English in

PHARMACY

Luisa Benigni
 FIRST SECTION: UNITS PAG
UNIT 1: Pharmacy and Pharmacists E 10
- What the field of science is concerned with.
- The scope of pharmacy
- Traditional and modem services
- Trained-related fields of pharmacists
- Traditional and modem roles
- British English and American English to define pharmacies and pharmacists

UNIT 2: Pharmacology 12
• Pharmacology and pharmacy:
• what the field includes
• difference between Pharmacology and pharmacy
• sub disciplines included
• Scientific background:
• pharmacokinetics and pharmacodynamics
• pharmacokinetics: LADME

UNIT 3:Types of drugs 14

- Definition of a drug:
• Difference between endogenous and exogenous biochemical, drugs and hormones
• Recreational drug: definition, use and effects, prohibition and restriction
• Medicinal drugs:
• Definitions, dispensing and administering methods
• OTC, BTC, POM medicines
• Patented and generic medicines

UNIT 4:Terminology of drug action (1) 16

- Drug use, Drug misuse, Tolerance, Addiction, Withdrawal symptoms, Stimulants, Depressants

UNIT 5: Terminology of drug action (2) 18

- Cross tolerance and cross dependence
- Potentiation, Additive effect. Antagonism, Hypersensitivity, Side effects

UNIT 6: FDA and AME 20

- Medicine development and testing: the USA and EU regulating bodies
- FDA: functions and responsibilities, testing process
- EMEA: Functions, mission, advantages for EƯ patients

UNIT 7: Before using medicines 22

- Can medicines be dangerous?
- Before using medicines

UNIT 8: What customers should know 24

- What you need to know about medicines:
- frequently asked questions
- dosanddon’ts
- Proper use of medicines
- Self- medication: facts to think about before treating oneself

UNIT 9: Some useful tips 26

- How to store your medicine: guidelines for a correct storage
- When travelling
- Side effects of your medicine
- How to get the most from your medicine

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- Understand generic versus brand medicine
- Know what to avoid while taking the medicine

UNIT 10: OTC pain relievers 28

- Common types of OTC medicines:
• A.Pain relievers, B.Antihistamines, C.Decongestants, D.Cough medicines
- A. Pain relievers, action and side effects:
• NSAIDSs ( aspirin, ibuprofen, naproxen, ketoprofen) action and side effects
• Acetaminopthen: action and side effects.

UNIT 11: Cold and cough medicines 30

- Antihistamines.
• How they work, the main three types, side effects,
- Decongestants:
• how they work, the only OTC decongestants: pseudopheđrinẽ, side effects.
• Cough medicines:
• antitussives (guaifenesin), and expectorants(codeine and dextromethorphan)

UNIT 12: OTC medicines to children 32

- Side effects with OTC medicines for special groups
• children: acetaminophen for children’s pain relief, ibuprofen's side effects with children allergic to aspkin. Reyes’s
syndrome. Cough suppressant without codeine.
• giving the right dose at the right times. What every six, eight hours means, teaspoons and milliliters
measurements.

UNIT 13: OTC medicines to other groups 34

- Elderly people:
• NSAIDs possible side effects,
• when to avoid pseudoephedrine and dextromethorphan. Side effects.
• Pregnant and breastfeeding women:
• safe and dangerous OTC medicines
• general tips.

UNIT 14: OTC pain relievers in selected diseases 36

- A chart containing disease state or medical treatments, preferred agents, drugs to be used with caution

UNIT 15: Generic drugs 38

- What are generic drugs? What is a brand name? International Nonproprietary Names (INN)
- Generic drugs approvakwhat manufactures need to prove
- Comparing prices between branded and generic medicines

UNIT 16: Branded versus generic medicines 40

- Switching to generics: Definition of generic medicines, comparison with branded ones, regulations in Italy
- Why are brand name drugs more expensive?

UNIT 17: The EU generic market 42

- Recent EU regulations, New regulations dated march 2004 -EU generic market, Central and Eastern Europe:
“Healthcare gap” -Points which prove the key role of generic market
- Biosimilar Medicines -The EU commission declaration in 2006 to authorize biosimilar products

UNIT 18: Biotechnology and biopharmaceuticals 44

- From past to present: Definition of biotechnology, difference between the pre-seventies and present times,
disciplines involved
- Biopharmaceuticals: What they include both in the EU and USA market, reason why they are increasingly being
developed, Illnesses they can treat effectively, human insulin: historical hints
- Transgenic: GMO: genetically modified organisms, why the production represent a serious risk for the investor,
Atryn story.

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UNIT 19: Biosimilar medicines 46
- Europe’s estimates concerning the date 2015.
- Advantage of introduction of biotechnology-derived medicines.
- What is the GMP? (good manufacturing practice)
- How can patients be assured of good quality?
- What do European pharmaceutical companies need to prove?
- What are some biological active substances?
- Where do they originate from?
- What are they used for?

UNIT 20: Prescriptions inserts 48

- What are they? What do they contain? Description, Clinical pharmacology, Indications and usage,
Contraindications, Warnings, Precautions, Adverse reactions, Drug abuse and dependence, Overdosage, etc.

UNIT 21: Reading OTC medicines labels 50

- Type of Antihistamine. Active ingredient, uses, warnings, dfrections, other information, inactive ingredients.

UNIT 22: Most common forms of medication 52

- Tablets, Capsules, Powders, Drops, Liquids, Injectable solutions, Inhalants and sprays, Suppository, - Skin
preparations (creams, ointments, lotions, pastes).

UNIT23: Types of medication 54

- ATC system-First Level Anatomical Group.

UNIT 24: Most important drugs 56

- What makes them most important: Penicillin, Insulin, Smallpox and polio vaccines, Ether, Morphine, Aspirin,
Psychiatric medications, Birth control pills, Help for the heart.

UNIT 25: Antibiotics 58

- How they work: what the majority are for, viruses against bacteria, what they don’t fight
- Selecting an antibiotic
- Antibiotics resistance: What may happen over time and why.
- Side effects and allergies

UNIT 26: Antihypertensives 60

- Hypertension: Antihypertensives: Diuretics, Beta blockers, Vasodilators

UNIT 27. AMIAS patient information leaflet n(l) 62

- What is in your tablets?, How do your tablets work?, Why do you need to take these tablets?, High Blood
Pressure, Heart failure, Are there patients who should not take these tablets?

UNIT 28. AMIAS patient Information leaflet (2) 64

- What you should know before taking ‘Amias’, Treatment for high blood pressure and heart failure, Unwanted
effects, How to keep tile medicines.

UNIT 29. Depression and antidepressants 66

- How nervous cells communicate, How depressants work.

UNIT 30: Complementary and alternative medicine 68

- Definition, how Cam differs from traditional medicine, some types of alternative medicine

UNIT 31 :Homeopathy and chiropractic 70

- Homeopathy, - Chiropractic: Definition and use

UNIT 32: Herbalism (1) 72

- What herbal medicine is
- Role of herbal medicine in modem human society
- Biological background

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UNIT 33: Herbalism (2) 74
- Some plants with therapeutic effects: Artchokes, Soy, Feverfew, Garlic, Black cumin, Oregano, Papaya, Valerian
root, Green tea, Lemon grass.

UNIT 34: Dietary supplements 76

- Definition: different positions of countries, the USA position
- FDA and EU regulations: before marketing and post-marketing regulations, reasons for some countries legal
challenge

SECOND SECTION
KEYS 79
IRREGULAR VERBS 103
THE SOUNDS OF ENGLISH 106
ONLINE MEDICAL DICTIONARIES 107

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FIRST SECTION
 Pharmacy
It is a multidisciplinary field of science that specializes in medicinal treatment and studies drugs I II, medicines and
their development, their use and effects mainly from the point of view of natural sciences, health sciences, as well
as social sciences. It is the health field that links health sciences with chemical sciences, and it is charged with
ensuring the safe use of medication. The scope of pharmacy practice includes traditional roles such as
compounding and dispensing medications, but also more modem services related to patient care, such as reviewing
medications for safety and efficacy, and providing drug information.

Pharmacists

Pharmacists have many areas of expertise and are a critical source of

medical knowledge in clinics, hospitals, and community pharmacies
throughout the world.
Pharmacists are exceptionally trained in medicine-related fields including
pharmacology, pharmacognosyIII, chemistry, pharmaceutical chemistry,
pharmacy practice (including drug interactions, medicine monitoring,
medication management), pharmaceutics, pharmacy law, physiology,
anatomy, biochemistry, kinetics, nephrology, hepatology, and
compounding medications.
In their traditional role pharmacists are health professionals trained in the
art of preparing and dispensing drugs; they take medical pr-’jCriptions,
dispense medications to patients and counsel them on the proper use and
adverse effects of that medication.
One of the most important roles that pharmacists are currently taking on
is one of pharmaceutical care, in this role, pharmacists ensure the safe
and effective use of medications. They may participate in disease state management in order to optimise and
monitor drug therapy often in collaboration with physicians or other health professionals. They may direct
responsibility for patients and theữ disease states, medications, and the management of each in order to improve
the outcome for each individual patient. Pharmacists are often the first point of contact for patients with health
inquiries. This means that they have large roles in the assessing medication management in the primary care of
patients.

Pharmacist, dispensing chemist, druggist

Pharmacists are sometimes referred to as chemists or dispensing chemists, in British English and Australian
English, or druggist in North American English. In this case they are allowed to fulfil prescriptions and usually
operate in a pharmacy or chemist's shop, usually abbreviated to "the chemist's" in the United Kingdom, Australia
and New Zealand. The United States and Canada use the term drugstore or pharmacy. It is possible for a shop to
be a general chemist without the ability to fulfil prescriptions. In such cases, only 'Over the Counter' (OTC) drugs
and medications may be supplied, as these do not require the services of a licensed pharmacist. Such shops will
also usually supply a wide range of health related goods.

I Adapted from: http://en.wikipedia.org/wiki/Phannacy

II A drug is the chemical basis for the production of a medicine, a medicine is the finished product after a drug is manufactured for
use as a cure, treatment or prevention of disease.
III This name is formed from two Greek words, phannakon, drug, and gnosis, knowledge, and literally means the "entire knowledge
of drugs" (distribution, cultivation, collection, selection, preparation, commerce, identification, evaluation, preservation, and use).

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■UNIT 1: Pharmacy and pharmacists (Practice)

1. Make word combinations using a word from each box. There may be various ones.
monitor 1
provide 2
optimise, medications, drugs 3
fulfil drug information 4
dispense drug therapy 5
compound prescriptions 6
review medications, drugs 7•
prepare 8
supply 9
assess 10

2. Complete the grid with suitable words.

Verb Noun Adjective Noun

treatment responsibility
assess chemical
practice pharmacy
provide safe
prescription efficient
dispense practice
owner medicinal
medication health

3. Answer the questions.

1. Why is pharmacy a multidisciplinary field of studies?

2. What are the pharmacist’s two main roles?

3. What do their traditional role consist in?

4. What is a more modem role of pharmacists?

5. What field are they trained in?

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Pharmacology and pharmacy
Pharmacology is a chemical science which studies the properties and reactions of drugs especially with relation to
their therapeutic value.IV If substances have medicinal properties, they are considered pharmaceuticals. The field
includes drug composition and properties, interactions, toxicology, therapy, medical applications and
antipathogenic capabilities. Pharmacology is not synonymous with pharmacy, though in common usage the two
are at times confused. Pharmacy is a medical science concerned with the safe and effective use of medicines while
pharmacology studies how drugs interact with die biological systems. The effect of chemicals may be beneficial
(therapeutic) or harmful (toxic). The pure chemicals or mixtures may be of natural origin (plant, animal, or
mineral) or may be synthetic compounds. Some subdisciplinẹs can be:
• clinical pharmacology, the medical field of medication effects on humans,
• neuro* and psychopharmacology, effects of medication on behavior and nervous system functioning,
• pharmacoepidemiology, study of effects of drugs in large numbers of people,
• toxicology, study of die effects of poisons,
• posology, how medicines are dosed.

Scientific background: LADME

With the increasing knowledge of cell biology and biochemistry,the field of
pharmacology has also changed substantially.
From the pharmacological point-of-view, a chemical has various properties:
pharmacokinetics describes the effect of the body on the chemical, and
pharmacodynamics describes the chemical's effect on the body (desired or
toxic).
When describing the pharmacokinetic properties of a chemical,
pharmacologists are often interested in LADME'. an acronym which stands
for liberation, absorption, distribution, metabolism, and excretion. It
describes the disposition of a pharmaceutical compound within an
organism:
• Liberation - It is the release of a drug from its dosage form.
• Absorption - It is the medication converted chemically inside the
body, the movement of a drug into the bloodstream. How it is absorbed
through the skin, the intestine, the oral mucosa. Before a compound can exert a pharmacological •effect on tissues,
it has to be taken into the bloodstream, usually via mucous surfaces like the digestive tract (intestinal absorption).
Factors such as poor compound solubility, chemical instability in the stomach, and inability to permeate the
intestinal wall can all reduce the extent to which a drug is absorbed after oral administration. Drugs that do not
absorb properly when taken orally must be administered in some less desirable way, either intravenously or by
inhalation.
• Distribution - It is how susbstances spread through the organism, how they are dispersed are or disseminated
throughout the fluids and tissues of die body.
• Metabolism - It is the medication converted chemically inside the body. Compounds begin to break down as
soon as they enter the body. The majority of small-molecule drug metabolism is carried out in the liver. As
metabolism occurs, the initial (parent) compound is converted into new compounds called t metabolites.
• Excretion - How the medication is eliminated. It is the removal of the substances from the body. Compounds
and their metabolites need to be removed from the body via excretion, usually through the kidneys (urine) or in the
faeces. Unless excretion is complete, accumulation of foreign substances can adversely affect normal metabolism.
There are four ways how drug excretion occurs: kidney excretion, biliary excretion or faecal excretion and
excretion through the lungs (breath) and skin.

IV It emerged as a major area in American medicine thanks to the efforts of John Jacob Abel (1857-1938) who stressed the
importance of chemistry in medicine, did research on the endocrine glands, and became the first pharmacology professor in the U.S.

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 Unit 2: Pharmacology (Practice)

A. Write the correct word. Choose from the ones given in the box.
Metabolism Liberation Pharmacokinetics Absorption Excretion

Pharmacodynamics Distribution Pharmacology Pharmacy Pharmacoepidemiology

1............... ............ deals with how drugs interact within biological systems to affect function,
2 ...... is a medical science concerned with the safe and effective use of medicines,
3 ....................... describes the effect of the body on the chemical,
4 . studies of effects of drugs in large numbers of people,
5 . ........ .................... describes the chemical's desired or toxic effect on the body,
6 . ................................ is the release of a drug from its dosage form,
7 ................................ is the movement of a drug into the bloodstream,, through the skin, the
intestine, the oral mucosa,
8 ........................... is the dispersion or dissemination of substances throughout the fluids and
tissues of the body,
9 . ........... .................... is the medication converted chemically inside the body,
1Ọ............................... ............. is how the medication is removed from the body.

81. Insert the correct preposition.

out with (x 3) on for

down from in

Inglese Italiano
1 to be concerned . ........ riguardare
. 2 to interact. .. ................... interagire
3 to act.............. agire SU
. 4 to be interested . .................. essere interessati a 1
5 to deal................... trattare
. 6 to stand.............. significare
7 to break..................... decomporre/si, disfarsi
. 8 to carry.................. aver luogo, awenire, svolgere, svolgersi
. 9 to remove....... eliminare
.
82. Complete with some of the previous verbal expressions. Use the correct tense.

You don’t need them all.

1. Pharmachology studies how drugs.................................................... .....................the biological systems.
2. Compounds begin ........................................................................................as soon as they enter the body.
3. Pharmacologists are often................................................. the pharmacokinetic properties of a chemical.
4. LADME...............................................Liberation, Absorption, Distribution, Metabolism, and Excretion.
5. Pharmacy is a medical science............................ ..................... . the safe and effective use of medicines.
...................................................... in the
liver.
..... .......................specific cellular
pathways.

6. The majority of small-molecule drug metabolism is

7. It has become possible to design chemicals that

ìăỄíí^^ẩ2Ẵ12_irL^ẩi^^B^ằ^?^ăỀẩểẫỂiẩỄfiỄiẼMỀẼÌliấl
Definition of drug
A drug, broadly speaking, is any substance that alters normal bodily functions. There is no single, precise
definition, as there are different meanings in medicine, government regulations, and colloquial usage.
In pharmacology, Dlctionary.com defines a drug as "a chemical substance used in the treatment, cure,
prevention, or diagnosis of disease or otherwise used to enhance physical or mental 'well-being.” Drugs may be
prescribed for a limited duration or on a regular basis for chronic disorders. A drug may be used for medical,
spiritual, or recreational purposes therefore they are distinguished into recreational drugs and medicinal drugs or
medicines'.
Drugs are usually distinguished from endogenous V VI biochemicals, such as hormones, by being introduced from
outside the organism. For example, insulin is a hormone that is synthesized in the body; it is called a hormone
when it is synthesized by the pancreas inside the body, but if it is introduced into the body from outside, it is
called a drug. Many natural substances such as beers, wines, and some mushrooms, blur the line between food and
drugs, since when they are ingested they affect the functioning of both mind and body.

Recreational drugs
They are psychoactive substances used to have fun, for a new experience, or to enhance an already positive
experience. Recreational drugs are chemical substances that affect the central nervous system, such as narcotics or
hallucinogens. They may be used for perceived beneficial effects on perception, consciousness, personality, and
behavior. Some recreational drugs can cause addiction and habituation. National laws prohibit the use of many
different recreational drugs and they also strictly regulate medicinal drugs that have the potential for recreational
use. Many other recreational drugs, on the other hand, are legal, widely culturally accepted, and, at the most, have
an age restriction on using and/or purchasing them. These include alcohol, tobacco and caffeine products.

Medicinal drugs (medicines): definition, dispensing and administering methods

A medicine is a drug used to prevent or cure disease or to relieve pain. It may be used as preventive medicine that
has future benefits but does not treat any existing or pre-existing diseases or symptoms.
The dispensing of medicines is often regulated by governments into three categories:

■ over-the-counter (OTC) medications, which are available in pharmacies and supermarkets without special
restrictions,
■ behind-the-counter (BTC), which are dispensed by a pharmacist without needing a doctor's prescription,
■ prescription only medicines (POM), which must be prescribed by a licensed medical professional, usually
a physician.

In the UK, BTC medicines are called pharmacy medicines which can only be sold in registered pharmacies by or
under the supervision of a pharmacist. However, the precise distinction between OTC and prescription drugs
depends on the legal jurisdiction of each country.
Medicines are typically produced by pharmaceutical companies and are often patented to give the developer
exclusive rights to produce them, but they can also be derived from natural substances called herbal medicines.
Those that are not patented (or with expired patents) are called generic drugs since they can be produced by other
companies without restrictions or licenses from the patent holder.

V The word medicine can also refer to the practice of disease prevention and cure (e.g., a doctor practices medicine) and the science
of drugs (e.g., drug research and development), rather than medical activities such as surgery or
physiotherapy.
VI The word endogenous means "arising from within", the opposite of exogenous. Endogenous substances are those that
originate from within an organism, tissue, or cell.

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 UNIT 3: Types of drugs (Practice)

A. Complete the grid with suitable nouns or verbs. Use the dictionary for help.
VERB NOUN
prevention
distinguish
define
synthesis
inttoduction
ingestion
produce
addict
prohibition
relieve
existence
treat
preceive
breath
B. Multiple choice. Fill In the spaces with a suitable connector from the grid below.
1..........................speaking a drug, is any substance that alters normal bodily functions, yet there isn’t only,
one definition 2................................the different meanings in various fields. In the UK, BTC are dispensed by
a pharmacist without needing a doctor's prescription, 3................................... OTC medicines are available in
pharmacies and supermarkets without special restrictions.
4.................... the precise distinction between ỌTC and prescription drugs depends on individual countries’
legislation.
Many natural substances 5.............................beers, wines, and some mushrooms, can have the same effects as
drugs, 6.............................. they may effect both mind and body. National laws not only impose heavy
regulations on the use of recreational drugs but they 7............................ ............ prohibit the use of thenL
8....... ........................many other recreational drugs, are legal, and, 9.......................... have an age restriction
on using and/or purchasing them. Some recreational drugs include, for example, alcohol, tobacco and caffeine
products. Drugs 10................................. medicinal .........recreational, can be administered in a number of
ways. °
1. broadly largely widely 6. for a since but
2. owing that depending on because of 7.however also besides
3. while when although 8.1n addition On the contrary On the other hand
4. Whatever However Whenever 9.at least at the most at large
5. like as such as among whom 10 both...and either...or neither.. .nor
c. Read the text and answer the questions.
1. How is a drug defined in pharmacology?

