Quan ly va cung ung thuoc giao trinh AVCN duoc

PREFACE
The Drug Supply and Management textbook is especially compiled to meet the
demand of equipping students of the Pharmacy Department at Lac Hong University
with vocabulary and reading comprehension ability.
This textbook is designed to help pharmacy – majored students build vocabulary and
access pharmaceutical materials. It introduces terms relating to pharmaceutical
contexts which are widely used in pharmaceutical prescriptions, reports, journals, and
studies. In addition, it also enhances students‟ reading and translation skills through
authentic reading texts with carefully planned activities.
In spite of the efforts to make it an efficient aid in the study of this ESP course, the
compilers are aware of the deficiencies that remain in the textbook. Needless to say,
the

compilers

will

greatly

appreciate

all

positive

contributions

sent

to

the General English Department via

i


TABLE OF CONTENTS
Page

PREFACE ..................................................................................................... i
TABLE OF CONTENTS ............................................................................. ii
UNIT 1 Drug Information ............................................................................. 1
Cefixime .............................................................................................. 1
Glipizide .............................................................................................. 7
UNIT 2 The pharmacological basis of Therapeutics .................................... 13
Certirizine .......................................................................................... 13
Betamethasone ................................................................................... 19
UNIT 3 The pharmacological basis of disease treatment ............................ 29
Omeprazole ........................................................................................ 29
Chlorpromazine ................................................................................. 38
UNIT 4 Leaflet ............................................................................................. 46
Augmentin ......................................................................................... 46
Amlodipin Stada ................................................................................ 59
UNIT 5 Pharmacovigilance .......................................................................... 65
UNIT 6 Good stockage practices ................................................................. 76
UNIT 7 Pharmaceutical care ......................................................................... 91
UNIT 8 Improving global health by closing gaps in the development,
distribution, and responsible use of medicines ................................. 99
UNIT 9 Medical status reports .................................................................... 107
UNIT 10 Purchase Orders .......................................................................... 142
UNIT 11 Pharmaceutical and Clinical Journals ......................................... 149

GLOSSARY ............................................................................................... 182
REFERENCES .......................................................................................... 190

ii


UNIT 1
DRUG INFORMATION
GUIDED STUDY

CEFIXIME

SCRUB UP

1. Work in pairs. Write the correct words or phrases given in the table under the
corresponding pictures.
1. antibiotic
2. vomit
3. breast-feeding

4. diarrhea
5. rash
6. sore throat

7. dizziness
8. patch
9. diet

a. ------------------------

b. ------------------------

c. ------------------------

d. ------------------------

e. ------------------------

f. ------------------------

g. ------------------------

h. ------------------------

i --------------------

2. Work in pairs. Match each phonetic spelling to one of the words or phrases
above. Try to say them to your partner.
a. /ˌæntibaɪˈɒːtɪk/ _______ c. /sɔː θrəʊt/ _______
e. /ˈdɪzɪnəs/ _______
b. /ˌdaɪəˈriːə/

_______

d. /ˈvɒmɪt/

_______
1

READING COMPREHENSION
1. Read the passage below and decide if these sentences are true (T) or false (F).
a. Cefixim is always safe. _______
b. An over dose of this medication sometimes causes death. _______
c. This medication may have effects on stomach. _______
d. Pregnant women must be careful with this drug. _______
e. The dosage of children is based on age. _______
f. This medication requires a medical prescription to be dispensed. _______
g. If a patient missed a dose, he or she would take a double dose to catch up the
missed dose. _______
2. Fill in each blank with a suitable word.
a. Antibiotics do not fight infections caused by cold and _______ viruses.
b. Do not stop taking the antibiotics early even if _______ disappear after a few
days.
c. You should check with your doctor immediately if any of these side effects,
such as stomach upset/pain, diarrhea, nausea, gas, headache, or _______ occurs
when taking cefixime.
d. Because no information is available on the effect of cefixime on breast milk,
you should consult your doctor before _______.
e. Do not save any of the antibiotics for another _______ unless told to do so by
your doctor.
f. Keep cefixime out of the reach of _______ and away from pets.
3. Translate the following sentences into Vietnamese.
a. If you are taking the chewable tablets, chew thoroughly and then swallow.
b. Stopping the medication too early may allow bacteria to continue to grow,
which may result in a relapse of the infection.
c. Use of this medication for prolonged or repeated periods may result in
oral thrush or a new vaginal yeast infection (oral or vaginal fungal infection).
d. This medication should be used only when clearly needed during pregnancy.

