidonic Acid (cell membrane)
Arachidonic Acid
PGsProstaglandin
PGI2
Prostacyclin
TXsThromboxane
LTsLeukotrienes
Cox enzyme
Phospholipase A2
Lipoxygenase enzyme
Corticosteroids
NSAIDs Singulair, Zyflo
Bronchoconstriction
cause
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Arachidonic Acid (cell membrane)
Arachidonic Acid
PGsProstaglandin
PGI2
Prostacyclin
TXsThromboxane
LTsLeukotrienes
Cox enzyme
Phospholipase A2
Lipoxygenase enzyme
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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
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Aspirin & Cox Enzyme
Cox 2 Enzyme = Inhibits Platelet
Aggregation
• Aspirin is primarily a Cox-1 INHIBITOR
– By inhibiting Cox-1 Enzyme = Anti-coagulant
Cox 1 Enzyme = Causes Platelet
Aggregation
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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
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Celebrex & Cox Enzyme
• Celebrex inhibit only Cox-2 enzyme
– Coagulant
Cox 2 Enzyme = Inhibits Platelet
Aggregation
Cox 1 Enzyme = Causes Platelet
Aggregation
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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
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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
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Course Notes
Course Textbooks
Current LiteratureClinical Experiences
Review Plan
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Additional Items Available
• Pharmacology Podcasts– Drug History; Pharmacokinetics;
Pharmacodynamics; NSAIDs; Opiates
![Page 39: Pharmacology in Athletic Training SEATA Student Symposium 2012 Dr. Jason Bennett, DA, ATC Chapman University](https://reader036.vdocument.in/reader036/viewer/2022062309/56649cef5503460f949bd06b/html5/thumbnails/39.jpg)
Questions