2. How can drugs be distinguished?

3. What is the difference between hormones and drugs?

4. Why are some natural substances similar to drugs? What are some of them?

5. What are recreational drugs?

2__i23iivJL22jL^_______________________________________________Ỉ
z

Drug use
Drug use consists in using any substance for its intended purpose, for example it would include taking an
antibiotic or a sleeping pill as prescribed. Drugs can cover: legal drugs (eg alcohol and tobacco - illegal drugs (eg
Cannabis, Ecstasy, amphetamines) and medicinal drugs, (eg Paracetamol, Insulin, Ventolin).

Drug misuse
Drug misuse is when people take medicines in a way not recommended by their doctor or by the manufacturer.
For example they take drugs in very large quantities that are dangerous to their health or they take them at more
fretpient intervals than prescribed. Examples of drugs that are commonly misused include: illegal drugs, alcohol,
tobacco, prescribed medicines including painkillers, sleeping tablets and cold remedies.

Tolerance
Drug tolerance occurs when a subject's reaction to a psychoactive drug (such as a painkiller, alcohol) decreases
so that larger doses are required to achieve the same effect. As an example, if you are an occasional drinker, you
may become intoxicated after drinking three beers. However, after drinking every night for a week, you may find
that it takes five beers to reach the same condition. This might indicate a developing tolerance to alcohol. The rate
at which an individual develops tolerance to a drug depends on the individual's genetics, the dose of the drug, the
size of the person, and the frequency of drug administration. Drug tolerance can involve both psychological drug
tolerance and physiological factors.

Addiction
It is defined as a chronic pathological condition characterized by compulsive drug-seeking and abuse and by
long-lasting chemical changes in the brain. VII This generally occurs with depressant drugs, which include alcohol,
barbiturates, tranquilizers, and opiates. The individual has an overpowering need for the substance, object, or
activity that produces a psychological and/or physiological dependence. The desire or need is repetitive,
impulsive, and compulsive. If the person ceases the activity or abstains from the substance, withdrawal symptoms
usually occur.

Withdrawal Symptoms
When one has become physically dependent on a drug and suddenly stops taking the substance, a psychological
and/or physiological reaction occurs. Psychological withdrawal symptoms, include restlessness, irritability,
inability to sleep, depression, and sleep disturbances and sometimes convulsions that ■may lead to death.

Stimulants
Stimulants (in slang “uppers”) are a group of drugs that tend to stimulate the central nervous system Stimulants
are used therapeutically to increase or maintain alertness, to counteract fatigue in situations where sleep is not
practical. The euphoria produced by some stimulants leads to their recreational use, although this is illegal in the
majority of jurisdictions. Habituation to these drugs can occur. Caffeine as well as nicotine are among some of the
world's most commonly used stimulants. Examples of other well known stimulants include ephedrine,
amphetamines and cocaine.

Depressants
A depressant drug, referred to in slang as a "downer", is a chemical agent that diminishes the function or activity
of a specific part of the body. Depressant drugs produce slowed brain function and a drowsy or calm feeling, and
are generally prescribed to relieve symptoms of anxiety and insomnia.The most common depressants used in
medicine are generally divided into two classes, namely barbiturates and benzodiazepines.

UNIT 4: Terminology of drug action (Practice)

A. What possible combinations can you make with the following words and the nouns In tile grid? Write
them in the spaces provided.

VII http://www.medterms.com

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 Illegal, depressant, cold, sleep, physical, recreational, drug, nervous,chemical, psychological,
withdrawal, sleeping, legal

In English In your language

1. tablets
2. drugs
3. remedies
4. disturbances
5. system
6. agent
7. dependence
8. symptoms
9. use
10. administratio
n.
B. What do the following sentences define? Choose the correct word in the box and write it in the spaces
provided.

Tolerance, Depressants, Dug use, Stimulants, Amphetamines, Drug misuse,

Addiction, Caffeine

1. ___________________Ị It is when you take prescribed drugs or medicines.

2. _______ : ITiey are considered illegal diugs.__________________________________________________
3. : it is when youtake medicines'in a way’ not recommended by your doctoror
= the manufacturer.
4. ; It develops when die response to die same dose of die drug decreases with
_______________________■ repeated use._______________________________________________________
5. _______■ It is considered to be the physical dependence upon a drug. ._______________________' -
6. I They are agroupofdrugs thattendto stimulate the central nervoussy stem.
7. : They are chemical agents that diminish die function or activity of a specific
________________________• part of the body._____________________________________________________
8. ; It is one of die world's most commonly used stimidants.________________________________________

c. Complete the sentences with the following prepositions.

I of by I for I to(x2) I at(x2) [into I on [after |in(x3) ~1

1. Drug misuse is when you take medicines ........ a way not prescribed...................your doctor.
2. The rate ........... which an individual develops tolerance ............ a drug depends ...... that individual's
genetics.
3. The term depressant is used.........particular with regard........the central nervous system.
4. The most common depressants used..........medicine are generally divided..........two classes.
5. If you drink..........occasional intervals you may become intoxicated.............drinking three beers.
6. In the case............. . addition, the individual has an overpowering need........the substance.

Cross Tolerance and Cross Dependence

Cross tolerance refers to the fact that if a person has developed a tolerance to a drug in a certain classification,
such as the depressants, that person is more likely to develop tolerance with another drug in that classification. As
an example, people who are dependent upon alcohol show an increased tolerance to barbiturates, synthetic and
natural opiate narcotics, and anesthetics. This, of course, means that file person must have a higher dose of the
new drug for it to be effective. In cross dependence, the withdrawal symptoms from one drug in a classification
can be relieved by another drug. As an example, many alcoholics are given barbiturates and tranquilizers to
prevent withdrawal symptoms. However, the person may soon develop a dependency on the other drug as well.

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Potentiation
Potentiation occurs when two drugs are taken together and one of them intensifies the action of the other. This
could be expressed by the formula a +b = B. As an example, Phenergan (R), an antihistamine, when given with a
painkilling narcotic such as Demerol(R) intensifies its effect, therefore die amount of the narcotic needed can be
cut down.

Additive Effect
Additive effect is the term used when two or more drugs are taken at the same time and the action of one plus the
action of the other results in the desired maximum response. It could be represented with 1+1 = 2. In other words
if a dose of Drug-A that produces 50% of the maximum response is given together with a dose of Drug-B that
produces 50% of the maximum response, then the maximum response of 100% will be produced. If a dose of
Drug-A that produces 25% of file maximum response is combined with a dose of Drug-B that produces 50% of
the maximum response, then 75% of the maximum response will be produced.

Antagonism
Antagonism is an action for which two drugs given together have an opposite effect on the body. This could be
expressed by 1+1=0. An example might be the use of a tranquilizer to stop the action of LSD. Some stimulants
will counteract the effects of depressants and thus are used to treat overdoses of barbiturates and narcotics.

Hypersensitivity
One of the biggest problems with many drugs, especially antibiotics, is an allergic or hypersensitive reaction. An
allergic reaction can range from hives, itching, and nausea to a shock in which the person can die. The allergic
reaction occurs after the first time the person has been exposed to the drug, not the first time the drug is taken. It
should be noted that a person can use a drug for years without any adverse reaction and then become
hypersensitive to it. This sometimes occurs to individuals handling drugs, such as nurses, pharmacists, and
veterinarians.

Side Effects
Most substances have side effects that may or may not be harmful to the individual. A side effect is an effect of
the drug other than the one for which it was administered. The main effect and side effects of a drug sometimes
depend upon the purpose of its administration. As an example, antihistamines are often given to dry and reduce
swollen nasal passages caused by allergies. However, antihistamines can also cause sleepiness, which would be
the side effect. The main effect of sleepiness is used by manufacturers of over- the-counter sleep aids to produce
drowsiness and promote sleep. In this case, a side effect of the medication would be the drying of the nasal
passages. Some side effects can cause serious problems, such as abnormal production of red blood cells called a
plastic anemia, or stomach bleeding from the consumption of too much aspirin.

1
Adapted from Engs, R.C. Alcohol and Other Drugs: Self Responsibility, Tichenor Publishing Company, Bloomington, IN, 1987. ©
Copyright Ruth c. Engs, Bloomington, IN, 1996. http://www.indiana.edu/~engs/rbook/drug.html

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 UNIT 5: Terminology of drug action (2) (Practice)
A. Complete the tables with a suitable verb or noun.

Verb Noun Verb Noun

intensify stimulant
classification reaction
withdrawal reduce
develop sleepiness
relieve promote
tolerance consumption
die dependency
expose administer
potentiation prevent

B. Complete the sentences with verbs or nouns from the previous table. Use correct tenses.

1. If a person ........................a tolerance to a drug in a certain...............................that person is more likely to

develop tolerance with another drug in that classification.
2. In the case of cross dependence, the.............................symptoms from one drug in a classification can be
............... by another drug.
3. occurswhen two drugs are taken together and one of them potentiates or..................................................
the action of the other.
4. An allergic ............................can range from hives, itching, and nausea to a shock that may also cause

5. The main effect of ................................. due to antihistamines is used by OTC manufacturers to

.......................................sleep.

c. From active to passive or vice versa. Don’t express the agent tf it is not specified.

1. People dependent upon alcohol show an increased tolerance to barbiturates.

2. This means that die person needs to take a higher dose of the new drug.

3. Many alcoholics are often given barbiturates and tranquilizers to prevent withdrawal symptoms.

4. However, alcoholics may develop a dependency on the other drug.

5. Potentiation often occurs when two drugs are taken together and one of them is intensified by the action of
the other.

6. The additive effect could be represented by 1+1 = 2

7. A side effect is an effect of the drug other than the one for which it was administered by practitioners.

8. Antihistamines are often given by practitioners to dry and reduce swollen nasal passages.

9. However, antihistamines can cause sleepiness.

Ỉ0. Some side effects can cause serious problems.

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Medicine development and testing
Development of medication is a vital concern to medicine, but it has also strong economical and political
implications. Many governments regulate die manufacture, sale, and administration of medication in order to
protect the consumer and prevent abuse, hl the United States, the main body that regulates pharmaceuticals is the
FDA (Food and Drug Administration), in the European Union, it is the EMEA (European Medicines Evaluation
Agency)

FDA: functions
The FDA is a government agency of the United States Department of Health and Human Services. It was
established in 1906 with the passage of the Federal Food and Drugs Act. The agency is responsible for the safety
regulation of most types of foods, dietary supplements, drugs, vaccines, biological medical products, blood
products, medical devices, radiation-emitting devices, veterinary products and cosmetics.
The FDA is responsible for creating guidelines for the approval and use of drugs and requires that all approved
drugs fillfill two standards:
1. the drug must be found to be effective against the disease for which it is
seeking approval,
2. the drug must meet safety criteria by being subject to extensive animal
and controlled human testing.
Currently, pharmaceutical companies must test drugs through four phases of
clinical trials before they can be sold to individuals. It usually takes several
years to obtain FDA approval.
Testing done on animals must be extensive and must include several species
to help in the evaluation of both the effectiveness and toxicity of the drug. The
dosage of any drug approved for use is intended to fall within a range in
which the drug produces a therapeutic effect or desired outcome. Every year the FDA monitors the testing of
3,000 new drugs on nearly 200 million people to determine their effects.

EMEA: functions
The London-based EMEA is the scientific body whereby, on the basis of its scientific evaluation, the European
Commission can issue a single marketing authorisation allowing a company to offer a product for sale
throughout the Union. The Agency’s mission is to protect and promote public health. It contributes to the
availability of good medicinal products in Europe by stimulating the development of innovative new medicines,
by assisting pharmaceutical companies with approval procedures, by evaluating the safety, efficacy and quality
of new medicines prior to authorisation and by constantly monitoring them once they are on the market.
Europe's basic pharmaceutical legislation is only a little over six years old, but it always needs to be adapted to
the new scientific progress, the international competition, the prospect of new therapies and the enlargement of
the Union.
Patients in all EU Member States have better access to new and important medicines because, by granting one
single marketing authorisation through tire centralised procedure, such new and important medicines are
available to all patients in the European Union. Consequently, essential information about these medicines for
doctors and patients is available in all EU languages.

UNIT 6: FDA and EMEA: functions (Practice)

A. Find words in the text with the following meanings.
( consequence, effect, result (V) a way of entering, approach
(n measure, quantity, amount (ADV) presently, nowadays
(n interest, involvement (N) security, without risks
n
(ads) excessive use (N) accessibility, handiness
( relating to the diet (N) accomplish, meet, carry out
(n injected to stimulate the ( expectation, outlook
n production of antibodies N
) )

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B. Write alternative sentences without changing the meaning. Use the connectors at the end.

Ỉ. Many governments regulate the manufacture, sale, and administration of medication in order to protect the
consumer and prevent abuse.(so that)
1 ............................................ ........................................................................................................................

2; The development of medication is a vital concern to medicine but it has also strong economical and political
implications, (although)
2......................................................................... .........;.......................................... . .......................................

3. The FDA is responsible for creating guidelines for the approval and use of drugs and requires that all
approved drugs fulfill two standards, (since)
3 ....................................................................................................... .■.....................................;;................

4. The FDA enforces regulations associated to the Public Health Service Act as well as specific rules for
control of disease on products (besides)
4 ................................................................... ....;........................................................ ...................................

5. Drugs must be tested through four phases of clinical trials, after which they can be sold to individuals,
(before)
5 ............................................................................................................................................................................

6. The Agency’s mission is to protect and promote public health.(both.. .and)

6...................................................................... ..................................................................................................

7. Europe's basic pharmaceutical legislation is only a little over six years old, but it always needs to be
adapted new scientific progress (despite)
7 ............................................................................................................................................................. -......

8. Consequently, essential information about these medicines for doctors and patients is available in all EƯ
languages, (therefore)
8 .......................................................................................................................................................... ....

c. Answer (possible answers).

1. Why do goverments intervene in the manufacturing of medicines?

2. What do FDA and EMẸA stand for?

3. What is the function of the FDA?

4. What process do drugs follow before obtaining the FDA approval?

5. What criteria do approved drugs have to respond to?

6. What is the function of EMEA?

7. What service does the Agency offer customers and pharmacists apart from evaluating new medicinal
products?

8. How does The European Union help patients better than their single countries?

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A. Read the text and circle the correct preposition ỉn brackets.
Can medicines be dangerous?
Medicines are very powerful substances and can be dangerous.
There are medicines that you buy ỉ.(on /over) the counter at the
pharmacy or 2.(in/ at) the supermarkets as well as those you get 3.
(from/of) your doctor. If used properly medicines will help to
overcome or control medical problems. Repeated studies have
shown that as many as 50% of patients do not take their medicine
proparly. Some medicine may look the same although they have
different names and uses. They can be prescribed ^.(from / by) their
brand name or chemical name.

Before using medicines.

a. Give information.
Everyone is different and the pharmacist will need to know some
facts (after/before) giving the customer the right advice. Therefore, before obtaining any medicine, doctor or
pharmacists might need the following information:
• the symptoms you have and how long they have occurred
• if you have seen any health care provider
• all the medicines and dietary supplements you are taking or have taken recently, including prescription and
non-prescription medicine
• any allergies and sensitivities to medicine, food or other substances
• your smoking, drinking and exercise habits
• any special diet you are 6.(at/on): low sugar, low-salt or a diet to lose or gain weight
• if you are pregnant, plan to become pregnant or if you are breast feeding
• family history of illnesses.

b. Read the label.

The instruction l.(in /on) the label are not just a rough guide but must be followed carefully. For example: • Take
before meals: this means about one hour before a meal and NOT two minutes before. Some medicines need to
be absorbed into your system quickly so that they can act %.(with/at) full strength. If your stomach is digesting
food, some of the effects of the medicine could be lost or delayed. But even if you forget to take it at this time, it
is probably better to take it after meal than rather not at all.
• Take after meals: some medicines can upset or irritate your stomach. To minimise this, the label may tell
you to take your medicines 9.(within/inside) five to ten minutes after meals.
• Take with water: instructions to take with water means a full glass of water. This will prevent tablets or
capsules iQ.(from / by) sticking into your throat. Do not substitute with other fluids without checking with your
pharmacist or doctor.
• To be swallowed whole, not chewed
Some tablets or capsules have special coating that stay in place as they travel ỈÌ.(through / across) your stomach.
The coating then dissolves in the intestine to release the medicine where it can best be absorbed without irritating
your stomach. Other type of coating allow medicines to be released gradually Ỉ2.(throughout/all over) the day.
Chewing would destroy these features.
• Take with or after food
Some medicine can irritate the stomach lining. To protect the stomach these medicine should be taken with or
after food.
• Take at regular intervals, complete the course
When you are taking antibiotics for an infection, you often feel better after just a day or two. However, the germs
could still be there, ready to multiply if you stop die medicine. By taking regular doses and finishing the course

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you maintain the antibiotic levels in your system. In this way you avoid that the germs might become resistant to
the medicine and make you ill again.

UNIT 7: Before using medicines (Practice)

A. Write complete sentences matching each verb in column A with a correct ending In column B.
1. to overcome a. instructions carefully
2. to take b. antibiotic levels so that none of the germs get away
3. to give c. tablets or capsules from sticking into the throat
4. tOttfitate d. better after one or two days
5. to follow e. medicines properly.
f. or control medical problems
7. to maintain g. the stomach lining.
h. customers the right advice

1............................................................................................... .....................................................................
2. ............................................................ .......................
..............................................
3.......... ............................................................. .........................................................................
4.......... ............................
5. ..........................................................................................................
6. ........................... ........................................................
.............................................
7............................................
8.......................................................................

B. Write the sentences again using correct modal verbs. Make the necessary changes in the underlined
parts without changing the meaning. There may be more than one answer.

1. It is possible that some medicines are dangerous since they are very powerful substances.

2. The instruction on the label is not just a rough guide, therefore it is prescribed to follow it carefully.

3. . It is possible that doctors need some information before prescribing any medicine

4. It is obligatory to take some medicines before meals because during digestion it is possible that some
effects are lost or delayed

5. Some medicines căn irritate the stomach lining therefore it is suggested to take them with or after food.

6. Although you are likely to feel better after just a day or two from taking antibiotic, it is advisable for you to
finish treatment to maintain the necessary antibiotic levels in your system.

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 ow

What you need to know about medicines

There is a number of things that customers should These ask themselves about each medicine they are taking.
include:

1. What is the name of the medicine?

2. Why am I taking it?
3. What will it do for me?
4. When should I take it?
5. What is the best time and how often?
6. How do I have to take it and how much?
7. Dol have any alternatives to this medicine?
8. What should I do if I miss a dose?
9. Are there any side effects?
10. How should I store my medicine?
11. 1. How long should I continue taking it?
12. Will this medicine affect any other medicines I am
taking?

Proper use of medicines

Medicines are generally very safe if used properly. This means taking them at the right dose, the right way and the right
time, otherwise the medicine might not work as well as it should or might even cause unpleasant side-effects.
• Do not take more than the prescribed dose or take the medicine more often than recommended. Twice as much
doesn't mean twice as good.
• If you forget to take your medicine, don’t double the next dose. Doubling up medicines is dangerous because it
may lead to over dosage.
• Don’t use other people’s medicine. A medicine that is good for you may be bad for someone else, even if the
symptoms are similar. So don’t share medicine with family or friends. They should see thek own doctor or
pharmacist for advice.
• Uon’t mix medicine without seeking advice first. If you take two medicines in the same classification, you might
be taking an overdose. Some medicine can react with others to produce unpleasant side effects while some can
block the actions of others and actually stop them from working. Before taking medicine homes, patients should
tell their pharmacist if they are taking any other medicine.

