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Medication

'*4'She/ He

currenrly treated with 2- This was managed/ relieved by -______ ,YHerl His.currenr medications includ"
is
iat

______-________-_-_.

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7- The patient was given ____----____ ro

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Corqplication __-___;____--_{;,The complication now is due to ___-_____ o.?{'However,.the simation has become worse due to 3- His condition has deteriorated due __-___--ro 4- The course of medication has recently been ineffective and the sitiration has

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Patient's state of rnind 1- The p4ienr is worried about / concerned abour ,2- The parient has concerns about
'1- The

anxious about

3-Thepatientisnotconvincedthat----------isessentialto
patienr has been advised on _____*__---_-----::-_._-__-_______ 5- The parient is now convinced rhat
Conclusion

as you see needed 4- i rvculd !e grateful for your opinion and advice regard.ing her/ his presetrr his 6#ealt6 conditions. ,'#l would appreciate your urgent assessment and treatment of this patient.

,,.Y-lnviervofher/hishistory,Ifeelthatshe/hemayhave ,2- I believe/ suspect that Mr. / Mrs. has _-___and is at risk of developing ___ 3- i would be grateful if you could undenake further investigations and treatrtre't of rhis parienr

Ina
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2-

3-IamwritingtoreferIvIr./Mrs.forfurtherassec'mentofher/1ris
presenr hesirh condirion. 4- I am referring Mr- /

I am wriring this letrer to refer Mr./ Mrs, --_---__ ro you. I am wriring to refer irlr./ Mrs. a 49 yearold bank manager, ro yorr.

lvrrs.

5- I am writing ro refer ro you Mr.

who visited today requesting / Mrs. who presented today complaining

Personal informarion
I - lv[r. / Mrs. is 54 years old, married and works as a bank ruanager. 2- lvlr. / Mrs. is a 54 year old bank manager. He is also maried and smokes2packetsaday.

Past historv

- She/ he had has a past hisrory of--------2- Ivlr./Mrs. Jackson's past hisrory includes
I

3- His previous medical records shodinclude ---------------which was/were associated with ----,-----------4- This patienr is a reg'.rlar cusromer of mine and has had since

---------

Svmptoms I - She/ he first visited on --*--------with 2- Today, he attended rhe pharmacy after/complaining of --------On 02.04.1995, he preseated witVhavin g ,d- She/he has been conrplaining of ------- for ---- days. 4- The parienr reponed thar she/he had ------5'During my conversarion wirh the patienr, I noticed that she/he had 6- During rhe conversarion, she/he began to --------Risk factors ,/- According to th.e parienr, the symptoms were made worse by ------2- Her/his risk factors include/are 3- The condition wa.s them aggravated/pxacerbated due to ---------

------------

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Time poltern 1- Two days/weels larer, she/he had 2- she/he has presenred ------ rimes over rhe past week requesting.

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In a letter..of res nse, use these sentences dated __!-,-, r wrire ro I"=:..:.:?:::^.? your leLrer r" v""i let t, e r' i,.x,-:i:',tl',,,1,:-'::l:::. leirer reseived on -1,"1'i,'iijiu like :: :i::I.:"..I_:": co clarify why I - I have read (wirh inE.eresE_grief) your letter h i gh1 i ghE ing/ regard ing/expl ii ning

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It is really (unfortunaEe/disappointing) that you misunderseood Ehe situation f was really saddened by your complaint about. sorry ro :.."r., abouE vou. comprainr in your i.il i:i*I.
-

pills that you desired are amongst. preseript,ion medicatiois. I , Eheref ore, refused Eo supply E,he sleeping piIIs considering Lhe healrh nazarasTrisks rh;; Ehey may eause. These risks can be like For Ehis reason, r could not dispense the medication.
lvlynducy. as a pharmacisE obliges me not to supply such mearcaE,ion excepL with a doctor,s advice and

medication acEs on You should know E.haE the sleeping

AcEually, t,he requesEed medicaEion is crassified under che.widd range of p.."cripEion medicaci;;u. AIso, this

prescription. f now advise you to

I fu1ly undersEand how you may feel but any rash decisions wilI Lead co iurthei compli"itior,". Kindly conform to my instrueEions and advices for speedy and safe recovery.

-I

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-I

hcpe you undersEald and appreciat.e my concern. hope r have clarified rrr"-ii"understindi;g Eo you. hope t.he siEuaEion has been made clear to you now.

a prescription fur yorr ro clrspcnse. #l#$s.':lSf-rn pdema.

i t'rc rncdication i.s trlr tirc According to your records, Mrs. smith is not currently r+s$.suon and has not previously takerr this kind of medication. ,/ g_tqn$ons ong that his wife maJ,*b-p may be pregnant. t/ nregnanr. -.

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..i,',j'il}r;.J -+u?v

Ess .:,.

"

i,' As a primary measure in the treatment of

fluid retention

The promotion of excretion of rvatet' ancl electrolytes via thr' kiclneys


Nausea, vomiting, diarrhea,. dizzir-,esr, weakness

Hypocalcaemia can occur with long term uqe, symptoms include: rnuscle cramps, muscle weakness, thirst, anorexia, vomiting, cardiac

arrhythmias.

AIcohoI and CNS depressants mly incrr.ase dizziness. Drug Y ahould be used with caution by pregnant nrornen since drugs

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Drug Y 5 nrg
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Brown's Pharmacy 138 Alexander [(oad Crystal Creek


24.05.2008

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Vickie Charlton 15 White Street Crystal Creek


Dear Mrs. Charlton,

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Topic
I am writing this letter to advise you on when and how you should use Drug X as prescribed by Dr. Goodrich to normalize your elevated blood pressure Dr. Goodrich has prescribed.

conhol.

D*g

X to bring yor.u elevated blood ptessrue riruler


..

I am writing this letter to explain how you should use Drug X as presciibed by Dr. Goodrich.
I have just received. a prescription of yours, from your neigtrbor, containi:igPrug

Usage

Pressure.
L:r

Actually, Dr. Goodrich has prescribed this medicine to treat your elevated blood

fact,

D*g

Dose

X is effective in treatnent of elevatd blood pressure...,;,l il,$iti ' l.; . .5.|:f1.;.:..

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You will need to take one rabiet (5 mg) of this medication once dailyii tht'i morning. Remember to take your medication afterbreakfast to minimizeany gaskic

upsets,
t

Every moming, after breakfast, you should swallow one tablet of Drug X with a full glass of

_.'

water.

Your doctor presaibed tlds medication to be taken once daily in the moming after breakfast for thirty days.
The prescribed dose of this medication is once dnily in the mornirig after breaKast.

The initial dose of this medication,may cause some . Use of Drug X rnay cause some dizziness after the iniEai dose and may alio decrease blood pressure, For this reason, you should mcveslowlf frol srtling to ' :'
,

dizziness.

standing posilions. (Thereforg you should be careful when moving from sithng ro standing positions) Side ef:fects
Less Serious

During heahnent, you may experience some common side effecglikeheadache, stomach upsets or restless.orl
Trealment with this med.ication may lead to headache, stomach upsets or restlessness as cornmon side effects. This medication may cause some side effects that may indude headache, stomach upsets 6r restlessness.

More Serious
However, you should consult your doctor immed,iately l if you unusual rash, itching or sensidvif to sun --r ' devetop or light. or light, you should inform your dcctor
an11:

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.,
.

immediately

ring or sensitivity

Interaction
You should know that alcohol interacts with the dizziness,

yotr medication and may increase

During treaknent, you should avoid alcohol completely to avoid any urrwanted symp toms of interaction.
Alcohol interacs with your medication and therefore should be avoided. in ord,er not to urorsen your condition.
Extra Advice (precautions)

symptoms iike dry.mouth,letharg:y, thirbt handled by increasing your fluidJintake.

and,

muscular weakness canbe

use of this medic".Ho:lraay decrease the body level of salts and minerals leading to thirst, dry mouth, rethaigy or muscurar *uuk ,urr. rhese ,y-pto-, *riu, managed by increasing your fluids intake.

Endine
o

Choose a sentence frorr, yo.ri writing guide.

