1. 1 1 المنشطات و أضرارها PERFORMANCE ENHANCING DRUGS

2. 2 Athletic or Performance-Related Fitness Agility Balance or equilibrium Coordination Power Reaction time Speed or velocity

3. 3 PERFORMANCE ENHANCING DRUGS

4. 4 Performance-Enhancing Drugs Anabolic Steroids Description Drugs derived from testosterone and approved for medical use, but often used by athletes to increase musculature and weight.

5. 5 Performance-Enhancing Drugs Anabolic Steroids Claims May enhance performance and improves physical appearance. Reported to increase lean muscle mass, strength, and the ability to train longer and harder.

6. 6 Performance-Enhancing Drugs Anabolic 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.

7. 7 Table 5-3, p.126

8. 8 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.

9. 9 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.!

10. 10 Performance-Enhancing Drugs Androstenodione Claims Improves testosterone concentration, increases muscular strength and mass, helps reduce body fat, enhances mood, and improves sexual performance.

11. 11 Performance-Enhancing Drugs Androstenodione 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.

12. 12 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

13. 13 SYMPTOMS OF P.E.D. USE Rapid weight gain with larger muscle mass Aggressiveness Jaundice/Skin color change Purple or red spots on body Swelling of feet and legs Shaking and/or trembling Persistent body odors Severe acne breakouts with abnormally oily skin

14. 14 DOES THIS LOOK APPEALING TO YOU?

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16. 16 CNS Stimulants CRACK METHAMPHETAMINE COCAINE

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18. Stimulants Description: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

19. 19 Types of Stimulant Drugs 1- Cocaine Products Cocaine Powder (Generally sniffed, injected, smoked on foil) “Crack” (smoked)

20. 20 Types of Stimulant Drugs 2- Amphetamine Type Stimulants (ATS) Amphetamine“Speed” Dexamphetamine“Ice” Methylphenidate “Crank” Methamphetamine“Go Fast”

21. Methamphetamine vs. Cocaine Cocaine 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 cessation Methamphetamine 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

22. Acute Stimulant Effects Psychological Increased energy Increased clarity Increased competence Feelings of sexuality Increased sociability Improved mood Powerful rush of euphoria - freebase and intravenous only

23. Acute Stimulant Effects Physical Increased heart rate Increased pupil size Increased body temperature Increased respiration Constriction of small blood vessels Decreased appetite Decreased need for sleep Numbness of nasal mucosa - intranasal only

24. Chronic Stimulant Effects Physical Weight loss/anorexia Sleep deprivation Respiratory system disease Cardiovascular disease Headaches Severe Dental disease Needle marks and abscesses - intravenous only Seizure Agitation and violence

25. 25 Long-term effects of stimulants  Strokes, seizures, and headaches  Irritability, restlessness  Depression, anxiety, irritability, anger  Memory loss, confusion, attention problems  Insomnia  Paranoia, auditory hallucinations, panic reactions  Suicidal ideation  Sinus infection  Loss of sense of smell, nosebleeds, chronic runny nose, hoarseness  Dry mouth, burned lips  Worn teeth (due to grinding during intoxication)  Problems swallowing  Chest pain, cough, respiratory failure  Disturbances in heart rhythm and heart attack  Gastrointestinal complications (abdominal pain and nausea)  Loss of libido  Malnourishment, weight loss, anorexia  Weakness, fatigue  Tremors  Sweating  Oily skin, complexion

26. 26 Crystalline white powder Snorted in “lines” of 10-35 mg each Adulterated w cheap local anesthetics, stimulants, and inert white powders Yields moderate to high blood levels Gradual onset of effects at 15-20 min with peak at 30-60 min Cocaine Hydrochloride

27. 27 Soluble in water Peak blood levels achieved instantaneously Rapid onset, brief duration, intense “crash” Rapid development of compulsive use pattern “Speedball” when mixed with heroin to cushion the “crash” Cocaine Hydrochloride: Intravenous Administration

28. 28 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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31. 31 Their Brains have been Re-Wired by Drug Use Their Brains have been Re-Wired by Drug Use Because…

32. 32 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!

33. 33 Euphoric mood Increased energy, alertness Increased sexuality Paranoia Increased heart rate, blood pressure Cocaine: Acute Effects

34. 34 Lethargy, fatigue Reduced attention span Sexual dysfunction Depression, irritability, anhedonia Paranoid psychosis Cocaine: Chronic Effects

35. 35 Cardiac arrhythmias, fibrillation Hyperthermia- > 106º F Convulsions, loss of consciousness Respiratory & cardiac arrest Abruptio placentae (miscarriage) Fatal reactions rare, but unpredictable Cocaine: Toxic Reactions

36. 36 Rebound dysphoria Agitation, restlessness Intensifies with dosage & chronicity of use Cravings & drug-seeking behavior Abuse of alcohol & other drugs Suicidal ideation, behavior Often followed by prolonged sleep Cocaine “Crash”

37. 37 Cocaine/Amphetamines “The Runs” DRUG TAKING CRAVING DRUG TAKING CRAVING The Blues FATIGUE DEPRESSION HYPERPHAGIA CRASH DRUG TAKING sleep

38. 38 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

39. 39 Ice High 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

40. 40 Cardiac Disorders and Methamphetamine Coronary Syndromes Arrhythmia Cardiomyopathy Hypertension Valvular Disease

41. 41 Neurologic Disorders and Methamphetamine Use Headache Seizure Cerebrovascular Ischemic stroke Cerebral hemorrhage Cerebral vasculitis Cerebral edema

42. 42 Respiratory Disorders and Methamphetamine Use Pulmonary edema Bronchitis Pulmonary hypertension COPD

43. 43 Formication

44. 44 Formication

45. 45 Source: The New York Times, June 11, 2005. “ METH Mouth ” METH Use Leads to Severe Tooth Decay!

46. 46 Methamphetamine Psychiatric Consequences Paranoid reactions Permanent memory loss Depressive reactions Hallucinations Psychotic reactions Panic disorders Rapid addiction

47. 47 Methamphetamine Psychosis Inpatients Psychotic symptomLifetimeCurrent Persecutory delusion Auditory hallucinations Strange or unusual beliefs Thought reading Visual hallucinations Delusion of reference Thought insertion or made act Negative psychotic symptoms Disorganized speech Disorganized or catatonic behavior 130 (77.4) 122 (72.6) 98 (58.3) 89 (53.0) 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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51. 51 THERAPEUTIC DRUGS Diuretics Rapid weight loss Boxing, wrestling, judo Excretion or dilution of illegal substances Overall negative impact on performance Dehydration, hypotension, muscle cramps, electrolyte imbalance

52. 52 THERAPEUTIC DRUGS Opioids Prescription 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

53. 53 THERAPEUTIC DRUGS Beta-Blockers Anti-tremor, anxiolytic effect Shooters, ski jumpers, archery Negative effect on endurance Depression, bronchospasm, fatigue

54. 54 PERFORMANCE ENHANCING DRUGS Peptide hormones: HCG Increases testosterone Maintains testicular volume with anabolic steroid use Ovarian cysts

55. 55 PERFORMANCE ENHANCING DRUGS Pituitary and synthetic gonadotropins Increases testosterone, anti- estrogenic Ovarian cysts Corticotropins Increase testosterone Rare and related to excess corticosteroids- pituitary suppression,  immunity, osteoporosis, hyperglycemia

56. 56 PERFORMANCE ENHANCING DRUGS Growth hormone Increase muscle mass & decrease fat mass Gigantism, acromegaly, hypothyroidism, cardiac disease, myopathies, arthritis, diabetes mellitus, impotence, osteoporosis

57. 57 PERFORMANCE ENHANCING DRUGS Erythropoietin (EPO) Stimulates RBC production Increases oxygen carrying capacity CVAs Blood doping RBC transfusion, artificial oxygen carriers Increases oxygen carrying capacity Allergic reactions, sludging of blood

58. 58 FOOD SUPPLEMENTS 76-100% of athletes use vs. 50% general population May or may not contribute to enhanced performance

59. 59 WHAT DO WE HAVE IN COMMON?

60. 60 Questions?