Self Medication

Before you treat yourself, think of these facts:

• Many illnesses run short and present natural courses

Uncomplicated colds are usually cured by themselves. Most sore throats get better in a few days, with or without
treatment. They are usually caused by viruses which are not cured by antibiotics.
• Symptoms dó not always need treatment
By coughing patients get rid of excessive secretion. If a cough is deep and distressing, or disturbs sleep, a cough
remedy can be taken; but a daytime cough should mostly be allowed to do its work.
• Some medicine can be harmful
Some medicine can be harmful especially if taken for a long time, for example nose drops should be instilled for
occasional relief only.
• Some medicine can create tolerance, dependence or addiction
Sleeping tablets and anti-anxiety drugs may develop tolerance or dependence when used too frequently.

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 UNIT 8: What customers should know (PRACTICE)

A. Think of possible questions that customers ask more frequently about medicines? Write them and compare
them with your partner.

B. Here are some possible answers to the questions in the text. They are not in the correct order. Number them
according to the question they refer to.

A. Because it improves allergic rhinitis symptoms

B. Singulair' is the brand name.
c. It will reduce the symptoms of seasonal allergies such as stuffy, runny, itchy
nose; sneezing; watery, swollen, red, itchy eyes.
D. There are no side effects reported in the majority of over dosage reports. The
most frequently occurring symptoms reported with over dosage in adults and
children, included abdominal pain, sleepiness, thirst, headache, vomiting, and
hyperactivity.
E. Keep die tablets in the original package in order to protect them from light and moisture and keep out of the
reach and sight of children.
F. It is advisable to start taking it before the period when allergy occurs and symptoms start.
G. Singulair can treat your allergy, only if you complete the whole course of treatment. It is important to continue
taking the tablets for as long as your doctor prescribes them. It will help control the symptoms.
H. Try to take Singulaữ as prescribed. However, if you miss a dose, just resume the usual schedule of one tablet
once daily.
I. You should not take aspirin or non-steroidal anti-inflammatory medicines or NSAIDs 2 if symptoms get
worse.
J. Once a day with or without food, morning or afternoon.
K. Take one 10 mg tablet with water each day.
L. Yes, you can take Montelukast the generic medicine.

Solution
1 2 3 4 5 6 7 8 9 10 11 12

c. Complete the following sentences. There might be more than one answer.

1. If a medicine is not taken as prescribed it might..............................................................................................

2. Customers should ask themselves a number....................................................................................................
3. You shouldn’t double a medicine if you.............................because.................................................................
4. Mixing medicines without seeking advice first may.................................................................................
5. There might be the danger of overdose if you are taking......................................................... .......................
6. Don’t suppose that the same medicine is good for everybody therefore..........................................................

7. Be careful because some medicines can be harmful especially...........................................................................................

8. It is not necessary to take medicines with all illnesses because many of them.................................................. and
...........................................................................................................................................................................

1
Non-steroidal anti-inflammatory drugs, they are drugs with analgesic, antipyretic and anti-inflammatory effects, they reduce pain, fever
and inflammation. The term "non-steroidal" is used to distinguish these drugs from steroids, which, among a broad range of other
effects, have a similar anti-inflammatory action.

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How to Store Your Medicine

It is important to store your medicines properly. Guidelines for proper storage include:
• keep out of reach of children,
• store away from direct heat and light,
• do not store capsules and tablets in the bathroom, near the kitchen sink, or in other damp places,
• heat or moisture may cause the medicine to break down. In addition, do not leave the cotton plug,
• in a medicine container that has been opened since it may draw moisture into the container,
• do not store medicine in the refrigerator unless directed to do 'so,
• do not leave your medicine in a car for long period of time,
• do not keep outdated/expired medicine.

When travelling

Carry your medicine with you rather then putting it in your checked luggage. Make sure an adequate source of
medicine is available when you travel or take enough supply until the last day during your visit. It is also a good idea to
take a copy of your written prescription with you in case you need it.

Side effects of your medicine

A'.ung with its intended effects, a medicine may cause some unwanted effects. Some of these side effects may need
medical attention; while others may not. If you are suffering from any unwanted effects, tell your doctor or pharmacist.
If you want to know more about possible side effects before starting any therapy, ask your doctor or pharmacist. They
may give you more detailed information on the medicines undesired effects.

How to get the most from your medicine

OTC medicines can help you feel better. But if they are taken the wrong way, they can actually make you feel worse. If
there is something you don*t understand about a medicine you're taking or are planning to take, ask your doctor or
pharmacist. If you still don't understand, ask him or her to explain things more clearly. If you are taking more than one
medicine, be sure to ask how the medicines will work together in your body. Sometimes medicines cause problems
when they are taken together. This case is called a drug interaction.

Understand generic versus brand name

Just like foods, some medicines come in both brand names and generics.
Generic medicines are generally cheaper. Compare the list of ingredients.
If the generic has the same ingredients as the brand name, you may want
to consider using it. But be careful, the generic may contain different
amounts of certain ingredients. You’d better ask your doctor or pharmacist
if you have questions about which medicine to choose.

Know what to avoid while taking the medicine

If you are taking medicines some foods can cause side effects, such as
stomach upset. Drinking alcohol should be avoided while taking
medicines. Some medicines cause reactions such as sun sensitivity (getting
a sunburn or sun rash), so you may have to limit your outdoor activities or
protect your skin from the sun.
Read the label to see what to avoid while you are taking an over-the-
counter medicine. Follow the instructions just as you would with a prescription medicine.

UNIT 9: Some Important tips (Practice)

A. Match parte on the left with parts on the right

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 Don’ts
1. Don’t leave the pharmacy without folly a. Some medicines won't work right unless they
understanding foe instructions. are swallowed whole.
2. Don’t stop a prescribed course of pills because you b. medicines unless your doctor says it's OK.
feel better. Antibiotics must not be stopped too
3. Don’t end a course of medicine because of some c. If you have trouble understanding them, be sure
minor side effects or because you are better to ask foe pharmacist again.
overnight
4. Don't combine prescription medicines and OTC d. or because you believe they are not doing any
good. Some medicines take time to work.
5. Don't crush, break or chew tablets or capsules unless e. soon since some of harmful bacteria may not be
your doctor tells you to. killed and therefore may become resistant to
foe antibiotic.
Solution:
1 12 13 [4 ~[5

B. Connectors to express contrast or add information.

Write the connectors under the suitable heading and use them to complete the sentences.

on the contrary, In spite of , however, both....and, too, besides, unless, as well as, either...or, although,

Express contrast Add Information

1.......................... intended effects, a medicine may cause some unwanted effects.

2. Some medicines do not give the intended effects ........................ they are swallowed whole.
3. OTC medicines can help you feel better. .........................
if they are taken the wrong way, they
can actually make you feel worse.
4. Do not store capsules and tablets in wet places............................... do not leave your medicine
inside a car.
5. I you are planning a holiday take enough supply.................................. a copy of your written
prescription.
6. Some medicines come in ............................. brand.........................................names generic
names.
7. Generics are as good as brand names,..........................they are much cheaper.
8. If you are suffering from any unwanted effects, tell .............................................. your doctor
............................... ;.......your pharmacist or both.
9. .....you usually take enough supply of your medicine when you travel, you’d better
take a copy of the written prescription...............................................

c. Change from active Into passive.

1. You should carry your medicine with you.

2. Some powerful medicines may cause some unwanted effects.

3. The generic medicine may contain different amounts of certain medicines.

4. You’d better not store capsules and tablets in wet places.

5. Always end a course of a medicine if you want the intended effects.

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 Common types of OTC medicines
OTC is short for over-the-counter. These are medicines you can buy without a prescription from your doctor. Chances
are, you've used OTC medicines many times to relieve pain and treat symptoms of the common cold, the flu, and
allergies. Four of the most common types of OTC products are: A. Pain relievers
B. Antihistamines
C. Decongestants
D. Cough medicines

A. Pain Relievers1
They are medicines that reduce of relieve headaches, muscle aches, arthritis, pains after
surgery, after injury, back pain, sore throat, earaches etc. There are many different pam
medicines, and each one has advantages and risks. Some types of pain respond better to
certain medicines than others. Each person may also have a slightly different response to a
pain reliever.
That's because the pain relievers can be: NSAIDs (nonsteroidal anti-inflammatory drugs)
or acetaminophen. Each of these drugs has a different way of working,

NSAIDs.
They relieve pain by stopping the production of prostaglandins, which are natural chemicals in the body.
Prostaglandins irritate nerve endings, triggering the sensation of pain. NSAIDs include:
Aspirin, mainly used for relief of pain and fever
Ibuprofen, to relieve pain and fever and also the symptoms of rheumatoid degenerative arthritis, Naproxen,
administered especially to treat arthritis
Ketoprofen, used to treat dysmenoưhea and the symptoms of rheumatoid arthritis and osteoarthritis.
The main side effect associated with aspirin and other NSAIDs is gasfrointestinal (GI) problems. These problems can
range from upset stomach to GI bleeding, a serious event that is more likely to occur in older people. The chances of
experiencing GI problems from NS AIDS or aspirin increase the larger the dose you take and the longer you take them.
NS AIDS can cause a variety of side effects related to kidney function. These side effects range from reversible
inflammation to permanent kidney damage.
Aspirin and NSAIDs may make high blood pressure worse or interfere with blood pressure medicines.
High doses of aspfrin pose a risk of liver damage for people who have liver disease, juvenile arthritis, or rheumatic
fever.

Acetaminophen
It relieves pain and reduces fever. We don't completely understand die way acetaminophen relieves pain. We do know
that unlike aspirin and NSAIDs, which work in the skin, muscles, and joints, acetaminophen blocks painful sensation in
the brain and the spinal cord. Acetaminophen is in products such as Tylenol and Tempra. Although safe in the majority
of users, long-term use of high doses of acetaminophen, especially in products that also contain caffeine (such as
Excedrin) or codeine (such as Tylenol with Codeine), has been shown to cause a form of kidney disease called
analgesic nephropathy. This serious condition may develop after years or decades of daily use. VIII IX

VIII www.FamiIydoctor.org
IX http://www.nlm.nih.gov/medlineplus/painrelievers.html
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 UNIT 10:OTC Pain relievers (Practice)
A. Look at the illustration. What do you think It means?

B. Write words from the text with the following meaningX.

1. Pair of organs located in the right and 1

left side of the abdomen I7' The belly, that part of the body that
contains all of the structures between the
chest and the pelvis
2. 1 state of hypersensitivity induced 1 by
A
exposure to a particular antigen 1 I8' Hann or hurt, synonymous with a wound
or trauma.
(allergen).
3. Pain due to the inflammation of the 1
larynx.pharynx, or tonsils. I9' Inflammation of a joint, which can
develop stiffness, warmth, swelling,
redness and pain.
4. 1An ache or pain called also otalgia 1
110; An organ in the upper abdomen that
plays a major role in metabolism,
digestion, detoxification and
elimination of substances from the body.

5. A popular term that describes a 1

illness that is characterized by fever, 1 1 1L It is the branch of medicine concerned
with diseases and conditions which
weakness and muscle aches. require operative procedures. It is the
work done by a surgeon.
1
6. A viral infection characterized by 1
inflammation of the mucous 1 membranes
1 12‘ It is due to streptococcus infection.
Symptoms include fever, pain in the
lining the upper 1 respiratory passages joints, nausea, stomach cramps, and
and usually 1 accompanied by malaise, vomiting
fever, 1 chills, coughing, and sneezing. A
J a ........ ■
D. Read the text and answer the following questions.

1. How do NSAIDs relieve pain?

2. How does Acetaminophen work?

3. What are some types of NSAIDs?

4. What pain relievers contain Acetaminophen?

5. What are possible side effects caused by long-term use of high doses NSAIDs?

6. What are possible side effects caused by long-term use of high doses acetaminophen?

2
X http://www.medtenns.com (dizionario medico )
9
 Antihistamines
Antihistamines work by blocking the receptors that trigger itching, nasal irritation, sneezing, and mucous production.
The three types of antihistamines are: Diphenhydramine, the medicine in
products such as Banophen, Benadryl Allergy, and Diphenhist
Brompheniramine, the medicine in products such as Dimetapp Allergy
Chlorpheniramine, tile medicine in products such as Aller-Chlor, Chlo-
Amine and Chlor-Trimeton Allergy
Antihistamines can cause sedation or drowsiness and, therefore, can
significantly reduce a person's ability to drive or operate machinery. The
sedative effects of antihistamines may increase the risk of falling.
Antihistamines can also cause temporary dry mouth or eyes.

Decongestants

Decongestants work by narrowing blood vessels in the lining of the nose. As a result, less blood is able to flow through
the nasal area, and swollen tissue inside the nose shrinks. Pseudoephedrine is the only decongestant used in OTC
products.
Pseudoephedrine is in products such as Allermed, Genaphed and Sudafed.
Pseudoephedrine can temporarily cause nervousness, dizziness and sleeplessness. It can make you lose your appetite or
retain urine. It can also cause heart palpitations, high blood pressure, or high blood sugar levels.

Cough Medicines

Cough medicines are grouped into two types: antitussives and expectorants.
Antitussives, or cough suppressants, block the cough reflex. Expectorants, on the other hand, are thought to thin
mucous and make coughing more productive in clearing the mucous from tile airway System.
• Guaifenesin is the only expectorant used in OTC products. It acts act by reducing sputum viscosity.
• Codeine, it is used as an antitussive. It is a narcotic alkaloid obtained from opium or prepared from morphine. It
may temporarily cause nausea, sedation and constipation.
• Dextromethorphan, has a lower risk of sedation, it lacks the analgesic properties of codeine but it may cause
feelings of confusion, agitation, nervousness, or irritability.

Alcohol and OTC Medicines

The body processes or metabolizes every drug differently. If drugs are used
together, thefr metabolism and effect on the body can change. When this happens,
the chance that you will have side effects for. each drug may become greater.
The combination of OTC antihistamines and alcohol can increase drowsiness,
especially in elderly people.
If you frequently drink alcoholic beverage during week and use NSAIDs,
including aspirin, you may be at increased risk of GI bleeding. People who
consume three or more alcoholic beverages each day should consult their
physician before using any pain reliever.
Acetaminophen is much less likely than NSAIDs to be associated with GI
problems, including bleeding. But to minimize the risk of serious liver injury, you
should never take more than the recommended daily dose (4g per day).

A. Write the following medicines under the correct heading. Find

information in Units 10 and 11.

Aspirin, Dextromethorpan, Guaifenesin Tylenol, Excedrin Naproxen, Diphenhydramine, Chlọrphenữamine,

Ketoprofen, Pseudoephedrine, Tempra, Ibuprofen, Brompheniramine
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 UNIT 11: OTC cold and cough medicines (Practice)
Pain relievers Antihistamines Decongestants Cough medicines

B. Complete the sentences with the help of the text.

1.............................................................. . .............................................................................. ...................... .
.......................................................................................^..... can be blocked by the use of antihistamines.
2. The sedative effects of antihistamines may reduce a person's ability to drive or operate machinery, may increase the
risk of falling and.............................;........................................... ...............................................................

3. With the use of decongestants less blood is able to flow through the nasal area, however, they can cause some side
effects such as....................... ........................................................................................................................

5. While antitussives, or cough suppressants, block the cough reflex, expectorants make

6. The metabolism and effect on the body can change when

7. Pain relievers shouldn’t be used in association with alcoholic beverage because they may

3
1
Some groups of people may be particularly liable to have the side effects associated with OTC products. The sections
below include tips for using OTC medicines in the following special populations:

• Children
• Older adults
• Pregnant or breastfeeding women
• Other groups

Children
FDA is urging parents to be careful when giving cough and cold medications to
children, especially those younger than two. Serious and even fatal adverse events can occur if a child is given too
much medicine, or it is given too often, or if the child is given more than one medicine that contains the same active
ingredient.
When used properly, OTC medications cause little risk to children. However, children metabolize drugs differently in
comparison with adults. Parents should know how OTC drugs will affect their children before you use them.
Acetaminophen is generally considered the treatment chosen for children's pain relief.
• Children who are allergic to aspirin are also likely to have problems using ibuprofen. Ibuprofen can make your
child's asthma worse, for example.
• Avoid using aspirin under the age of 18 because of the risk of Reye's syndromeXI a drug reaction that can lead to
permanent brain injury.
• It's very easy to give too much of a decongestant to a young child. It’s advisable to use these medicines with
extreme care.
• It’s recommended to avoid using cough suppressants that contain codeine in young children.
It can be helpful for parents and other caretakers to keep track of the medicine a child is taking. One way to do that is
with a medication log, it can help avoid "double dosing", giving too much medicine or giving it too often. It can also
provide important information to your family doctor if there is a problem.

Giving the right dose at the right times

When your doctor says to give the medicine "every 6 hours" that generally means the medicine is taken 4 times a day
(for example, at breakfast, lunch, supper and bed time). It doesn't generally mean to wake the child up in the night to
take medicine. And "take every 8 hours" generally means the medicine should be taken 3 times a day.
Pay close attention to the dosage given on the label. Labels for liquid medicines give measurements in both teaspoons
(tsp) and in milliliters (mL).
Your pharmacist can give you a measuring device, a spoon that’s made especially for measuring medicine, a syringe or
a cup that's labeled with both tsp and mL.
Your pharmacist should also show you how to use it. One tsp is not the same as 1 mL, read the label carefully and
make sure you give the right amount of medicine to your child. An ordinary kitchen teaspoon may not contain the right
amount of medicine.
• Measure the medicine carefully. If you're using a measuring cup, set it on a level surface such as a countertop and
then pour the medicine into it.
• The idea "If a little medicine is good, a lot is better (or will work quicker)" is wrong. Giving too much medicine
can be harmful. Be sure you only give the recommended dose of each medicine.
• If you use a syringe-type measuring device to give liquid medicine to your child, first throw away the small cap of
the syringe. Children can choke on these caps.
• If your child has a bad reaction to a medicine or is allergic to a medicine, tell your doctor right away. * Also, keep
a record of the following information at home: toe name of the medicine, toe dosage dữections, toe illness the
medicine was used for and toe side effects toe medicine caused.

XI From study cases of an Australian pathologist (1912-1977). It’s a fatal encephalopathy especially of childhood characterized by fever,
vomiting, fatty infiltration of toe liver, and swelling of the kidneys and brain.
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 UNIT 12: OTC medicines to children (Practice)
A. Complete the table with suitable words. Don’t use the same word twice.
VERB ADJECTIVE NOUN
to risk
meaning
to react reactive
measure/measurement
to help help
careful
to harm harm

B. Use some of the words in the grid to complete the sentences.

1. Some OTC medicines may cause........................................;. effects on children, if used improperly.

2. It may be...........................................for children’s health to use aspirin.
3. A.............. ........................ to the use of aspirin in young children may cause the Reye's syndrome.
4. Labels contains ............................................. both in teaspoons and milliliters for liquid medicines.
5. When doctors say every eight hours they usually.................................................three times a day.
6. Parents should take a lot of.............................................................. when giving OTC medicines to their
children.
7. Match each part of a sentence in column A with a second part In column B.

A
1. There are groups of people, ỉn particular children a. children cough medicines that contain codeine.

2. Before using OTC medicines parents should b. in teaspoons and in milliliters for liquid medicines

3. Aspirin and ibuprofen drugs that can worsen c. teaspoon may not hold the right amount of
Children’s asthma medicine
4. The consumption of aspirin in children may cause d. is allergic to it, tell your doctor right away
the Reye's syndrome
5. Talk to your pharmacist before giving young e. that can be affected by OTC medicines
f. know how they will affect their children
6. It can be helpful for parents and other caretakers
7. Read the label carefully, they give measurements g. therefore avoid giving them to children under the
both age of 18
h. a drug reaction that can lead to permanent brain
8. Make sure you give the right amount of medicine injury
to your child because an ordinary kitchen
9. Be sure you only give the recommended dose of i. to keep track of the medicine a child is taking
each medicine
10. If your child has a bad reaction to a medicine or j. Giving too much medicine can be harmful

Older Adults
Elderly people use a number of medications at the same time and therefore need to pay carefol attention to drug -to-
drug interactions between OTC medications and prescription medications. .Older adults should talk to theứ doctor
about the medications they take and potential interactions with OTC medicines.
• There is a relatively high risk of kidney disease and GI bleeding in elderly patients who use NSADDs 1.
• The use of PseudoephedrineXII XIII can increase blood pressure and the pressure in the eyes that can lead to,

XII a nonsteroidal anti-inflammatory drug (as ibuprofen)

XIII A crystalline alkaloid CIOHJSNO that is isomeric with ephedrine and is administered chiefly in the form of its hydrochloride
3
C10H15NO HCI or sulfate (CIOHJJNO^-HJSO^ especially to relieve nasal congestion.
3
 glaucoma. It can also make existing blockages in the urinary tract worse. Pseudoephedrine interacts negatively
with many other drugs such as beta-blockers, antidepressants, insulin, and some medications that treat low blood
sugar.
• If you use a monoamine oxidase inhibitor (MAOI) XIV, a type of prescription antidepressant, or take any medication
for a seizure disorderXV, you should avoid using pseudoephedrine. Pseudoephedrine can change the way these
drugs work in your system. Some common MAOIs include the following generic substances: isocarboxazid,
phenelzine sulfate and tranylcypromine sulfite.
• If you use a MAOI, you should not use dextromethorphanXVI as it interferes with the way MAOIs work

Pregnant or breastfeeding Women

Pregnant or breastfeeding women should talk to their doctor before using any medicine. Some can affect your baby.
The following are some general guidelines.