Discuss the risks and benefits with your doctor.
e. Although most antibiotics probably do not affect hormonal birth control such as
pills, patch, or ring, some antibiotics may decrease their effectiveness.
2


Reading 1
CEFIXIME
1. Uses
Cefixime is used to treat a wide variety of bacterial infections. This medication is
known as a cephalosporin antibiotic. It works by stopping the growth of bacteria.
This antibiotic treats only bacterial infections. It will not work for viral infections
(e.g., common cold and flu). Unnecessary use or overuse of any antibiotic can lead to
its decreased effectiveness.
2. How to use cefixime
Take this medication by mouth with or without food as directed by your doctor,
usually once a day. For children, this medication may also be taken twice a day (every
12 hours). If you are taking the chewable tablets, chew thoroughly and then swallow.
The dosage is based on your medical condition and response to treatment. For
children, the dosage is also based on weight.
Antibiotics work best when the amount of medicine in your body is kept at a constant
level. Therefore, take this drug at evenly spaced intervals.
Continue to use this medication until the full prescribed amount is finished, even if
symptoms disappear after a few days. Stopping the medication too early may allow
bacteria to continue to grow, which may result in a relapse of the infection.
Tell your doctor if your condition persists or worsens.
3. Side effects
Stomach upset/pain, diarrhea, nausea, gas, headache, or dizziness may occur. If any of
these effects persists or worsens, notify your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has

judged that the benefit to you is greater than the risk of side effects. Many people
using this medication do not have serious side effects.
Tell your doctor immediately if any of these rare but very serious side effects occur:
severe stomach/abdominal pain, persistent nausea/vomiting, yellowing eyes/skin, dark
urine, unusual tiredness, new signs of infection (e.g., persistent sore throat, fever),

3


easy bruising/bleeding, change in the amount of urine, mental/mood changes (such as
confusion).
This medication may rarely cause a severe intestinal condition (Clostridium difficileassociated diarrhea) due to a resistant bacteria. This condition may occur weeks to
months after treatment has stopped. Do not use anti-diarrhea products or narcotic pain
medications if you have the following symptoms because these products may make
them worse. Tell your doctor immediately if you develop: persistent diarrhea,
abdominal or stomach pain/cramping, or blood/mucus in your stool.
Use of this medication for prolonged or repeated periods may result in oral thrush or a
new vaginal yeast infection (oral or vaginal fungal infection). Contact your doctor if
you notice white patches in your mouth, a change in vaginal discharge, or other new
symptoms.
A very serious allergic reaction to this drug is rare. However, get medical help right
away if you notice any symptoms of a serious allergic reaction, including: rash,
itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble
breathing.
This is not a complete list of possible side effects. If you notice other effects not listed
above, contact your doctor or pharmacist.
4. Precautions
Before taking cefixime, tell your doctor or pharmacist if you are allergic to it; or to
penicillins or other cephalosporin antibiotics (e.g., cephalexin); or if you have any
other allergies. This product may contain inactive ingredients, which can cause allergic

reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history,
especially of: kidney disease, a certain intestinal disease (colitis).
Before having surgery, tell your doctor or dentist about all the products you use
(including prescription drugs, nonprescription drugs, and herbal products).
The chewable form of this medication may contain aspartame. If you have
phenylketonuria (PKU) or any other condition that requires you to limit/avoid

4


aspartame (or phenylalanine) in your diet, ask your doctor or pharmacist about using
this medication safely.
This medication should be used only when clearly needed during pregnancy. Discuss
the risks and benefits with your doctor.
It is unknown if this medication passes into breast milk. Consult your doctor before
breast-feeding.
5. Interactions
Drug interactions may change how your medications work or increase your risk for
serious side effects. This document does not contain all possible drug interactions.
Keep a list of all the products you use (including prescription/nonprescription drugs
and herbal products) and share it with your doctor and pharmacist. Do not start, stop,
or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug include: "blood thinners" (e.g.,
warfarin), live bacterial vaccines.
Although most antibiotics probably do not affect hormonal birth control such as pills,
patch, or ring, some antibiotics may decrease their effectiveness. This could cause
pregnancy. Examples include rifamycins such as rifampin or rifabutin. Be sure to ask
your doctor or pharmacist if you should use additional reliable birth control methods
while using this antibiotic.

