SCS Pharmacology & Medication Management 3 — Questions and Answers
Question 1: An athlete tests positive for a prohibited substance but provides a prescription. Under WADA rules, this athlete should have filed:
- A medical exemption certificate
- A therapeutic use exemption (TUE) (Correct answer)
- A physician waiver form
- A competition clearance letter
Correct answer: A therapeutic use exemption (TUE)
WADA requires athletes to obtain a Therapeutic Use Exemption (TUE) prior to using a prohibited substance for legitimate medical purposes.
Question 2: Which of the following is the correct mechanism of action of NSAIDs?
- Inhibit lipoxygenase pathway reducing leukotriene synthesis
- Inhibit cyclooxygenase (COX) enzymes reducing prostaglandin synthesis (Correct answer)
- Block histamine H1 receptors reducing inflammation
- Inhibit phospholipase A2 preventing arachidonic acid release
Correct answer: Inhibit cyclooxygenase (COX) enzymes reducing prostaglandin synthesis
NSAIDs inhibit COX-1 and COX-2 enzymes, blocking the conversion of arachidonic acid to prostaglandins, thromboxanes, and prostacyclin.
Question 3: A high school wrestler uses androstenedione as a supplement. As SCS, you should explain that this substance:
- Is a legal dietary supplement with no hormonal effects
- Is a WADA-prohibited androgen precursor that converts to testosterone (Correct answer)
- Only affects female athletes' hormone levels
- Is banned only in professional sports
Correct answer: Is a WADA-prohibited androgen precursor that converts to testosterone
Androstenedione is a direct precursor to testosterone and estradiol; it is classified as an anabolic androgenic steroid precursor and is prohibited by WADA at all levels.
Question 4: Which local anesthetic agent has the longest duration of action for nerve blocks?
- Lidocaine
- Procaine
- Bupivacaine (Correct answer)
- Mepivacaine
Correct answer: Bupivacaine
Bupivacaine has a duration of action of 4–8 hours for peripheral nerve blocks, significantly longer than lidocaine (1–2 hours) or mepivacaine (2–3 hours).
Question 5: Metered-dose inhalers (MDIs) used for exercise-induced bronchoconstriction are ideally administered:
- Immediately after exercise onset of symptoms
- 30 minutes before exercise
- Only during acute attacks
- 15–20 minutes before exercise for prophylaxis (Correct answer)
Correct answer: 15–20 minutes before exercise for prophylaxis
Short-acting beta-2 agonists used prophylactically for exercise-induced bronchoconstriction should be administered 15–20 minutes before exercise to provide peak bronchodilation during activity.
Question 6: An athlete on SSRIs reports increased bruising after collisions. Which pharmacological mechanism best explains this finding?
- SSRI-induced thrombocytopenia
- Serotonin depletion in platelets impairing aggregation (Correct answer)
- SSRI-induced liver dysfunction reducing clotting factors
- Increased capillary fragility from serotonin excess
Correct answer: Serotonin depletion in platelets impairing aggregation
Platelets rely on serotonin (stored from plasma) to augment aggregation; SSRIs block serotonin reuptake in platelets, depleting platelet serotonin stores and impairing hemostatic aggregation.
Question 7: Creatine monohydrate supplementation is associated with which clinical concern during pre-season two-a-day practices?
- Rhabdomyolysis exclusively
- Potential for muscle cramping and dehydration due to intracellular water retention (Correct answer)
- Cardiac arrhythmias from phosphocreatine accumulation
- Hepatotoxicity from methylation reactions
Correct answer: Potential for muscle cramping and dehydration due to intracellular water retention
Creatine draws water into muscle cells, potentially reducing plasma volume; during intense heat training, this may contribute to cramping and relative dehydration if fluid intake is inadequate.
SCS Pharmacology & Medication Management 3
An athlete tests positive for a prohibited substance but provides a prescription.
Under WADA rules, this athlete should have filed: