SCS Pharmacology & Medication Management 2 — Questions and Answers
Question 1: An athlete taking warfarin for a DVT wants to use ibuprofen for knee pain. What is the primary concern?
- Reduced anticoagulant effect
- Increased bleeding risk due to additive anticoagulation and GI irritation (Correct answer)
- Decreased ibuprofen efficacy
- Warfarin-induced hepatotoxicity
Correct answer: Increased bleeding risk due to additive anticoagulation and GI irritation
NSAIDs like ibuprofen inhibit platelet aggregation and cause GI mucosal irritation, potentiating warfarin's anticoagulant effect and significantly increasing bleeding risk.
Question 2: Which medication class is most commonly associated with exercise-induced hypotension in athletes?
- Beta-blockers (Correct answer)
- Calcium channel blockers
- ACE inhibitors
- Thiazide diuretics
Correct answer: Beta-blockers
Beta-blockers blunt the compensatory increase in heart rate during exercise and can impair cardiac output augmentation, leading to exercise-induced hypotension.
Question 3: A college soccer player is prescribed fluoroquinolone antibiotics for a sinus infection. What sports medicine concern should be communicated?
- Increased photosensitivity during outdoor training
- Elevated risk of tendon rupture, particularly the Achilles (Correct answer)
- Reduced aerobic capacity during treatment
- Potential for cardiac arrhythmia with exertion
Correct answer: Elevated risk of tendon rupture, particularly the Achilles
Fluoroquinolones are associated with tendinopathy and tendon rupture, with the Achilles tendon being most commonly affected, requiring activity modification during treatment.
Question 4: Corticosteroid injections administered repeatedly into a tendon can cause which pathological change?
- Calcific tendinopathy
- Tendon degeneration and increased rupture risk (Correct answer)
- Peritendinous fibrosis
- Acute tendon hypertrophy
Correct answer: Tendon degeneration and increased rupture risk
Repeated corticosteroid injections inhibit collagen synthesis and promote collagen breakdown, leading to tendon degeneration and a significantly elevated risk of rupture.
Question 5: An athlete using inhaled corticosteroids for asthma asks if the medication will affect their performance. The SCS should explain that:
- Inhaled corticosteroids are banned in all competitive sports
- Inhaled corticosteroids at therapeutic doses do not significantly enhance performance (Correct answer)
- Systemic absorption is high enough to require a therapeutic use exemption
- They improve VO2 max in asthmatic athletes
Correct answer: Inhaled corticosteroids at therapeutic doses do not significantly enhance performance
Inhaled corticosteroids at standard therapeutic doses have minimal systemic absorption and are not considered performance-enhancing; they are permitted in competition with appropriate documentation.
Question 6: Which analgesic has the greatest risk of nephrotoxicity when used chronically in a dehydrated athlete?
- Acetaminophen
- NSAIDs (Correct answer)
- Tramadol
- Codeine
Correct answer: NSAIDs
NSAIDs inhibit prostaglandin-mediated renal afferent arteriole dilation, reducing glomerular filtration rate; dehydration exacerbates this effect, increasing nephrotoxicity risk.
Question 7: A marathoner prescribed lithium for bipolar disorder competes in hot weather. What electrolyte imbalance should be monitored?
- Hyperkalemia
- Hyponatremia leading to lithium toxicity (Correct answer)
- Hypercalcemia
- Hypermagnesemia
Correct answer: Hyponatremia leading to lithium toxicity
Sodium depletion from sweating increases renal lithium reabsorption (lithium is handled like sodium), raising serum lithium levels and increasing toxicity risk.
SCS Pharmacology & Medication Management 2
An athlete taking warfarin for a DVT wants to use ibuprofen for knee pain.
What is the primary concern?