This medication may cause false positive results with certain diabetic urine testing
products (cupric sulfate-type). This drug may also affect the results of certain lab tests.
Make sure laboratory personnel and all your doctors know you use this drug.
6. Overdose
If overdose is suspected, contact a poison control center or emergency room
immediately. Symptoms of overdose may include: severe vomiting, seizures.
Notes
Do not share this medication with others.
This medication has been prescribed for your current condition only. Do not use it
later for another infection unless told to do so by your doctor. A different medication
may be necessary in those cases.
5


7. Missed dose
If you miss a dose, take it as soon as you remember. If it is near the time of the next
dose, skip the missed dose and resume your usual dosing schedule. Do not double the
dose to catch up.
8. Storage
Store at room temperature away from light and moisture. Do not store in the bathroom.
Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to
do so. Properly discard this product when it is expired or no longer needed. Consult
your pharmacist or local waste disposal company.

6


SELF-STUDY

GLIPIZIDE
READING COMPREHENSION
1. Answer the questions about the text.
a. How should glipizide be used?
b. Can glipizide cause upset stomach?
c. Will taking glipizide for diabetes make people gain weight?
d. Are people with type 1 diabetes allowed to use glipizide?
e. What should people do if they forget a dose?
f. What side effects can this medication cause?
g. What should people know about storage and disposal of this medication?
2. Translate the following paragraphs into Vietnamese.
a. Glipizide is used with a proper diet and exercise program to control high blood
sugar in people with type 2 diabetes. It may also be used with other diabetes
medications. Controlling high blood sugar helps prevent kidney damage,
blindness, nerve problems, loss of limbs, and sexual function problems. Proper
control of diabetes may also lessen your risk of a heart attack or stroke.
Glipizide belongs to the class of drugs known as sulfonylureas. It lowers blood
sugar by causing the release of your body's natural insulin.
b. Before using this medication, tell your doctor or pharmacist your medical
history, especially of: liver disease, kidney disease, thyroid disease, certain
hormonal conditions (adrenal/pituitary insufficiency, syndrome of inappropriate
secretion of antidiuretic hormone-SIADH), electrolyte imbalance
(hyponatremia).
c. Store at room temperature away from light and moisture. Do not store in the
bathroom. Keep all medications away from children and pets.
d. Do not flush medications down the toilet or pour them into a drain unless
instructed to do so. Properly discard this product when it is expired or no longer
needed. Consult your pharmacist or local company waste disposal

7

Reading 2
GLIPIZIDE
1. Uses
Glipizide is used with a proper diet and exercise program to control high blood sugarin
people with type 2 diabetes. It may also be used with other diabetes medications.
Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems,
loss of limbs, and sexual function problems. Proper control of diabetes may also lessen
your risk of a heart attack or stroke. Glipizide belongs to the class of drugs known as
sulfonylureas. It lowers blood sugar by causing the release of your body's
natural insulin.
2. How to use glipizide
Take this medication by mouth 30 minutes before breakfast or the first meal of the day
as directed by your doctor, usually once daily. Some patients, especially those taking
higher doses, may be directed to take this drug twice a day. The dosage is based on
your medical condition and response to treatment.
To reduce your risk of side effects, your doctor may direct you to start this medication
at a low dose and gradually increase your dose. Follow your doctor's instructions
carefully.
If you are already taking another anti-diabetic drug (such as chlorpropamide), follow
your doctor's directions carefully for stopping the old drug and starting glipizide.
Colesevelam can decrease the absorption of glipizide. If you are taking colesevelam,
take glipizide at least 4 hours before taking colesevelam.
Use this medication regularly to get the most benefit from it. To help you remember,
take it at the same time(s) each day.
Tell your doctor if your condition does not improve or if it worsens (your blood sugar
levels are too high or too low).
3. Side effects
Nausea, vomiting, loss of appetite, diarrhea, constipation, upset stomach, headache,

and weight gain may occur. If any of these effects persist or worsen, tell your doctor or
pharmacist promptly.
8


