Non-anti-inflammatory

Analgesics

Acetaminophen / Tylenol

Only OTC in this category Analgesic Antipyretic Effective for mild to moderate pain Rx or OTC No GI effects No interaction with insulin / gout medications Safe for aspirin intolerance

Acetaminophen

Administered

Orally: tablets, caplets, liquid(30 – 60’)

Suppositories: (20-30’)

Acetaminophen

Dosages

– 325 mg. Tablets 2 every 4 hrs.– 500 mg. Tablets 2 every 6 hrs.– Not to exceed 4000 mg. / 24 hrs.– Children’s doses

AcetaminophenSide Effects and Reactions

Extremely safeLiver effects with:

Long term useHigh dosesAlcohol abusefasting

Overdose symptomsNausea, vomiting, sweating, abdominal pain,

loss of appetite

Considerations for ATC

Acetaminophen’s hepatoxicity

- watch use with females that exhibit signs of eating disorders

- wrestlers trying to make weight

- post surgical, too sick to eat

Opiate Agonists

Only by RX Narcotics that alter the sense of pain & induce sleep

– Inhibits neurotransmitters or stimulates opiate receptors

– cause release of endorphins & enkephalins– Depresses CNS

Controlled substances Pure = Schedule II Combinations = Schedule III

Different levels for degree of pain Levels correlate with dependency

Opiate Agonists

Characteristics - – Similar to opium; morphine extracted from

dried poppy seeds– Relieves moderate to severe pain - illness,

surgery, trauma, chronic pain– Treatment for severe diarrhea

Opiate AgonistsMild to Moderate Pain

Codeine – + acetaminophen = Roxane– Cough suppressant

Hydrocodone– + aspirin = Percocet, Roxicet, Panasal– + acetaminophen = Hydrocet, Lortab, Vicodin,

Lorcet, Panacet

Mild to moderate pain

Oxycodone– + aspirin = Percodan, Roxiprin– + acetaminophen = Percocet, Roxicodone, Tylox

Propoxyphene– + acetaminophen = Darvocet

Opiate AgonistsModerate to Severe Pain

Meperidine – moderate to sever pain– (ex) Demerol

Morphine for severe pain

– Often used with cancer and other debilitating conditions

Opiate Agonists

Administered

Orally (30-60’)Intravenously (< 30’)Intramuscularly (< 30’)

Dosages depend on specific drug but usually taken every 4-6 hrs.

Opiate AgonistsSide Effects and Reactions

Relatively safe when used for limited time Reactions:

Drymouth, drowsiness, nausea, constipation, urination problems

(Severe) depressed breathing, rashes, decreased HR/BP, nausea, stomach pain, vomiting

Tolerance Withdrawal = runny nose, fever, diarrhea, pupil dilation,

goose flesh, irritability, rapid HR

• Should never be used if hx of opiate addiction• May induce seizures if taken with anti-depressants

or if there is head trauma

Other Systemic Analgesic

Tramadol (Ultram) For moderate to severe pain Less addictive? Weak agonist for opiate receptors and

prevents the re-uptake of norepinephrine and serotonin

Considerations for ATC’s

NCAA bans heroin USOC bans opiates with some exceptions Will decrease performance because of CNS

effects Not to be used by athletes throwing, catching,

shooting Overuse Add on effect of opiates if combined with

alcohol

Corticosteroids

Anti-inflammatory

Drugs

Corticosteroids

Steroid hormones that are lipid soluble– Produced in adrenal cortex– Synthetic versions also made in laboratory

Not Anabolic Steroids 4 types

– Mineralcorticoids (acts on salt metabolism)– Glucocorticoids (cortisol & derivatives)– Androgens– estrogens

Indications

Powerful Systemic – affect more than the affected area Available only by prescription except for

topical hydrocortisone Used in sports for inflamed joints,

brochiospasm w/ EIA, allergic rhinitis, and topical itch relief

Mechanism of Action

React with receptors in the cytoplasm (RNA) of affected cells

Anti-inflammatory action due to suppression of chemical mediator reaction to inflammation

Also inhibit collagen formation, thus prolonging the healing process

Lipid soluble = longer effects– Effects may last for days to weeks

Topical Applications

Skin infections and disorders Used to treat the skin irritation and itching

– Hydrocortisone & hydrocortisone acetate– Does not treat the fungal or yeast infection– Not effective with ringworm

Nasal Inhalants & Sprays

Used to treat nasal inflammation & rhinitis– Beclomethosone (Beclovent, Vanceril)– Budesonide (Rhinocort)– Dexamethasone (Decadron, Turbinaire)– Flunisolide (Nasalide)– Triamcinolone (Nasacort)

– Watch for irritation

Oral Inhalation

Treatment of asthma and respiratory problems

– Beclomethasone (Beclovent, Vanceril)– Dexamethasone (Decadron Respihaler)– Flunisolide (Aerobid)– Triamcinolone (Azmacort)

– Watch for coughing, dysphonia

Injection

Used to treat “itis’s” – Betamethasone (Celestone)– Dexamethasone (Decadron)– Hydrocortisone (Solu-Cortef)– Methylprednisolone (Depo-Medrol)– Prednisolone (Hydeltrasol)– Tramcinolone (Aristospan, Kenalog-10)

– Rest and reduced stress to soft tissue must be part of treatment plan

– DO NOT INJECT Patellar / Achilles Tendons

Oral Ingestion

Systemic inflammatory conditions such as arthritis, Crohn’s disease, colitis

Prednisone (Deltasone)

Adverse Reactions

Numerous Topical

– Increase the rash like symptoms Systemic

– Nausea– Restlessness / sleeplessness– Skin color changes– Unusual hair growth

Serious Side Effects

Eye pain / blurred vision Stomach pain, nausea, tarry stools, vomiting General fluid retention and swelling of

extremities Hives, rashes, acne, skin eruptions

•Menstrual irregularities•Suppression of immune system = symptoms of infection

•Softening of cartilage in joints / local tissue atrophy

More Side Effects….

Even More Side Effects …

Prolonged use leads to Birth defectsOsteoporosisCataractsGlaucomaCushing’s syndromeDiabetes Osteonecrosis

Contraindicated for…

Heart Disease Hypertension Diabetes Diverticulitis Gastritis / peptic ulcer Glaucoma / cataracts

Liver / Kidney disease TB Lupus Infections such as cold /

flu HIV/AIDS

Athletic Considerations

Inhaled corticosteroids have no effect on natural testosterone

Oral ingested over long period can reduce plasma concentration of testosterone by up to 33% = masking agent

Effectiveness of oral ingested agents can be decreased by exercise but not inhaled or injected

More Considerations for the ATC

Athletes with an inhaler should take a dose before exercise (MD’s orders)

Wound healing may be slower Do not stop using suddenly – gradual

withdrawal helps avoid serious side effects Combining w/ alcohol or NSAIDS can cause

stomach ulcers

Banned Substance Lists

NCAA has no restrictions on use USOC bans

– Intravenous– Intramuscular– Rectal – Oral

USOC allows with prior permission– Intra-articular– Inhaled– local