Youre sincerely, Pharmacist

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Every cther hour

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At bedrimc cluring thc tlay rhr same mq{te Iu thr: rnonr:ng l.la.sal drop'; fiocl- i\r nighl [);.ily In ;hc rnou;irg

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Its occasior rcquircs (as needccl) Ilvery Every rwo lrt:urs Every [orrr hr)Lrrs Iivery six h..,,rt, F-very uight ::trurs i r,:ry day I;rrur times,, Cay ljvr:r) hour. h\)url',, Four times:, 'Jay Iivery iour l,ours
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Srrblingr.ral, rrnder the tongue

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Immcdiateji,, with no Celay


'l hree times a day TI*ee tlrnc$ rr day ,'il, {irtcir.'c'l

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Patient

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Robinsou is a regular custorner of yours who senrls her husba*d rvith an Avandia prescriptio* for her we2 diabets. Dr.-Fredrieks recommended a consumption of4mg daily.

Prescription
Dr. Scan Fredricks 35 Main Street
Surrey 3634
3

Mrs. Ashley Robinson


124 Crystal Crcek

I (2rng) noctc;x:

Prescribing info:mation for

Indications
for
use

Avattdiais a prescription nredicinc use6 with 4iet and exercise to tieat type 2;("ad u ft -oruet" or ..non-i nsul in dcpendent',) Avandfu can help your body respond better to insulin made in your body' Avrndia does not cause your body to make more insulin.

fmpurtant
facts

Ayanora rs nor an omt lonn of insurin, ono insulin-

runnlil*ed

in place of

Avandia r,von't helP type I diahctics, rvho are unable to producc iin1. insulin at rll. lnsulin shots al'B a nccessity for this form of mr iltncss.

g/

You should be arvare that people taking Avandia tend to gain a little weight, typiurfiftltund 5 to i0 pouncts

Contra indieatious

You should not use this drug if you:

. ' '
.

have heart or liver problerns.

have type

I ('Juve'ile"fdiriberes or rrart?iabetic
riyirg kr luc,r,u

kctoacicrosis.

These conditions shoulcl be treated with insutin. arc trreg?rant or Frr:ginirnl arc hreasllcr;ding. the *change df

titUl'who

Side effects

' . '

TIre most commori side ell'ects of Avanclia included colcl-like syr':rptolns antl hcutllclrc. heart failure.
a.way

irvelling (edc.ra) ti'our fluid retention. call yourdoctor right iiyou have syrnptonrs slch as:

o o
oo

t,' l_t

-swelling or fluid retention, especialty in the ankles


legs

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:r : ;_i. g':'l

"-

",j .sho4|ess of breath or trouble breathing, especially wlren you lie down
an unusuatly last incrcasc in rveighl. unusual
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tiredness

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I.?* bloo<I sugar (hypoglycemia). Lightheadedness, dizzines{i " ihakiness or hurrgcr nlay nrca, that your blood sugar is too liii,,r. 'l'his can happen you if skip nrcars,'iIyou use anoth., medicirie --.tirat lorvers blood strgar. low red blood cell count (auenria). Call your cloctor iiyou have uncxplained symptonrs
as:

. '

o o I o .o o
Dosage and

nausea or vomiting

stonurch pain. unusunl trr unr:,rpllirrctl lircrhtuss loss of appetite

L,

tlark urinc

Yelloling'of your skln or

the

wEifgffiour

syes.

administratio
u

'fhe usual daily starting dose is 4 mg a day taken once a ciay or '2 nrg taken twice a day.
Take Ayandin with or without t'oocl.

It carr take 2 weeks for At'antliu to start lowering blcod sugar. It may l^ake 2 to 3 uronths to see the lirll effect on youi bloocl
suuar lcvt'!, v
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11,

I'f you miss a dose of

lva ndia,lakEyour pill ffr soon as you

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. -up-for Diet and excrcisc can

next dose at the usual time. Do not takc a doublc dose t6 make a nrissed dose.

body use its blood sugar betlcr.


ar gxsrqrsc.

.
rWilffiffi'ffiSE,

Avandia is not recomrnended tbr children undeiTS.

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and horv trr copoy

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Lrcc'LrBat:-ona ! Irnq:1. 1 sn lo51: hrr i:r nr; 'l'euL - ph.rrrrrrr:L:rL:t Trrne allon6d: {O minutes

Raad the case noras berow and coxqpJ.ate the rrrtJagr task rp{cb -foLl.ors.
.-\.s i,;if rir:k, t,he scr, c;l- Steve Murray, has reccntly finished his -.'.i .:.:.1 tr-aining ::r;u:.:e, he now cai js requesling your advice on how 'l , .,t(: t\r)clltrsinc ! ... :_ r..; {at.her. yo:lr record:: a.Lso show that the-...-.s currenLly orr Advj.cor.
1

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Adenosine

sanre

Drug

Action

\v eP;,.,'
Mechanism

Adr'rr.,s:rrc reduces th. norma] J low of t.he e.Lectrical impulses thrr:ugir Lhe atriovenLricular (AV) node of the heart withoui: causinc neqative effect,s. Adenosine is used to rt'r5torg- s. rriirma) hearr. rate arrd rnytnm-irTEilffiFtraving an _'--

Arl.'r:.-*-::i(. -3ri be verT effcctive at slowing or endlng a rapid . he;.:t r,rir' iI L:1e pr()blem is c'aused by an abnormal erectrica] path'*'a'.. in the hearc. Adenosj.ne will not $rork if the fast hearL r.ir.e has a di_f ferent. cause. Therefore, it nay have li.nri:-e;i value in diagnosing t;rchycardia or helping identify the I ot'a t ion cf the f asi. heart rate.
Whr:;r

!'!e

tabolism

I r+,iil. I ..rr iu;:rn..,l *, an rnir,.bj_tor of adenosine deaminase, aJlows adeni,sinc r.o accumuLate in thc blood stream- This causes "in incrnas.r'in coronary vasodilal ation.
ves:i,.
Di

adc:'-.-s::^.ir .:i(a.)r:in;rse, wiri.ch

;:'iLl...r r lr,.' eni.ers the cirr:ulation,

it is broken down by is present i.n red cells and t:he

.SrCe

effects

. Br j.r: f Ioss ,-. f . Pa r', -s: l:;: r: i a . . H6 ,..i6,'i,r: ,

consc, ousrress

.Ligh:

'Pal pit ar ions.


. it r,/c('
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dizziness. . B.Lurred vision . . Sho r tne:is of breath .Eacial flushing

headedness and
.

.C|:,.:ll

' N;rUS,e. ;l I ilii. :tr'cr.

.MetaIlic taste.
.Anxiety.

Rish factors

Caf _---..--f ;rj r,::, nicotitre, or alcohoj or use of ille.gal drugs, such 6 as (:.rcoine por peopre who are especialry c@. sen::: t : vc, even decaf feinated E.eas or coffee can cause

dj}(r ',!',r.. L,rand$). l-'d)(:i.OrS all'o warn against using non:.)re-r:j:jp_Lt.on dieL.. piL l.s or "pep:,li1l!, because many con:-.)lri ca.t.fcine, ephedra '(ret'errtly bannbdl , ephedrine, the her r ma ilt.lng, or otlter s[imul anEs. Dosage and

N.,nPrQSCri f;i::,rri ;&!!,",gcsE!_nEs Lhat contain stimulants shorrLd als i-:t.;r,,/,.)i,:.ler1, inr:trr(linrJ oxymet.azoline (such as Afr.in and ol r:. l.'.rnii:i) (11(l rr::r.t'C(){'lrll(Xir irie (SUCfr a-s SUdafed, Ar:LiIecl,

rirrl.: tvr':,; r ti_'tr.tJr tr'](:l;ycardia r.oisode

arlninis trat,icn

1L ..- !-tui:n t.hrough a r/ein {irrE,ravenous, or f V) . Adenosine :.. ?...r i. quickly and laosi-,s urlly a shorE period of Eime iless ;lt.'r... I ninure) . Give 6mg IV push rnprt.Ly .'':vt:r 1-3 ser:unctri as close E.o ve.,.n as posiiUte. lf no r.3,c-.:.r::.*. 1.-i obsgi-v{:C ai;Egr f-i'rnin, adrni,nis!er 1Z mg 0l.f,ir 1-J sti;. 'l'r(', s..j(:ond i2 rne Cr.rse ma5r be fepea[ed Once if
r',.?f
r'r--rr.Jr

ri ...r:<imrln 30

mrg!