Remember that your doctor has prescribed this medication because he or she has
judged that the benefit to you is greater than the risk of side effects. Many people
using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: signs of
infection (such as persistent sore throat, fever), easy bleeding/bruising, stomach pain,
yellowing eyes/skin, dark urine, unusual tiredness/weakness, unusual/sudden weight
gain, mental/mood changes, swelling hands/feet, seizures.
This medication can cause low blood sugar (hypoglycemia). This may occur if you do
not consume enough calories from food or if you do unusually heavy exercise.
Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat,
hunger, blurred vision, dizziness, or tingling hands/feet. It is a good habit to carry
glucose tablets or gel to treat low blood sugar. If you don't have these reliable forms of
glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table
sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor
immediately about the reaction and the use of this product. To help prevent low blood
sugar, eat meals on a regular schedule, and do not skip meals. Check with your doctor
or pharmacist to find out what you should do if you miss a meal.
Symptoms of high blood sugar (hyperglycemia) include thirst, increased urination,
confusion, drowsiness, flushing, rapid breathing, and fruity breath odor. If these
symptoms occur, tell your doctor immediately. Your dosage may need to be increased.
A very serious allergic reaction to this drug is rare. However, get medical help right
away if you notice any symptoms of a serious allergic reaction, including: rash,
itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble
breathing.
This is not a complete list of possible side effects. If you notice other effects not listed

above, contact your doctor or pharmacist.
4. Precautions
Before taking glipizide, tell your doctor or pharmacist if you are allergic to it; or if you
have any other allergies. This product may contain inactive ingredients, which can
cause allergic reactions or other problems. Talk to your pharmacist for more details.
9


Before using this medication, tell your doctor or pharmacist your medical history,
especially
of: liver disease, kidney

disease, thyroid disease,

certain

hormonal

conditions

(adrenal/pituitary insufficiency, syndrome of inappropriate secretion of antidiuretic
hormone-SIADH), electrolyte imbalance (hyponatremia).
You may experience blurred vision, dizziness, or drowsiness due to extremely low or
high blood sugar levels. Do not drive, use machinery, or do any activity that requires
alertness or clear vision until you are sure you can perform such activities safely.
Limit alcohol while taking this medication because it can increase your risk of
developing low blood sugar. Alcohol can rarely interact with glipizide and cause a
serious reaction disulfiram-like reaction) with symptoms such as facial flushing,
nausea, vomiting, dizziness, or stomach pain. Consult your doctor or pharmacist about
the safe use of alcohol.

It may be harder to control your blood sugar when your body is stressed (such as due
to fever, infection, injury, or surgery). Consult your doctor because this may require a
change in your treatment plan, medications, or blood sugar testing.
This medication may make you more sensitive to the sun. Avoid prolonged sun
exposure, tanning booths, and sunlamps. Use a sunscreen and wear protective clothing
when outdoors.
Before having surgery, tell your doctor or dentist about all the products you use
(including prescription drugs, nonprescription drugs, and herbal products).
Older adults may be more sensitive to the side effects of this drug, especially low
blood sugar.
During pregnancy, this medication should be used only when clearly needed. Discuss
the risks and benefits with your doctor.
Pregnancy may cause or worsen diabetes. Discuss a plan with your doctor for
managing your blood sugar while pregnant. Your doctor may change your diabetes
treatment during your pregnancy (such as diet and medications including insulin).
It is unknown if this medication passes into breast milk. However, similar drugs pass
into breast milk. Consult your doctor before breast-feeding.
10


5. Interactions
Drug interactions may change how your medications work or increase your risk for
serious side effects. This document does not contain all possible drug interactions.
Keep a list of all the products you use (including prescription/nonprescription drugs
and herbal products) and share it with your doctor and pharmacist. Do not start, stop,
or change the dosage of any medicines without your doctor's approval.
Many drugs can affect your blood sugar levels, making it more difficult to control your
blood sugar. Before you start, stop, or change any medication, talk with your doctor or
pharmacist about how the medication may affect your blood sugar. Check your blood
sugar levels regularly as directed by your doctor. Tell your doctor about the results and

of any symptoms of high or low blood sugar. (See also Side Effects section.) Your
doctor may need to adjust your anti-diabetic medication, exercise program, or diet.
Beta-blocker medications (including metoprolol, propranolol, glaucoma eye drops
such as timolol) may prevent the fast/pounding heartbeat you would usually feel when
your blood sugar level falls too low (hypoglycemia). Other symptoms of low blood
sugar such as dizziness, hunger, or sweating are unaffected by these drugs.
Check the labels on all your medicines (such as cough-and-cold products) because
they may contain ingredients that could affect your blood sugar. Ask your pharmacist
about using those products safely.
6. Overdose
If overdose is suspected, contact a poison control center or emergency room
immediately. Symptoms of overdose may include: shakiness, fast heartbeat, sweating,
loss of consciousness.
Notes
Do not share this medication with others.
Attend a diabetes education program to learn more about diabetes and the important
aspects of its treatment, including medications, diet, exercise, and getting regular
eye/foot/medical exams.
Learn the symptoms of high and low blood sugar and how to treat low blood sugar.
Check your blood sugar levels regularly as directed.

