Clinical Pharmacology in Athletic Training

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. Michael 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.

Part I. Foundational Pharmacology Concepts

Chapter 1. Legal Aspects of Therapeutic Medication Management
Health Care Providers With Prescribing Authority
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
Athletic Training Clinic
Guidelines for Administering Medications
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
Drug Liberation
Drug Absorption
Drug Distribution
Drug Metabolism
Drug Elimination
Pharmacokinetics and Exercise
Summary
Case Studies

Chapter 5. Pharmacodynamics
Mechanism of Action
Drug Receptors
Drug–Receptor Binding
Drug–Receptor Interactions
Drug Dosing
Dose Responses
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
Clinical Procedures for Enteral Drug Administration
Summary
Case Studies

Part II. Classes of Therapeutic Medications

Chapter 7. Drugs to Treat Pain: Nonopioid Analgesics and Anesthetics
Biopsychosocial Model
Differentiation of Pain
Pathophysiology of Pain
Analgesics
Nonopioid 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 Nonsteroidal Anti-Inflammatories
Inflammatory Process
Controlling Inflammation
Corticosteroids
Nonsteroidal Anti-Inflammatory Drugs
Summary
Case Studies

Chapter 10. Drugs to Treat Infection: Antibiotics
Indications for Use
Mechanism of Action
Therapeutic Effects
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

Chapter 11. Drugs for Treating Asthma and Other Respiratory Conditions
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
Glucose Homeostasis
Metabolic Disorders
Antidiabetic Agents for Managing Type 2 Diabetes Mellitus
Insulin for Managing Type 1 and Type 2 Diabetes Mellitus
Diabetes Care Plan
Summary
Case Studies

Chapter 14. Drugs for Treating Digestive Disorders
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
Bacterial Skin and Soft-Tissue Infections
Fungal Skin Infections
Candidiasis
Viral Skin Infections: Herpes Simplex and Molluscum Contagiosum
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
Summary
Case Studies

Chapter 18. Drugs for Treating Mental Health Conditions
Mental Health Conditions
Behavioral Health Emergencies
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. Drugs and Supplements to Enhance Performance
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
Concepts of Anesthesia
Effects of General Anesthesia
Levels of Sedation
Stages of Anesthesia
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