Pregnancy
• Acetaminophen is generally considered safe for short-term pain relief during pregnancy.
• Avoid using aspirin during pregnancy. It can cause abnormalities in the baby or problems during delivery.
• Avoid using other NSAIDs, especially during the thừd trimester of pregnancy. They can cause heart abnormalities
in the baby.
Breastfeeding
• Acetaminophen and NSAIDs such as ibuprofen provide safe pain relief for women who are breastfeeding.
• Avoid using aspirin because is excreted in breast milk and can cause rash and bleeding problems in nursing infants.
• Limit long-term use of antihistamines. Antihistamines are excreted in breast milk and may cause side effects such
as sedation, irritability, crying, and sleep disturbances in nursing infants. Antihistamines may also interfere with
the production of milk.

General Tips
These steps can help minimize the risk of side effects during pregnancy and breastfeeding:
• Talk to your doctor about possible alternatives to medicine.
• Avoid the use of medications during the first trimester.
• Take oral medications after nursing or before the infant's longest sleep period.
• Avoid the use of extra-strength, maximum-strength, or long-acting medications.
• Avoid "combination" products.
• Watch your infant for possible side effects, such as a rash, difficulty breathing, headache or other symptoms
that your child didn't have before taking the medicine.

XIV Any of various antidepressant drugs which increase the concentration of monoamines in the brain by inhibiting the action of
monoamine oxidase
XV a sudden attack (as of disease); especially : the physical manifestations (as convulsions, sensory disturbances, or loss of consciousness)
resulting from abnormal electrical discharges in the brain (as in epilepsy)
XVI a nonaddictive cough suppressant that is widely used especially in the form of its hydrobromide C18H25NO-HBr in over-the-counter
cough and cold preparations
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 UNIT 13: OTC medicines to other groups (Practice)

A. Scan the text and find similar words to the following ones.
In the text In the text
over sixty people alleviation
physical or mental interfere (v)
defectiveness A
raise (v) illness
ill humour efflorescence
rule influence (v)

B. Cause and effect.

When you talk about causes and effects you can either put the cause first or the effect
For example
Cause Effect

Taking more OTC medicines at the

causes results in drug interaction
same time
gives rise to brings
about leads to

Effect Cause
is caused by results
from
is the effect of is the
Drug interaction taking more OTC medicines at the same timeJ
result of is brought
about is due to

Study the following list Items In column A are causes of items in column B but they are mixed up.
a. match causes with thefr effects
b. link them by using a suitable linker with the modal verb “can” or “may” if necessary. For each sentence
there may be two solutions following the example in the previous table.

a.Solution (match)____________________________________________________________
1. |2 |3 |4 |5 |6

A(cause) B(effect)
1. The use medicines that contains the same active a. the risk of Reye's syndrome
ingredient.
2. The use of aspirin in children under 18 b. rash and bleeding problems in nursing infants
3. Using pseudoephedrine together with betablockers, c. irritability, crying, and sleep disturbances in
antidepressants, and insulin nursing infants
4. The use of NSAIDs during pregnancy d. serious health complications in young children
5. Using aspirin while breast feeding e. high blood pressure and other complications
6. Antihistamines f. problems in delivery or baby abnormalities

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5
 ~r-- ?
People with health problems such as kidney disease, heart disease, diabetes, asthma, blood clotting disorders, or gout
may be at increased risk of side effects associated with OTC medicines.
The chart contains detailed information on use of OTC pain relievers in patients with these and other medical
conditions. Individuals with any of these conditions should talk with their family doctor before taking OTC pain
relievers.

Use of OTC Pain Relievers in Selected Diseases and Conditions1

KI

'rVi- '•
®

I
Allergy to aspirin, NSAIDsXVII XVIII Acetaminophen (Panadol, Tempra, Aspirin, ibuprofen, ketoprofen and
or tartrazine Tylenol), choline salicylate (Arthropan) naproxen sodium
or sodium salicylate
Asthma or nasal polyps Acetaminophen, choline salicylate or Aspirin, ibuprofen, ketoprofen and
sodium salicylate naproxen sodium
Bleeding disorder Acetaminophen or nonaspirin Aspirin, ibuprofen, ketoprofen and
salicylates naproxen sodium
Congestive heart failure Acetaminophen Sodium salicylate, effervescent aspirin
tablets with a high sodium content, and
nonsalicylate NSAIDs
Dysmenorrhea Ibuprofen (Advil, Menadol, Motrin), None
ketoprofen (Orudis KT) or
naproxensodium (Aleve)
Hepatic failure Acetaminophen! XIX All NSAIDs
Hypertension Acetaminophen All NSAIDs
Lactation Acetaminophen Salicylates
Lithium therapyXX Acetaminophen or aspirin Ibuprofen, ketoprofen and naproxen
sodium

Methotrexate therapyXXI Acetaminophen All NSAIDs

Non-insulin-dependent diabetes Acetaminophen or ibuprofen Ketoprofen, naproxen sodium and
mellitus managed with first- salicylates
generation sulfonylureasXXII
Oral anticoagulant therapy AcetaminophenXXIII Aspirin, ibuprofen, ketoprofen and
naproxen sodium
Peptic ulcer diseaseXXIV Acetaminophen AllNSAIDs
Pregnancy Acetaminophen All NSAIDs
Renal impairment Acetaminophen All NSAIDs
Urticaria Acetaminophen Salicylates
Acetaminophen or ibuprofen Salicylates
Varicella or influenza symptoms in
a pediatric patient

XVII http://íãmilydoctor.org/otc/painrelieveruse.html. Adapted from APhA drug treatment protocols: self-care of self
XVIIIlimited pain. J AmPharm Assoc. 1999;39:321-30.
XIX NS AIDS = Nonsteroidal anti-inflammatory drugs.
3
Patients who have chronic liver disease that is not progressing may use acetaminophen.
XX Lithium carbonate is a salt that was first approved in the United States in 1970 to treat manic depression.
XXI Methotrexate is indicated for the treatment of active Rheumatoid Arthritis and some other inflammatory arthropathies.
XXII Sulfonylurea derivatives are a class of antidiabetic drugs that are used in the management of diabetes mellitus type 2.
XXIII1 Patients taking anticoagulants who also take acetaminophen regularly or at higher doses should be monitored carefully.
XXIV A peptic ulcer is a sore or hole in the lining of the stomach or duodenum.

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 UNIT14: OTC pain relievers in selected diseases (Practice)

A. Tick true or false. Correct the false statements. Some statements refer to your previous knowledge.

1. Methotrexate is currently indicated for the treatment of acute lymphocytic leukemia, T F

rheumatoid arthritis and psoriasis.

2. Most NSAIDs must be used with caution by patients who are under Methotrexate therapy.

3. Oral anticoagulants are used to prevent or treat deep vein thrombosis and pulmonaiy embolism. It
isn’t normally used for stroke prevention.

4. The preferred agent used in die Methotrexate therapy is Acetaminophen.

5. None of the NSAIDS should be used with a Methotrexate therapy.

6. Women with Dysmenorrhea treated with ibuprofen, ketoprofen or' naproxensodium' must not
use NSAIDs.

7. Breast feeding women under Acetaminophen treatment can use Salicylates without any risks of
side effects.

8. Acetaminophen or ibuprofen are active agents used for the treatment of Varicella or influenza
symptoms in a pediatric patient.

9. Acetaminophen, choline salicylate or sodium salicylate are preferred agents to treat Asthma or
nasal polyps.

1Ọ. All NSAIDs must be avoided in the freatment of congestive heart failure with acetaminophen.

B. Fill in with the following quantifiers: some, any, no, none, most or all.
1. Can.............of the NS AIDS produce adverse effects when Dysmenorrhea is treated with
Ibuprofen? No,
.............effects are produced.
2. of the NSAIDs should be used when treating Pregnancy with Acetaminophen.
3. In treating..............disease states with Acetaminophen it is recommended to use Salicylates with caution.
4. ofthe OTC pain relievers can increase the risk of side effects when associated with OTC
medicines.
5. In................disease states treated with Acetaminophen aspirin should be used with caution.
6. Are there ...............medical conditions when NSAIDs can be used without the risk of adverse side effects?
Yes, there’s only one condition, when Dysmenorrhea is treated with Ibuprofen.
7. In.............. cases Acetaminophen should not be used in association with ...............NSAIDs.
8. Are.............of die painkillers in the grid used to treat Urticaria? Yes, Acetaminophen.

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What are Generic Drugs?1
When ạ new drug is developed, it is given a name that indicates the chemical substance of that drug. This is called
generic or chemical name. The new drug is also given a brand name XXV XXVI for marketing purposes. The brand name is
usually easier to say and remember than the chemical name.
Patients and Doctors will learn to know the new drug by this brand name. A well-known example of a brand name drug
is Prozac (proprietary name), its generic or chemical name is fluoxetine hydrochloride XXVII. Generic medicines are
copies of brand name medicines with tile same active ingredients. Therefore, equivalent brand name and generic
medicines have the same chemical name and the same therapeutic effect.
International Nonproprietary Names
An 'International Nonproprietary Name' (INN) is the official chemical name (nonproprietary name) given to a
pharmaceutical substance as designated by the World Health Organisation (WHO). The proprietary name is the brand
name. The intention of an INN is to ensure there is a standard name for each chemical substance across the world.
Occasionally, the United States and/or Britain may designate their own nonproprietary name for a particular substance,
rather than adhering to the INN. In such instances, the nonproprietary name may be referred to as a United States
Adopted Name' (USAN) or as a 'British Approved Name' (BAN).
Sometimes the US AN or the BAN can differ from the INN.
This is the case with the nonproprietary name for tile common asthma
product: Ventolin. The INN and tile BAN for Ventolin is Salbutamol, while
the USAN is Albuterol.
Another example is the commonly used diuretic Lasix. The INN and the
USAN is furosemide, while frusemide is the nonproprietary name that the
British approved.
The brand name is usually written most clearly on any packaging. However, you will always see the generic name
written somewhere on the packet (often in small print). Some medicines only have the generic name on the packet.
Generic Drugs approval
The approval process for generic drugs is rigorous. A company that manufactures a generic drug needs to prove that it
has the same effect in the body and is manufactured according to the same high standards of its brand name counteipart
before it can be registered and therefore sold to patients.
In order to obtain the FDA approval generic medicines must show that they:
• contain the same active ingredients as the brand name drug (inactive ingredients may vary)
• are identical in strength, dosage, form, and route of administration
• are used for the same condition(s)
• are bio-equivalent (i.e. are available to the same extent in the body when taken or administered)
• meet the same requứements for sữength, purity, and quality
• are manufactured under the same strict standards of good manufacturing practice as required for brand name
products.
Comparing prices
It is a common perception that more expensive equals better quality. In the case of drugs, however, this is not
necessarily true. When a brand name drug has a generic competitor this simply means that the brand name product has
been around long enough for its patent to expire which then allows copy products ("generics") to be made. Most often
generics will be the cheapest drugs when compared to their brand name counterparts. These are the same requirements
that exist in most developed nations, where the quality standards required for the cheapest drugs (usually generics) are
as high as they are for the most expensive drugs (usually brand name products).
r „................................................................................................................................................ --......--.........-

Al. Find verbs ỉn the text that have the meanings. Write the infinitive form of the verbs underlined.

XXV http://www.medstoreintemational.com
XXVI Brands were originally developed as labels of ownership: name, term, design, symbol. Today powerful brands can drive success in
competitive and financial markets, and indeed become the organization's most valuable assets.
XXVII An antidepressant drug that is administered in the form of its hydrochloride CpH^FjNO HCl and enhances serotonin activity.

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8
 Verbs In the text Meanings
to guarantee, to make certain of something
to end, to stop, to cease, to lose validity
to demonstrate, to support
to dispense, distribute, to treat
to be identical or equivalent
• to be different from
to need, to necessitate, to demand
to grant, to permit
to agree, to accept
to decide, to fix, to establish

A2. Complete the sentences with a suitable verb from the grid on the left column.
You don’t need them all.

1. Manufacturing companies are .................................................... to prove that generics produce the same
effect of their brand name counter parts.
2. The FDA................................................... companies to produce and sell generic after a rigorous approval'
process.
3. By using the INN the WHO wants........................that there is a standard name for each chemical substance
across the world.
4. Occasionally Britain and the USA do not............................................... to INN........................................
bytheWHO.
5. Generic drugs are often made when the brand name’s patent........................v...............................after being
around for a long time.

B. Circle the correct alternative <

Broadly speaking / Strictly speaking the generic name indicates the chemical composition of a drug although / while
the brand name is given by the manufacturing company for marketing purposes. In addition / on the contrary the brand
name easier to remember both/eừher for patients and/or doctors.
An example can be given with Prozac, the brand name accordingly /whereas fluoxetine hydrichloride is the generic
name. Yet /Since generic drugs contain the same active ingredients of brand name drugs they neừher /also have the
same therapeutic effect. Anyway/Although WHO usually gives drugs standard names (INN) to be used across the
world, The USA and Britain may occasionally /always choose their own names. For example / After all the
international standard name Ventolin, coưesponds to salbutamol in Britain and albuterol in the USA. In order / As a
result to obtain the approval for registering and selling a drug, the manufacturing company needs to prove that it has
the same effects and responds to the same high standards of its counterpart brand name, similarly I consequently the
approval process for generic drugs is very rigorous. In general there’s the common perception that more expensive
items offer better quality, moreover I however this is not true in the case of medicines. In fact/ Because of generics are
usually much cheaper than their counterparts despite having the same active ingredients.

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9
Switching to Generics

In some countries over half of all prescriptions filled in are for generic medicines. A generic prescription drug is
usually a discount prescription drug. However, this does not mean it is a lower quality product provided it is
manufactured in a country that has strong regulations controlling the standards that generic pharmaceuticals must meet
in order to be available there.
Many brand name drugs have generic equivalents available. This is expected to increase over the next decade. In some
countries, including Italy, pharmacists are requested to substitute a generic medicine on prescriptions even though a
brand name product may have initially been prescribed, whenever the generic medicine is sold at a lower price than it
brand name counterpart.
Many insurance plans, in the USA, also encourage patients to accept generic medicines over their brand name
counterparts whenever it's medically safe. This level of use demonstrates the widespread acceptance of generic
medicines as discount prescription drug alternatives as long as the quality is assured.
There is a small number of brand name drugs with which great care should be taken when substituting generic
pharmaceuticals. These are drugs that have what is termed a 'narrow therapeutic index'. This means that for these drugs
a small variation in dose can cause problems, such as too little effectiveness or too many side effects. In these few
cases, a patient should only switch to generics after consulting with their doctor and then do so only with his or her
approval and close supervision.

Why are brand name drugs more expensive?

While the active ingredients in generic pharmaceuticals are the same as

the active ingredients in their brand name counterparts, there may be Your prescription,
differences in their appearance, for example, the shape or the colour of a
tablet.
your choice.
If your doctor has suggested to switch to a generic drug, or has
prescribed one for the first time, you can expect to receive the same
clinical effect as with its brand name counterpart, but at a considerably
reduced cost. Generic medicines are usually less expensive than their
brand name equivalents because the investment in discovering them is
not reqmred or less intensive or because they are essentially copy
products.
Original brand name drugs usually have 20 years patent protection from
initial discovery of the molecule before copy generic medicines can be
marketed along side them. However, research has shown that after
discovery the average drug takes approximately 12 years to develop and costs several hundred million dollars from
initial discovery to public release. This may mean that the original manufacturer has only a few short years of
exclusivity in the market before the copy medicines are introduced.
Manufacturers of brand name products must, therefore, charge a price that will compensate die research and
development costs of thefr new drug when it finally reaches the market. Following approval to sell a new drug, there
are additional large costs required to promote the product and educate medical professionals in its use. Manufacturers
of generics do not incur the risks and costs associated with the research and development of innovative medicines.
Since generics contain well-known, safe and effective substances, pre-clinical tests and clinical trials can be replaced
by simple bioequivalence studies'.
By the end of 2004 some 35% of the top selling pharmaceuticals that year became patent expired, creating a major
opportunity over the following years for increasing the purchase of generic medicines, both in community prescription
and in hospital sectors.

4
0
UNIT 16: Branded versus generic medicines (Practice)

A. Look at the diagram and explain what it presents.

B. The following sentences make up a short summary of the text. Complete them with ideas from the text
There may be more than one answer.

1. A generic medicine offers the same quality of a branded medicine as long as it is.........................................

2. In some countries a large part of prescriptions.................................. ..............................................................

3. Even though a brand name product may have been prescribed pharmacists are requested to substitute die generic
medicine on prescriptions whenever..................................................................................................................
4. With a small number of brand name drugs it is necessary to use................................................................

5. Problems such as too little effectiveness or other side effects may be caused by substituting generics

6........................In this case, before switching to generics, patients should ........................................... and use
them only..........
7. Although generic pharmaceuticals contains the same active ingredients of....................................................

8. Since generic medicines do not involve investment expenses and are mainly copy products they are usually less
................................................................................................................. .............................................
9. Brand name drugs have patent protection for a period of twenty years, that goes from initial discovery of

10. After the initial discovery the drug takes about twelve years to develop, therefore the effective period of
exclusivity in the market......................................... ..........................................................................................
11. When calculating selling prices manufactures need also to calculate the costs..............................................

12. When producing generics pre-clinical tests and clinical trials can be replaced..............................................
........................................................since they contain...........................................................................................
Recents EU regulationsXXVIII XXIX
After a long procedure which involved different economic positions the European Commission approved a new
regulation, concerning both generic and branded medicines which was adopted in March 2004. The final outcome
has been hailed as reaching a fair compromise among the various interests, as proved by the fact that none of the
groups involved seems fully satisfied with the final decisions. The revised law contains a number of important
advances towards making lower-priced generic medicines more readily available to European. patients and
healthcare systems. It also increased the market protection granted to the pharmaceutical companies to help them
recover their investment in researching and developing new treatments.

Europe’s generic market

According to European generic medicines association (EGA) medicines, currently generate some € 18 billion in
savings each year for EU healthcare systems. If generic medicines were taken out of the pharmaceutical market,
the EU’s healthcare systems would become financially unsustainable. XXX
European citizens are familiar with generic medicines mostly in the self-medication area where payment is made
directly from their own pockets. For example, consumers invariably choose the lower-priced generic paracetamol
over the branded Panadol™ for pain relief, or generic loratadine as opposed to Claritiri™ for tackling hayfever
or allergies. However, it is in the area of critical illness where generic medicines play the most crucial role
because costs are mostly paid by health insurance and taxes contributions.
The size of the generic market differs widely in the various EU member states. Generics make up a relatively
large part of the pharma market in Germany (41%), Sweden (39%), Denmark (22-40%), the UK (22%) and the
Netherlands (12%). In Italy, Spain and Portugal, generics barely count for 1% of the pharma market, compared to
3-4% in France. By contrast, generic medicines in the United States account for 40 % of all prescribed medicines.
These differences are mainly a consequence of the different policies followed by the member states. The size of
the generic market may depend on the following factors: market conditions for new medicines; pricing /
reimbursement structures; prescribing /dispensing traditions; requừements; the existence of specific incentives, to
encourage generic use.