11


Keep all regular medical and laboratory appointments. Laboratory and/or medical tests
(such as liver and kidney function tests, fasting blood glucose, hemoglobin A1c,
complete blood counts) should be performed periodically to monitor your progress or
check for side effects.
7. Missed dose
If you miss a dose, take it as soon as you remember. If it is near the time of the next

dose, skip the missed dose and resume your usual dosing schedule. Do not double the
dose to catch up.
8. Storage
Store at room temperature away from light and moisture. Do not store in the bathroom.
Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to
do so. Properly discard this product when it is expired or no longer needed. Consult
your pharmacist or local waste disposal company.

12


UNIT 2
THE PHARMACOLOGICAL BASIS OF THERAPEUTICS
GUIDED STUDY

CERTIZINE
SCRUB UP
1. Work with a partner. Match each phonetic spelling in column A to one of the
words in column B. How do you pronounce those eight words?
A
B
1. /ˈælədʒɪ/
itching _______
sneezing _______
tablet _______
2. /haɪv/
bruise _______
3. /ˈsʌbstəns/
dose _______

rash _______
stomach pain _______
4. /ˈɪtʃɪŋ/
prescription drug _______
drowsiness _______
restlessness _______
5. /ˈdraʊzɪnəs/
dizziness _______
swelling _______
substance _______
6. /ræʃ/
side effect _______
allergy _______
antihistamine _______
7. /ˈdɪzinəs/
kidney _______
liver _______
hive _______
8. /bruːz/
irritability _______
symptom _______
2. Work in pairs. Decide if each of the words in column B is used in the sections
(Uses, Side effects, Interactions, etc.). Then, underline the parts of the words that
are stressed (the first two words are done).

13


READING COMPREHENSION
1. Choose the word or phrase marked a, b, c, or d that best complete each

sentence.
1. Certirizine is used to treat _______.
a. allergy symptoms
b. cramp
c. fever
d. diarrhea
2. Certirizine is available in the forms of _______.
a. tablet
b. syrup
c. chewable tablet
d. all of the above
3. Serious side effects of certirizine contain _______.
a. difficulty urinating
c. tiredness

b. drowsiness
d. dry mouth

4. Chewable tablets may be taken with _______.
a. milk
b. water
c. orange juice
d. tea
5. The common side effect of certirizine is _______.
a. weakness
b. swelling
c. drowsiness
d. rash
6. Do not use any other antihistamines applied to the skin, such as _______.
a. cream

b. ointment
c. spray

d. all of the above

2. Answer the questions about the text.
a. Should antihistamines be used by women who are breast feeding?
b. Does certirizine interact with other medications?
c. What is cetirizine indicated for?
d. Are patients allowed to crush or chew enteric-coated preparations of certirizine?
e. What should we know about storage and disposal of this medication?
3. Read the passage below and decide if these sentences are true (T) or false (F).
a. Certirizine is available without a prescription. _______
b. Certirizine causes anxiety. _______
c.
d.
e.
f.

14

People using this medication may become drowsy. _______
It is okay to take certirizine during pregnancy. _______
It is possible to take certirizine tablet twice a day. _______
People who have missed a dose of certirizine can doube it to catch up. _______


Reading 1
CETIRIZINE
1. Uses

Cetirizine is an antihistamine used to relieve allergy symptoms such as watery eyes,
runny nose, itching eyes/nose, sneezing, hives, and itching. It works by blocking a
certain natural substance (histamine) that your body makes during an allergic reaction.
Cetirizine does not prevent hives or prevent/treat a serious allergic reaction (such as
anaphylaxis). Therefore, if your doctor has prescribed epinephrine to treat allergic
reactions, always carry your epinephrine injector with you. Do not use cetirizine in
place of your epinephrine.
2. How to use cetirizine
If you are taking the over-the-counter product to self-treat, read all directions on the
product package before taking this medication. If you have any questions, consult your
pharmacist. If your doctor has prescribed this medication, take it as directed, usually
once daily.
If you are using the chewable tablets, chew each tablet well and swallow. If you are
using the rapidly-dissolving tablet, allow the tablet to dissolve on the tongue and then
swallow, with or without water. If you are using the liquid form of this medication,
measure the dose carefully using a special measuring device/spoon. Do not use a
household spoon because you may not get the correct dose.
The dosage is based on your age, medical condition, and response to treatment. Do not
increase your dose or take this medication more often than directed.
Tell your doctor if your allergy symptoms do not improve, if your hives do not
improve after 3 days of treatment, or if your hives last more than 6 weeks. Get medical
help right away if your condition worsens or if you think you have a serious medical
problem (such as a very serious allergic reaction/anaphylaxis).
3. Side effects
Drowsiness, tiredness, and dry mouth may occur. Stomach pain may also occur,
especially in children. If any of these effects persist or worsen, tell your doctor or
pharmacist promptly.