.tl
r,,
act:

tt;a',/ ;r rn: ; I Ihe. ,trri,yt-hmi.t ,,,u ,r.u.uo' ,riO'"r.;]i.;;;;a,l; ceti! i r," jed) snd has lot regurredDo not drive rL if Ehe "vu srryE arrlryl::nia is noL r:o.trol [ed. Llr.ri ':, rr..s ,..,.r1 c.r{r:ie signif symr)l.cms, you do, noL have ic;rnt arrhyrhmialf you have an to sgpp or limj,t driving. However,

c_

Hoae care

Yoti:rr.f oe ;rb1e to. st:rrt driviog havi.ng :/our pacemaker implantr.d] again innediately afLer to,, ,ry. need to wait for monr.hs cr more afrer radiofrerlu.""y uuiuti;;-";-d" irnpL.rnt...iLion of an fCD ti.pfaliaUie cardioVerter defibriliator) to show ti,"l V"u--.i. fr.. of sltrrptoms.

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i ,lerr.

r",

Titrffy*:i*Felt"ewso
6

;:lm"; l':l"tffil"iXr"lii"l
ue

Homc care incLude tachyr-:rrti: r^r t'vlnq -:.-T:l

d.rci!!:(r I ,

i.' h.J-;"i;: 3:.,.::-.:::ura!: ".t,rii lil,l,,i:, ?:-:,:::'I_:l-f:i-[;,;;-;;i""ffi'"vigo*",


counr

l:l:ffiv;"ga-*i;e ::rf, ?iffi dfu :=i;ff' il ; ff 3

helgfui ro ke ,.,u! ,"srse wnen you have

:':h,*'d:: ":1

lar 'ii".

heart

of your'

svmp-to4p-gl!..:gCqiC"Fh6 Ehar ir vour n:," hearF ; IH 13' ri I r';::" your pulse i :.' and

yo,

may be
d

or overeat ing_that, tr i

kinS
D-OUUll

;,od bearins down, or j_mmersins Xlll;,' l';...n:,j.o].:y_y:::-?':ath. water_ro .j., I?:,, :: .,1 "?.rd "r,." yori-;;r;";;l.l'r"ilT'i]lll, lrolii,.xi,.-r; yi.ur f.rst !rt:,rfL rc.ltr Occurs.

Old Prescription
D!:ug Advicor sig: 1 noct e pc

Sir;: I nocte pc Actions


ADV:.:OR

Drrtg fbuprcr fsn

i s r he onl y. p rescripti an cholesterol medicati.on r-l)at coml:i:ie:' Lro effectivt: ingrlOi"nt" in just one tabLet to sign,!'i.'.'ir'tIiy i.mpr:r-rve both your LDL (,,bad,,) ana noi (,,good,,) '., r:ttr.: i.

;;1.

.l

for

I ncirca

tions

t.:vg] s

use

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Contrar ndica trons Precautions

nct Lake ADVrcoR if you- are pregnant or nursing or t'. ,r r .,ui' I iverr p-::ot,lems, sLrtirach ulcers, or a _serj.ous b Iet:.: i t: .t pr'()t-\Ietn., f
the right balance of chol.esreror levels is T:::::].t.g rmpcrtanr. for reducing yogr risk of heart ai"ease.Do r,or. .rubsrirur--ADV;c6F f;;;;y may. cause damage to your ' o*,e, niacin producrs as ir liver. rYrrh vr-' :- coctor's approval, take aspirin or ibuprofeir
about

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wlteil ,:r.;r At)VICOR dOse is incr,.raSed.

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ing (warmth, r.dness, j Eching, and/or tingling of the ski.n) :s the most corrulon side effect. You may feel it.in yorrr f'ace,i neck, chest,, and./or back. - I1 t 1,.:;h ing should wake you up and you want to get out cf Ue'ti, nd stand up JI;wIr;-r pronclunced heartbeatT 6-r faintingFl
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Othe,r common side effects may Lnclude weaknesg, f1u symptoms, heac;rch(:r infect.ion, pain, dia r:rhea, nausea, itching, and srash. calrse an increase in blood sugar levels. havr: rii.-.betesr yorr shor:ld carefully check your blood levr:I;; ,,rrrl rt,.porL any changes Lo your doctor,
ADVITiCR' may

InEeraction

The f r:i!,rwing have bd?rn reporl ,:d:

tr

,,r/'t Tf yaa( { sugar / > ;' j f\ U*lg

th. Tr,,u. - A1. - Vit1i._u,reel"r"ntq. X - tetf-@F?Gt6E-Soul any other medications you rnay be , i:"* \? '.. Lak inrl , cspeciallyr
,

ibiorics, antifungals, HfV protease inhtbilors, blood tJ'ii pressure medications, antidepressants, fibratesr bile acid ,' iu' brndin-g re-sins, or cyclosporine. {' 't'''=
arrt

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Administraeion

- Acirninistered oral1y. - AdraEiffirEEllIl-frinutes after aspirin or lhuprofen. -fakr.' ADVICCR at bedtime with a low-fat snack.

!{riting Eask Using the drug informat.ion for both medications, write a I(:Lrer to Patrick at 18fl RusseIl. SEreet, Alberta, 3123,.
::ulrrn3f j.zing rr.cl i caLions
i
I

informalion on uhen and how t.o administer the

to his f ather

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Occupatsional English Test Writing test: . Pharmacists ?ime al-Iowed: 40 minutes

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. Wi I1i-am, one of your cust.omers, sent you his neighbor, Mrs. .jones, E.o cbEain some sleeping pills for his wife who is currently suffering Alzheimer- Upon your refusal Eo dispense t.he pills, he sends you the below letter.
l,1r

15.03 .1995

Dear PharmacisE. in Charge,

o IE is reatly unfortunate t.hat you refused the sieeping pills to Mrs. ,Jones, RY neighbor.

Eo dispense

i
I :

As you know, the sleeping pills are for my wife r'rho is suf fering Alzhe-imer. This disease has affect.ed our whole life. Her short memory is gone, she cannot find words to say what. she needs, she wears Ehe clothes for weeks, becomes disorienEed many times and can no longer doanyt.hing around t.he house. she is becoming also to lose bowel and bladder control.
Boch of our sons have lefE home as E,hey could not' eope anymore. It is all becoming Eo much for mb although that feeling fills me with a sense of guilt and failure- The woman I loved and have spenE close to 50 years with is now a sLranger to me. f am anguished by the change, ove::urhelmed b1z che responsibility, and distressed by what the future

holds.

visiced her docEor on 02.05.1995 and I feel guilty as f IosE her prescriptions. I am a man in my late 70's and f cannoE Eake her Eo hospj.tal due to long distance and inability eb drive. Therefore, I hoped E,haL some sleeping pi1ls for my wife would help us bot,h get some rest
She lasE

and have enough sleep.

I hope you underscand t.he siuuation and dispense the medicaEion to l'lrs. Jones tomorrow.
Thank you ver-l much
aavdnce ]'

Kind regards,
Adam

William

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on the following day, you receive Mr, wirliam,s neighbor at Ehe pi:arracy again- Sh; came Eo deliver Mr. William,s lecter Eo you.

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After you had read the lecter carefully, you decid.ed. Eo reply to Mr. William.

