Lesson 3: DEALING WITH MEDICATION

Check up

1 Classify the drugs a-h according to type.

a
Paracetamol
b
Cyclizine
c
d
Salbutamol
Aspirin
e Amoxicillin
f Ranitidine
g Chlorphenamine
h
Diazepam

1 _______ antibiotic
2 _______ analgesic
3 _______ antiemetic
4 _______ sedative / hypnotic
5 _______ gastrointestinal
6 _______ antihistamine
7 _______ cardiovascular
8 _______ respiratory
2 Work in pairs. Discuss the benefit of each drug given.
Useful expressions
It is used to ... It’s prescribed in order to ....
It helps ...
3 In the United States, drugs are approved for use by the Food and Drug Administration
(FDA) and in the UK by the National Institute for Clinical Excellence (NICE). Which
body licenses / approves drugs in your country?
4 Discuss the arguments for and against making generic versions of new medicines
available in every country.

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Patient care
1 There are guidelines for prescribing any drugs in the hospital.
Discuss why these are important and what might go wrong if you
do not follow them.
1 Always consult the BNF when prescribing for children.
2 Consult your seniors when in doubt.
3 Check if the patient has allergic reactions to drugs.
4 Check is the patient is a responsible person.
5 Check for alternatives to drugs.
2 What other guidelines do you think should be followed before
prescribing on or off the ward?
Vocabulary
Abbreviations
1 Match these common prescription abbreviations with their meaning.
1 PO a in the morning
2 prn b two tablets
3 stat c by mouth / orally
4 od d immediately
5 g e gram
6 ṪṪ f as required
7 om g once a day / 24h
2 Work in pairs. Say the meaning of these abbreviations used in administering drugs.
the frequency of drugs: on. bd. tds. qds. 4-6h. 8h. 1-4h

the route of administration: IV. IM. SC. PR. INH. NEB

measurements: µg. mg. ml

3 Work in pairs. Take turns reading this chart aloud. Say the abbreviations as complete
words.
Drug Dose Freq Route 24 h Max
paracetamol 1g qds PO 4g
loperamide 4mg PRN PO 16 mg
ranitidine 150 mg bd PO 300 m

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 atorvastatin 10 (10-80 mg) od PO 80 mg
Example
Give the patient one gram of paracetamol four times a day by mouth up to a maximum of
4 grams.
Give between ... and ....
Give up to a maximum of ...
Listening 1
A drug chart
1 Study the chart below and make sure you understand the abbreviations, headings, and so
on.
Patient Dob Hospital No
Mrs. T Hawthorne 04.02.63 1834572Z
Drug Date
____________1 ___________2
Route Dose Start Time
___________3 50 mg ___________4 __________5
Max Frequency Max dose / 24hr Dose
___________6 600 mg 50 mg
Indications for use Route
___________7 ___________8
Signature Pharmacy Given by
A Smith ___________9

2 Listen to a doctor checking the chart with a

colleague and complete the missing information
in the chart.

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It’s my job

Joyce Carne
I work as a nurse practitioner (NP) at New York City Hospital. I am a registered nurse who has
completed specific advanced nursing education. I have a master’s in cardiovascular medicine and
training in the diagnosis and management of common medical conditions in this specialty.

I provide much of the same basic, non-emergency care provided by physicians, generally of the
type seen in their specific practice areas like family practice offices, urgent care centers, and rural
health clinics, and maintain collaborative working relationships with physicians. As an NP, I am
licensed by the state in which I practice through the NCC (National Certification Corporation) for
specialty practice. Rather than a generic focus of education as a nurse practitioner I am able to
specialize in an area of study I desire and provide care within the scope of my expertise.

I may treat both acute and chronic conditions, as well as

prescribe medications and therapies for the patient at
hand. The core philosophy of the field is individualized
care. Nurse practitioners focus on patients’ conditions as
well as the effects of illness on the lives
of the patients and their families.
Informing patients about their health care and encouraging them to participate in
decisions are central to the care provided by NPs.

A major concern for myself and other medical practitioners at all levels is
concordance, once a drug has been prescribed. Concordance involves a process
of prescribing and medicine-taking; it is a kind of partnership. It is not just a
matter of explaining the benefits of prescribed drugs and the side effects which
can sometimes happen, but which may not. Improving concordance is about
involving the patient in making decisions about the treatment.