Central and Eastern Europe: “Healthcare Gap"

According to the European generic medicines association generic medicines play a key role in healthcare
provision in the new EU Member States. They are crucial to making quality medicines accessible to patients who
cannot afford high co-payments for essential treatment. These points will perhaps be appreciated more . clearly if
we consider the following:
• GDP per capita in the new Member States is 5 times lower than the EU Average.
• Real spending per capita on healthcare in the new Member States is less than €400 compared to over €1,600
in the EU.
• Several new Member States are already experiencing healthcare budget deficits due, at least in part, to rising
pharmaceutical costs.
• Many patients do not buy their prescriptions simply because they cannot afford the high out-of-pocket co-
payments

Biosimilar Medicines
Focus is now increasingly dữected to competitive biosimilar products. Since 2006 the European Commission has
authorised several biosimilar medicines in Europe, declaring that each of them: “has been compared to and
matches the reference medicine [...] in terms of quality (how it is made), safety (for example the side effects that
can occur when receiving treatment are similar), and effectiveness."

UNIT 17: the EU generic market’(practice)

A. Write verbs or nound to complete the grid

XXVIII’ http.7/www.euractiv.com/en/health/generic-medicines/article-117497
XXIX http://www.euractiv.com/en/health/generic-medicines/article-l 17497
XXX http://www.egagenerics.com/gen-geneurope.htm EUROPEAN GENERIC MEDICINES ASSOCIATION

4
2
 Verb Noun Verb Noun
recover reimburse
involve exist existence
satisfaction require
choose encourage
provide compare
develop appreciation
B. Fill in the spaces with the correct preposition

1. The European Commission took a long time before passing new legislation concerning pharmaceuticals as
they wanted to reach a balance................................the different economic interests.
2. The economic groups involved were non completely satisfied.............................the results reached by the •
EƯ, which proved that the law was good.................................................the intended purpose.
3. In the case of self-medications European consumers are very familiar................................generic medicines
because they have to pay.............................. their own money.
4. pain relief consumers usually choose lower-priced generic medicines ...................................................... the
branded ones.
5. In some European countries the use of generic medicines counts.................................a small percentage as,
for example, in Italy because they have to pay directly................... ...... .theứ own pockets.
6. The health care systems all ........... ..... Europe would be financially unsustainable if generic medicines were
taken .................................................ofthe market.
7. In the United States generic medicines account................................40 % of all prescribed medicines, they
play a crucial role in the area of critical illness, where costs are mostly paid ....................................... health
insurance.
8. Pricing and reimbursement structures are two important factors ..................................which the size of the
generic market depends............... .........................
9. In the new Eu member countries, where GDP ................................ person is 5 times lower than the EU
average, generic medicines play a key role because they make quality medicines accessible patients who
can’t pay....... ................................................essential treatment.
10. The Eu has recently declared that biosimilar medicines have given positive results if compared
reference medicines as regards quality, safety and effectiveness.

’ htto://www.euractiv.com/en/health/generic-medicines/article-l 17497

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Broadly speaking biotechnology is a technology based on biology, especially when used in agriculture, food
science, and medicine. The United Nations Convention on Biological
Diversity defines biotechnology as "any technological application that
uses biological systems, living organisms, or its derivatives, to make or
modify products or processes for specific use ”.
While before 1971, die term biotechnology was primarily used in the food
processing and agriculture industries now it IS used to manipulate and
modify organisms, often at the molecular level and in applying biological
research techniques to the development of products that improve human
health, animal health and agriculture.
Biotechnology combines disciplines like genetics, molecular biology,
biochemistry, embryology and cell biology, which are, in turn, linked
to practical disciplines like chemical engineering, information technology
and robotics. Biotechnology is often used to refer to the genetic
engineering technology of the 21 st century.

Biopharmaceuticals
It is a relatively young industry. "Biopharmaceuticals" refer to complex biological medical products manufactured
by biotechnology methods/prOcesses.
Both in the U.S. and European Markets they include all microorganism and animal cell and tissue-derived
proteins, vaccines, blood products, antibodies, enzymes, cytokines, radioimmune conjugates and certain
engineered tissue grafts/implants. Also vaccines and blood products are included, often not considered as
biopharmaceuticals by others who consider only recombinant proteins and monoclonal antibody-based products as
biopharmaceuticals Products are included irrespective of whether they involve old (e.g., fermentation) or new
(e.g., recombinant DNA, monoclonal antibody) biotechnologies.
Biopharmaceuticals can treat human deseases that may not be accessible with traditional medicines. A patient
typically is dosed with a small molecule via a tablet while a large molecule is typically injected. Small molecules
are manufactured by chemistry but large molecules are created by living cells such as those found in the human
body, for example, bacteria cells, yeast cells, animal or plant cells. Biotechnology is also commonly associated
with landmark breakthroughs in new medical therapies to neat hepatitis B, hepatitis c, cancers, arthritis,
haemophilia, bone fractures, multiple sclerosis, and cardiovascular disorders. The first genetically engineered
products were medicines designed to treat human diseases. In 1978 synthetic humanized insulin was developed so
that it was possible to produce it in vast quantities at low cost. Insulin, widely used for the treatment of diabetes,
was previously extracted from the pancreas of cattle and/or pigs.

Transgenỉcs
Nowadays biotechnology refers more and more to the production of genetically modified organisms (GMO). A
potentially controversial method of producing biopharmaceuticals involves transgenic organisms, particularly
plants and animals that have been genetically modified to produce drugs. The production of these organisms
represents a significant risk on the part of the investor, both in terms of the risk of failure to produce die required
organism, and in the risk of non-acceptance by government bodies due to the perceived risks and ethical
issues.One potential approach to this technology is the creation of a transgenic mammal that can produce the
biopharmaceutical in its milk (or blood or urine). Once an animal is produced, typically using the pronuclear
microinjection method, it becomes efficacious to use cloning technology to create additional offspring that carry
the favorable modified genome. The first such drug manufactured from the milk of a genetically-modified goat
was ATryn®, but marketing permission was at first blocked by the EU agency and then approved, in August
2006, for treatment of patients with hereditary antithrombin XXXI XXXIIdeficiency, undergoing high-risk surgical or
childbirth procedures.

XXXI'Adapted from Wikipedia, the free encyclopedia

XXXII Antithrombin (AT) is a small protein molecule that inactivates several enzymes of the coagulation system.

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 UNIT 18: Biotechnology and biopharmaceuticals (Practice)

A. Fill in the sentencess with the combination of two words from the box on the right
1. Before the seventies biotecnology was mainly used in........................................................and agricultural
industries.
2. Nowadays biotechnology is largely used to manipulate and modify molecular research
organisms at the................................................................................................
modified molecules
3. Biotechnology consists in applying .•...................................................to the
development of products that improve human health and farming. food products
4. Genetic .............................................. .................. is connected to the 21th ethical insulin
century biòtecnologies.
blood processing
5. The FDA and the European market consider also vaccines and as
..................biopharmaceutical products. human concerns
6. Bacteria cells, yeast cells, animal or plant cells are .........................................
engineerin medicines
................................................ created by living cells found in the human g
body. large organisms

7. The development of..................................................... ... made it possible to traditional level

produce this hormone ạt lower cost than in the past.
biological technolog
8. Human diseases are treated with biopharmaceuticals when are not y
accessible.

9. A more recent development of biotechnology is concerned with the production of genetically

10. Some governments do not accept transgenics both for possible risks and for............................................

B. With the help of your knowledge explain what the following tables Illustrate.

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Why are biosimilar medicines being introduced?
Medicinal products developed through biotechnology constitute an
essential part of medicines available for patients today. They represent
approximately 6% of the pharmaceuticals currently marketed and
account for more than 9% of the total pharmaceutical expenditure.
As already noted, Europe has a critical need to control healthcare
costs. It.is estimated that by 2015 the number of people over 60 will be
at least 25% of the total population. This equates to approximately 120
million people aged over 60. Since this age group spends on average
three to four times more on medicines than when they were 30. Costs
for providing access to medicines for these people are going to
explode. Oncology is the largest area of biotechnology. However,
many biopharmaceuticals are more and more used to treat long-term
conditions such as diabetes, cancer, chronic kidney failure and
multiple sclerosis.
Some major biotechnology-derived medicines are, or will soon, no
longer be protected by patents. As for all other medicines when their 20-year patent expires, they will become
open to development and manufacture by other companies. This introduces competition on the market which
ensures patient access to safe, effective and more affordable biotechnology-derived medicines. Many patients
who could benefit from these medicines do not have access to them and with pharmaceutical spending growing
more than twice as fast as the gross domestic product (GDP), that situation can only worsen. It is therefore
essential to facilitate patient access to cost effective biopharmaceuticals and biosimilar medicines as soon as
patents expữe.

How can patients be assured of quality?

Both originator reference products and biosimilar medicines are made under carefully controlled conditions to
ensure the products are consistent and of the required quality. This is known as Good Manufacturing Practice
(GMP). Companies involved in the developing of biosimilar medicines must demonstrate, with a high degree of
certainty, that the quality of the medicine is comparable to the originator/reference medicinal product. All
biotechnology medicines, including biosimilar biotechnology-derived medicines, are or will be assessed by the
European Medicines Agency in London (EMEA). When the EMEA assesses data for a .biosimilar medicine, the
scientific principles for ensuring product quality, safety and efficacy are identical to those applied to the
originator/brand reference medicine with which comparability is demonstrated. AU European pharmaceutical
companies are legally required to monitor the use and effects of all theữ medicines. They must have systems
capable to detect, assess, understand and communicate any adverse reactions or any other medicine-related
problem.

Examples of active substances of mator reference products

Scientific name of the biological active substance (INN - Main treatment Area
International Non-proprietary Name)
Imiglucerase (from Chinese hamster ovary cells) Gaucher’s disease1
Human Insulin (from the cells of the pancreas) Diabetes
Interferon Alpha (from peripheral blood leukocytes3) Various cancers, Hepatitis B/C
Interferon Beta (from fibroblasts*) Multiple sclerosis
Somatropin (from the human pituitary gland) Human growth hormone deficiency
Erythropoietin (EPO) (from specialised cells in the kidneys) Anaemia associated with chronic kidney failure
' http://www.egagenerics.coni/FAQ-biosimilars.htin - September 2007
2
Gaucher’s disease is an inherited metabolic disorder in which harmful quantities of a fatty substance accumulate in the spleen,
liver, lungs, bone marrow, and sometimes in the brain.
3
White blood cell
4
Connective-tissue cell that secretes proteins and molecular collagen.

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 UNIT 19.Bỉosỉmỉỉar Medicines (Practice)

A. Write sentences changing from passive to active or vice versa.

1. Biopharmaceuticals represent approximately 6% of medicinal products

1........ ....................................... .... ................................................
2. Elderly people spends a lot more on medicines than young people.
2............................................................................................... .........................................................................
3. Many biopharmaceuticals are being used by physicians to treat long-term illnesses.
3... ............. ..."................................... .................................................................................................
4. Some major biotechnology-derived medicines will no longer be protected by patents.
5. ........................................................ ..............................................................................................
6. They need to do everything possible to facilitate patient access to cost effective biopharmaceuticals.
7. ................ "...........................................................................................................
8. All European pharmaceutical companies are required by EMEA to monitor the use and effects of all their
medicines.
8.1. ......................,................................................ . ........... . . ......................................................................

9. Here is a short summary of the text. Complete it with the combination of adjective and
noun.
Today an....................................................................................of medicines monitoring systems
available originator medicine
to patients is represented by .............................................................................. medicinal products
...................................................................... essential part
..................................developed through biotechnology. Nearly 10% of the total careful control
is...............................covered high certainty
by biosimilar medicines. The largest area is Oncology. By the year 2015 the cost scientific body
for providing medicines to the ............................................... pharmaceutical
............................................................................................... expenditure
................................ of elderly people will increase considerably. growing number
At present the number of patients treated with ..................... ........................ biosimilar drugs
............................................................................................... easy access
..................................
reference products and biosimilar is still medicines
low. However, onceunder................................................................................
are made patents expire companies are or
Companies developing biosimilar medicines need to prove with .......................................................................
.....................................that the quality of the biosimilar medicine is comparable to the originator/reference
medicinal product. The European Medicines Agency in London (EMEA) is die................................................
...................................... of the European Commission responsible for the evaluation of medicines. The EMEA
uses the same scientific principles for ensuring product quality, safety and efficacy as those applied to the......
However,...........all European pharmaceutical companies are
legally requửed to adopt................................................................................... and to communicate any adverse
reactions related to the medicines problem.

A prescription insert or a Patient Package Insert (PPI) is a printout that contains specific information on a particular
prescription drug. There are many online resources that allow patients to print out inserts for all prescription drugs at

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no cost. Companies may use different insert styles to convey drug information, but inserts usually include related
sections in a similar order. Common sections include:
• Description. This section includes general information about the prescription drug. People with drug allergies can
review this section to ensure that they are not taking a medication that may trigger an allergic reaction. This
section contains:
o Generic name (the scientific or chemical name)
o Brand name
o Type of dosage (e.g., liquid, tablets, capsules)
o Administration method (e.g., oral, intravenous, rectal)
o Pharmacological or therapeutic class (e.g., analgesics, antibiotics) ,
o Chemical information, including names, structural formulas and other information.
• Clinical pharmacology. Here they state how the drug actually works (e.g., how the medicine acts in the body,
how it is absorbed and eliminated, its effects with different concentrations).
• Indications and usage. Information about the condition(s), diagnosis or symptom(s) is declared in this section
following the approval obtained. However, drugs can sometimes be prescribed for reasons other than for what
they were approved initially (off-label use).
• Contraindications. This section describes those cfrcumstances in which the drug should not be used or should be
used with caution because the potential risks may outweigh any potential benefit. For example, using the drug at a
particular age, by a particular gender, with pre-existing diseases or mixing it with other drugs may cause a serious
risk. This section may also urge not to use the drug in an individual with an allergy or known hypersensitivity to
specific substances.
• Warnings. Adverse reactions and possible hazards are indicated here and what to do if they occur.
• Precautions. Vital information about precautions for most people taking the drug is displayed in this section.
Special groups of people, such as children, pregnant women and nursing mothers, may also have information
specifically adapted for them. This section includes also advice and instructions for special care to be taken by the
physician, (e.g., precautions when using alcohol or other drugs). Information about laboratory tests and possible
adverse reactions will be listed here.
• Adverse reactions (commonly called “side effects”). Any unwanted effect that may be connected with the use of
the drug is listed here. Adverse reactions can be caused by medication errors (e.g.,
, overdosage), drug or food interactions, allergic reactions or other causes. Information about adverse reactions with
drugs in the same class (e.g., antihistamines, bronchodilators, corticosteroids) may be in this section of the
package insert.
• Drug abuse and dependence. It will be clearly stated in this section if a drug is thought to have a potential for
abuse, dependence or withdrawal symptoms.
• Overdosage. Any information referring to signs, symptoms and laboratory findings associated with an overdosage
of a drug will be confirmed here.
• Dosage and administration. Under this section heading, the recommended dose is stated along with the usual
dosage range allowed, and perhaps an upper limit beyond which safety and effectiveness have not been
established. Also included in this section is information about the intervals recommended between doses, the usual
duration of treatment and any changes of dosage needed for special patients such as children, the elderly or
patients with a disease. *
• How supplied. This section includes information about available dosage forms. The strength of the dosage forms
is indicated here along with the units in which the dosage form is usually available for prescribers, the description
or appearance of the dosage form and special handling and storage • conditions.
• Additional sections. This section will include additional information if appropriate.
The package insert contains important information and instructions but it should not take the place of instructions from
a physician or healthcare professional. It is important, however, to review the inserts for details regarding patient-
specific conditions (e.g., allergies, adverse effects to medications). Studying the information in the inserts will help
avoid errors and increase patient awareness of potential problems.

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 UNI 20: Preseriptionjnserts (Practice)

A. Find ỉn the text the opposites to the following words. Choose from the underlined words. Two of them
are not necessary.

In the text In the text

favourable (adj) damage (n)
handout (n) hide (v.)
prohibit (v) lower (adj)
expected (v) weakness
refuse/reject (v) eliminate (v)
B. Find suitable nouns in the text for the following deflnitions.

Noun Definition (from http://www.wordreference.com)

identifying the nature or cause of some phenomenon
maltreatment, ill-treatment, ill-usage
how medication is given
written instructions from a physician concerning the form and dosage of a drug
a process in which one or more substances are changed into others
excessive quantity or amount of a drug
hypersensitivity reaction to a particular drug or substance
any sensation or change in bodily function experienced by a patient and associated with a
particular disease
c. Make noun+noun combinations using a word from each box.

1. drug test 1
2. patient interaction . 2
3. prescription range 3
4. brand symptoms . 4
5. administration insert 5
6. laboratory abuse 6
7. food awareness 7
8. dosage name . 8.
9. storage method 9.
10. withdrawal condition 1
0
D. Complete the sentences with the combinations made in the previous exercise. You don’t need them all.
1. .Detailed information on a particular prescription drug is contained in the......................................................
2. In the section abuse, dependence and.............................................................. associated with....................
.............................are clearly stated.
3. In this section you will find the recommended........................................................... as well as information
about the intervals between doses.
4.In the section “Overdosage”, any information referring to results from.............................................................
are confirmed. .
5.Medication errors, drug or............................................................ allergic reactions or other causes may
cause
adverse reactions.

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Drug Facts
Active Ingredient fin eech tablet) Purpcte
Chlorpheniramine maleate 2 mg ■ ■ . . ................................................................................... Antihistamine
Uses temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: ■ sneezing ■ runny
nose ■ itchy, watery eyes ■ itchy throat
Warning*
Ask a doctor before use if you have
■ glaucoma ■ a breathing problem such as emphysema or chronic bronchitis
■ trouble urinating due to an enlarged prostate gland
Ask a doctor or pharmacist before use if you are taking tranquilizers or sedatives _______________________ When
using this product
■ you may get drowsy ■ avoid alcoholic drinks
■ alcohol, sedatives, and tranquilizers may increase drowsiness
■ be careful when driving a motor vehicle or operating machinery
M excitability may occur, especially in children ______________________ ____________________
If pregnant or breast-feeding, ask a health professional before use.
Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.
Direction*
adults and children 12 years and over take 2 tablets every 4 to 6 hours;
not more than 12 tablets in 24 hours
children 6 years to under 12 years take 1 tablet every 4 to 6 hours;
not more than 6 tablets in 24 hours
children under 6 years ask a doctor

Othor information store at 20-25° c (68-77° F) ■ protect from excessive moisture tnactivo ingrocfionta o&c yellow
no. 10, lactose, magnesium stearate, microcrystalline cellulose, pregelatinized starch

An active ingredient is the This section will tell you what

chemical compound m the Sometimes also referred to as other medications, foods or
medicine that works with your Indications, this section tells you situations to avoid (such as
body to bring relief to your driving) when taking this
the ONLY symptoms the
symptoms It can always be found medicine.
medicine is approved treat.
as the first item on the label.

.I "J........................-

The only recommended daily Any other important An Inactive Ingredient is a

dosage and frequency of information about the chemical compound in the
dosage will be listed here. You product, such as how to medictie that has no effect on
should follow this strictly Its' store the medicine, will be your body. Preservatives,
not just how much you take, Items that bind the pm
listed in this section.
but also how often. together and food colors are
listed here.

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 UNIT 21: Reading PTC medicines labels (Practice)

A. Here are some words expressions related to symptoms. Write the equivalent in your language.
Verbal Expression In your language
To have itchy eyes /nose
To have runny eyes /nose
To have watery eyes
To have breathing problems
To have chills

Verbal Expression Nouns In your language

To feel drowsy drowsiness
To feel anxious anxiety
To feel dizzy dizziness
To feel moody mood
To rest rest
To breath breath
To sneeze sneeze
To sweat sweat
To shiver shiver

B. Say If the sentences are true or false. Correct the false statements in the spaces provided. Some answers
depend on you previous knowiedge.(y?mZ answers in http://familydoctor.org)

1. Antihistamines can help prevent and treat the symptoms of allergies, colds and the flu.
2. These symptoms include sneezing, itchy, watery eyes, and a runny nose.
3. Antihistamines can also relieve itchiness caused by insect bites and stings.
4. One of the most common side* effects of antihistamines is feeling excited therefore they are not used to help people
who feel weak.
5. Broadly speaking OTC antihistamines do not work as well as prescription medicines.
6. It is recommended to ask a doctor before using antihistamines in the case patients suffer from chronic bronchitis.
7. Brompheniramine, Chlorpheniramine, Doxylamine and magnesium stearate are active ingredients for
Antihistamines.
8. Antihistamines may slow people’s reactions without you even their being aware of it.
9. Children under 6 can take no more than 4 tablets each day.
10. Moisture might damage the substance therefore it should be stored at dry house temperatures.

