Updated: 10/3/2018

Steroids & Stimulants

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Anabolic steroids
  • Introduction
    • cause increase in muscle strength 
    • increase aggressive behavior
    • increased erythropoiesis
    • side effects  
      • hypertension
      • liver tumors
      • increased LDL
      • decreased HDL  
      • hypercholesterolemia
  • Intake
    • either oral or injection routes possible
  • Evaluation
    • an abnormally low high-density lipoprotein level should alert the physician to the possibility of steroid use in an athlete. 
    • blood testing examines for testosterone to epitestosterone ratio of > 6:1
  • Physical exam
    • increased body weight
    • testicular atrophy
    • irreversible deepening of female voice
    • alopecia (irreversible)
    • reduction in gonadotropic and sex hormones (estrogen and testosterone)
      • can lead to decreased bone mineral density
      • oligospermia or azoospermia
    • growth retardation
    • gynecomastia
  • Type of steroids
    • Human Growth hormone (HGH)
      • the most abundant substance produced by the pituitary gland.  Growth hormone has a direct anabolic effect by accelerating the incorporation of amino acids into proteins.  It is becoming an increasingly popular anabolic steroid substitute; 
      • similar effects from insulin-like growth factor (IGF-1)
      • increased muscle size but not strength
      • Side effects:
        • myopathic muscles development
        • carpal tunnel syndrome
        • insulin resistance
    • Androstenedione
      • an androgen produced by the adrenal glands and gonads
      • acts as a potent anabolic steroid and is converted in the liver directly to testosterone with a resultant increase in levels after administration.
    • DHEA
      • is a naturally occurring hormone made by the adrenal cortex.
      • it is converted to androstenedione, which in turn is converted to testosterone.  
      • the beneficial and adverse effects of DHEA can be correlated directly with those of testosterone.
    • Erythropoietin (EPO)
      • stimulates hemoglobin production and increases O2 carrying capacity
      • side effects
        • increased blood viscosity which can lead to stroke or myocardial infarctions
    • Somatotropin
      • a growth hormone that causes hypertrophy of type 1 muscles and atrophy of type 2 muscle
Catabolic Hormones
  • Glucagon
    • has a catabolic effect on skeletal muscle 
Supplements
  • Creatine
    • Introduction
      • derived from glycine, arginine, and methionine
      • a muscle and power building supplement (not an anabolic steroid)
      • mechanism is that creatinine is converted to phosphocreatine, which acts as a source of ATP for muscle
        • studies have shown although it can increase work in anaerobic trials, it cannot increase peak force
      • widely used in conjunction with off-season weight lifting programs
    • Outcomes
      • studies show mixed results with regard to enhanced sports performance
    • Risks
      • pulls water from blood vessels into cells, creating a theoretical risk of dehydration
    • Reports of
      • cramps
      • increased muscle injury
      • renal insufficiency (rare)
Stimulants
  • Includes
    • caffeine
      • doses of 2 to 3 mg/kg have been shown to improve performance
      • works by reducing fatigue and increasing alertness
      • previously banned by the International Olympic Committee (IOC)
        • now allowed up to 12 micrograms per milileter of urine
    • ephedra
    • ephedrine
    • "ma huang"
      • often included in energy drinks
    • amphetamines 
  • Risks include
    • dehydration
    • impaired heat management
    • high blood pressure
    • nervous system impairment

 
 

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Questions (14)
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(OBQ08.62) An athlete asks about performance enhancing substances. Which of the following side effects is more common with creatine than with testosterone? Review Topic

QID: 448
1

Muscle cramping

96%

(3254/3381)

2

Hair loss

1%

(22/3381)

3

Testicle atrophy

1%

(46/3381)

4

Acne

1%

(28/3381)

5

Impotence

1%

(20/3381)

L 1

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(SAE07SM.45) What is the most common behavioral effect of anabolic steroid use in athletes? Review Topic

QID: 8707
1

Increased aggression

92%

(213/231)

2

Psychosis

0%

(0/231)

3

Drug dependence

3%

(6/231)

4

Depression

4%

(10/231)

5

Mania

0%

(0/231)

L 1

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(OBQ07.268) A weightlifter informs you that he has been using methandrostenolone for performance enhancement. You advise him of the potential side effects. Which of the following has not been linked to the use of this product? Review Topic

QID: 929
1

Decreased sperm count

2%

(37/1501)

2

Hypertension

2%

(34/1501)

3

Altered lipid profiles

2%

(29/1501)

4

Acne

1%

(21/1501)

5

Decreased vision

91%

(1373/1501)

L 1

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(OBQ07.238) At present, there is no widely accepted urine test to detect the use of which of the following performance-enhancing drugs? Review Topic

QID: 899
1

Ephedrine

9%

(105/1173)

2

Dihydroepiandosterone

7%

(78/1173)

3

Androstenedione

4%

(50/1173)

4

Human growth hormone

73%

(857/1173)

5

Tetrahydrogestrinone

7%

(78/1173)

L 2

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(SBQ07SM.45) A 17-year-old wrestler is noted to demonstrate increased aggression and hostility toward others at school. These are the most common behavioral side effects of what performance enhancing drug? Review Topic

QID: 1430
1

Furosemide

0%

(6/1315)

2

Erythropoietin

4%

(57/1315)

3

Stanozolol

78%

(1030/1315)

4

a-Ketoglutarate

16%

(213/1315)

5

Propranolol

0%

(4/1315)

L 2

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(SBQ07SM.19) Which of the following is a side-effect from anabolic steroid use? Review Topic

QID: 1404
1

Renal failure with secondary hyperpararthyroidism

14%

(43/317)

2

Decrease in low density lipoprotein

3%

(8/317)

3

Decreased blood pressure

1%

(3/317)

4

Decrease in fat

5%

(17/317)

5

Decrease in high density lipoprotein

76%

(242/317)

L 3

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(OBQ05.248) A 32-year-old professional cyclist suffered a myocardial infarction 6 months ago secondary to long term anabolic steroid use. Which of the following options describes the mechanism by which steroids most likely caused this patient's heart disease? Review Topic

QID: 1134
1

Increased plasma levels of high density lipoproteins

6%

(42/743)

2

Decreased systolic and diastolic blood pressure

2%

(14/743)

3

Increased plasma levels of low density lipoproteins

76%

(564/743)

4

Alteration of myocardial conduction patterns

6%

(45/743)

5

Direct endothelial damage to coronary arteries

10%

(78/743)

L 3

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(OBQ05.215) What effect does glucagon have on skeletal muscle? Review Topic

QID: 1101
1

Anabolic

24%

(379/1548)

2

Catabolic

68%

(1052/1548)

3

No effect

6%

(91/1548)

4

Nootropic

0%

(3/1548)

5

Ergogenic

1%

(22/1548)

L 3

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