UNIT 1

MEDICINE
A. KIND OF MEDICINE
There are many different types of medicines available to us today, some of which cure
diseases while others make us feel better and able to carry on with our lives. They include:
 Medicines which destroy infectious organisms, e.g. antibiotics.
 Medicines which relieve symptoms but do not destroy pathogens, e.g. different kinds of
pain killers such as ibuprofen, paracetamol.
 Medicines which destroy cancer cells. Anticancer medicines are often given in
combination, e.g. mitomycin, ifosfamide and cisplatin (MIC).
 Medicines which change the chemistry of the blood eg statins which help reduce
cholesterol levels.
 Medicines which replace missing chemicals in the blood, e.g. insulin.

The major families of antibiotics are:

Penicillins: amoxicillin, ampicillin, benzathine penicillin, benzylpenicillin, dicloxacillin,
procaine penicillin, and others.
Medicines of the penicillin family are very effective for a variety of infections. They have
very few side effects and are safe to take if pregnant or breastfeeding. They are widely
available, cheap, and come in oral and injectable forms, but they cause more problems
with allergic reactions than many other medicines. They have been overused and some
diseases are now resistant to penicillins.

Macrolides: azithromycin, erythromycin, and others

Erythromycin is an older, commonly used and widely available antibiotic that works for
many of the same infections as penicillin and doxycycline. It is often a good substitute
for doxycycline when a woman is pregnant or breastfeeding, or if there is penicillin
allergy.

Tetracyclines: doxycycline, tetracycline

Tetracycline and doxycycline both treat many different infections and are cheap and
widely available. Neither drug should be taken by pregnant or breastfeeding women or by
children under 8 years of age.

Sulfas (sulfonamides): sulfamethoxazole (part of cotrimoxazole), sulfisoxazole

These medicines fight many different kinds of infections and they are cheap and widely
available. But they are less effective now because some infections are resistant to them.
They cause more problems with allergic reactions than other medicines. They can be
taken during pregnancy, but it is better to take a different medicine just before you give
birth and during the first few weeks of the baby’s life. Stop using sulfonamides
immediately if you develop signs of allergy (see Medicines for allergic reactions).

Aminoglycosides: gentamicin, streptomycin, and others

These are effective and strong medicines, but most of them can cause serious side effects
and can only be given by injection. They should only be used when infection is severe
and no safer drug is available.
Cephalosporins: ceftriaxone, cephalexin, and others
These are a large family of newer, powerful drugs that treat many women’s infections
that have become resistant to the older antibiotics. They are often safer and have fewer
side effects than the older antibiotics but can be quite expensive and hard to find. They
are safe to use during pregnancy and breastfeeding.

Quinolones: ciprofloxacin, norfloxacin, and others

Ciprofloxacin and norfloxacin are newer, powerful antibiotics. They are expensive and
may be hard to find. They cannot be taken while pregnant and breastfeeding or by
children less than 16 years old.

Medicines for Pain

For mild to moderate pain, as with monthly bleeding or a headache:

Paracetamol (acetaminophen) is widely available and cheap. It is the safest pain

medicine for pregnant and breastfeeding women, and it also works to reduce fever. Do
not take it with alcohol or to treat a hangover, or if you have liver or kidney problems.

Aspirin is also widely available, cheap, and works well to lower fever and to treat pain
and inflammation in muscles and joints, and for pain with monthly bleeding.
Breastfeeding women can use aspirin one week after the baby is born, but pregnant
women should use paracetamol instead. It is safe when taken in the correct amounts, but
it can irritate the stomach, so it should not be taken by people with stomach ulcers.
Aspirin keeps blood from clotting normally, so it should not be taken if the person is
bleeding or before any surgery.

Ibuprofen is widely available but more expensive than aspirin or paracetamol. Like
aspirin, it is very effective in lower doses for pain with monthly bleeding, and for muscle
and joint pain and inflammation. Ibuprofen is a good medicine for the lasting pain of
arthritis. It can also cause irritation of the stomach and bleeding problems, so it should
not be taken before surgery or by people with stomach ulcers. Breastfeeding women can
use ibuprofen but pregnant women should not use it during the last 3 months of
pregnancy.

Codeine is a drug of the opiate family which is useful for pain after surgery or an injury.
Taking codeine for too long can cause addiction.

For severe or ongoing pain:

Codeine in higher doses can be used for severe pain.

Morphine is a very strong medicine of the opiate family that is good for pain during the
last stages of cancer or AIDS. Morphine is usually difficult to get unless you are in a
hospital, but it may be available with a doctor’s prescription.

