Clinical Pharmacology in Athletic Training

Part I. Foundational Pharmacology Concepts

Chapter 1. Legal Aspects of Therapeutic Medication Management
The Sports Medicine Team
Federal and State Laws
Drug Development, Studies, and Standards
Summary
Case Studies

Chapter 2. Administering Medications in the Athletic Training Setting
Administering Medications in the Athletic Training Clinic
Guidelines for Administering Medications in the Athletic Training Setting
Preventing Medication Errors
Summary
Case Studies

Chapter 3. Drug Names, Classification, and Safety
Drug Names
Drug Classes
Drug Safety
Adverse Drug Effects and Therapeutic Monitoring
Allergic Drug Reactions
Medication Use Process
Drug Information Resources
Summary
Case Studies

Chapter 4. Pharmacokinetics
Biopharmaceutics
The Process of Drug Liberation
The Process of Drug Absorption
The Process of Drug Distribution
The Process of Drug Metabolism
The Process of Drug Elimination
Pharmacokinetics and Exercise
Summary
Case Studies

Chapter 5. Pharmacodynamics
Drug-Receptor Binding
Types of Drug Receptors
Drug–Receptor Interactions
Summary
Case Studies

Chapter 6. Drug Delivery, Dosages, and Procedures
Drug Delivery Systems
Routes of Administration
Enteral Drug Delivery
Parenteral Drug Delivery
Mucous Membrane Drug Administration
Topical Drug Administration
Transdermal Drug Administration
Medication Dosing
Drug Administration Procedures
Clinical Procedures for Enteral Drug Administration
Summary
Case Studies

Part II. Classes of Therapeutic Medications

Chapter 7. Drugs to Treat Pain: Non-Opioid Analgesics and Anesthetics
Biopsychosocial Model
Differentiation of Pain
Pathophysiology of Pain
Analgesics
Non-Opioid Analgesic Agents
Local Anesthetics
Topical Analgesics: Creams, Gels, and Ointments
The ATs’ Role in the Clinical Management of Pain
Summary
Case Studies

Chapter 8. Drugs to Treat Pain: Opioid Analgesics
Appropriate Use of Opioid Analgesics
Classes of Opioid Analgesics
Summary
Case Studies

Chapter 9. Drugs to Treat Inflammation: Steroidal and Non-Steroidal Anti-inflammatories
The Inflammatory Process
Controlling Inflammation
Corticosteroids
Non-Steroidal Anti-inflammatory Drugs
Summary
Case Studies

Chapter 10. Drugs to Treat Infection: Antibiotics
Indications for Use
Therapeutic Effects
Mechanism of Action
Routes of Administration
Pharmacokinetics
Pharmacodynamics
Dosing Guidelines
Adverse Effects
Indications and Precautions
Patient Education for Use of Antibacterial Medications
Summary
Case Studies

Part III. Drugs for Treating Common Conditions in the Athletic Patient

Chapter 11. Drugs for Treating Respiratory Conditions
Respiratory Infections
Supportive Care for Respiratory Infections
Allergic Rhinitis and other Allergies
Asthma
Summary
Case Studies

Chapter 12. Drugs for Treating Cardiovascular Conditions
Ischemic Chest Pain: Angina Pectoris
Atherosclerosis and Coronary Artery Disease
Acute Coronary Syndrome
Hypertension and Hypertensive Crisis
Cardiac Arrhythmias
Thromboembolisms
Summary
Case Studies

Chapter 13. Drugs for Treating Diabetes and Disordered Glucose Metabolism
Normal Glucose Metabolism
Disordered Glucose Metabolism
Diabetes Mellitus
Antidiabetic Agents for Managing Type 2 Diabetes Mellitus
Insulin for Managing Type 1 and Type 2 Diabetes Mellitus
Diabetes Care Plan
Managing Hypoglycemia
Summary
Case Studies

Chapter 14. Drugs for Treating Digestive Disorders
Recognizing Common Conditions of the Digestive System
Nausea and Vomiting
Diarrhea
Constipation
Gastroesophageal Reflux Disease
Gastritis and Peptic Ulcer Disease
Gastroenteritis
Functional Bowel Disorders: Inflammatory Bowel Disease
Supportive Care and General Management of Digestive Disorders
Summary
Case Studies

Chapter 15. Drugs for Treating Common Musculoskeletal and Neurological Conditions
Articular (Joint) Pain
Musculotendinous Pain
Neck and Back Pain
Fibromyalgia
Complex Regional Pain Syndrome
Headache Disorders
Summary
Case Studies

Chapter 16. Drugs for Treating Dermatological Conditions
Protective Barrier of the Skin
Principles of Topical Dermatologic Pharmacology
Pathophysiology and Treatment of Dermatologic Disorders
Bacterial Skin and Soft-Tissue Infections
Fungal Skin Infections
Candidiasis
Viral Skin Infections
Autoimmune Inflammatory Skin Conditions
Summary
Case Studies

Chapter 17. Drugs for Treating Reproductive and Genitourinary Concerns
Family Planning and Contraception
Short-Acting Hormonal Contraceptives
Long-Acting Reversible Contraception
Barrier Methods
Emergency Contraception
Recommendations for Exercise During Pregnancy
Sexually Transmitted Infections
Reproductive and Urogenital Concerns
Cancer and Cancer Treatment
Summary
Case Studies

Chapter 18. Drugs for Treating Mental Health Conditions
Mental Health Conditions
Serious Mental Illnesses
Mental Health Services and Professionals
Approach to the Patient with Mental Symptoms
Treatment Options for Mental Health Disorders
Mood Disorders
Anxiety Disorders
Stressor-Related Disorders
Sleep or Wakefulness Disorders
Neurodevelopmental Disorders: Attention-Deficit/Hyperactivity Disorder
Eating Disorders
Substance-Related Disorders
Summary
Case Studies

Chapter 19. Performance Enhancing Drugs and Supplements
Substances Banned for Competition
Supplements for Enhancing Musculoskeletal Performance
Supplements for Treating Neurological Conditions
Supplements for Treating Skeletal Conditions
Manipulation of Approved Medications to Enhance Performance
Summary
Case Studies

Chapter 20. Cannabis and Cannabinoids
Cannabis
Cannabinoids
Acute Effects of Cannabis Use
Chronic Effects of Cannabis Use
Adverse Effects of Cannabis
Cannabidiol
Medical Cannabinoids
Research on Cannabinoid-Based Medicines
Performance Effects and Sport Regulation
Regulation of Cannabis Use
Clinical Recommendations
Summary
Case Studies

Chapter 21. Drug Testing in Sport
Drug Education
The Evolution of Drug Testing in Sport
Supplement Standards
The Drug-Testing Process
Testing for Marijuana
Testing for Anabolic Steroids
Masking Agents
Results of Drug Testing
Drug Exemptions
Summary
Case Studies

Chapter 22. Medications for Surgery
Anesthesia Protocols
Effects of Anesthetics
Types of Anesthesia
Common Applications of Anesthesia in Sports Medicine
Preparation for a Surgical Procedure
Recovery From a Surgical Procedure
Adverse Effects of Anesthesia
Summary
Case Studies

Athletic trainers have a responsibility to provide high-quality pharmaceutical care while meeting both legal and ethical requirements. Clinical Pharmacology in Athletic Training empowers athletic trainers with a functional understanding of pharmacology that enables them to formulate a treatment plan intended to mitigate disease and improve the overall health of their patients. This text incorporates the most up-to-date content from the 2020 Commission on Accreditation of Athletic Training Education (CAATE) standards, and it emphasizes interprofessional practice to enable future and current athletic trainers to collaborate with other health professionals in a manner that optimizes the quality of care.

Clinical Pharmacology in Athletic Training begins by addressing drug legislation and the legal aspects of the athletic trainer’s role in sport medication. The text provides an overview of pharmacokinetics and pharmacodynamics with an emphasis on concepts relevant to clinical practice. Students are introduced to the generic and brand names, general classifications, and appropriate administration of drugs and are guided toward appropriate online reference materials. Part II of this text describes common medications for pain, inflammation, and infections. Part III includes medications for specific conditions, including respiratory, cardiovascular, gastrointestinal, neurological, gynecological, and mental health conditions. The text also includes current information on opioid analgesics, cannabis, and cannabinoid-based medications.