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- Alzheimer is an old age problem. - rhe harmful effecEs or pilrs on her cNS. =i;;;ing - Th" imporEance of usingri," rhis *"ai"ltion with a Coctor,s advice and prescription, - The necessi-ty or prolessiorr"t medicar eheekup before
Iong

Also suggest' E,haE she should be admit,ced to an elderry house in che neighborhood and explain why

Writinq Test rn your repry t'o Mr ' wirliam, consider t,he above given points and address Ehe letEer as follows.
WiIIiam L28, Beaver Close Kir:gston 3624
Adam
NSW
,

Your pharmaey address .is as follows:

Ellena Hil1er, s pharmacy 38, Bond Street, Kingston 3624


NSW

Elton ol^4 Hitta,TS .pW*.qg 'a3 , G.,-ti !ir'aet, K,Y, don 3624
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. (::!ll. ehe ownor of a dayeare llur.sry. you prewiously wrote a ]'6t,ter r'r r':err'-wet'ting and ras addressed by h6r,-o^ rhora your beharf, to oi"-;;;g;;"t:, ":'t""j': cl:rrdrerr actend Lre= daycale, has reguasted, once again,.your herp to provi-de the motshers ri.th rnfornation aborri childrerr,s vascineg. !'-leasi J:akr: tion.
lraccines Overvt !!r

cc

Babi,es get six vaceines betneen birLh and 5 monthg of age. Thege vaccines protect your baby frou 8 serious diseases] o Ilepatitis B o Polro o Pneumococeal Disease o Diphthelia, Tetanus E pertuss:.s o Rotavirus ,r Hrb -

' 'l'hcse vaeeines ma'i br grven separately, or son night be givcn together rrr tha r;'rrrre slr()t, (for ex-mple. Hepatitis B and Hib can bs given together, and so can

DTaP, Po1ro and He.pacrtis B) . 'rhese "combrnation waccines" ars as safe and effective as the indi,viduar uaccines, and mean ferer strot.s for your baby.

It

Vacc:nss l:enef : : s

chrldren hawa hai at ieast one rotavirus infection by their Sth birthclay. Nr-rne of these disaases has courp.Ietery disappeared. I{ithout vaccination, they }rij.l n..:ne krack. This has nappened in other parts of tha rorl.d.
D

Your chi'ldrert's first vaccines protect, then from I eerious dieeases, causeciby viruses and bacteria- Ttrese diseases have iajured rnd ki]-]..d raany ctrild::(}D ("cDd adults) ower the years. Polio paralyzed about 3z,oo0 peop]'c arii rirrea about 1,700-. each year in the 195os befors there rras a vrccinc. rn tlre 1980c, HiJc diseage.uas.the leadj'ng cause of bacterial meningitis in children under 5 years of age. About L5'o00 peop'le a'year died frora ciphtheria bafore tbere uas a vacqine,
Most

: a:ir

th.e=ra : Bacteria

'lou can get it, from contact. rrith an infected parson, Sigxls and symptoras incl-u<ie a rl,ick cowering in the back of the .throat that can m-ke it hard to breathe. It can I Lead ro breathing problerns, heart failure, and deatlr,

Te:anus (Lockiaw) . Bacteria You can get it from a cut, ori wound. rt dos not epread frou peraon to person*-# srgns and symPto'= i.:]_9. p"irfirf tighteningr of the .museleg, usual].y arl over the body' rt can }ead co stiffness of the jaw, so the wicli-ra canrt op3,n his mouth or swallow- It laads to death in about 1 case out of, 5. Fert.ussis iiihoopin? Cough) : Bacteria You ean get' it fron contact with an r-nfected person, signrs and synptoms include 'j:r'-:'ent coughj-ng sXeils ihat can make it harr{ for in infant to eat, drink, or i:r'+irthe:. 'i.'rrr.sE can rast for weeks. r! can read to pne..rnonia, geizures "p'oir. { ": l,.i.nrl ard st.l! r:rg ?pv-l!"_*} . lrraitr danage, and Jeatlr. ll ::' ( Ji;ernoEhj I us .3i[:_:rrr*g_Sxpe t{.1_ BagErli:l = yrt\: cdn get ic frcrn.:ontact rrith arr inf,ected person. Sigms'ana synptons, There nay be no signs or sympt.firs in uild cases. It can lead to neningitis (infection of the
o

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(yertorr skin or eyes), and pain in museres, jointr and stoElcah. rt can read to Liwez da.mage, liwer cancar, and death. Pol-io: Virus You can gt it from close contact, r.rith an'infectcd porson. rt ontcrs the body Lhrough the,nouth. Signs and symptoms can inc].udc a cold-Iike illness, or there m"y be no signs or sympt-om! at 6rl. rt. can lead to paralycia (srnrt mgv. arm oE Ieg), or daath (by paralyzj.ng breathing nuseles) Pneunococcal : Bacteria You can get it from contact with an infected prson. signs and elaptomg include fever, chills, eough, and chest pain. It can lead to uaningit-ir (j.nf,aetion of tha brain and spinal cord eoverings), blood infectiongf ca! inf.ctiong. pneunonia, deafness, brain damag:e, and death. Rotavirus: Vi,nrs You can get it from contact nith other children yho are infccted. signs and slr'nPto&P include severc, diarrhea, vomiting and fever, rt clan le,ad to dehydration, hospitalization (up to about ?0,000 a year), and deattr.
Ac t
J ..:',

Hepatigis B: Virus You can gat it froB contact, rith blood or body f]-uids of an infbcted porson. Babies can get it at birth if the srothar is infectad, o= through a cut, or r*o,nd. Adults can get it frorn unProtacted sex, sharing acedles, or otlrer e..posures to blood, Signs and syoptoag includa tirod.nes, diarrhea and votriting, jaundice

Ec{:}s, and covering of the tleart,brain danaga; deafnessi and death.

n and spinal core{ covrLnq-) .' pnor:moni.a' infrr,:tiong

of th,, Lrlootl , l:,,-nLs,

(t'

rrnmunity froo disease: Flhen a child gets sick with one of thege.risases, tlr6 lmmurre systah produces immuaity, which keeps froB gatting the game disease agai.n. But getting sick i.s unpleasant, and can be dangarous. rmmunit'y from vaccines: vaccitls are aade with the gaoe'bactlria or wiruses ttrat cause a disease, but Ehey have been waahened or Li].}ed to rcakc thon safe. A child's imsrune system responds to a uaccine ths saao ray it yould if the child had t'he disease' Tlris mearrs he rrill d.evglop immunity rithout

having to get sick first.

Rout.:-ne

chr I i:',ocd
iraa:c:
:-= s

Srx vaccines ijre recommended for childrsn between birth and 6 monttrs of age. children wirr also get at laast one "booster" d,o8e'of Eoet of t}ege vaccinas uhan they are older, ' : 5 dos6s -,2 uonths, { mont}rs, E months' 15-18 months, 4-6 years. some ehilclren should not get pertussis vaccine. These,chiidreon can geE a vaccine callgd DT, rrhich doas not contain pert.t'ssis. ' lepaEr'-is B %ccrne: 3 doses - Birth, 1-2 luonths, 6-1g montha. . Polto vaccin- 4 doses - 2 Eonths, 4 months, 6_1g.uonths, {-6 yars. 3 or 4 dosas -- 2 aonths, 4 months, 6 months, 12-15 months. severar Hib vacciaa ar rwrilabre. with on type, the 5month dose is not needeo. . Pneuruococcal Vaccine: 4 doses _ 2 months, 4 monlhs, 6 months, 1A-15 nonths. OLder children rith certain diseasss may also need this vaccine.

i
I

' Rotavi-rus Vaecj.ner 2 or 3 doses - 2 nonths, { rloaths, E uonths. BcEav*rus *$ en oral' (sHa]'lored) vaceine, not a shot. Tlro rotavir:us vaccineg are available. witlr onE E)Tro, the 6 EonEh doee is no! n6ded,

i I

Vq.CC,ine5 coneqrrse Si&g e,$fe$S?"qo/ othg liodrcrn.l, Mortry thess om mrltr "Iocal" reactions such ag tenderness, re&ress sr ewelling rhere the shot is given, or a rnild fever. They happen in up to 1 child out of { rith Eoet childhood waccj.neg. ttrey appear sgon aftsr the shot ir Eiven and go arey wittrin a day or
two, t

rrr.s

*.

