16.3 Pharmacological Principles & Common Medications
Key Takeaways
- In most jurisdictions ATs do not prescribe; they administer only as allowed by state practice act and standing orders, then educate, document, and store medications legally.
- Pharmacokinetics is ADME—absorption, distribution, metabolism, elimination; pharmacodynamics is what the drug does at the receptor and tissue.
- NSAIDs carry GI and kidney risk, especially with dehydration; do not overclaim fracture-healing harm; tendon corticosteroid injection is a physician procedure.
- NCAA/WADA banned classes include stimulants, anabolic agents, and diuretics/masking agents; a TUE or NCAA medical exception is not a teammate’s pill bottle.
- Exam traps: sharing a teammate’s ADHD amphetamine, and calling a supplement legal because it is natural.
Quick Answer: Athletic trainers typically do not prescribe. They administer medications only as allowed by state practice act, standing orders/protocols, and federal law; they educate, document, and store legally. Pharmacokinetics is ADME (absorption, distribution, metabolism, elimination). Pharmacodynamics is what the drug does to the body. Know NSAID GI and kidney risk without overclaiming fracture nonunion; acetaminophen liver risk; corticosteroid tendon injection as a physician procedure (fat-pad atrophy, tendon-rupture risk); SABA inhalers, epinephrine, glucagon, and naloxone only per protocol. NCAA and WADA ban stimulants, anabolic agents, diuretics/masking agents, and related PED classes. Therapeutic use exemption (TUE) / NCAA medical exception is a documented medical pathway—not a teammate’s Adderall. Exam traps: sharing ADHD amphetamine; “it’s natural so it’s legal.”
CAATE professional standards expect the AT to educate patients on indications, contraindications, interactions, and adverse effects, and to administer medications upon the order of a physician or other provider with legal prescribing authority. The 2018 Inter-Association Consensus Statement on Management of Medications by the Sports Medicine Team is blunt: unless a state practice act says otherwise, ATs cannot prescribe or dispense prescription drugs. A physician cannot delegate dispensing of a multi-dose prescription supply to an AT. Some states allow administration of emergency prescription medications (epinephrine auto-injector, naloxone, glucagon) and limited OTC single-dose administration under protocol. Your job on the exam is to know the default: no prescribing, no unsupervised dispensing, yes to protocol-based administration plus education and locked storage with lot/expiration documentation.
Pharmacokinetics vs Pharmacodynamics
Pharmacokinetics is what the body does to the drug. Teach it as ADME:
| Process | Meaning | AT-relevant example |
|---|---|---|
| Absorption | How the drug enters circulation | Oral NSAID vs inhaled SABA vs intramuscular epinephrine; food, vomiting, and formulation change absorption |
| Distribution | Where it goes after absorption | Protein binding, body water, inflammation; dehydration concentrates some drugs |
| Metabolism | How it is chemically changed | Hepatic pathways; acetaminophen overdose stresses the liver, especially with alcohol |
| Elimination | How it leaves | Renal clearance; NSAIDs plus heat/dehydration raise acute kidney-injury risk |
Pharmacodynamics is what the drug does to the body: receptor agonism/antagonism, dose–response, therapeutic index, and adverse effects. A SABA (short-acting beta-2 agonist such as albuterol) agonizes airway beta-2 receptors to relax bronchial smooth muscle—that is pharmacodynamics. How much of an inhaled dose actually reaches the lung is pharmacokinetics. You need both to explain why a poorly used inhaler “doesn’t work” and why a second athlete’s unused inhaler is still the wrong solution.
Do not invent milligram doses as if they were BOC facts. Emergency epinephrine intramuscular dosing for anaphylaxis lives in the emergency chapter and on the auto-injector label; this chapter’s job is role, class, risk, and protocol.
Common Medication Classes in Athletic Health Care
NSAIDs (ibuprofen, naproxen, others) inhibit cyclooxygenase and reduce prostaglandin-mediated pain and inflammation. Counsel GI risk (dyspepsia, ulcer, bleed—worse with alcohol, anticoagulants, prior ulcer) and kidney risk (especially in a dehydrating sport, heat, or with ACE-inhibitor/diuretic “triple whammy” pictures). Cardiovascular risk exists with some agents and longer use. Fracture-healing controversy: animal models and some observational series raised concern for delayed union; more recent meta-analyses are mixed, with some showing little overall nonunion signal and others suggesting higher adverse-healing odds in adults, possibly dose- and duration-related. Do not overclaim “NSAIDs always stop bones from healing” or “NSAIDs are always bone-safe.” Short, physician-directed courses are common; the AT does not independently stop a prescribed NSAID or start a high-dose, multi-day pack.