15

If your doctor has prescribed this medication, remember that he or she has judged that
the benefit to you is greater than the risk of side effects. Many people using this
medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: difficulty
urinating, weakness.
A very serious allergic reaction to this drug is rare. However, get medical help right
away if you notice any symptoms of a serious allergic reaction, including: rash,
itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble
breathing.
This is not a complete list of possible side effects. If you notice other effects not listed
above, contact your doctor or pharmacist.
List cetirizine side effects by likelihood and severity.
4. Precautions
Before taking cetirizine, tell your doctor or pharmacist if you are allergic to it; or to
hydroxyzine; or to levocetirizine; or if you have any other allergies. This product may
contain inactive ingredients, which can cause allergic reactions or other problems.
Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history,
especially of: difficulty urinating (such as due to an enlarged prostate), kidney disease,
liver disease.
If you are using this medication to treat hives, tell your doctor right away if you have
any of these other symptoms because they may be signs of a more serious condition:
hives that are an unusual color, hives that look bruised or blistered, hives that do not
itch.
This drug may make you drowsy. Do not drive, use machinery, or do any activity that
requires alertness until you are sure you can perform such activities safely. Avoid
alcoholic beverages.
Liquid products may contain sugar. Caution is advised if you have diabetes. Ask your
doctor or pharmacist about using this product safely.

16


Before having surgery, tell your doctor or dentist about all the products you use
(including prescription drugs, nonprescription drugs, and herbal products).
During pregnancy, this medication should be used only when clearly needed. Discuss
the risks and benefits with your doctor.
This medication passes into breast milk. Consult your doctor before breast-feeding.
5. Interactions
Drug interactions may change how your medications work or increase your risk for
serious side effects. This document does not contain all possible drug interactions.
Keep a list of all the products you use (including prescription/nonprescription drugs
and herbal products) and share it with your doctor and pharmacist. Do not start, stop,
or change the dosage of any medicines without your doctor's approval.
Tell your doctor or pharmacist if you are taking other products that cause drowsiness
including alcohol, other antihistamines (such as diphenhydramine), drugs for sleep or
anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and narcotic pain
relievers (such as codeine).
Check the labels on all your medicines (such as cough-and-cold products) because
they may contain ingredients that cause drowsiness. Ask your pharmacist about using
those products safely.
Do not use with any other antihistamines applied to the skin (such as diphenhydramine
cream, ointment, spray) because increased side effects may occur.
Cetirizine is very similar to hydroxyzine and levocetirizine. Do not use these
medications while using cetirizine.
This medication may interfere with certain laboratory tests (including allergy skin
testing), possibly causing false test results. Make sure laboratory personnel and all
your doctors know you use this drug.
6. Overdose

If overdose is suspected, contact a poison control center or emergency room right
away. Symptoms of overdose may include: severe drowsiness. In children,
mental/mood changes (such as restlessness, irritability) may occur before drowsiness.

17


Notes
Keep all regular medical and laboratory appointments.
7. Missed dose
If you miss a dose, take it as soon as you remember. If it is near the time of the next
dose, skip the missed dose and resume your usual dosing schedule. Do not double the
dose to catch up.
8. Storage
Store at room temperature away from light and moisture. Do not store in the bathroom.
Different brands of this medication may have different storage needs. Check the
product package for instructions on how to store your brand, or ask your pharmacist.
Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to
do so. Properly discard this product when it is expired or no longer needed. Consult
your pharmacist or local waste disposal company.

