1 1 المنشطات و أضرارها performance enhancing drugs

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المنشطات و المنشطات و أضرارهاأضرارها

PERFORMANCE ENHANCING DRUGS

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Athletic or Performance-Related Fitness

AgilityBalance or equilibriumCoordinationPowerReaction timeSpeed or velocity

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PERFORMANCE ENHANCING DRUGS

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Performance-Enhancing DrugsAnabolic Steroids

Description Drugs derived from testosterone and approved for medical use, but often used by athletes to increase musculature and weight.

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Performance-Enhancing DrugsAnabolic Steroids

Claims May enhance performance and improves physical appearance.

Reported to increase lean muscle mass, strength, and the ability to train longer and harder.

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Performance-Enhancing DrugsAnabolic Steroids

Risks Liver tumors, jaundice, fluid retention, high blood pressure, severe acne, aggression and other psychiatric side effects.

Men: Shrinking testicles, reduced sperm count, infertility, baldness, and development of breasts.

Women: growth of facial hair, changes in or cessation of the menstrual cycle, enlargement of the clitoris, and deepened voice.

7Table 5-3, p.126

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Androstenedione produced by:1- the ovary, testes, and the adrenal cortex,

2-is a prohormone for both estrogen and testosterone..

3- Androstenedione supplementation has become popular with male athletes because they believe they will be more powerful.

4-Research shows no measureable effect on free or total testosterone,

5-but HDL levels dropped and plasma estrogens rose.

6- No measurable effect has been noted on athletic performance.

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GYNECOMASTIA

These pictures are the “BEFORE” (left) and “AFTER” (right) pictures of a man that had surgery to correct his case of gynecomastia. I’m sure he thought “It won’t happen to me.” as well! Think about it before you choose to take P.E.D.!

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Performance-Enhancing DrugsAndrostenodione

Claims Improves testosterone concentration, increases muscular strength and mass, helps reduce body fat, enhances mood,

and improves sexual performance.

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Performance-Enhancing DrugsAndrostenodione

Risks Breast enlargement, increased risk of cardiovascular disease and pancreatic cancer in men, acne, male pattern baldness, and a decrease in “good” (HDL) cholesterol.

In women, high testosterone levels can cause increased body hair, deepening of the voice, and other male characteristics.

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RISKS OF P.E.D.

Steroid induced acne

Anti-hypertensive behaviors

Hypertension or fatigue

Chronic gonadotrophin

Increased level of female hormones in a man’s body

Testicular atrophy

Induced gynecomastia

Presence of abnormally large breasts in men

Increased use of other drugs to mask symptoms

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SYMPTOMS OF P.E.D. USERapid weight gain with larger

muscle massAggressiveness Jaundice/Skin color changePurple or red spots on bodySwelling of feet and legsShaking and/or tremblingPersistent body odorsSevere acne breakouts with

abnormally oily skin

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DOES THIS LOOK APPEALING TO YOU?

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CNS Stimulants

CRACK

METHAMPHETAMINE

COCAINE

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١٤٤٤/١٠/١

StimulantsDescription: A group of synthetic or plant-

derived drugs that increase alertness and arousal by stimulating the central nervous system.

Medical Uses: Short-term treatment of obesity, narcolepsy, and hyperactivity in children No medical use for methamphetamine

Method of Use: Intravenous, intranasal, oral, smoking

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Types of Stimulant Drugs 1- Cocaine Products

Cocaine Powder (Generally sniffed, injected, smoked on foil)

“Crack” (smoked)

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Types of Stimulant Drugs2- Amphetamine Type Stimulants

(ATS)

Amphetamine “Speed”Dexamphetamine “Ice”Methylphenidate “Crank”Methamphetamine “Go Fast”

١٤٤٤/١٠/١

Methamphetamine vs. CocaineCocaine half-life: 1-2 hours

Methamphetamine half-life: 8-12 hours

Cocaine and the amphetamines have very similar effects on mood, patterns of abuse, the type of dependence produced, and their toxic effects.

Cocaine paranoia: 4 -8 hours following drug cessationMethamphetamine paranoia: 7-14 days

Methamphetamine psychosis - May require medication/hospitalization and may not be reversible

Neurotoxicity: Appears to be more profound with amphetamine-like substances, rapid formation of lesions

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Acute Stimulant Effects

PsychologicalIncreased energyIncreased clarityIncreased competenceFeelings of sexualityIncreased sociabilityImproved moodPowerful rush of euphoria -

freebase and intravenous only

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Acute Stimulant EffectsPhysicalIncreased heart rateIncreased pupil sizeIncreased body temperatureIncreased respirationConstriction of small blood vesselsDecreased appetiteDecreased need for sleepNumbness of nasal mucosa - intranasal only

١٤٤٤/١٠/١

Chronic Stimulant EffectsPhysicalWeight loss/anorexiaSleep deprivationRespiratory system diseaseCardiovascular diseaseHeadachesSevere Dental diseaseNeedle marks and abscesses - intravenous onlySeizureAgitation and violence

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Crystalline white powder Snorted in “lines” of 10-35 mg eachAdulterated w cheap local anesthetics,

stimulants, and inert white powdersYields moderate to high blood levelsGradual onset of effects at 15-20 min

with peak at 30-60 min

Cocaine Hydrochloride

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Soluble in waterPeak blood levels achieved instantaneouslyRapid onset, brief duration, intense “crash”Rapid development of compulsive use

pattern“Speedball” when mixed with heroin to

cushion the “crash”

Cocaine Hydrochloride: Intravenous Administration

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Increases the synaptic concentration of dopamine and Norepinephrine by preventing its reuptake

Dopamine agonists/replacements have not proved therapeutically useful in addicts

Cocaine: Mechanism of CNS Action

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Their Brains

have been

Re-Wired by Drug Use

Their Brains

have been

Re-Wired by Drug Use

Because…Because…

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Partial Recovery of Brain Dopamine Transporters in Methamphetamine

(METH)Abuser After Protracted Abstinence

Normal Control METH Abuser(1 month deter)

METH Abuser(24 months detox)

0

3

ml/gm

Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

Hint: Ask about free radicals!

