2 December 1951Bukit Tinggi

PhD in Clinical PharmacologyFUSA-Flinders Medical Centre Australia, 1988

ProfessorHead of DepartmentPharmacology & TherapeuticSchool of Medicine, USU

Jln. Tridharma 22Kampus USU, Medan

SpFK, Clinical PharmacologistPB-IDI & FK UI, 1995

MD, FK USU, 1978

Email: aznanlelo@yahoo.com

Aznan LeloDep. Farmakologi & Terapeutik,

Fakultas KedokteranUniversitas Sumatera Utara

7 Oktober 2011, PIT X PERDOSRI, Semarang

BEN JOHNSON

DOPING

The use of any substance (natural or synthetic) taken into the body

• by any route – mouth, injected, instilled, inhaled or inserted

• for non-therapeutic reasons to enhance performance.

• Anabolic-androgenic steroids (AAS)• Human growth hormone (hGH)• Blood transfusions• Brake drugs

Physical fitness is the ability to function effectively throughout your workday, perform your usual other activities and still have enough energy left over to handle any extra stresses or emergencies which may arise.

Flexibility is the distance

of motion of a joint, which may be increased

by stretching

Gerak Tubuh

• Gerakan otot yang prima sangat diperlukan dalam berbagai aktivitas sehari-hari, termasuk menari, olah raga dan kegiatan lainnya.

• Gerak tubuh tidak hanya ditentukan oleh kondisi otot, banyak system organ tubuh ikut berperan: – otak,

– syaraf,

– neuromuscular junction,

– otot dan – tulang.

Gerak biasa merupakan gerakan yang disadari dan impuls akan

diolah oleh SSP (otak dan medulla spinalis) terlebih dahulu

sebelum terjadi gerakan.

Five Components of Health-Related Physical Fitness

Muscular strength Muscular endurance Cardio-respiratory

endurance Flexibility Body Composition

Reasons for taking drugs

to build muscle faster than regular training

to kill pain or mask injury to calm themselves before a big

competition to pep them up for competition

Glucosa

• merupakan sumber energy untuk berbagai aktivitas tubuh.

• meningkatkan daya tahan.

• “carbohydrate loading".– increase muscle glycogen levels– prolongs time to exhaustion– higher effect in untrained persons

6 performance enhancing drugs

1. Anabolic steroids

2. Stimulants

3. Beta blockers

4. Narcotic analgesics

5. Diuretics

6. Peptide Hormones: EPO

Anabolic steroids

• Increase muscle mass and develop bone growth, therefore increasing strength and allowing the athlete to train harder and recover quicker.

• Anabolic agents occur naturally in the body.• However, they are also made artificially and

can be used to illegally improve their performance.

• No effect on endurance exercise

Anabolic steroids – side effects

Increased risk of heart attacks and strokesHigh blood pressureLiver diseaseIncreased risk of muscle injuryInfertility in womenThe worst case scenario - death Increase aggressionfacial hair growth and deepening of the voiceEffects can sometimes be permanent!

Stimulants

• Caffeine• Amphetamines• Cocaine• Sympathomimetics

– Ephedrine– Pseudoephedrine– Phenylephrine– Phenylpropanolamine (PPA)

• Nicotine

Stimulants – proven effects

• Increases Endurance– Increases use of free fatty acids and

triglycerides– Spares muscle glycogen early in exercise– Decreased perceived exhaustion

• Enhances Anaerobic Exercise– Decreases time to exhaustion – Decreases perception of exertion– Hypo-analgesic effect

• Small amount of weight loss

Stimulants - Side Effects

High blood pressureAnxietyIrritability InsomniaHallucinationsIrregular heart beatIncreased heart rate Addiction – such as amphetamines, are highly addictive

Death

Sympathomimetic

• Derivate amphetamine dapat meningkatkan glikogen dan metabolisme asam lemak, sehingga digunakan untuk meningkatkan kinerja atletik, daya tahan, dan mengurangi kelelahan serta meningkatkan kepercayaan.

• Berbagai sediaan simpatomimetik tersedia dalam obat bebas, misalnya antiflu mengandung efedrin dan sejenisnya.

Caffeine

• a mild CNS stimulant • consists of a xanthine molecule with three methyl

groups • can be found in many products like sodas, tea,

and coffee, but it also occurs in several other products such as prescription medications, diuretics, and pain relievers.

• Caffeine’s widespread use and popularity have caused many people to view the substance as an addictive drug.

Purpose of Caffeine

• Caffeine has many specific benefits for different types of athletes.

• There are many athletes that believe the substance can enhance their physical as well as mental performance.