Possible corrections;
N°............................................................................................................................................................................

N°..........................................................................................................................................................................

N°..........................................................................................................................................................................

N°..................... ..................................................................................................................................................

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This is how most common forms of medications are produced.

• Tablet This is a solid pill created by packing the active ingredient together with a binding agent. Tablets are usually
the cheapest form of medication, but they may be difficult for some people to swallow.

• Capsule. This is the term for a hollow gelatin container that holds a powdered medication.
Many people have less difficulties in swallowing capsules than they do in swallowing ordinary tablets.

• Powders. Ultra fine drug particles in a dry form. Depending on the specific medication, they are usually dissolved
or mixed in liquids or food and taken immediately after being prepared.

• Drops. Sterile solution or suspension administered by a dropper directly into the eye, die outer ear canal or
the nose.

• Liquids. They are available in the following forms:

- solutions, drug preparations that are already dissolved,

- syrups which are mixed with sugar and water,
- suspensions, drug preparations that need to be dissolved,
- elixirs, medications dissolved in alcohol and water.

• Injectable solutions, sterile solutions or suspensions

supplied in ampules, vials, bags or bottles.

• Inhalants and sprays, medication is breathed or sprayed into the nose or mouth, some medications are formulated
to deliver specific fixed doses, while others are formulated to deliver at random without fixed doses.

• Suppository, large bullet-shaped tablets administered either rectally or vaginally, they are designed to melt . at
body temperature, they come in forms of rectal vaginal or urethral applications.

• Skin preparations, available in the following forms:

- creams, they are not greasy and use on the skin only,
- ointments, spreadable, greasy preparations use for local application, they have a thicker texture than creams,
- lotions, solutions or suspensions used on the skin and are not as sticky and greasy as creams and ointments, they
are usually used in areas such as the scalp where an ointment or cream would adhere to the hah,
- pastes, they are stiffer preparations which contain more powdered solids.

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 UNIT 22: forms of medication (Practice)

2. What are capsules made of?

3. How many forms of suppositories can be found in pharmacies?

4. Why do many people choose capsules instead of tablets?

5. How are powders usually administered?

6. Are all inhalants formulated in the same way?

7. What makes ointments different from creams?

8. What are possible forms of injecttable solutions?

ATC System
The purpose of the ATC system is to serve as a tool for drug research in order to improve quality of drug use.
MedicationXXXIII XXXIV can be usually classified in various ways, for example, by its chemical properties, by the mode of
administration, or by the biological system affected. An elaborate and widely used classification system is the
Anatomical Therapeutic Chemical Classification System (ATC system) XXXV, controlled by the WHO and first
published in 1976. The system divides drugs, according to the organ or system on which they act and to their
therapeutic and chemical characteristics. Drugs are classified into five different hierarchic levels. The first level
contains the principal anatomicgroups and is marked with a letter from the alphabet as shown here below: .

First level: Anatomical group

A Gastrointestinal tract

u Dioou anaDiooa lOHDing organs c

Cardiovascular system
D Skin
G Reproductive system
H Endocrine system
J Anti-infectives
L Malignant and Immune disease
M Musculo-skeletal system
N Nervous system
p Antiparasitic products, insecticides
and repellents
R Respiratory system
s Sensory organs
V Various

Here are examples of medications for some anatomical groups

First level: Anatomical group Examples of medications
Gastrointestinal tract Antacids’ H2 antagonists* Laxatives* Antidiarrhoeals
Cardiovascular system Antihypertensives* Diuretics* Vasodilators* Beta blockers*
Endocrine system Anti-diabetics • Corticosteroids • Sex hormones • Thyroid hormones
Infections (J, p) Antibiotics* Antivữals* Vaccines* Antifungals* Antiprotozoals •
Malignant and Immune disease Anticancer agents* Immunostimulators* Immunosuppressants
Muscles, Bones, and Joints (M) Anti-inflammatories* Antirheumatics • Corticosteroids •
Nervous system Anesthetics* Analgesics* Anxiolytics* Sedatives Antidepressants •
Respiratory system (R) Bronchodilators* Decongestants • H] antagonists

XXXIII Adapted from Wikipedia, the free encyclopedia (2007).

XXXIV Medication, also refered to as medicine, is usually a drug or any other substance used to prevent or cure disease or to relieve
pain, anxiety or any form of perceived discomfort.
XXXV http://www.whocc.no/atcddd/

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 UNIT 23. Types of Medication (Practice)
A.1 Read the definitions and with the help of the illustration on the previous page write the correct name of the
human body anatomy. Choose from the names given in the box.
2. Find the equivalent of the words in your own language.
Spleen. Lung. Esophagus. Bladder Liver. Aorta
Gallbladder Urethra Kidney Pancreas Diaphram
Definitions of part of human anatomy In your
language
1. A .7,^ It is an organ located in the abdomen of the human body, where it
functions in the destruction of bld red blood cells and holds a reservoir of blood.
2. ..........................Then primary role is to maintain the homeostatic balance of bodily
fluids by filtering and secreting metabolites and minerals from tile blood and
excreting them, along with waterT as urine.
3. A........i It is a hollow, , muscular, and distensible (or elastic) organ that sits
on the pelvic floor in mammals.
4............................Also called cholecyst. It is is a pear-shaped organ that stores about
50 ml of bile (or "gall") until the body needs it for digestion.
5. ................... It is the essential respiration organ in afr-breathing vertebrates, the most
•
primitive being the lungfish.
6. ..........................It is the largest internal organ in the human body, and is an organ
present in vertebrates and some other animals.
7.......................... Pronounced "ay-OR-tuh", it is the largest artery in the human body,
originating from the left ventricle of the heart and bringing oxygenated blood to all
parts of the body in the systemic cữculation.
8............................. It is a tube which connects the urinary bladder to the outside of the
.body.
9. ........................... is a gland organ in the digestive and endocrine system of
vertebrates.
10........................... Also called gullet, it is an organ in vertebrates which consists of a
muscular tube through which food passes from the pharynx to the stomach.
11. .................... It is a sheet of muscle extending across the bottom of the ribcage.

B. Fill in the sentences with typesof medications in previous grid.(http://en.citizendium.org)

1. Aminpglycosides are a group of..............................that are effective against certain types of bacteria.
2. Some common examples of...... .......................are: ibuprofen, aspirin and naproxen
3. Propranolol (INN) is a non-selective...........................mainly used in the treatment of hypertension.
4. Phenylephrine or Neo-Synephrine is an a-adrenergic receptor agonist used primarily as a.......... .....................
as an agent to dilate the pupil and to increase blood pressure.
5. Barbiturates and benzodiazepines are responsible for most of the problems with abuse of................................ due to
their widespread "recreational" or non-medical use.
6. areused to treat flare-ups of atopic eczema. They are applied directly to die affected
areas of skin (as creams or ointments, for example) to reduce inflammation and itching.
7. Triamterene is used in combination with thiazide...............................for die treatment of hypertension and
edema.
8. Cocaine, was one of the first effective local .................................... in ophthalmic surgery in 1884 at the
suggestion of Sigmund Freud.
9. The first..............................for rabies were produced by growing the virus in rabbits, and then weakening
it by drying the affected nerve tissue.
10. Azathioprine is a safe and effective drug used alone in certain autoimmune diseases, or in combination with other
in.........organ transplantation.

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Two things make a drug important: first, that the drug is used to treat a large number of people with a range of
problems, secondly that a drug has led the way to treat a disease.

1. Penicillin: First on all Lists

At the top of the list is penicillin, as the first antibiotic. It pointed the way to the treatment of microbial disease. No
other drug changed the world like this. Before penicillin, if you had a serious infection, you died.
2. Insulin: the first hormone therapy
Patients with advanced diabetes cant use die energy stored in their
bodies. Their bodies stop making a hormone known as insulin, so in
order to achieve their target blood glucose levels, they need to be treated
with insulin, hl die beginning it was made from cows, pigs or salmon.
Almost all insulin is now human insulin.
3. Smallpox and polio vaccines
Smallpox is universally considered one of the most dreadful scourges of
humanity. Thanks to vaccination, which got its name from the cowpox
virus used in the vaccine, smallpox is the first disease wiped from the
face of die earth. Polio was the second scourge tó be eliminated thanks
to the vaccine. It's now hard to remember how frightening polio once
was.
4. Ether: the making of modern surgery
It was the first drug used as an anesthetic, since then there have been a
series of improved versions of anesthetics.
5. Morphine: banning the bane of pain
Despite the terrible problem of narcotic addiction, untold numbers of people would have spent their lives in great pain.
It is used after surgery, alleviating a lot of suffering. It is the forerunner of several generations of pain-alleviating
drugs. Ironically, efforts to create a non-addictive form of morphine led to the creation and marketing of a new drug in
1898 by the Bayer Company, the brand name was Heroin.
6. Aspirin: more than a headache pill
As an analgesic aspirin is very important. It was the first drug to treat simple pain. Most people in the world have
some kind of peripheral pain, muscle pain, or headache or arthritis, just to give a few examples. For those people,
morphine would be inappropriate.
7. Psychiatric medications
The insane asylums of the past were built to contain people suffering from the severe psychiatric diseases known as
psychoses. These drastic diseases brought equally drastic "treatments" for patients.
The advent of modem psychiatric drugs in the 1950s changed everything. Thorazine and Halsol were the first drugs
used in modem psychopharmacology.
8. Birth control pills
Oral contraceptives changed the world. By giving women control over their reproductive system, these drugs had far-
reaching medical and social impact.
9. Help for the Heart
Heart patients today owe a lot to two breakthrough drugs: Lanoxin (digoxin) and Lasix (furosemide).
Lasix is one of the first diuretics which is still a very important drug for hypertension and heart failure. Furosemide is
included in the World Anti-Doping Agency's banned drug list because it may be used as a masking agent for other
drugs. In terms of preventing heart disease, the new cholesterol-lowering drugs, called statins promise to have a huge
impact. They are group of drugs that inhibit the synthesis of cholesterol with the result of a decrease in the level of
LDL (“bad cholesterol”) but with a modest increase in the level of HDL (“good cholesterol”) cfrculating in blood
plasma..

1
http://www.mediciftenet.com/script/main/art.asp?articlekey=47775&page=2

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 UNIT 24: Most important drugs (Practice)
A. Complete with a suitable connector. Choose from the table below. Capital letters may be of help.
Initially Before (x 2) both... and now
while After on the contrary In spite of in addition
as well as in order to owing to however since

1. A drug is considered of primary importance................................for its extended use........................... .........

for having led the way to treat a disease.
2. the discovery of penicillin, many people with serious infections died.
3. Patients are treated with insulin..............................achieve target blood sugar levels.
4. insulinwas of animal derivation, while...........................................................................it is mainly human.
5. thediscovery of Ether, many other effective anesthetics were developed.
6. the risk of drug addiction, morphine has alleviated a lot of suffering to people
with serious pains.
7. Efforts to create a non-addictive form of motphine were not completely successful.................... ..............
they led to the creation of Heroin.
8. Morphine is used to treat serious pains, ......................................... aspirins are used to treat simple pains
such as headache.
9. the1950s people suffering from psychoses were cured in asylums,
........................................ ..now they can be cured at home thanks to tile modem psychiatric drugs.
10. The advent of oral contraceptives had far reaching medical effects, ................... ..................... it created
important social impacts.
11. Furosemide, .............................................. some other diuretics, is included in the World Anti-Doping
Agency’s banned drug list .................... .................. .... its alleged use as a masking agent for other
drugs. ,
12. Statins are effective at lowering bad cholesterol, .............................................., they have less effect in
reducing triglycerides.

B. Change the sentences into i£t when clauses keeping the conceptual meaning.
More solutions are accepted.

1. People don’t die of serious infections thanks to the discovery of penicillin.

2. Pancreas produces enough insulin so blood does not contain too much glucose.

3. Bodies start to break down fat, they cannot use glucose as their energy source.

4. Alcohol is combined with morphine, dangerous side effects or death may occur.

5. Modem psichiatric drugs were developed so it was possible to stop using drastic "treatments" for patients with
psychoses.

6. Furosemide is used illegally as a masking agent for other drugs so it is included on the World Anti-Doping Agency's
banned drag list.

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How they work.
Antibiotics are medicines that help your body fight bacteria and viruses, either by directly killing the offending bugs or
by weakening them so that your own immune system can fight and kill them more easily. The vast majority of
antibiotics are bacteria fighters; although there are millions of viruses, we only have antibiotics for half-a-dozen or so
of them. Bacteria are easier to kill, they can live independently while
viruses must "live" in a "host".
Antibiotics do not fight infections caused by viruses, Tetracycline is prescribed
such as: for many different
infections particularly
• colds and flus respiratory tract infections
• most coughs and bronchitis due to Hemophilus
• sore throats, unless caused by strep influenza, Streptococcus
pneumonia
Selecting an antibiotic
An antibiotic is a selective poison. It has been chosen so that it will kill tile desired bacteria, but not the cells in your
body. Each antibiotic is effective only against certain bacteria. For some infections, doctors know that only certain
types of bacteria may be responsible. If there is one antibiotic that is predictably effective against all of these bacteria,
testing is not needed. On the contrary for specific infections that may be caused by many different types of bacteria or
by bacteria whose susceptibility to antibiotics is not predictable, a laboratory test will be needed to identify the
infecting bacterium from samples of blood, urine, or tissue taken from the person. However, antibiotics that are
effective in the laboratory do not necessarily work in an infected person. The effectiveness of the treatment depends on
how well the drug is absorbed into the bloodstream, how much of the drug reaches the sites of infection in the body,
and how quickly the body eliminates the drug. In selecting which antibiotic to use, a doctor also considers the nature
and seriousness of the infection, the drug's possible side effects, the possibility of allergies or other serious reactions to
the drug, and the cost of the drug. Combinations of antibiotics are sometimes needed to treat severe infections,
particularly in the first days when the bacterium's sensitivity to antibiotics is not known. Combinations are also
important for certain infections in which the bacterium rapidly develops resistance to a single antibiotic.

Antibiotic resistance.
Bacteria, like all living organisms, change over time in response to environmental developments and to the abuse and
misuse of antibiotics. Although many bacteria die when exposed to antibiotics, some develop resistance to the drugs'
effects. For example, 50 years ago the bacterium Staphylococcus aureus (a common cause of skin infections) was very
sensitive to penicillin. Over time, strains of Staphylococcus aureus developed an enzyme able to break down
penicillin, making the drug ineffective. Researchers responded by developing a form of penicillin that the enzyme
could not split, but after a few years tile bacteria adapted and became resistant even to this modified penicillin.
Medical researchers continually work to ensure that there are effective drugs to fight bacteria. Taking antibiotics only
when necessary and for the full prescribed course helps limit the development of antibiotic-resistant bacteria.

Side effects and allergies.

Common side effects of antibiotics include upset stomach, diarrhea, and, in women, vaginal yeast infections XXXVI XXXVII.
Some side effects are more severe and, depending on the antibiotic, may disrupt the function of the kidneys, liver,
bone marrow, or other organs. Blood teste are used to monitor such adverse reactions. ' Some people who receive
antibiotics develop colitis, an inflammation of the large intestine. Antibiotics can also cause allergic reactions. Mild
allergic reactions consist of an itchy rash or slight wheezing. Severe allergic reactions can be life threatening and
usually include swelling of the throat, inability to breathe, and low blood pressure. Many people tell their doctor that
they are allergic to an antibiotic when in fact they have only experienced side effects from it that are not allergy-
related.

XXXVI adapted from U.S.National Library Medicine- http://www.nlm.nih.gov and The Merck Manuals - http://www.merck.com
XXXVII caused by an overgrowth of a fungus of the genus Candida.

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 UNIT 25: Antibiotics’CPractice)

A. Complete with a suitable preposition. Choose from the grid. One preposistion is not necessary.

on under over from

by into against to

1. Bach antibiotic is effective only...........certain bacteria

2. The effectiveness of the treatment depends...........how well the drug is absorbed................ .the bloodstream
3. The colitis results ......... a toxin produced.............a bacterium
4. Bacteria, like all living organisms, change............time in response.............environmental developments.

B. Change the sentences using the passive form.

1. Using antibiotics your immune system can fight offending bugs

2. You can kill bacteria more easily than viruses.

3. They have selected antibiotics in order to kill only the desired bacteria.

4. They will carry out a laboratory tests when different types of bacteria may cause specific infections.

5. They can identify the infecting bacterium by analysing samples of blood and urine taken from the person;

6. Patients with the same infections may give different responses to specific antibiotics.

7. Doctors may treat patients With combinations of antibiotics when they don’t know the bacterium’s
sensitivity to them.

8. Antibiotics kill many bacteria, however, bacteria may develop resistance to the drugs’ effects.

9. They have developed many forms of penicillin because, over time, the development of enzymes could break
them down.

10. Patients should take antibiotics only when necessary in order to limit resistance to bacteria.

11. Some kinds of antibiotics can cause side effects or allergic reactions.

12. Some antibiotics may disrupt the function of the kidneys, liver, bone marrow, or other organs.

1
Adapted from U.S.National Library Medicine- http://www.nlm.nih.gov and The Merck Manuals - http://www.merck.com

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Hypertension

High blood pressure is a serious problem when left untreated. It frequently has
no symptoms and often occurs for unknown reasons. It is an indication that the
heart and the blood vessels are being overworked, it is a measure of the force of
the blood pushing against the walls of the arteries; when Olis force is elevated
beyond a normal level, a patient will be diagnosed with either pre-hypertension
or hypertension. It can damage the heart and cardiovascular system and can
contribute to heart attacks and strokes. High blood pressure frequently occurs in
patients with diabetes and also affects other organs such as the kidneys and the
eyes. Frustration is common because many patients have no symptoms and
cannot tell if a medication is working or not.
Self-monitoring of blood pressure is often an important tool during
antihypertensive therapy. It can provide important information about the effectiveness of therapy.
People taking antihypertensives are also encouraged to make healthy lifestyle changes, such as giving up smoking,
losing weight and getting regular exercise.

Antihypertensives

They are medications used to treat high blood pressure (hypertension). People who are prescribed medication need to
take it exactly as prescribed to avoid the serious medical problems associated with the condition. Several classes of
antihypertensive medications are available to treat high blood pressure.
They lower blood pressure by opening and widening the blood vessels, preventing the blood vessels from closing
and tightening, or reducing the workload of the heart. These medications include:
• Diuretics. Sometimes called “water pills,” these medications promote the formation of urine in the kidneys,
causing the body to flush out fluid and minerals such as sodium. The reduction in fluid volume and sodium levels
causes blood vessels to open wider, increasing blood flow and reducing the pressure of blood against the vessels.
Three types of diuretics are used in the treatment of hypertension: loop, potassium sparing and thiazide.
• Beta blockers, any of a group of drugs that block the activity of a beta-receptor to decrease the heart rate and
force of contractions and lower high blood pressure.
• Vasodilators. Medications that expand or widen blood vessels, reducing blood pressure against the walls of the
vessels. This allows blood to flow more freely and the heart to pump more efficiently. Vasodilators include:
o ACE inhibitors (angiotensin-converting enzyme inhibitors). Vasodilators block the production of a
substance (angiotensin II) that causes blood vessels to tighten. This results in lowering the resistance of
the blood vessel to the flow of blood from the heart.
o Calcium channel blockers. Vasodilators that reduce the force of contraction of the myocardium (muscle of
the heart).
o Central adrenergic Inhibitors. Vasodilators that act directly on the brain to prevent it from signaling the
central nervous system to increase heart rate or narrow blood vessels.
The wide variety of antihypertensives and combinations of different medications may lengthen the time it takes to
find the ideal treatment for each patient.
- The choice of which drug to use first is not settled, especially because the various drugs are roughly equally
effective. A number of clinical trials have proved this by comparing the drugs in head-to-head studies among ■
various patient groups. Trials began in 1994 and involved more than 42,000 individuals. The researchers concluded
that medication therapy to lower blood pressure should begin with diuretics.