the uost serious rsactiong to waccinelr are Bovorcr al'J.ergie rgactions tso a substance i-n a waccine, Thess reaetions happen very rarely - Less than once in a million shots. They usua].].y happen very soon after Ehs Shot is given. Doctor's office or clinic sEaff are trainad to doal vith thoo. The risk of an3, vaceine causing serious ha:aa, or death, i's'extraEsly suaIl. Getting a diserase is much raore J'ikely to harm a child thaa gcttsing a vaccina.
Aroong

Other

reactrons'

The follow.ing conditions have been associated with routins childhooa ,""":,r,"s. By "associatad" ir mean that they appear Eoro oftan in chil&en lrho hawe bean recently vaccinated than in those who have not, In assoeiation docen't prove that a vaccine sauged a reaction, but doeg uean it ic probablc. DTaP Vaccina --------.'-H Mild Problems: Fussiness (up to 1 child in 3); tirednese or PooE appetite (uP Eo 1

child in 10) ; vomiti.ng (up to 1 child in 50) ; srelling of, t'-lre cnuiro a:rm or Iag for 1-? days (up to 1 child in 30) - usually after tho {th or 5th dosa. Moderate Problems: Seizure (Serking or staring) (1 child in 1{,000}; non-stoP crying for 3 hours or more (up to 1 child in 1,000); fever over 105 degrees Fahrenheit (1 chrld in 15,000). Serj,ous groblems: Long-tela saizures, coma, lorered consciottslte8sr, and Pt:Earrnt brarn damago have been reportad vary rareJ.y aftcr D.T.a.P. vrccine. They arlr !o rare we can't.be sure they ar caused by the vaicine. Pofio vaccine / Hepat,itis B vascine / Ilib vaccine these vaccirres have not bean associated with nild problens oth6r ttran local reactions, or t,ith modrate or sari-ous prob].ems.
Pneurnococeal Vaccine

Mrld Problems: During studies of the vaccine, soue children or iost their appetite.
Rr:t,avirus Vaccine

became

fussy or drowsy

!.!rld PEoblems: Children who get rotavirus vaccine are slightly more likely than cl*i^.er ehrldren to be irritabJ.e or have nild, temporary diarrhea or vorniting. This happens within the first week after getting a dose of vaccine. Rotavirus vaccine does no'. appear to cause any serious side effects.
Frecau Lr ons

rt' your child is sick on the date waccinations arg gcheduled, your prowider uay uant to Fut thru off until she resovers. A child with a uild cold or a lou fewer can usually be waccinated that day. But for a Bcrre sarious illnega, it uay be betster to wait. Some chi).dren should not get cer,tain waccirr:g. trrlk rittr your provider if youJ child had, a serious roaction after a previous dose of a waccine, or has any life-threacening allergies. (These reactions and ilLergiee are rare.)
I

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- A seizure or eorrap"" - A faver over 105. Eahrenlrcit

,,g.'r-.'t ::'. yt:ur ch:.1d had aly of ,j.iacElon.s to a prvrous doae of, DTap: - A brain or nervous systen di.sease rrithin ? daye - Non-stop cryiag for 3-or Eore hours -..''.,........-.-

Li

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,/' Talk to your provider before getting Eepatitis B vaecine,"rr .1i.fe.threa!eaingaI1ergytoyeast.-----5-'-Y.--v.vg4rlq,I5yourqhi:

TaLk to your prowider before gettirrg polio vaceirrs if your chird hasr A lifethreatening allergy to the .E-s neomycia, 8trcpto'!,cia, or po].yul,xin B.

rour ehird has:.A

Tark to your provia-- o.ro..lJtrn Rotavirus vaccine if your ch.ird has: - A rreakened i-'uune systsra - Ongoj.ng digestive probLams - Recent'ly gotten a brood transfusion or ottrer b100d produot - Ever had intussuscepcion (an uncornmon type of intertigal 0batruction) rf the chird hag a uoderate or sqvere raetion, loo&. for any u,.u8uar conrrition, -r..rrr..., such as a serious alrergic ."."iioi, high fcvrr, or unutu.r bchavior. serioEs allergic reactions alo oxtrealy ra* ritrr rny vacoiac. rf onc yere to happen' it would rnost I'ikely con rithin a fer sinuteg to r fcr houre after the shot. Siggs of a ,serious allergic reaction can j.nc}ude: - difficulty breathing - weakness - hives - hoarseness or wheezrng o - drzzines" - paleness - ssel).ing of ths :hroar_ - fast heart beat
Manaoement

"

?eLl your doctor trhat happened, the date and tine it haplrnsd, and rhen tlre shot , was given.
Task

Writinq

sununarlze the above information and write a lettei to the nothers at, !{rs. GiLI's davcare (24, Roval e-""-g"---rose, Epsom;;;";;y 2363) provid.ing w:'ch informaEion about trre inecaJsary ."coines neerled for ttreir chir&en. theu Yorrr 1etcer should not .*c.ei

20A words.

_/

t:-orra.l" Enslish Test ng Ies c: Pharmacrsts 1':.me allowed: 40 mi.nutes


pa
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Mrs. Gr11, the You to aeriver :T::i:"'orrot{"1te nurse}ar, has prewiously inviEed. whcse cni-raren artend i".-aliffiffis t: *" 1,"";;H.."
S.].nee you Ere.r

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for siaply may not "orrarol rf 'bed-wetting continues, treat t*e problem with patience irncr ;l}";:ffndins'' Blaclder i'"i'i's,' n,oi!t]Ir-L"".s or u,ediearion Bed-wetting is !'Iost kid" are -characterized. by a r"ri"-."ij;;ir: toit e..t4n-: I::: T:"s J."-tr1ly "ErE
beoestabai_Jn;.=

"'* "or.'iJJ""a before ase ::::::i:"i.oii:letins _n", aighttiure 6 or 7 isn,r


bladde.

.,J;"j:.:"Firf:: -o'iirni.' :# ;:"li"l: ;:: ff:";*=:F.:: :i," months *:::=::r "r ro have secondary
primary
cause

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Bed-wetting, also known as

tage r

ro

No one knows fr

]$,1-pLp^-H+". : roui child, s bladder

ractors .", o.,ii :"::r::"t

causes bed-wettins,

but various

-;;-, " ;:_.*..,osoi=" #"1;; ;";"i: "_':"SjlIiir", :::::"i.,il;-::i1o:; o " iff1"t,,it:fii: .Ieep :::;.=-sl.eepe:. your chiLd T:"I:If^ :','., r.< om " r;; isa "". - A horrncae, During chi..rdhooal, some kids p rodr:ce ll,"i ruretic don't hormc,ne, or ADII , to slow nighttirne z--- stress' stressfur' eventrs such as becon'ing a.big brother or o" ::!ff:; ;5::::3iin'"'-"J'oor "t."piis ",,"v rrom home - may

,"jl3i.:::

-i,.iTi:g"I:

ffi:::: rlil"ofil::

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r. r,rde u"a _,". iL;:. il:::H,,Tf E:J:.llii!l;.: : T:"il3". o ,i:::iH:I""HT:qm;"r" . s:""p-;n;; " sieep apnea, a c:nciiii"" ;* or obsrrustive " lli"na"n ti"_"rrgi,, ;nr-errupred <irrri.ns sleep _br""thing is u;;""l:f arr"a-*aa;;* 't:'.).a.:gecl Lonsil,s "i.""'
:
-

=1,:';3trttt';:;,.fiae,r",'i-"*

"" "a.ioioJl oaner signs ana slrnptoms nay and sinuJ inrecrions, sore hroat

appetite. . Chronie ccnsEipation. Sometimes chi]-&en who don't have re$-,Tl; b'iiwer *oi..erEs retain urine as ueLl. Ehis can lead Lo bed-wett5-ng at night : Anatomieal- defect.- Rarely, bed-wettinE is r'eiated to a def,ecE in the ehild's'neurological system or urinary systen.