• It is supposed that caffeine can improve the athlete’s endurance in sports where long-term stamina is needed.– Increased time to fatigue in prolonged, moderate

intensity exercise – No effect on repeated sprints/heavy exercise

How caffeine works

Three theories have been presented :

1. The first theory, caffeine causes the body to burn more fat and fewer carbohydrates. – Studies show that in the first fifteen minutes of exercise caffeine has the

potential to reduce the loss of glycogen by fifty percent. – When this happens, the saved glycogen can be used for the remainder of the

workout where normally it would be entirely depleted.

2. The second theory, caffeine enhances the athlete’s mental focus.

3. The third theory, caffeine may have the ability to strengthen muscle contractions. – By transferring calcium, sodium, and potassium in the cells, membrane

permeability increases. This in turn results in more powerful muscle contractions.

Fisher SM, et al. Influence of caffeine on exercise performance in

habitual caffeine users. Int J Sports Med. 1986 Oct;7(5):276-80.

• habitually high caffeine users acquire a tolerance to caffeine which reduces its effects during prolonged exercise.

• furthermore, to magnify the effect of caffeine, habitual users should withdraw from caffeine use for about 4 days.

Obat jalanan

• Alkohol• Tembakau• ganja, • kokain, • heroin, • methylenedioxy-

methamphetamine (MDMA, ekstasi),

• diethylamide asam lysergic (LSD),

• mescaline, • phencyclidine (PCP),

dan • psychedelics lainnya

serta • halusinogen

Alcohol

• All alcoholic drinks contain a chemical called ethanol

• it may be used as a sedative (have a calming effect)

• it slows down reaction times and impairs judgement.

• It causes extra urine to be produced, this increases the risk of dehydration.

• The liver can be damaged long term this is called cirrhosis.

Tobacco, nicotine • A stimulant which raises alertness and

highly addictive• Increase blood pressure and heart rate

dizzy• Nicotine is a mild poison• Tar is a mixture of chemicals causes

many serious diseases. • This has a negative effect on fitness,

especially aerobic fitness, and often results in poorer performance.

Kokain & Ekstasi

Kokain

• meningkatkan jumlah dopamine di synaps,

Ekstasi

• Derivat amfetamin

• meningkatkan jumlah serotonin,

Narcotic analgesics

• it is used to suppress pain and enable them to carry on, even with an injury.

• they can increase the risk of severe or long lasting injury.

Narcotic analgesics have some side effects:Loss of concentrationLoss of balanceLoss of coordinationEmotional effects, including hallucinations (morphine).Narcotic analgesics are highly addictive

Sympatolytic

Beta-blocker• slow the heart rate and breathing rate and • suppress feelings of anxiety and nervous

tension.• to calm and steady their hands (shooter,

snooker).

penghambat reseptor dopamin • menyebabkan berbagai gerakan tak

terkendali atau dyskinesia.

Diuretics

• to reduce their body weight very quickly before a competition. – Some jockeys use diuretics to keep their

weight down.• Side effects due to dehydration:

muscle weakness and crampsheadachesdizziness and nauseakidney problems – long term.

Miscellaneous Losersin endurance exercise performance

• Vitamin E and other vitamins• Minerals: Cr, Mg, Zn, Se• L-Carnitine• Antioxidants• Pyruvate• Arginine• Hydroxy-methyl-butyrate (HMB)

inflamasi dan stres oksidatif

• Kejadian yang terjadi selama latihan telah dikaitkan dengan metabolism dan kerusakan otot.

• Asam amino creatine diproduksi secara alami dalam tubuh, namun bisa diperoleh dari makanan, daging dan ikan.

• Umumnya creatine disimpan dalam otot rangka di mana sebagian dikonversi menjadi kreatin fosfat untuk menyediakan energi awal kontraksi otot.

Creatine

• Replenishes ATP in anaerobic exercise

• No federal assessment of quality, performance, or safety

• Proven to increase lean body mass, strength

• Meta-analysis 2003: – No significant difference in field-based athletic

performance (e.g. running, swimming)

Branch JD. Int J Sports Nutr Exerc Metab June 2003

Margaritis I, Rousseau AS. Does physical exercise modify antioxidant requirements?

Nutr Res Rev. 2008 Jun;21(1):3-12.• High doses of antioxidant supplements

can minimize the effects of radical oxygen species themselves or generate pro-oxidant effects.

• Effects are only exhibited when nutritional status is deficient.

• There are no convincing effects of supplementation in well-trained athletes.

Nitric Oxide-releasing agents

• Physiology– Arginine is a precursor of NO– NO regulates BP and blood flow to organs– Most supplements: Arginine α-ketoglutarate

• Claims– Improves “pump” and blood flow to muscles– Increases strength and size– Speeds recovery

• Endurance exercise studies• No benefit in endurance athletes

Kesimpulan

• Sampai saat ini belum cukup bukti untuk merekomendasikan obat oral atau supplement anti-oksidan yang berkhasiat dalam memperbaiki dan mempertahankan kebugaran, fleksibilitas dan daya tahan atlit.

Be a smart doctor and the right one too

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