1 Work in pairs. Read the text and then answer the questions.
1 Is concordance a cause for concern for Nurse Carne and her fellow NPs?
2 What type of conditions can she treat?
3 What does she consider the central philosophy of working as a nurse practitioner?
4 Why does she feel her patients need to be involved in treatment decisions?
5 What specific post-graduate training has she undergone?
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 6 How does her work compare with that of physicians?
2 In groups, discuss who you think should have the right to prescribe medicine.
3 Do you have nurse practitioners or nurses with similar roles in your country? Describe
their roles regarding administering and prescribing medicine.
Listening 2
Benefits and side effects
1 The sentences below are from an explanation of the benefits and side effects of aspirin to
a patient, Mr. Johnson, who is being discharged after an uncomplicated MI. Work in
pairs. In your own words, complete the blank spaces in the doctor’s sentences.
1 I’ve got some good news for you. you’ve made ____________ and we’re going to
____________.
2 First, I’d just like to have a brief chat with you ____________.
3 If at any time you want to stop me and ask questions, ____________. There’s a lot of
information to take in at one time.
4 We’re going to give you a very small dose of 75 mg. It’s much smaller dose than
you’d normally buy over the counter, You take it ____________.
5 The aspirin will help you a lot, as ____________ and so ____________.
6 And I emphasize the word possible, ____________. But I just have to point them out,
so that you are aware of them and can do something about it if anything happens.
7 Sometimes, people get ____________. Or aspirin can make ____________. Or it can
cause ____________.
2 Listen and make notes for each blank space in 1.
Do not try to write down every word.
3 Compare your notes with a partner and then write
the complete sentences.
4 Listen again and check your answers.
5 Look at the listening script and see how close your
answers were.
6 Work in pairs. Take turns explaining the benefits and side effects of aspirin.

Speaking
1 Work in pairs. Answer the questions below about the doctor in Listening 2. Does the
doctor:

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 1 use the simple non-technical language?
2 keep the drug regime simple?
3 explain the function of the medication clearly?
4 ask the patient to repeat the information given?
2 Does the doctor involve the patient in making decisions about taking the medication?
Why / Why not?
3 If you think that the doctor could have done more, what could he have done?
4 Work in pairs. Take turns explaining the benefit and side effects of aspirin again. If you
need help, check the script on page 135.
Language spot
Phrasal verbs
 In Listening 2 the doctor says to the patient:
There’s a lot of information to take in at one time.
 The verb to take in means here to understand. It is a separable phrasal verb because you
can separate the verb take and the particle in:
It is difficult to take in information.
 
verb particle

It is difficult to take information in.

 
verb particle

 The verb to get up is an example of an inseparable phrasal verb because you cannot
separate the verb and the particle:
If you can, take the medication soon after you get up in the morning.
 
verb particle

Rewrite these sentences using the phrasal verbs. You may have to change the form of the
verbs and you may be able to separate the particle from the verb.
take out write out point out cut down look at
get in touch with get into
1 The doctor identified a few benefits and a few side effects.
2 You could keep a pill box with the days of the week on it and remove the tablets each
day.
3 Completing a prescription requires great care.
4 Don’t forget to read the instructions on the label.

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 5 Try to adopt a routine for taking medication if you can.
6 Contact the hospital immediately if anything changes.
7 It works by reducing the workload of the heart.
Explaining side effects: can / may
 When you explain the benefits of a drug to a
patient, you state what the drug does. To show that
a drug or medicine causes side effects in some
people, it is important to understand the difference between can and may. Both words are
used to express possibility and are often used interchangeably. However, can indicates a
theoretical possibility while may indicates a real possibility. Compare:
That door can be locked.
= It is possible to lock that door. Right now, it is either locked or unlocked.
That door may be locked.
= It is possible that the door is locked right now. Is it is locked, we won’t be able to open
it.
Can
Can is used to say that a side effect is possible.
This medication can cause some stomach irritation.
= It is possible for this medication to cause some stomach irritation.
Here, can indicates that stomach irritation is a possibility. To reassure patients, you can
emphasize that the side effects is theoretical possible, but not of serious concern to the patient
you’re talking to.
This occasionally causes stomach irritation in some people.
Sometimes, people get stomach irritation with this, but it isn’t usually a problem.
May
May also expresses that a side effect is possible.
This medication may cause some stomach irritation.
= It is possible that this medication will cause some stomach irritation.
In this case, may indicates the possibility of the statement being or becoming true. The word
may in this sense is frequently stressed, and indicates that stomach irritation is a strong
possibility. You may want to emphasize this.
There’s a strong possibility that this will upset your stomach.

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 1 Use the words to complete the sentences.
possibility will probably
may may may not
1 In some people, it can cause a fleeting headache,
but it doesn’t mean you ___________ get one.
2 Theoretically, this can cause low blood pressure,
but you ___________ won’t have a problem.
3 Some people get blurred vision, but it ________
happen in your case.
4 There’s a strong __________ that this will upset
your stomach. In fact, it may make you feel
really ill.
5 Swelling of the ankle is not common, but it is possible – it ___________ happen.
6 This ___________ make you feel dizzy, so you should be careful when you drive.
2 Work in pairs. write sentences like those in 1 about the benefits and side effects of the
sedative diazepam.
Speaking
1 Work in groups of three. Discuss the benefits and side effects of these drugs for a patient
at discharge who has had a mild, uncomplicated MI.
Atenolol GTN spray Simvastatin
Benefits
Side effects
2 Take turns explaining the medication to your partners.
Useful expressions
And like aspirin ......
In some cases the tablets can ...
Some people ...
There are some people ...
Is everything clear so far?
How do you feel about taking this medication?
Do you think you will be able to remember to take them as prescribed?
Also try to use some of the phrasal verbs from Language spot on page 40.

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 3 The third student should listen and give feedback using this grid, where 1 is the highest.
Feedback form
1 Using simple language 12345
2 Deals with the benefits 12345
3 Deals well with the side effects 12345
4 Involves the patient 12345
5 Checks the patient has understood 12345

4 If possible, keep a video record. Play back the recording to your classmates. Use the
feedback form to discuss the conversation.
Reading
Concordance
1 Read the text and answer these questions.
1 What features of new medicines should make people take the medicines prescribed to
them?
2 Which medicines are least likely to be taken by patients?
3 Which group is more likely not to take medicine prescribed because they do not
believe the illness is there?
4 Besides providing information, what effective ways can improve compliance?
5 What is more important than increasing compliance in patients?
6 What do patients need to be helped to make?
7 What can be of help to both the individual and the general population?

Non-compliance in medicine taking is a long-standing problem in all therapeutic areas,

including the treatment of cancer. There is strong evidence that, despite the introduction of
new medicines which have fewer side effects and are more convenient to use, many people
still do not take them as prescribed – even when not doing so can have life-threatening
consequences.
Medicines prescribed for preventive purposes are especially likely not to be taken as
prescribed. This may be because people do not feel immediately threatened and, in case of
symptomless conditions such as raised cholesterol levels and hypertension, feel no obvious
benefit at the time when medicines are taken.

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 Factors associated with poor compliance include:
 complex regimens involving multiple doses and several medicines.
 unwanted side effects
 concerns about the value or appropriateness of taking medicines in particular contexts.
 denial of illness, especially among younger people.
 confusion or physical difficulties associated with medicine taking, which most frequently
affect older people.
Effective ways of improving compliance rates involve the complementary use of educative,
practical, and emotionally and behaviourally supportive interventions, rather than the
provision of information alone. There is evidence that, regardless of the specific knowledge
imparted, self-management programmes which help to raise people’s sense of self-efficacy
and confidence promote better medicine taking.
Health professionals should respect patient’s autonomy and accept that increasing compliance
with prescribing instructions is not as important as meeting patient’s individual needs and
priorities. Patients need help to make informed choices about treatment. For example, there is
a need to differentiate clearly between situations where varying the timing or quantity of
medicine doses may do little harm or even be beneficial, and situations in which there is a
high probability of adverse clinical outcomes.
Improvements in self-management skills and compliance in medicine taking can generate
significant benefits for individuals and the population as a whole. Combining medication
reviews with other forms of timely and appropriate support for patients and careers represents
an important route towards better and more cost-effective use of medicines.
2 Work in groups. Discuss the question of compliance among patients in your country by:
1 answering questions 1-7 in 1.
2 comparing the statistics at the top of page 41 with those for your own country, if they
are available.
3 giving examples of non-compliance and effective ways of dealing with it.
Project
Search the web and check references to clinical incident reporting in UK hospitals. Find out
what is involved in the procedure.
1 Is such reporting a good idea?
2 What is it called in your country and what happens there?

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Writing
Clinical incident reporting
1 Look at the sample clinical incident reporting form below.
Name of staff involved Grade and specialty Agency / locum
C.J. Flint PRHO Medicine N/A

Brief details of incident:

Patient was prescribed augmentin 625 mg/8h PO, despite penicillin allergy (this was

stated on drug chart). This was noted by the pharmacist and the patient did not

take any augmentin. The team PRHO was contacted and an alternative antibiotic was

prescribed.

2 Without looking at the from in 1, expand the notes below into full sentences.
Notes
patient prescribe augmentin 625 mg/8h PO

penicillin allergy state on drug chart. noted pharmacist patient not take augmentin

Dr Perez team

contact alternative antibiotic prescribe

3 Complete two clinical incident reporting from the notes below. In each case it was a ‘near
miss’ incident.
Notes
1
patient flumazenil 200 mcg iv up to 1 mg. drug chart / patient epileptic.

noted Duncan patient not take flumazenil Dr Zhou team contact alternative

drug.

2 Notes
prescribe tetracycline 250-500 / 6h drug chart patient photosensitive noted

pharmacist patient not take drug Dr Harper team contact alternative

4 In groups, discuss clinical incident reporting. Give examples from your experience.
Discuss why the procedure is important for the patient, the hospital, and for you and / or
your colleagues.
5 Is it difficult to admit mistakes like this in all cultures? Give reasons and examples.

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Checklist
Assess your progress in this unit. Tick () the statements which are true.
I can talk about medications.
I can understand drug charts and abbreviations.
I can talk about the benefits and side effects of medication.
I can understand and use patient language.
I can write / understand a clinical incident report.
Key words
Nouns Abbreviations
benefit bd g
side effect IM INH
IV NEB
od om
on PO
PR prn
qds stat
tds ṪṪ
Definitions
- concordance (n): a process whereby the doctor / prescriber and the patient cooperate in
the prescribing process to maximize the taking of medication.
- generic (adj): general, non-specific
- master’s (n): a postgraduate degree: an MA / MSc
- scope (n): range, capacity
- complementary (adj); balanced
- factor (n): cause, element
- regimen (n): course of treatment, schedule

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