' ulgg-e3es. For a chrld who's ugually dry at night, hred*we[ting mav be the flrsE si.;:., rrf t--yce 1d:_r}*t+5. Other signs and q\ symptoms may rnelude passing J.arge alioounts of urine at once, increased thirst, fatigrue and weight J.oss in spite of, a grood

\ factors
"'Medrcaf
assl.s eance

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Bed-wetting can affect anyone, but it's more comnon itt f,?, It also tends to run in fani]-ies. A child with tlro parents i'86 wet the bed as children has an 80 percent chance of wettiag th6. bect, too. Most children outgrow bed-wettir-g on their own - but some need help. In other cases, bed-wetteng may indicate an underlying condition that needs medical atter.tion. Consult the doctor if:

r Ycur child still wets the bed after age 5 or 6 r Your child starts to wet the bed after a period of being dry at night : The bed.-wetrEing is aceompanied k'y painful urination, unusual
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urine tests may be done to or diabetes. If the doctor suspects an anatomical abnoroality 9r ottrtsr problem, yoi-rr chi.l-ct may nee<i. X-rays (radiographs) or ottrer imaging studies of 'the kidneys or bJ-addere
The g.uilt and embarrassment 3 stri-.],d f,eels about wetting the bed can lead to low self-esteem.

Depending on the cireunstances, cheek for signs of an infection

thirst.

Coep)-rcations

on theEi@nital area may be an issue as well .if your chi-ld sleeps in wet underwsar. To pfevent it "erpecially rash, help your child rinse his or her bottom and genital area er/ery morninq. It al.soG] frefp to cover the affected area with a petroleura o;:-ntment at bedtime.
Rashes
I

Most ch-ildrerr .--'Jt.grow beld-wetting on their own. If there's a farnrly histcry of bed-rvetting,, the child likely nill stop at the age the par:=nt did If your child rs still wetting the bed by age 7 - and is motivated to stop - a doctor may recommend Bore aggressive treatr.ent,,

Moistlrre alarms devices - availablq r*iEhout a ffittery.-operated preseription- connect, to a moisture-sensitive pad on your ehild's pajannas. I{hen the pad s}nses rcetnesg, t}re ala:cm goes off. Idea1ly. the moisture alarm sounds just as your child begins to urinatse - in time to help your child wake, scop the urine stream and qet to the toilet. ff your child is a heavy sleeper.. another person may need tso Listen for tha alarn. lt often takes two weeks to see any tlpe of response and up Lo 12 weeks ;[o en;oy dry nights. Moisture alarms may Provide a better lorrg-term solution Lhan nedicatiorr does.

l .. -. ; r..,:-;rrr rn.ty progc:.ib medleetl.on Lo s[op bed-wettj.ag. various .i ty?es of,'medication can: ;:.

tt :

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6A nighttime urine producfion. "/'stow acetate (DDA:,rp) boosts revers of a The druq desaopregsin natural'ho*or," (anti_ diuretic' f,or*""e, or ADH) that forces the bocly to make less urine at night. The n.ai-"aiion is available as pil, or aagal sPray and strould taken at bedtiae. DDAyp ha.gafew side effects' The mostbe serious i= seizure if t'e rnedication is accompanied by too many fluid,s. "

' Chang,e a child,s sleeping anri.depressant imipramiie and waking pattern. The ir"ililii;";;ioviae bed_wetrins rerief bv changing a chird;" partern. ]rhe =i;,;i"r-"io'"aking medication may also increase tHL anount of time a child can hord urj-ne or reduce the *o*ia-oilr;;;roduEed,. side effecrs tend to be rare wrth eorreet'dosage uut :.ncrude nervorlsness, anxiety, constipation, -,,c.rlp.rsonality changes, Arr overclose courd be fatal ' rt may ue c-onriaed wirh d.esnopregsin if desmopressin al.one ie-nJt eiiectire.

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,r y.our has a smalr bladcer, _ "6i,1d dr,sr ",,1n -v-4.., rrr=vsrney, 6r,evsrn, r."*,=i.r"7i-;;;ilil may he].p reduce b.].adder
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' Desraopressin acetate (DDAvp) is a slmthetie fom of ant.idiureitic hormone (Aor1 , a sr:bstance that occurs ,,aturally in rhe bodv. rhis cirus imirates *r-li-uilH;: ;ich is secreted by the brain,' it increases the concentration of the urinb and reduces tlre a.uourrt rts main use is for children who i'ave n.r- been "izrir,". helped i" ararm. rt is ar'o used as 'r stopgrap aEtend c.arntrrs or 'oeasure to herp "i.i'a""r, "r, sleepowers wit-hout embarras;;;;:' oxybutYnin (D:-tr.opan) and hyoscyamine (Levsin) are medications tshat reduce unwanted bladd,er contractions. They uncompli'cated bedwetting. rieir \n,r side Lrr"lt" i;.irra" d,ry uouth, ' flushing, heat sensitivity, an. constipation,/crrowsiness, Treatnent of uncomplicated +--bedwetting i.s not appropriate for .r children young.er thaa S yea"s ' Because a majorrty of chir-dren 5 years and older spontaneously j stopobedwetting ,.l.tUor.a any treatmeat, Bany medical professionars choose to observe the child until age ?,
rrr'|r rrr Elrg ,.:trtld arrd sor*eL:rr::J,?crrff:,.:c wigh par.ata. Tho iringle Eost :l'::': :'-'-:':'-t= :-r. e:.c s:-c,:rd. do i,-s be staSnrrr* ir-r :::::::::'= -._:___-:::; ti-_._.i: _*:an tl=.f,.:ng a_a pr:nishing. ll"rlwtrll r'lrl ' f."""'lly ''| "r'i'rrr"'rl rtr ,.:-'... 'rr rr.','rr arirr., n.: l rr,,lal tltrtttrlrrttt,,'rrrrrEs tr.rr.!r.4EBtBerrL and anx.i,oty llralt

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" 'i '' ,r,^, rruirr ul.r.l-c:i,g f luid intlke clurrng ehe eveilng. Make .r_r^ sure l--_:r],,r, your ch6fd urinates bef,ore going to Cq bed. Reaind your child -tf,at it,a the night if needed- use smal1 OK to use the toi]-et during can easily find the way betweennightri.ghts so ttrat your child the bearoom arld bathroou. . Be sensitive to your If your child.is sU "{!}L,sfeelings. r to e:qpress those feerings- when your ehild teets ealm may beeoue a thj.ng of the past. "r,d "."rrre, bed-rretting . Put your-child to bed earlier, perhaps surprisingly, an extrj-T0-rni"-rt:r or sleep a night herps '--E- so&e^ chirdren stop ' wetting the bed
t Plan for

" Homt: ca:-r:

of stiekers e.Lrrrs a reward . Make sure tire chiJ.d has easy access to the toilet,. ' You should awoid using aiapers or pu,l-ups at home because they can interfere with the motivation to wake up and use the toilet. er The parents' attitude toward_the bedwet.ting i.s arl-important rn motivatifrg Ehe chi1d. ,'Avoid blamrng or punishing the chird. The chird cannot conLrol ' "r,J bram.i.ns and punishiag jusr make rhe problem :::.::"wettins, ' Be patient and supportive. Reassure and encourage the child. ' Enforce a "no teasi-ngr', rure in the frmiry. No one is allowed Lo tease the chird a-bout the bedwetting. Do not discuss the bedr,retting in front, of other family mernbers. ' Help the ch'Id und,crstand that the responsibi.rity for being dry is his or hers. and not that of the plrents. ' The ehird shouJ-d be incruded in the cLean-up process. o ' ?o increase comfort arra r"iu.;--a"r"g;;;r" washable absorbent sheets, watetproof bed'covers, and rooa deodorizers. ' one technigue is to have the child rehearse tlre eerguence of, event's invorved in getting up from bed to use the toirst during rhe nl.ghr prios to going io hed eash night,. should awaken the ehiid, tfrie"*y ar the parenrs, ;"]::r::rent ' when'this is done for seven nights in a row, the child is ei*-her cured or ready for serf,-awakening progra&a or al,a:rns.
U

f;*rn concain the urine. Keep extra bedding and. pajanas handy. Enlist your_childJs Letp. perhaps your chird ' can rj.nse his or her wet under!''ear anrr--pajanas, or place these iteas in a specifie container for wisrring. Takin! iespoasitririty f,or berd_ wetting may herp your ch'Id feel more control 0ver the situation. ' celebraLe effort. Donrt puni-sh or tease your ehird for wetting the bed- rnstead, praise your child for folr_owing the bedtine rourine and helpi;g cre"r';;-.iler accidents. /'Reduce Lven:ng flui-d, intake. The child. should try not to give '"ry fruids, chocolate, caffej-ne, or citrus after 3 p.m. ,/ T}.e child should, urinate in the toiret before bed,time. ' Flerp the chird und.erstand that up every night to use the toilet. it is more important to wake ' I: Fystem of siicker charts and reward,s works for some ch,irciren. ?he chird gets a sticker on tlre chart for every night of renaining dry- coirecting a certain nrrnber

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Occupatioual EnglisL Test

Writing Tesc pharmacist Tiue Allowed: 40 minutes


Lerrer of Referral
Barbara cook presented ro your pharmacy symProms:

wirh

a 3 day

history of rhe forlowing

- Abdominal pairr.