Acetaminophen is analgesic/antipyretic without meaningful anti-inflammatory effect at usual doses. The exam risk is hepatotoxicity in overdose or in combination with other acetaminophen-containing products. It is not “harmless because it is not an NSAID.”
Corticosteroids: systemic bursts are physician decisions (glucose, mood, infection, WADA in-competition glucocorticoid rules). Tendon or bursa injection is a physician procedure. Counsel the athlete that repeated peritendinous steroid can contribute to fat-pad atrophy and tendon rupture risk; the AT does not inject the Achilles “because it is swollen.”
Antibiotics are prescribed for infection; ATs reinforce completing the course, photosensitivity (some tetracyclines), and the fluoroquinolone–tendon association as a reason to report new tendon pain to the physician—not as a license to discontinue a drug yourself.
Inhaled SABA: used per the athlete’s asthma action plan and standing order for known, physician-diagnosed asthma or exercise-induced bronchoconstriction. NCAA: inhaled beta-2 agonists generally require prescription; they sit in a banned class if misused. Do not hand a teammate’s inhaler to a first-time wheezer as if it were community property.
Epinephrine auto-injector for anaphylaxis, glucagon for severe hypoglycemia when the athlete cannot take oral carbohydrate, and naloxone for suspected opioid overdose are protocol and practice-act emergency medications. Know where they are, who may administer, and that they are documented events—not informal “just in case” pocket drugs without orders.
NCAA, WADA, TUEs, Caffeine, Supplements
The World Anti-Doping Agency (WADA) Prohibited List groups substances (examples): S1 anabolic agents (all times), S2 peptide hormones/growth factors, S3 beta-2 agonists, S4 hormone and metabolic modulators, S5 diuretics and masking agents (all times), S6 stimulants (in-competition), plus narcotics, cannabinoids, glucocorticoids, and beta-blockers in designated sports, and prohibited methods (blood manipulation, tampering, gene doping). A Therapeutic Use Exemption (TUE) is a documented, prospective (when possible) permission to use a prohibited substance because it is needed to treat a diagnosed condition, there is no reasonable permitted alternative, and the dose returns the athlete toward normal health rather than providing extra performance. Athletes apply to their anti-doping organization, not to “WADA Twitter.”
The NCAA banned-drug classes (2026–27 published list) include stimulants; anabolic agents (including SARMs); beta blockers (golf and rifle); diuretics and masking agents; narcotics; peptide hormones, growth factors, related substances and mimetics; hormone and metabolic modulators; and beta-2 agonists. NCAA language notes alignment with WADA classes except the glucocorticoid and cannabinoid classes. Examples of stimulants on the NCAA list include amphetamine (Adderall), methylphenidate, ephedrine, DMAA, synephrine (bitter orange), and caffeine and caffeine sources (green-tea extract, guarana, yerba mate). Phenylephrine and pseudoephedrine are listed NCAA exceptions among related compounds—check the current PDF, do not memorize a supplement label as gospel.
Caffeine: the NCAA does not ban ordinary coffee as a binary positive. A positive is a urinary concentration above 15 micrograms per milliliter. WADA currently monitors caffeine rather than listing it as prohibited. Energy-drink stacks plus caffeine pills can still produce a NCAA positive; metabolism varies, so do not treat a single milligram number as a personal guarantee.
Supplements are a contamination engine (anabolic agents, stimulants, diuretics). DSHEA does not make a product legal in sport. “Natural” is not a legal defense. Third-party testing (NSF Certified for Sport, Informed Sport) reduces but does not zero risk. The athlete is responsible for what is in their body; the AT’s job is education and a hard stop on sharing prescription stimulants.
NCAA medical exceptions are not identical to WADA TUEs (the programs do not automatically recognize each other). ADHD stimulant exceptions are a documented medical process—often activated around testing with records already on file—not a sideline loan from a teammate.
Exam trap: giving an athlete a teammate’s ADHD amphetamine. That is controlled-substance diversion, a banned-class exposure without that athlete’s prescription or exception, and a documentation nightmare. Exam trap: “it’s natural so it’s legal.” DHEA, synephrine, and contaminated botanicals have ended eligibility.
Which statement best describes the athletic trainer’s typical legal role with medications in U.S. practice?
A starter forgot their prescribed ADHD amphetamine. A teammate offers two of their own tablets “so you can focus for kickoff.” What is the most appropriate AT action?
An athlete wants a “natural” pre-workout that lists synephrine and DHEA, arguing that plants and hormones made by the body cannot be banned. Which teaching point is most accurate?