UNIT 26: Antihypertensives (Practice)

A. Complete the sentences with one of the following expressions.

give up smoking treat high blood pressure widen blood vessels
lose weight change lifestyle reduce blood pressure
provide information stimulate the production damage tile heart

1. High blood pressure can.......... .................................................................. and cardiovascular system.

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2. Self-monitoring of blood pressure can..................................................................................................... about
the effectiveness of therapy
3. There are several classes of medications to............................................................................
4. Diuretics ................................................................................of urine causing the body to flush out fluid
and minerals such as sodium
5. Vasodilators ..........................................against the vessels since they...............................................
6. People heated with antihypertensives need to.............................................................................. for example
they need to...........................and...........................................................................

B. Write if/when sentences linking the two parts and using correct tenses. There may be more than one.
answer.

1. The force of the blood against the walls of arteries too high. There is a pre-hypertension or hypertension
diagnosis.

2. Untreated hypertension can contribute to heart attacks and strokes.

3. People with hypertension don’t give up smoking and lead unhealthy lifestyles. They run serious risks.

4. Patients treated with diuretics. The blood flow increases and the pressure of blood against the vessels is
reduced.

5. Beta blockers are used for heating hypertension . They release certain chemicals that bind with beta receptors
in the heart.

6. Many people died from heart stroke. They did not follow a suitable antihypertensive therapy.

7. Thanks to various clinical tests carried out by comparing drugs in head-to-head studies it was possible to
develop a medication therapy.

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 UNIT 27: AMIAS* patient information leaflet1 (1)

(candesartan ciỉexetiỉị

Dear Patient,
Please read this leaflet carefully because it contains important information for you. If you have further
questions, please ask your doctor or your pharmacist. Keep this leaflet. You may want to read it again.

What is In your tablets?

Active ingredient: The active ingredient in ‘Amias’ Tablets is candesartan cilexetil. Five strengths of ‘Amias’ Tablets are
available: 2,4, 8,16,32 mgs.
Other ingredients: Carmellose calcium, hydroxypropyl cellulose, lactose monohydrate, magnesium stearate, maize starch
and macrogol. In addition the 8 mg, 16 mg and 32 mg tablets contain iron oxide red E 172.

How do your tablets work?

The active ingredient in ‘Amias’ Tablets is candesartan cilexetil. This belongs to a group of medicines known as angiotensin II
receptor antagonistsXXXVIII XXXIX. By blocking the effects of the hormone angiotensin n, these medicines work by relaxing your
blood vessels, which lowers your blood pressure and makes it easier for your heart to pump blood to all parts of your body.

Why do you need to take these tablets?

Your doctor has prescribed ‘Amias’ because either you have a condition known as hypertension (or high blood pressure) or you
have a condition known as heart failure. High blood pressure and heart failure can be treated and controlled with medicines.

High Blood Pressure

Your blood pressure is measured by twb numbers, e.g. 120/80 mmHg. The top number measures the pressure while your heart
beats and the bottom number measures the pressure in between heart beats.
Normal blood pressure is part of good health. High blood pressure is caused when the blood vessels tighten and the
measurement goes above the normal range for your age. There are usually no symptoms of high blood pressure and you will
only know you have it if you have had your blood pressure measured.
Although you might feel quite well, if your high blood pressure is not treated, it can damage your heart, blood vessels and
kidneys, and in some cases lead to strokes, heart attacks, heart and kidney failure, or blindness.

Heart failure
Heart failure is a condition where the pumping action of the heart is inadequate, which results in reduced flow of blood out
from the heart. Heart failure may be caused by any condition that overloads, damages or reduces the efficiency of the heart
muscle. Symptoms include breathlessness, even when lying flat, and swelling (edema) of the legs.
Your doctor may also recommend that you make some changes to your lifestyle to help your condition, such as rest, losing
weight, avoiding alcohol and smoking and reducing the amount of salt in your diet. Your doctor may also encourage you to take
more mild exercise.

Are there patients who should not take these tablets? Yes, do not take the tablets if:
1. You are pregnant, think you may be pregnant or are planning to become pregnant as this medicine may affect your baby. If
you become pregnant whilst taking this medicine see your doctor immediately.
2. You are breast-feeding.
3. You are allergic to any of the ingredients.
4. You have severe liver disease.
‘Amias’ should not be given to children. If you think any of these apply to you, do not take the tablets. Talk to your doctor first
and follow the advice given, pharmacist, who will give you further information.

XXXVIII From http://emc.medicines.org.uk

XXXIX Angiotensin-n receptor antagonists (or blockers) are a newer class of antihypertensive agents, that are well tolerated.
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 UNIT 27: AMIASpatient information leaflet (1) Practice

A. Read the leaflet answer the questions

1. Why should patients keep the leaflet ?

2. How many strengths are available for Amias tablets?

3. What is candesartan cilexetil in relation to AMIAS?

4. How does the active ingredient work?.

5. Do all tablets contain ữon oxide red E 172?

6. What do the two numbers mean in the measurement of blood pressure?

7. How can people know they have high blood pressure?

8. What complications may derive when high pressure is not freated?

9. When does heart failure occurs and what are the symptoms?

10. What is the first thing to do to prevent or reduce heart failure?

8.1 Match each part of a sentence in column A with a second part in column B

Solution: l....,2....,3....,4....,5....

8.2 Write tf/when clauses joining the two parts In Bl. Use modal verbs when possible: may, might, can, had
better, should etc. Pay attention, the main sentence can be in the second part.

1. You have further questions. a. You have become pregnant while taking AMIAS
2. Blood pressure is reduced b. Run the risk of heart damage
3. High blood pressure occurs c. Help theừ condition
4. Patients change their lifestyle d. The blood vessels tighten
5. Treat blood pressure e. Blood vessels relax
6. Talk to the doctor immediately f. Ask your doctor or your pharmacist.
1......................................................................................................................................
2............................................................... ................................................................
3......................................................................................................
4................................................................................................................................. ;
5 .......................................................................................................................... .......................................;........
6......................................................................................................

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 UNITZStA^IAS^pati^tinformationleafletXL (2)

What you should know before taking ‘Amias’?

It is important to tell your doctor before taking ‘Amias’ if you suffer from liver or
kidney problems, have had a recent kidney transplant or are being treated with
lithium, potassium sparing diuretics, potassium supplements, salt substitutes
containing potassium or heparin. In a few such cases, a blood sample may need to
be taken periodically from you. You should tell your doctor if you are taking ACE
inhibitors (such as enalapril, captopril, lisinopril or ramipril), diuretics (water
tablets),, or if you are taking or plan to take, particularly non-steroidal anti-
inflammatory painkillers (such as ibuprofen, naproxen or diclofenac), COX-2
inhibitors (such as celecoxib or etoricoxib) or more than 3 g of aspirin and any
medicines you obtain without a prescription. In these cases your doctor may need to
monitor you more closely.
If you are going to have an operation, tell your doctor or dentist that you are taking ‘Amias’. ‘Amias’, combined with some
anesthetics, may cause a drop in blood pressure. It’s also important to inform him/her if you have recently suffered from
excessive vomiting and/or diarrhea or if you are taking diuretics (water tablets). In such cases, it may be necessary to adjust
your fluid balance before prescribing ‘Amias’.
The treatment of high blood pressure or heart failure may lead to dizziness in some patients. Make sure you are not affected
in this way before driving and operating machines.

Treatment for high blood pressure and heart failure

Treatment is usually started with a dose of 8 mg once a day. Your doctor may increase the dose to reduce your blood pressure
to the desired level. This may be up to 32 mg once a day.
If you have kidney problems or are at risk of low blood pressure, your doctor may prescribe a lower starting dose of 4 mg
once a day. If you have liver problems, your doctor may prescribe a lower starting dose of 2mg once a day. ‘Amias’ is not
normally recommended for children.
Treatment is usually started with a dose of 4mg once a day. Your doctor may prescribe a dose of up to 32mg once a day to
control your heart failure. You can take ‘Amias’ with or without food. It is recommended that you take your tablet at the
same time each day, preferably in the morning.

Unwanted effects
Like all medicines, some people taking ‘Amias’ may occasionally experience unwanted effects, which are usually mild and
do not last for long. Effects that have been experienced include dizziness, headache, cold or flu-like symptoms and
hypotension (low blood pressure). In patients with existing kidney problems or heart failure, changes in kidney function and
potassium and sodium levels may occur. Such changes are usually detected by a blood test. Unwanted effects reported very
rarely are swelling of the face, lips, tongue and/or throat, feeling sick, muscle or joint pain, back pain, rash, hives, itching,
jaundice (yellow skin and/or eyes), raised liver function tests, hepatitis (inflamed liver), changes in red blood cell levels and
decreased levels of white blood cells (which are involved in the immune system for fighting infection). If you notice any
unusual symptoms or feelings, contact your doctor or pharmacist. If you develop swelling of the face, lips, tongue, eyes
and/or throat or jaundice stop taking ‘Amias’ and contact your doctor immediately. It will help if you make a note of what
you experienced, when it started and how long it lasted.

How to keep the medicines

Keep your tablets out of the reach and sight of children, do not store above 30°C(86°F)
Do nor take the tablets past the expiry date, which is clearly marked on the pack.

UNIT 28: AMIAS patient information leaflet1 (2) Practice

A Put the verbs in brackets into the correct tense.

Before taking the medicine teỉỉ/askyour doctor..................

1. if you recurrently........................................ (suffer) from liver or kidney problems,

XL From http://emc.medicines.org.uk

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2. if you...............................................................(have) a recent kidney transplant or if, at the moment you
....................................................................(treat) with lithium and salt substitutes,
3. if you ..................................................... ........ (take) or ...................................................... (plan) to take,
non-steroidal anti-inflammatory painkillers,
4. if you...................................... .........................(have) an operation in the near future,
5. if you .................................................. recently .... ............................................................ (suffer) from
excessive vomiting and/or diarrhea,
6. if you....................................................................(notice) any unusual symptoms or feelings,
7. when unusual symptoms first................................(appear) and how long.......... . ..................(last),
8. if you ........................... just ....................................... (become) pregnant or .............................................
(breastfeed) at the. moment.

B. Find the words In the text for the following meanings referring to drugs or diseases.
In the text Meanings
an agent tending to increase the excretion of urine.
a drug that causes unconsciousness or a loss of general sensation.
condition where there is ineffective pumping of the heart leading to an accumulation of
fluid in the lungs.
pressure exerted by the blood upon the walls of the blood vessels.
abnormally low pressure of the blood also called low blood pressure.
allergic skin eruption.
disease or condition marked by inflammation of the liver.
abnormally frequent intestinal evacuations with more or less fluid stools XLI XLII.
an uneasy irritating sensation in the upper surface of the skin usually held to result from
mild stimulation of pain receptors.
the forcible voluntary or involuntary emptying of the stomach contents through the oral
cavity.
yellowing of the skin (and whites of eyes) by bilirubin, a bile pigment. Frequently
because of a liver problem.
a sensation of unsteadiness, faintness or an inability to maintain normal balance in a
standing or seated position.

XLI From http://emc.medicines.org.uk

XLII escrementi
1
http://health.discovery.com/centers/depression/depressionl01/depression.html

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 UNTĨ29. Depression and antidepressants

How nervous cells communicate

To understand how antidepressants work, you need to
have a general understanding of how the cells
communicate with each other in the brain. Within the
brain, there are many cells called neurons. Messages
pass from neuron to neuron using chemical messengers
called neurotransmitters. A message passes from a
sending neuron to a receiving ; neuron.
Neurotransmitters leave the sending neuron and enter
the space between the sending and receiving neurons.
This space is called the synapse.
The neurotransmitters then hook up to a receptor on
the receiving neuron to deliver thefr message.
The messages can pass on information about emotions,
behavior, body temperature, appetite, or many other
functions. The type of information sent depends on
which neurons are activated and what part of the brain
is stimulated.
Once neurotransmitters have sent thefr message, they
return and can be reabsorbed by the sending neuron in
a process called reuptake. ReUptake allows
neurotransmitters to be reused.
Two of these chemical messengers are serotonin and
norepinephrine. Low levels of serotonin and
norepinephrine in the synapse are associated with depression and sadness. Some medications, used to treat depression, work
by increasing the amount of certain neurotransmitters that are available to carry messages.

How antidepressants work

All antidepressants are about equally effective against depression, though different patients may respond better to one
medication than another.
All antidepressant medications influence how certain neurotransmitters work in the brain, especially serotonin and
norepinephrine. Here are some types:
- SSRIs (Selective Serotonin Reuptake Inhibitors) and TCAs (Tricyclic Antidepressants), work by slowing or blocking the
sending neuron from taking back the released serotonin. In that way, more of this chemical is available in the synapse. The
more of this neurotransmitter is available, the more likely the message is received, and depression is reduced
-MAOIs'. (Monoamine Oxidase Inhibitors) The antidepressants known as MAO inhibitors, or MAOIs, affect
neurotransmitters differently. Monoamine oxidase (MAO) is a natural enzyme that breaks down neuroừansmitters. The drug
MAOI inhibits the action of the enzyme MAO. In that way, there is an increase in the amount of neurotransmitters in the
synapse, making more messengers available to the receiving neuron, and thus reducing depression. Two brands are Zoloft
and Prozac.
It typically takes two to three weeks to experience the effect of antidepressant medications. Initially, only side effects (e.g.,
nausea, drowsiness, weight gain) may occur. However, in most cases, the side effects, which vary according to the particular
medication, improve or go away after about a week or two. Newer antidepressants have fewer side effects than older
antidepressants. When antidepressants are stopped suddenly, they may cause withdrawal symptoms, such as nausea,
headache and dizziness and insomnia.
It is generally recommended that patients refrain from consuming alcohol while taking antidepressants. A number of other
drugs may also interact poorly with antidepressant medications. Therefore, patients should notify thefr physician of all
medications they are taking before starting a new antidepressant.

—:---------------- --------:—-----------—-------------------------------------------- - --ị

_____________________UNIT 29.: Depression and antidepressants (Practice) ị.ị
A. Look at the flow chart and explain in your own words how the cycle of depression works. Ị
■

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 B. Complete with words from the text with the following meaning.

1................................................... One of the cells that constitute nervous tissue, that have the property of
transmitting and receiving nervous impulses.
2.................................... A chemical substance that transmits nerve impulses across a synapse.
3.......................................... The reabsorption by a neuron of a neurotransmitter following the
* transmission of a nerve impulse across a synapse.
4..... ...... ....... ;........................The place at which a nervous impulse passes from one neuron to another.
* 5................................................. A psychoneurotic or psychotic disorder marked especially by sadness,
inactivity, difficulty with thinking and concentration.
6.............................. ................. Used or tending to relieve or prevent psychic depression
7 A very sleepy state.
8 A stomach distress with distaste for food and an urge to vomit.
9........... A sensation of unsteadiness accompanied by a feeling of movement
within the head.
10 Prolonged and usually abnormal inability to obtain adequate sleep. V

c. Match parts of sentences in column A with part in column B:

1. Neurons are the cells in the brain that A. Neurotransmitters, in particular serotonin and
norepinephrine.
2. Messages pass from a sending neuron to a B. communicate with each other.
receiving neuron
3. Neurotransmitters enter the space, called c. are activated and what part of the brain is
stimulated..
4. Then neurotransmitters deliver thefr message by D. return and are reabsorbed by the sending
neuron.
5. The messages sent may convey.different types E. allows neurotransmitters to be reused.
6. The information sent depend on which neurons F. by means of the brain’s chemical messengers
called neurotransmitters.
7. After sending the message neurotransmitters G. synapse, between the sending and receiving
normally neurons.
8. The process of reabsorption, called reuptake,
H. of chemical messengers in the synapse are low.
9. Depression occurs when the levels I. of information ranging from emotional to
physical ones.
10. Depression is usually treated by increasing the J. linking up with a receptor on the receiving
amount of certain neuron.

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 UNfT30 0omplementaryandAIternative medicine

Although there is no strict definition of alternative

medicine, it generally includes any healing practices
that are not part of mainstream medicine. A typical
definition is "every available approach to healing
that does not fall within the realm of conventional
medicine". The boundaries of alternative medicine
are constantly changing as different types of care are
becoming more accepted by doctors and more
requested by patients. A few practices (such as
hypnosis) that were dismissed as nonsense 20 years
ago in the USA are now considered helpful therapies
in addition to traditional medicine. Some alternative
medicine practices are homeopathy, naturopathy,
chiropractic, acupuncture and herbal medicine
Alternative medicine is often associated with
complementary medicine using the term CAM (Complementary and Alternative Medicine). Therefore, both herbal remedies
and meditation, as well as dozens of other treatments, fall under the heading of CAM.

How CAM differs from traditional medicine1

Alternative therapy is frequently described with holistic methods, which means that the doctor or practitioner treats the
"whole" person and not just the disease or condition. In alternative medicine, many practitioners address patients' emotional
and spiritual needs as well. This "high touch" approach differs from the "high tech" practice of traditional medicine, which
tends to concentrate on the physical side of illness.
New centers for integrative medicine are offering a mix of traditional and alternative treatments. There, you might receive a
prescription for pain medication (as you might get from a ttaditional health care provider) and massage therapy to treat a
chronic back problem. Such centers usually employ both medical doctors and certified or licensed specialists in the various
alternative therapies. Some potential problems associated with alternative therapies may be difficult to identify owing to the
lack of scientific study. Almost all the studies that have been carried out involved adults as test subjects, therefore there is
little research on the effects of alternative medicine on children. Although approaches such as prayer, massage, and lifestyle
changes are generally considered safe complements to regular medical freatment, some other therapies might involve risks.

Some types of alternative care

In the USA, the National Institutes of Health (NĨH) classifies four general areas of CAM:
1. Mind-body medicine. This includes practices such as meditation, prayer, Tai Chi XLIII XLIV, and music therapy, which are
intended to develop the mind's ability to affect physical symptoms.
2. Biologically based practices. These include substances such as herbs, foods, vitamins, and dietary supplements. Herbal
remedies include a wide range of plants used for medicine or nutrition. They are available in grocery stores, over the
Internet, in health food stores, or through herbalists.
3. Manipulative and body-based practices. These practices are based on the manipulation or movement of body parts. It
includes methods like massage therapy and therapeutic touch, which manipulate and realign body parts, to help alleviate
symptoms.
4. Energy medicine. This area of medicine is based on the theory (which has not been proved scientifically) that certain
energy fields surround and penetrate the body. It also includes therapies based on bioelectromagnetics, the theory that
electrical currents in all living organisms produce magnetic fields that extend beyond the body.

UNIT 30: Complementary and Alternative medicine (Practice)

A. Complete with one of the following alternative medical practices.

Phytotherapy Naturopathy Osteopathy
Homoeopathy Acupuncture Chiropractic

XLIII Adapted from: http://familydoctor.org/online/famdocen/home.html

XLIV Tai Chi, as it is practiced in the west today, can perhaps best be thought of as a moving form of yoga and meditation combined.

68
 1 . ................................................A system of medicine which uses various remedies derived from plants
and plant extracts to treat disorders and maintain good health. This type of treatment is also called herbal
medicine.
2 Itis a system and philosophy of health care that places emphasis on the
musculoskeletal system. It strongly believes in the healing power of the body and is practiced to facilitate that
power.
3 Asystem of medical practice that treats a disease especially by the
administration of minute doses of a remedy that in healthy people would produce symptoms similar to those of
the disease.

4 Asystem of medical practice based on a theory that diseases are due

chiefly to loss of structural integrity which can be restored by manipulation of the parts supplemented by
therapeutic measures (as use of medicine or surgery).

5 Asystem of treatment of disease that avoids drugs and surgery and ■

emphasizes the use of natural agents (as air, water, and herbs) and physical means (as tissue manipulation and
eỉecừotherapy).

6 . ..............................................An originally Chinese practice of inserting fine needles through the stein at
specific points especially to cure disease or relieve pain.

8. Join the sentences using a suitable connector. Choose from the table below. You don’t need them .all. ■
...

owing to, as a result, both.... and, in addition, Although, whereas, Since

. 1. There is no strict definition of alternative medicine. Alternative medicine generally includes any healing
practices that are not part of traditional medicine.