Medicines for allergic reactions

A person can be allergic to medicines, foods, or things that are breathed in or touched.
Reactions may be mild—with itching, hives or rash, or sneezing—or they can be
moderate or severe. Some reactions can worsen and bring on allergic shock. Severe
reactions and allergic shock can be life-threatening and must be treated.
 In this book, we talk about how some medicines may cause allergic reactions. Any
medicine that causes an allergic reaction should be stopped and never given again—even
if the reaction was mild.
Depending on how strong the reaction is, allergic reactions are treated with 1, 2, or 3
kinds of medicines:
1. Antihistamines, like diphenhydramine, hydroxyzine, or promethazine. None of these
medicines are good for pregnant or breastfeeding women, but promethazine is the least
dangerous of them. Otherwise diphenhydramine is usually the cheapest and most widely
available.
2. Steroids, like dexamethasone or hydrocortisone. Dexamethasone is a better choice for
pregnant or breastfeeding women.
3. Epinephrine or adrenaline. These medicines are safe for pregnant or breastfeeding
women.

B. ROUTE OF MEDICINE
Classification:
1. Enteral route
2. Parenteral route
3. Inhalation

1. Enteral Route:
Enteral route is through the alimentary canal. It might be:
1. Oral
2. Sublingual
3. Per rectum
a. Oral Route:
Oral route is the most common route of drug administration. It is mostly used for the
neutral drugs. It may be in the form of tablets, capsules, syrup, emulsions or powders.
Advantages:
1. It is convenient
2. It is the cheapest available route
3. It is easy to use
4. It is safe and acceptable.
b. Sublingual Route:
Sublingual route involves tablets placed under the tongue or between cheeks or Gingiva.
The drug should be lipid soluble and small.
Advantages:
1. Rapid absorption takes place.
2. Drug is dissolved easily
3. Drug enters the blood directly
4. Less first pass effect.
5. Spitting out of the drug removes its effect
c. Rectal Route:
Drugs in solid forms such as suppositories or in liquid forms such as enema are given by
this route. This route is mostly used in old patients. Drugs may have local or systemic
actions after absorption.
Advantages:
1. This route is preferred in unconscious or uncooperative patients.
2. This route avoids nausea or vomiting
3. Drug cannot be destroyed by enzymes.
4. This route is preferred if drug is irritant.
2. Parenteral Route:
Parenteral route includes:
Injections:
1. Intra muscular
2. Intra venous

3. Inhalation:
Inhalation may be the route of choice to avoid the systemic effects. In this way drugs can
pass directly to the lungs. Drugs used involve volatile drugs and gases. Examples include
aerosols like salbutamol; steam inhalations include tincture and Benzoin
Advantages:
1. Rapid absorption takes place.
2. Rapid onset of action takes place.
3. This route has minimum side effects.
4. No first pass effect takes place.
5. This method is easy.
6. Fewer doses is required.
 UNIT 2

INFORMING HEALTH PROBLEM / DISEASE

GIVING ADVICE AND SUGGESTIONS

Useful expressions
 You should + verb 1
( seharusnya anda ……….)

 I suggest you to + verb 1

( Saya sarankan anda untuk………….)

 It’s better for you to + verb 1

( Sebaiknya anda …………….)

 Why don’t you + verb 1

( Bagaimana kalau anda……. )

 You must + verb 1

( Saya pikir anda sebaiknya….)

 I think you should + verb 1

( Saya pikir anda sebaiknya….)

 The best way to do is + verb 1ing

( Jalan yang terbaik adalah…..)

 If you ask my advice, you have to + verb 1

( Jika anda minta saran saya, anda harus……)

 If I were you I would + verb 1

( Saran saya adalah……..)

Example:
1. Situation: Your patient has got anemia. What would you suggest him or her to do?
You will probably say

- You should drink milk

- I suggest you to eat spinach and beef
- You must sleep enough
- It’s better for you not to think too much

2. Situation : The patient feels worried and restless ( pasien merasa kawatir dan gelisah )
You will probably say

- You should take a rest (Sebaiknya anda istirahat)

- I suggest you to lie down on your bed (saya sarankan anda untuk berbaring di tempat
tidur )
 - Why don’t you listen to slow music?(Bagaimana kalau anda mendengarkan musik slow?

Practice:
1. Situation: Your patient is a hard smoker
Suggestions:

2. Situation: Your patient is difficult to sleep

Suggestions:

Discussion
Complete the following table using the right food, drink, and recommendation for your
patient.

No Disease Food Drink Recommendation

1. Diabetes mellitus - corn - Mineral Water - Don’t think too much

- vegetables - Low fat milk - Don’t eat sweet food
- fruits - Exercise regularly

2. Hypertension - Papaya - Low fat milk - Don’t drink coffee

- Rice, brown rice - Mineral water - Avoid stress
- Banana - Rosella tea - Don’t smoke
- Steamed potato - Yogurt - Sleep enough

3. Obesity

4. Anemia

5. Diarrhea

6. Influenza
7. Coughing

8. Typhoid