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Euphoric moodIncreased energy, alertnessIncreased sexualityParanoiaIncreased heart rate, blood pressure

Cocaine: Acute Effects

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Lethargy, fatigueReduced attention spanSexual dysfunctionDepression, irritability, anhedoniaParanoid psychosis

Cocaine: Chronic Effects

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Cardiac arrhythmias, fibrillationHyperthermia- > 106º FConvulsions, loss of consciousnessRespiratory & cardiac arrestAbruptio placentae (miscarriage)Fatal reactions rare, but unpredictable

Cocaine: Toxic Reactions

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Rebound dysphoria Agitation, restlessnessIntensifies with dosage & chronicity of useCravings & drug-seeking behaviorAbuse of alcohol & other drugsSuicidal ideation, behaviorOften followed by prolonged sleep

Cocaine “Crash”

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Cocaine/Amphetamines“The Runs”

DRUG TAKING CRAVING

DRUG TAKING

DRUG TAKING

CRAVING

CRAVING

The BluesFATIGUEDEPRESSIONHYPERPHAGIA

CRASH

DRUG TAKING

sleep

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Speed Methamphetamine powder

ranging in color from white, yellow, orange, pink, or brown

Color variations are due to differences in chemicals used to produce it and the expertise of the cooker

Other names: Crystal, Crystal Meth, Crank, Go Fast, Zoom

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IceHigh purity

methamphetamine crystals or coarse powder ranging from translucent to white, sometimes with a green, blue, or pink tinge color

Depends on additives and filtering

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Cardiac Disorders and Methamphetamine

Coronary SyndromesArrhythmiaCardiomyopathyHypertensionValvular Disease

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Neurologic Disorders and Methamphetamine UseHeadacheSeizureCerebrovascular

Ischemic strokeCerebral hemorrhageCerebral vasculitis

Cerebral edema

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Respiratory Disorders and Methamphetamine UsePulmonary edemaBronchitisPulmonary hypertensionCOPD

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Formication

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Formication

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Source: The New York Times, June 11, 2005.Source: The New York Times, June 11, 2005.

“METH Mouth”“METH Mouth”

METH Use Leads to Severe Tooth Decay!

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MethamphetaminePsychiatric Consequences

Paranoid reactionsPermanent memory lossDepressive reactionsHallucinationsPsychotic reactionsPanic disordersRapid addiction

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Methamphetamine Psychosis Inpatients

Psychotic symptom Lifetime Current

Persecutory delusionAuditory hallucinationsStrange or unusual beliefsThought readingVisual hallucinationsDelusion of referenceThought insertion or made actNegative psychotic symptomsDisorganized speechDisorganized or catatonic behavior

130 (77.4)122 (72.6)98 (58.3)89 (53.0)64 (38.1)64 (38.1)56 (33.3)

35 (20.8)75 (44.6)39 (23.2)27 (16.1)38 (22.6)20 (11.9)18 (10.7)36 (21.4)19 (11.3)14 (8.3)

No. of patients having symptoms(%)

Srisurapanont et al., 2003

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THERAPEUTIC DRUGS

DiureticsRapid weight loss

Boxing, wrestling, judo

Excretion or dilution of illegal substances

Overall negative impact on performance

Dehydration, hypotension, muscle cramps, electrolyte

imbalance

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THERAPEUTIC DRUGS

OpioidsPrescription pain killers most common

Allow performance while injured

75% used after injury only

Increased risk of further injury, dependence,

drowsiness, mental clouding; in high doses: respiratory

depression, hypotension

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THERAPEUTIC DRUGS

Beta-BlockersAnti-tremor, anxiolytic effect

Shooters, ski jumpers, archery

Negative effect on endurance

Depression, bronchospasm, fatigue

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PERFORMANCE ENHANCING DRUGS

Peptide hormones: HCG

Increases testosterone

Maintains testicular volume with anabolic

steroid use

Ovarian cysts

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PERFORMANCE ENHANCING DRUGS

Pituitary and synthetic gonadotropinsIncreases testosterone, anti- estrogenicOvarian cysts

CorticotropinsIncrease testosteroneRare and related to excess corticosteroids-

pituitary suppression, immunity, osteoporosis, hyperglycemia

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PERFORMANCE ENHANCING DRUGS

Growth hormone

Increase muscle mass & decrease fat mass

Gigantism, acromegaly, hypothyroidism,

cardiac disease, myopathies, arthritis, diabetes

mellitus, impotence, osteoporosis

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PERFORMANCE ENHANCING DRUGSErythropoietin (EPO)

Stimulates RBC productionIncreases oxygen carrying capacityCVAs

Blood dopingRBC transfusion, artificial oxygen carriersIncreases oxygen carrying capacityAllergic reactions, sludging of blood

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FOOD SUPPLEMENTS

76-100% of athletes use vs. 50% general

population

May or may not contribute to enhanced

performance

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WHAT DO WE HAVE IN COMMON?

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Questions?