- Difficulry urinating. - Ceneral weaknes and exhaustion. - Difficulty walking and strerching her back. - Persisrenr pai4 berw."en the bellybutron

and rhe upperpan of the right hip.

Consider the following points:

- Regular .*,o-", y' - 26 lears *J / - Single r ,, - Compurer ?nalyst// - p1 t,irrory of severe sromachache and vomiting after fatry, junk or spiqkv foods.
takes Prilosec for hearrburn and panadol for headache. She has taken 4 analgesic injections to relieve her

only

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Insisred on raking a fifth injection ar rhe also has not earen for the whole oShe Concerned about the surgery and body
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You refused to adminisrer any injection as you suspected that she had appendicitis' You, therefore, decided to get her a cab and refer her to the nearest c,nrergency unit.

WritingTask

write a letter of referrar to rhe emergency department at Melbourne Royal Hospira! at 236 Castle Srreer, South *tAt n U.

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Time Allorved,: 40 minutes

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Alice simpson, a cus[omer of y.urs, wfl)rc a lellcr ro rhe lrlrr\ claiming that you dispensed an expire<t mecricario, Lo rreaE rr",' r,ypE*rron. rn. patient is really ennsygd and be[eves thar rhis is an irresponsible behaviour. Upon tle receipi of her lener, an FDA official writes,o y*, ,g-qgg8_i{fGh inquire abouc rhat iucident. ""

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Parienr: Alice Sirnpsoa

Age

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akh problems: Hlperrension Ivledication: Drug X Doctor: Ronald Armstrong Dare of adminisrradon: Sunday, 2g June. Time of adminisuarion:2:00 pm
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The dare irnmediately herps you rernember rhe foilowiag i,cidenus: ;'".;rr'l,ilrllrl1,gtrga
-

- The pharmacy was oyercrowded on rhar day - k was yotrr assistant,s day off - There was no[ enough stock of Drug X. only a rbw packers rverc. reft, - Medicine packets were mislaid on the sheJves; coming old packe:s in the back and new ones in the front-

F o

you sPoDtaneously dispensed rhe medicarion, yer you are aw.ue that you !&::9h shoulc have
checked.it out befoie giving ir to the patient.

Therefore. )rou decide to i : . \-' , uu'** - Respond. ro trre rpe ofnciar apologizing about this inepdnro..\ ' - Explain the situarion clearly. *--"r-do to avoicl recurrence o('such incident. 1Y ylr* Xf.;l,,r1f iti - utfer to comperl{atb the patient with a free of charge drug e for rhe period r --- of

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reference to your Iast reuer concerning -.---' simpson,s ' Mrs. -""r"- compraint, I wrirc ro explain the siiuation clearly to you.
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yo.* Iasi le*er dated ------, I write ro crarifi Mrs. simpson,s

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Ilris leaer ro apologize for rJispensing an expired drgg ro Mrs. simpson.

Bodv Here in this lecer I will give explanad.n for rrris rnisrate.

In this letter I will provide you with all the necessary clemils reguriling this incident.
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Dispeqsing'.hg,.,ppkpd
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was realry accidental,

it

was merery an oversight.

understoncl that rhis unprofessional rnishup (rrri.srukc- uccitlerrr) lrus c0used emr*tional troubles to Mrs. Simpson.
So,

I will

To avoid recu.rrerce of such ingptirude, I

wjll

_______--___

A-fter this incident, I will with a betcer senrice to ensure their safery.
ro

to provide my customers

.o tmprove my senices, I

will

apology.

Endilg I hope I have provided you with all the necessary information regarcling rhis marr.er. I iomplet6tli',i.ifiadiston.t Mrr. si,rrfrun,* sir.uar.ion'arr<.r r rr.pe.srre will accepr rny

on rhat day. I hope you will accepr my apology. (please accepr my apology)

I hope I have made the siruarion.l..i ro you now. I hope that you will accept my apology and

appreciare the prcssured workload'l had

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A regular custcmer of yours has recently decided to quit smoking. He called the doctor and he recomrnended taking Bupropion tablets for six months. Your cr:stomer wishes to get nrorelnformition about the drug and how to use it on shorl and long

tenns.

Drug:
Usa'ge:

Bupropion

srioking cessiitirin
Some medicines or medical conditions may interact with - Antidepressant, high blood pressure fteta blockers). - Other nicotine products.(patches and gums) - Pregnancy and breast feeding.
-

Internctions:

&is dnrg:

.
l)i'ections:

Qiabetes, Anorexia or Bulimia At) 'i

- Swaltorv rvhote (do not break, crush or chew) - One dose a day. - [n case of more than one dose a day give an interval of g hours.

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Doses:
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- Skip the missed dose anrl lollow the regular schedule.


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Cautions: 4a Cont'nue snrokin_e during the first week.

"

- Decrease snroking during the second week. ,-_- Driving or operating any machineiy is not allowed. ,r!>Overdosage and alcohol will cause a possible seizure Pregnant or breast feeding women should not take this rnedication.'

Possible side

Ef't'ccts: .

- Restless*ess, agitation, headaches and dry mouth. dizziness. rrousea, difficulty sleeping and vomiting - Constipatio:r, change in weight and tremor.

Drug

lnteractions:

find out if your rnedicines intgract with each other.

Drug interactions can result in unwanted side effects or prevent a meriicine trom doing its job. Use the drug interaction checker to

.\dditionnl o Intbrmation

- It takes this drug a week to take effect. - It gives s harmle$s ador, - Do not share ir with others tbr whom it was not prescribed. - Do not use this drug for other health conditions.

an actended period of obtaiu refills before your supply runs out. check wi& your doctor if you expcrie,nce any meotaumood -changes or pal pitations-

: Iiyou_are using this mdisiOe for

time

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|fyou experience any breathing difficulty, swelling of eyelids or deielop any rash or hives, please tell your doctor.

lVritine Task
Using the above information, write a letter to Mr. charles Mandel, 124 Bloomsbury Road, Kingston rr7g6,to provide him with more inforrration about Brlpropion.

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lv rirrng t'esr: pharntacist 'l'ime Allowed: 40 minutes


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customer of yours, has just called in seeking your advice on what to d' to,manage her d n. Amanda, her dauglter is only t *fuold and weighs 5 kE You wish to write her a lerter highlighting how she should use ry:llgiyre r"*g: rhur you recomrhendeci on the phone.
C LS' l'RO

l'inda Liarner,

LYTE (OraI glucrpse elecrolyce preparations)

COMPOSITION 'ompound sodium chloride and glucose oral powder and effervescent tablet. Sachct: Sodium chloride 470mg, potassium chloride 300mg, sodium acid citrate 5ll0mg, glucose 3.569. l:rlrlt'l: Sotlium chloridc I I7mg, poturssium chtoritlc l86mg, anhydrous citric acicl -11{.lrrrg. sotliurn bicarbonats -t36mg, glucosc l.629. Sachet: Silicon dioxide, saccharin sodium or aspartame, orange flavour, pineapple )
{lavou
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bler: Saccharia sodium, blackcurrant flavour-

r)F:SCRIPTION
Sachets I I- of made up solution (5 sachets, 5x200ml) coareins sodium (Na*) 60mmo1, (K') 20mmol, chloride l)orassium (Cl-) 60mmol, cirrate l0mmol and glucose 9gmmol. Tabl;'r 1l' of made-up solution (10 tablets, 5x200ml quanrities) conraiili sodium (Na,) {'oi;ii:t.|, porassium (K') 25mmoi, chloride (Cl-) 45mmol, citrate 2ommol and^ glucose -i '.;i ) r' r r :':,.' l . t rra I osmolarity is 240mOsm/L.

lrrdirrrtions )ral t'orrcctit-rn of fluid and etectrolyre loss in infants, children and adults. The product has bein formulated to treaE fluid and elecuolyte loss associated with acute dehydrarion in infantile diarrhoea, but is also appropriate for the trearmerir of older children and adults.
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Ca.strolyte is also indicated for the correction of dehydration due to vigorous and prolonged exercise.
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AND ADMINISI'RATTON

ijr:r' r' ;'t ! .r.-iministration orrlv.