Clinical Pharmacology in Athletic Training teaches students to administer appropriate pharmacological agents for the management of the patient’s condition. The information includes indications, contraindications, dosing, interactions, and adverse reactions. The following features are included to aid in the learning process:

• Chapter objectives set the stage for the main topics covered in the chapter.
• Key terms are boldfaced to indicate terms of special importance, and a glossary of definitions is included at the back of the book.
• Red Flag sidebars highlight warnings and precautions for certain medications or medicolegal issues.
• Evidence in Pharmacology sidebars highlight recent research regarding medications.
• Clinical Application sidebars present real-life stories from the field of athletic training.
• Case studies highlight specific therapeutic medication applications and are accompanied by questions that prompt readers to think critically about the issues presented.
• Quick reference drug tables describe medication types, generic and brand names, pronunciations, common indications, and other special considerations for the athletic trainer.

Over the past decade, there has been an increased emphasis on pharmacology in athletic training. Clinical Pharmacology in Athletic Training will equip students with appropriate skills and competencies, prepare them to meet patient needs, and enable them to work in interprofessional teams.4

Michelle Cleary, PhD, ATC, is an associate professor in the physician assistant studies program in the Crean College of Health and Behavioral Science at Chapman University. Prior to joining Chapman in 2012, Cleary taught at Temple University, where she earned her doctorate, and at Florida International University and the University of Hawaii. She is certified as an athletic trainer by the Board of Certification (BOC). She has 20 years of experience teaching in accredited athletic training programs.

In addition to numerous journal articles and book chapters, Cleary has written two national position statements for the National Athletic Trainers’ Association (NATA), has served on several NATA committees, and received the Most Distinguished Athletic Trainer award from NATA in 2019. Cleary wrote Acute and Emergency Care in Athletic Training with Katie Walsh Flanagan. She is the chair of the Research and Grants Committee of the Far West Athletic Trainers’ Association and is also an active member of the California Athletic Trainers’ Association, receiving the Outstanding Service Award in 2015. Her clinical experience includes time as an athletic trainer at the high school, NCAA Division I, and international/Olympic levels.

Thomas E Abdenour, DHSc, ATC, CES, received his doctorate degree in health science from A.T. Still University in 2011. He is a member of the National Athletic Trainers’ Association (NATA) and is currently on the NATA’s Foundation Board. Abdenour was inducted into the NATA Hall of Fame in 2007 and received the Most Distinguished Athletic Trainer award from NATA in 2014. He contributed to the 2009 NATA consensus statement Managing Prescription and Non-Prescription Medication in the Athletic Training Facility.

Abdenour is best known for his work in the National Basketball Association, where he spent 23 years as the head athletic trainer for the Golden State Warriors. In 1990, he was recognized as the Athletic Trainer of the Year by the National Basketball Athletic Trainers Association. Abdenour served as athletic trainer for the gold-medal-winning USA men's basketball team at the 2000 Summer Olympics in Sydney, Australia. He also founded the Champion Guidance Center for Men in Oakland, California, to support underprivileged men. Following his time with the Golden State Warriors, he served as the head athletic trainer at San Diego State University. While at San Diego State University, he was an approved clinical instructor and an adjunct faculty member in the department of exercise and nutrition science.

Mike Pavlovich, PharmD, earned his doctor of pharmacy degree in 1989 from the University of the Pacific. He is currently the president and owner of Westcliff Compounding Pharmacy. Pavlovich was an American Pharmacists Association (APhA) trustee from 2008 to 2014 and served in the APhA House of Delegates for more than 25 years. He received the Distinguished Achievement Award in Specialized Pharmacy Practice from APhA in 2012 and was recognized for his influence on the practice of pharmaceutical compounding and sports medicine. He is a past president of the California Pharmacists Association and a past board member of Pharmaceutical Care Network.

Prior to his employment at Westcliff Compounding Pharmacy, Pavlovich was the chief pharmacist for SportPharm, which revolutionized athletic trainers’ capacity to manage prescription medications under the guidance of a team physician. He served as team pharmacist on the U.S. Olympic medical team at the 2008 Summer Olympics in Beijing, China. Pavlovich also contributed to the 2009 NATA consensus statement Managing Prescription and Non-Prescription Medication in the Athletic Training Facility. Many of his core recommendations for medication management in the athletic training clinic are still being followed today.