18


SELF-STUDY

BETAMETHASONE
READING COMPREHENSION
1. Complete these sentences using the bold words in the text. There are more

words than sentences.
a. Immunologic side effects have included delayed wound healing and increased
susceptibility to bacterial, viral and _______ parasitic infections.
b. _______ suppression can persist for up to twelve months after long-term
corticosteroid therapy.
c. Women during pregnancy should use corticosteroids in caution because they
may show harmful effects on _______ or neonatal adrenal suppression.
d. Corticosteroids should never be withdrawn suddenly, but rather must be
_______ slowly.
e. Tell your doctor or pharmacist if you have a history of heart problems (eg,
congestive _______ failure [CHF]) and heart attack).
f. _______ changes or other eye problems can be found upon prolonged use of
ophthalmic preparations containing corticosteroids.
g. Corticosteroids use may get women to experience _______ abnormalities.
h. The _______ of betamethasone are usually applied one to four times a day
following the directions on your prescription.
2. Find the synonym from the text of each word below.
a. meltable
b. injury
c. optical
d. termination
e. consumption
f. system
g. newborns
3. Translate Section 2 (Treatment, adverse effects, withdrawal, and precautions)
into Vietnamese.

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Reading 2
BETAMETHASONE
1. Pharmacopoeias.
Ph. Eur. 6.2 (Betamethasone). A white or almost white, crystalline powder.
Practically insoluble in water; sparingly soluble in dehydrated alcohol; very slightly
soluble in dichloromethane. Protect from light.
USP 31 (Betamethasone). A white to practically white, odourless, crystalline powder.
Soluble 1 in 5300 of water, 1 in 65 of alcohol, 1 in 15 of warm alcohol, 1 in 325 of
chloroform, and 1 in 3 of methyl alcohol; sparingly soluble in acetone and in dioxan;
very slightly soluble in ether. Store in airtight containers at a temperature between 2°
and 30°.
2. Treatment, adverse effects, withdrawal, and precautions
2.1. Treatment
Betamethasone is used for:
Treating certain conditions associated with decreased adrenal gland function. It
is used to treat severe inflammation caused by certain conditions, including severe
asthma, severe allergies, rheumatoid arthritis, ulcerative colitis, certain blood
disorders, lupus, multiple sclerosis, and certain eye and skin conditions. It may be used
for certain types of cancer (e.g., leukemia). It may also be used for other conditions as
determined by your doctor.
Betamethasone is a corticosteroid. It works by modifying the body's immune
response to various conditions and decreasing inflammation.
2.2. Adverse effects of corticosteroids
The adverse effects of corticosteroids may result from unwanted mineralocorticoid or
glucocorticoid actions, or from inhibition of the hypothalamic-pituitary-adrenal axis.
Mineralocorticoid adverse effects are manifest in the retention of sodium and water,
with oedema and hypertension, and in the increased excretion of potassium with the
possibility of hypokalaemic alkalosis. In susceptible patients, cardiac failure may be
induced. Disturbances of electrolyte balance are common with the naturally occurring
corticosteroids, such as cortisone and hydrocortisone, but are less frequent with many

synthetic glucocorticoids, which have little or no mineralocorticoid activity.
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Adverse glucocorticoid effects lead to mobilisation of calcium and phosphorus, with
osteoporosis and spontaneous fractures; muscle wasting and nitrogen depletion; and
hyperglycaemia with accentuation or precipitation of the diabetic state. The insulin
requirements of diabetic patients are increased. Increased appetite is often reported.
Impaired tissue repair and immune function can lead to delayed wound healing, and
increased susceptibility to infection. Increased susceptibility to all kinds of infection,
including septicaemia, tuberculosis, fungal infections, and viral infections, has been
reported in patients on corticosteroid therapy. Infections may also be masked by the
anti-inflammatory, analgesic, and antipyretic effects of glucocorticoids. The increased
severity of varicella and measles may lead to a fatal outcome in non-immune patients
receiving systemic corticosteroid therapy.
Other adverse effects include menstrual irregularities, amenorrhoea, hyperhidrosis,
skin thinning, ocular changes including development of glaucoma and cataract, mental
and neurological disturbances, benign intracranial hypertension, acute pancreatitis, and
avascular necrosis of bone. An increase in the coagulability of the blood may lead to
thromboembolic complications. Peptic ulceration has been reported but reviews of the
literature do not always agree that corticosteroids are responsible for an increased
incidence.
The negative feedback effects of glucocorticoids on the hypothalamic-pituitary-adrenal
(HPA) axis may lead to adrenal atrophy, in some cases after therapy for as little as 7
days. This produces secondary adrenocortical insufficiency which may become
manifest after overly rapid withdrawal of treatment or be precipitated by some stress
such as infection or trauma. Patients vary considerably in the degree and duration of
adrenal suppression after a given course of corticosteroid, but adrenal atrophy may
persist for months or years, and withdrawal should be gradual in those who have been
treated for any length of time (see also Withdrawal, below). High doses of