9. The boundaries of alternative medicine are constantly changing. Different types of care are accepted by doctors
and requested by patients

10. Complementary and Alternative Medicine includes not only mind practices but also body practices.

11. In alternative and complementary medicine the doctor or practitioner treats the "whole" person. In traditional
medicine the doctor treats the disease or condition.

12. Some alternative medical treatments may be dangerous.There is no scientific evidence.

13. All the studies that have been carried out involved adults as test subjects. There is little research on the effects
of alternative medicine on children.

69
 UNIT 31: Homeopathy.and chiropractic1

Homeopathy
This medical practice, created in the late 18th century, (from the Greek hómoios, "similar" + pathos, "suffering" or "disease")
is described by its practitioners as a complementary and alternative medicine. In homeopathy, a key premise is that every
person has an energy called a vital force or self-healing response. When this energy is disrupted or imbalanced, health
problems develop. Homeopathy seeks to stimulate the body's defense mechanisms and processes so as to prevent or treat
illness.
Homeopathic treatment involves giving extremely small doses of substances, called remedies, that produce the same or
similar symptoms of illness in healthy people when given in larger doses. Most homeopathic remedies are derived from
natural substances that come from plants, minerals, or animals. A remedy is prepared by diluting the substance in a series of
steps, with shaking at each stage. According to homeopaths, serial dilution, with shaking between each dilution, removes die
toxic effects of the remedy while the qualities of the substance are retained by the diluent (water, sugar, or alcohol).
Remedies are sold in liquid, pellet, and tablet forms. Treatment in homeopathy is individualized (tailored to each person).
Homeopathic practitioners select remedies according to a total picture of the patient, including not only symptoms but
lifestyle, emotional and mental states, and other factors.
Various explanations have been proposed as to how homeopathy might work. However, none of these explanations has been
scientifically verified. Some analyses have concluded that there is no strong evidence supporting homeopathy as effective for
any clinical condition, others have found positive effects from homeopathy. However, the positive effects are not readily
explained in scientific terms.
The legal status of homeopathy varies from country to country, but homeopathic remedies are generally not tested and
regulated under the same laws as conventional drugs. Usage is also variable and ranges from only two percent of people in
Britain and the United States using homeopathy in any one year, to India, where homeopathy now forms part of traditional
medicine and is used by approximately 15 percent of the population.

Chiropractic
(from Greek chiros and praktikos meaning "done by hand")
Chiropractic was founded in 1895 by D. D. Palmer in the USA, and it is now
practiced in more than 100 countries. According to The Association of
Chừopractíc CollegesXLV XLVI, "Chiropractic is a health care discipline -which
emphasizes the power of the body to heal itself without the use of drugs and
surgery”
The chiropractic perspective on health and disease emphasizes two fundamental
concepts:
1. the structure and condition of the body influences how the body functions and
its ability to heal itself;
2. the mind-body relationship is instrumental in maintaining health and in the
healing processes.
A healthy, well aligned spinal column moving with full range of motion
allows the nervous system to perform properly, which is vital because it controls every function of your body. The brain and
the nerve system assemble and transmit information necessary to ensure the proper coordination of the body. The spinal
system, consisting of the vertebras, the spinal cord, and the spinal nerves which exit through holes in the sides of the
vertebras, carry this information from the brain to all parts of the body
Chiropractic philosophy gravitates toward a holistic ("total person")-approach to healing which combines elements of the
mind, body and spirit and maintains that health depends on obedience to natural laws, and that deviation from such laws can
result in illness.While there is still debate about the effectiveness of chiropractic for the many conditions in which it is
applied, it seems to be most effective for acute low back pain and tension headaches. One small pilot study has shown that
upper cervical spinal manipulation may be beneficial for certain types of hypertension.
■UNIT 31: Homeopathy and Chiropractic (Practice)

XLV Adapted from nccam.nih.gov/health/homeopathy/

XLVI http://www.dcdoctor.com

70
 A. Read the text and answer the questions.

1. What is the key premise in homeopathy?

2. How does it seek to stimulate the body?

3. What are remedies?

4. How are they prepared?

5. How do practicioners select remedies?

6. What conclusions came from the research on homeopathic treatments?

7. What country makes most use of this practice compared with others?

8. What main concepts is chiropractic based on?

9. Why does the spinal system play an essential role in maintaining good health?

10. Why do chiropractic treatments involve a holistic approach?

B. Complete the sentences with suitable linking words.Choose from the box below.

so as also not only mainly however

although according to while as to according to

1. Homeopathy seeks to stimulate the body's defense mechanisms and processes............................to prevent or
treat illness.
2. to homeopath practitioners, serial dilution, with shaking between each dilution, removes
the toxic effects of the remedy...............................the qualities of the substance are retained by the diluent.
3. Homeopaths choose treatments remedies..................................a holistic approach, that includes...............
symptoms but..............................lifestyle, emotional and mental states.
4. They have given varios explanations ..............................how homeopathy might work..................................
none of them has been proved scientifically.
5. ........................ there is still a research about the effectiveness of chữopractìc, this alternative
treatment has been proved effective...................................for acute low back pain and tension headaches.

What is herbal medicine?

Herbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Herbalism is also
known as botanical medicine, medicinal botany, medical herbalism, herbal medicine, herbology, and phytotherapy. Many
plants synthesize substances that are used for preserving health in humans and animals. These include aromatic substances,
most of which are phenols or thefr oxygensubstituted derivatives such as tannins In many cases these substances serve as
plant defense mechanisms against predation by microorganisms, insects, and herbivores. Many of the herbs and spices are
used by humans to season food . The scope of herbal medicine is also extended to include fungi and bee products, as well as
minerals, shells and certain animal parts

71
Role of herbal medicine in modern human society
The use of herbs to treat disease is almost universal among non-industrialized societies; herbal medicine is a major
component in all traditional medicine systems and a common element in homeopathic, naturopathic, traditional Chinese
medicine and native American medicine. Herbal remedies, such as opium, aspirin, digitalis, and quinine have been used since
ancient times The use of, and search for, drugs and dietary supplements derived from plants have accelerated in recent years.
The World Health Organization (WHO) estimates that 80 percent of the world's population presently uses herbal medicine
for some aspect of primary health care and that approximately 25% of modem drugs used in the United States have been
derived from plants. Pharmacologists, microbiologists, botanists, and natural-products chemists are combing the Earth for
phytochemicals, containing substances that might be developed for treatment of various diseases.

Biological background
All plants produce chemical compounds as part of their normal metabolic activities. These include primary metabolites, such
as sugars and fats, found in all plants, and secondary metabolites found in a smaller range of plants. The functions of
secondary metabolites are varied. It is the secondary metabolites and pigments that can have therapeutic actions in humans
and which can be refined to produce drugs. In addition, some secondary metabolites are toxins used to deter predation, and
others are pheremones1 used to attract insects for pollination. The chemical profile of a single plant may vary over time as it
reacts to changing conditions, plants upregulate and downregulate their biochemical paths in response to the local mix of
herbivores, pollinators and microorganisms. They synthesize a bewildering variety of phytochemicals but most are
derivatives of a few biochemical substances:
Alkaloids contain a ring with nitrogen. Many alkaloids have dramatic effects on the central nervous system. Caffeine is an
alkaloid that provides a mild lift but some kind of alkaloids may cause severe intoxication and even death.
• Phenolics contain phenol rings. The anthocyanins that give grapes and the tannins that give tea its astringency are
phenolics.
• Terpenoids are built up from terpeneXLVII XLVIII building blocks. Each terpene consists of two paired isoprenesXLIX.
• The names monoterpenes, sesquiterpenes, triterpenes etc. are based on the number of isoprene units. The fragrance of
rose and lavender is due to monoterpenes. The carotenoids produce the reds, yellows and oranges of pumpkin, com and
tomatoes.
• Glycosides. They are compounds containing a carbohydrate portion of glucose and a noncarbohydrate residue in the
same molecule, called aglycone.The aglycone may be methyl alcohol, glycerol, a sterol, a phenol, etc. The cardiac
glycosides are an important class of naturally occurring drugs whose actions include both beneficial and toxic effects on
the heart.
A. Here is a summary of the text. Complete it with words from the box.
herbalism range extracts derivatives traditional animals
cooking metabolites. humans countries environment substances
drugs predation malntanence treatments

Botanical medicine, medicinal botany, medical herbalism, herbal medicine, herbology, and phytotherapy are some
of the names used to refer to 1 .............................................................................. that is a traditional medical
treatment based on the use of plants and their 2................................................................Fungi and bee products,
as well as minerals are also included in the 3 .................................................................. of herbal substances.
Many substances synthesized from plants are used for agriculture, human a animal health 4 . . In the case
of 5...................................................... .......................................herbal medicines
are used to fight microorganisms, insects and herbivores. Herbs are also widely used in 6 , to season
food. Herbalism has always been the major medical
treatment in all developing 7............................................................... besides herbs are the major components in
traditional 8 .......................................... ............., such as homeopathy, naturopathic and in Chinese and native
Americam medicines. However, a wide range of currently available pharmaceuticals have been made with 9
........................................................ ..., herbs for a very long time, known as opium, aspirin, digitalis, and
XLVII A volatile hormone or behaviour modifying agent.
XLVIII Any of numerous hydrocarbons (CsHg)„ found especially in essential oils, resins, and balsams.
XLIX A flammable liquid unsaturated hydrocarbon CjHg used especially in synthetic rubber.

72
quinine. For example it is estimated that one out of four 10................................................................used in the
USA are derived from plants. Phytochemistry is always being subject to research in order to synthetize 11
......................................................... that might be developed for the treatment of various diseases. Plants
can produce chemical compounds including primary and secondary 12.......................... ........7...............: Only
secondary metabolites, that are only found in a small number of plants, have therapeutic effects' in 13
....................... and can be synthetized to produce rugs. Besides,, some of them’are
used against 14 .......................................................... by microorganisms, insects, and herbivores and some
others to attract insects for pollination. However, plants can change overtime their chemical structure' in response
to the changing conditions of theứ 15 .................................................. . ......................... The large variety* of
phychemicals they synthetize are 16............................................................. of a small numer of biochemicals,
that are alkalodis, phenolics, turpenoids, glycosides.

B. Write the correct form of the verb in brackets.

1. Although many pharmaceuticals................................................(produce) with herbs for a very long time,
research about drugs derived from plants.............................................(increase) enormously in recent years.
2. Many phytochemicals...................................................(analyze) by pharmacologists and microbiologistss in
order to select substances that are likely....................................(use) for the treatment of various diseases.
3. The reds, yellows and oranges of pumpkin, com and tomatoes...........................(produce) by carotenoids.

73
Some plants with theraupetic effects'
Here are some well-known plants whose therapeutic effects are usually recognized:
• Artichoke. Its leaf extract has been used medicinally for many years. Traditional use, as well as recent clinical studies,
continue to verify die multi-beneficial effects of the artichoke leaf extract including lipid-lowering, anti-oxidative,
hepato-protective, as well as aiding dyspepsia, and abdominal pain where the stomach, gallbladder, liver and pancreas
are primarily affected. Further studies suggest artichoke leaf extract benefits in such areas as HIV, cancer, IBS L LI and
diabetes.
• Soy is a complete protein, and soyfoods are rich in vitamins and minerals including folate, potassium and, in some cases,
fiber. Recent research suggests that soy may also lower risk of prostate, colon and breast cancers as well as osteoporosis
and other bone health problems, and alleviate hot flashes associated with menopause. However, it has only modest effect
on cholesterol levels.
• Feverfew is sometimes used to treat migraine headaches. It should be avoided in patients taking medications to prevent
blood clotting (anticoagulants). Besides, it is not recommended for pregnant women as it may be dangerous to the fetus.
• Garlic lowers cholesterol, improves blood flow, fights bacteria and viruses.
• Black cumin has demonstrated analgesic properties in mice. The mechanism for this effect, however, is unclear.
Research supports antibacterial, antifungal, anticancer, anti-inflammatory effects.
• Oregano may be effective against multi-drug resistant bacteria.
• Papaya can be used for insecticidal purposes (killing lice, worms).
• Valerian root Valerian is used against sleeping disorders, restlessness and anxiety and as a muscle rúaxant. It often
seems only to work when taken over longer periods (several weeks), though many users find that it takes effect
immediately. Clinical studies show mixed results and researchers note that many trials are of poor quality.
• Green tea. Over tile last few decades green tea has begun to be subjected to many scientific and medical studies to
determine its effectiveness, they gave as results that regular green tea drinkers may have lower chances of heart disease
and developing certain types of cancer.
• Lemon grass can lower cholesterol, the latter may be useful in wound healing.

Routes of administration of herbal medicines

There are many forms in which herbs can be administered, these include:
• Tinctures (alcoholic extracts of herb, such as echinacea extract)
• Tisanes (hot-water extracts of herb, such as chamomile)
• Decoctions (long-term boiled extract of usually roots or bark)
• Macerates (cold infusion of plants with high mucilage-content as sage and
thyme). Plants are chopped and added to cold water. They are then left to stand
for 10 hours.
• Topicals: oils, creams and lotions, poultices and compresses , whole-herb consumption, eating vegetables also easily fits
in this category (besides medicinal herbs), all of the vitamins, minerals and antioxidants are phytochemicals that we are
accessing through our diet.
• Steam inhalation as in aromatherapy can be used as a mood changing treatment to fight a sinus infection or cough’or to
cleanse the skin on a deeper level.
Risks connected to the use of herbal medicines
Many consumers believe that herbal medicines are safe because they are natural while may interact with synthetic drugs
causing toxicity to the patient. Some herbal remedies may have the potential to cause adverse drug interactions when used in
combination with various prescription and over-the-counter pharmaceuticals. For example a case of major potassium
depletion has been attributed to chronic licorice ingestion, black Therefore, proper double-blind clinical trials are needed to
determine the safety and efficacy of each plant before they can be recommended for medical use.

L’Adapted from: http://en.wikipedia.org/

LI Irritable Bowel Syndrome. A chronic functional disorder of the colon often considered to be of psychophysiological origin and that is
characterized by diarrhea or constipation or diarrhea alternating with constipation, abdominal pain or discomfort. It is also called irritable
colon syndrome, mucous colitis, spastic colon.

74
 UNIT 33: Herbalism (2) (practice)
A. Fill in the table with name of herbs from the text.

Herb Definitions
1. Mediterranean plant widely cultivated for its large edible flower head.
2. North American tree with purple flowers and a yellow edible fruit.
3 Bulbous herb from southern Europe, that breaks up into separate strong-flavored cloves.
4. A perennial European bushy composite herb (Chrysanthemum parthenium) bearing small white flowers,
widely cultivated as an ornamental.
5. An aromatic herb of the mint family, having leaves used as seasoning in cooking.
6. Its leaves are lighter in color than ordinary ones found in the market. They are in order to prevent
fermentation leaves are steamed and then rolled and dried.
7. Vegetable with highest contents of proteins. Source of oil; used for forage, for soil improvement and as
food.
8. Grass (Cymbopogon citratus) native from southern India and Ceylon that is grown in tropical regions for
its scented foliage. It is used as a seasoning and as a source of an aromatic essential oil.

B. Write the correct tense of the verbs given in brackets (either active or passive). Sometimes a modal verb
is needed.

1. Leaf extract from artichokes.................................................................(to use) medicinally for many years. •

2. Areas such as HIV, cancer, IBS and diabetes.................................................................. (benefit) by artichoke
leaves extract.
3. Recent studies.......................................(find) that soy has only a modest effect on cholesterol levels.
4. Green tea ............................................................. (begin) to be subjected to many scientific and medical
studies over the last few decades.
5. Before marketing medicinal plants it ................................................................................. (recommend)- by
healthcare institutions to test them clinically.
6. On some occasions adverse drug interactions .............................................................. (cause) by herbal
remedies
7. A case of major potassium depletion.............................^...... (attribute) to Chronic licorice ingestion.
8. Patients treated with anticoagulants.................................(avoid) to take feverfew herbal medicines.

c. Match parts of sentences in column A with parts ỉn column B

1. Traditional use, as well as recent clinical A. physical symptoms such as hot flashes.
2. According to the research results the risk of prostate, colon B. antifungal, anticancer, anti-inflammatory effects as well as
and breast analgesic properties in mice.
c. studies continue to verify the multi-beneficial effects of the
3. As women move into menopause they feel uncomfortable artichoke leaf extract.
4. It is believed that soy alleviates menopausal D. drinkers may reduce the risk of heart disease and certain
kind of cancers.
5. Although feverfew is occasionally used to treat migraine
headaches, it should E. cancers as well as osteoporosis may be lowered by soy.
F. longer periods, while in others it seems to give immediate
6. In vitro studies demonstrated black cumin antibacterial, effects.
7. In some cases Valerian roots seems to work when taken G. be avoided by some groups of patients including pregnant
over women.
8. It has been discovered that regular green tea H. symptoms, however this aspect is still being debated.

Solution: 1...... 2......., 3.........,4........, 5. ., 6...., 7...., 8............

7
5
A dietary supplementLII (also known as food supplement) is a preparation intended to supply nutrients, (such as vitamins,
minerals, fatty acids or amino acids) that are missing or not consumed in sufficient quantity in a person's diet. Some countries
define dietary supplements as foods, while in others they are defined as drugs. In die United States, the definition of dietary
supplements includes non-medicinal herbal supplements and steroids hormones, such as melatonin. Supplements containing
vitamins or dietary minerals are recognised by the United Nations’ highest authority on food standards as a category of food.
In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994 as
a product that is intended to supplement the diet and contains any of the following dietary ingredients:
• a vitamin, a mineral, a herb or other botanical (excluding tobacco), an amino acid,
• a dietary substance for use by people to supplement the diet by increasing the total dietary intake, or a concentrate,
metabolite, constituent, extract, or combination of any of the above. ,

The USA and EU regulations

Generally, manufacturers do not need to register their products

with FDA nor get FDA approval before producing or selling
dietary supplements. Manufacturers must make sure that product
label information is truthful and not misleading. FDA's post-
marketing responsibilities include monitoring safety, e.g.
voluntary dietary supplement, adverse event reporting and
product information, such as labeling, claims, package inserts,
and accompanying literature. The Federal Trade Commission
regulates dietary supplement advertising. Some vitamins are
essential in small quantities but dangerous in large quantities,
notably Vitamin A.
Consequently, only those supplements that have been proved to
be safe, may be sold without prescription. In practice, however,
there appears to be little risk to supplement users of experiencing
adverse side effects due to excessive intakes of micronutrients.
In Europe, it is also an established view that food supplements
should not be labeled with drug claims but can bear health claims,
although to a degree that differs from one member state to the
other.
The dietary supplements industry in the UK, one of the 27 countries in the European Union, strongly opposed the Directive.
In addition, a large number of consumers throughout Europe, including over one million in the UK, and many doctors and
scientists, have signed petitions against what are viewed by the petitioners as unjustified restrictions of consumer choice. In
2004, along with two British trade associations, the Alliance for Natural Health had a legal challenge to the European Union's
Food Supplements Directive referred to the European Court of Justice by the High Court in London. Although the European
Court of Justice's Advocate General subsequently said that the EU's plan to tighten rules on the sale of vitamins and food
supplements should be scrapped, he was eventually overruled by the European Court, which decided that the measures in
question were necessary and appropriate for the purpose of protecting public health. ANH, however, interpreted the ban as
applying only to synthetically produced supplements - and not to vitamins and minerals normally found in or consumed as
part of the diet. Nevertheless, the European judges did acknowledge the Advocate General's concerns, stating that there must
be clear procedures to allow substances to be added to the permitte4 list based on scientific evidence. They also said that any
refusal to add a product to the list must be open to challenge in the courts.

LII http://en.wikipedia.org/wiki/Dietary_supplement

76
 UNIT 34: Dietary supplements (Practice)

A. Answer the questions

1. What is a dietary supplement?

2. What do they include in the USA?

3. How are supplements containing vitamins considered in the USA?

4. What does a dietary supplement contain acccording to DSHE?

5. What procedure needs to be followed to market dietary supplemnts in the USA?

6. What about the post-marketing process?

7. What is an established view from the EU according to labelling dietary supplements?

8. What is the UK’s position this regard?

9. What was the final result of the Alliance for Natural Health’s legal challenge to Eu’s directive concerning
resctrictions of dietary products?

10. How did the Alliance for Natural Health finally interpret the ban?

77