corticosteroids given during pregnancy may cause fetal or neonatal adrenal
suppression. Although the precise mechanism is uncertain, growth retardation may
follow the use of even relatively small doses of corticosteroids in children.
Large doses of corticosteroids, or of corticotropin, may produce Cushingoid symptoms
typical of hyperactivity of the adrenal cortex, with moon-face, sometimes with
hirsutism, buffalo hump, flushing, increased bruising, ecchymoses, striae, and acne.
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Giving large intravenous doses of corticosteroids too rapidly may cause cardiovascular collapse.
Hypersensitivity reactions have occurred with corticosteroids, mainly when applied
topically.
Adverse effects occur, in general, fairly equally with all systemic corticosteroid
preparations and their incidence rises steeply if dosage increases much above
physiological values, traditionally considered to be about 7.5 mg daily of prednisolone
or its equivalent (see Uses and Administration, below, for equivalent doses of other
corticosteroids). Short courses at high dosage for emergencies appear to cause fewer
adverse effects than prolonged courses with lower doses.
Most topically applied (including inhaled) corticosteroids may, under certain
circumstances, be absorbed in sufficient amounts to produce systemic effects. The
topical application of corticosteroid preparations to the eyes has produced corneal
ulcers, raised intra-ocular pressure, and reduced visual function. Application of
corticosteroids to the skin has led to loss of skin collagen and subcutaneous atrophy;
local hypopigmentation of deeply pigmented skins has been reported after both the
intradermal injection and topical application of potent corticosteroids. Dryness,
irritation, epistaxis, and rarely ulceration or perforation of the nasal septum have
followed intranasal use; smell and taste disturbances may also occur. Hoarseness and
candidiasis of the mouth or throat may occur in patients receiving inhaled
corticosteroids.
Intrathecal dosage (including inadvertent intrathecal dosage after attempted epidural

injection) has been associated with arachnoiditis.
Adverse effects should be treated symptomatically, with the corticosteroid dosage
reduced or slowly withdrawn where possible.
2.3. Withdrawal of corticosteroids
The use of pharmacological doses of corticosteroids suppresses the endogenous
secretion of corticotropin by Hie anterior pituitary, with the result that the adrenal
cortex becomes atrophied. Sudden withdrawal or reduction in dosage, or an increase in
corticosteroid requirements associated with the stress of infection or accidental or
surgical trauma, may then precipitate acute adrenocortical insufficiency; deaths have
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followed the abrupt withdrawal of corticosteroids. Adrenocortical insufficiency has
also occurred after the effective reduction in systemic corticosteroid concentrations
produced by overly rapid transfer from oral to inhaled corticosteroid therapy. For
the emergency treatment of acute adrenocortical insufficiency caused by abrupt
withdrawal of corticosteroids.
In some instances, withdrawal symptoms may involve or resemble a clinical relapse
of the disease for which the patient has been undergoing treatment. Other effects
that may occur during withdrawal or change of corticosteroid therapy include fever,
myalgia, arthralgia, weight loss, benign intracranial hypertension with headache
and vomiting, and papilledema caused by cerebral oedema. Latent rhinitis or
eczema may be unmasked.
Duration of treatment and dosage are important factors in determining suppression
of the pituitary-adrenal response to stress on cessation of corticosteroid treatment,
and individual liability to suppression is also important.
After short courses at moderate doses it may be appropriate to withdraw
corticosteroids without tapering the dose (see below). However, after high-dose or
prolonged therapy, withdrawal should be gradual, the rate depending upon the
individual patient's response, the dose, the disease being treated, and the duration of

therapy. Recommendations for initial reduction, stated in terms of prednisolone,
have varied from as little as steps of 1 mg monthly to 2.5 to 5 mg every 2 to 7 days.
Provided the disease is unlikely to relapse the dose of systemic corticosteroid may
be reduced rapidly to physiological values; dose reduction should then be slower to
allow recovery of pituitary-adrenal function. Symptoms attributable to over-rapid
withdrawal should be countered by resuming a higher dose and continuing the
reduction at a slower rate. Giving corticotropin does not help to re-establish adrenal
responsiveness.
This gradual withdrawal of corticosteroid therapy permits a return of adrenal
function adequate for daily needs, but years may sometimes be required for the return of function necessary to meet the stress of infection, surgery, or trauma. On
such occasions patients with a history of recent corticosteroid withdrawal should be
protected by means of supplementary corticosteroid therapy as described under
Precautions below.
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