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l)osage: The volume of reconsdruted GAsTRoLyTE needed per day should be derermined by the physician, taking into accounr rhe weight of the patient and severity of rhe condition.
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For toddlers and older children, GASTROLYTE may be given freely until their is satisfied or frequently while diarrhoea persists.

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A number of different regimens are recommended for the treatment of infantile tliurrhoea, but rhe basic principle is ro provide enough fluid to rehydrate the infant. I;urt ht'r f'luid is then given to allow for ongoing losses unril the diarrhoea sertles. I iuring rhe first 12-24 hours of rehydration, miJk and solid feeds can be omitted., but t lr'-''t' shottld b<' rapidly reintroduced to avoid malnurridon. Milk feeds may be halfsrrcrrgth initially, but full-strength feeds should be given within 2d hogrs. If the diarrhoea persists or is worsened by the milk, then the possibility of a temporary int<.rlerance to lactose should be considered. If confirmed, a low lactose forrrula can then he offered. I n lantile diarrhoea is uncommon in breast-fed infants- However, if tream.ent with GASTROLYTE becomes necessary, it is suggested that for each feed. the.chosen regimen is followed such that the infant is given the appropriate volume of CAS'|ROLYTE for that feed and then put to the breast until sarisfied. F,xpression of residual milk from the breasts may be necessary during this period. In those parienrs who are vomiting at the start of treatment, it may be advisable to of'fer very sma]l volumes initia.lly until vomiting is under control. If the vomiting and iliarrhoea sho'*' no sign of moderaiing, the patient should be reassessed.. 'l'i':c il, rsage and regrading schemes are onry a general guide and the volume of (;,1S'l'ROL-\"ili given and rhe speed o[reintroducdon of the uonnal feeds is ar rhe
cliscrr-.tion of rhe physician.

(no dehydratic.n): During rhe first 24-48 hours the infant is offered GAS'IROLY'I'E solution in the sarne quantities as are used for tlre uzual feeds. For the ne.ti 12 to 2l hours, the infanr can be given half strength feeds of the usual formula mired with an equal volume of water. Foilowing this, full strergth feeds should be recommenced. ordinary solid feeds should be conrinued tlroughout.
ful ;i<l (lasc-s

l)osAGn-: voLUME oF FLUID REQUIRED ovER 6 HouRs FoR THE I) R F:V EN'IION OF DEHYDRATION [);:rirnr's u,eight (kg) Volume of Gastrolyre (mL) in 6 hours.
.:
i
(,1

r50 - 210
300 - 420

t5
20 30

450-530
600 - 840 900

1260

i or pacienb over 30kg, flt:id replacemenr should be S-zm]Uxg/l,,plus replac.-uot any additional losses. e lvlore severe cases (dehydration): prornpr medical anention should be sought if dehydrarion is sr'spected. signs of dehydration include d.oqrmented weight loss, reduceci urine ouqput, and. diminished skin *g*. a *gg.*a regimen for the trcatmenr of infantile diarrhoea with markea alhydratiln based on bodyweighr in k ilograrns is given. DOSACE: VOLUM19.. R.EqUIRED OVER 5 HOURS FO*.THE 'f R EATIvIENT OF DEHYDRATION Parienr's weight (kg) Volume of Gastrolyte (mL) in 6 hours
5

of

1,

riUr,

200 _ 400

i0.
I5
20

400 _ 800

900
900

1000

1s00

30

1000 _ 2000

" l,:;:#;J::3',
II' rhe

replacement shourd be 5

7 mukgthourprus reptacement of any

condition worsens' or the dia:-hoea has not stopped within 6 ho,rs in infants under 6 months' within 12 hours for children under 5 yu"*, 24 hogrs in children 3-6 years of age or 4g hours in children over 6 years of or tle child has decreased urinary output' the clinician should ensure patients "g., and parents are aware of the rish and early warning signs of dehydration in ytung chfldren and infants. lf the condition further worsens or fails to i*prlre, ry fluid replacement is requirecl.

I)osAGIi: 'I-REATIMEN1'oF DEHYDRATION IN OLDER CHIIDREN &ADULT' chitd


.\pprtrx. nirrnircr

AduIt
2 sachets after each'loor" motion or 8-16 sachets per 24 hrs

sachcLs
|

of

I sachet after cach loose mot:ion


or 6_12 sachets per Z4hours Limired food
i {'

I or

)ie

r l.tur. I
2

desired

I)icr I)ay

e.g. cereals, toast, etc.)

cradually rerurn to normar dier by slowry reducing rhe amount of Gastrolyte and increasing the .mounr of food (Light sorids at first,

WA RI.JINGS Ilse water ONLY to mix Gastrolyte powder or effervescent tablets. Never dilute with lcmonade' soft drinks, ccrdiars r'o other fluid than water. "ry ( iastrolvte nowdcr is available '*ith either sodium saccharin or aspartame i., a srveetening agent' Phenylkeronurics are warned that this product, in some forms,
a: I

.,,

,.::'.]:::::::::i:Inc

,ircasc reter ro the packasing fbr informarion ret.ring ro rht

I'RI'CAUTIO}.IS l;or oral adminisuQEiln o,nly' The contents of one sachet or'two effervescent abrets should always be made ub ro 200mI with water (rhe produc mustnot be reconstirured in diluents other rhan sr u t i o n s). A wea ker so u ti o n,h* susar and elecrrolytes and a stronger sorution rhan recomm.rra"a may gifd rise to hvpt'rnatraemia' Int'u'"nous rehydration is required for dehydrated children with 'shock' very large stool losses (>10mlftg/ho.rr;,-sever" vomiting that interferes with 'rirl [luid replaceme,t' or glucose malabsorpti,on. patients with gastroenteritis shoutd ire monirored carefuIly ,o Jrr.rr. rhat their condition does not detariorate. In particular' young infanrc may become severely dehydrated iu patienrs a short time. andlbr parents should be advised to seek medical if the condition worseDs. clinicians should particularly ensure patients are "i*i.u aware of the risk of dehydration in and infants- Ear{y warning signs of impending dehydration shouid be fi::il:]ldren
> r

#:';:"Uff

;:r[#::ffi: ::#1"

seek medical advice if diarrhoea persists for more than 6 ho,rs in infanr u'der 6 months' 12 hours in children o months to 3 years, 24 hours ,,r children aged 3 ro 'z'vqrD in srus'rer "g"a 6 years and 48 hours in ch,drei over 6 years of

age.

:i:ll::::.ff:."""'or
.\ l-)\/ l:R.SE EFFECTS
NrJnc reported.
PR iJS

llcc iq&sgnancy and lacarioq 'l'h':rc i's no contiaindication to the use of castrolyte in pregnancy and lactation, Iactatins women wirh gastro.or"iri,

shoutd seek speciarist

NNTATIONS

'Sacherc: orange flavour:5.2g, IO's; Aspartame: Nanrrar and 'fa hlers, eflfervescent (blackcurrant): 20,s

Fruit flavour:4.9g, r0,s

W ririne Task i,formarion, write a Ietter of advice surnmarizing.inforrnation on horv N{rs' Garner should rrse the sachets you recommended.
ii d-d r95s_ gg_l qtrelrq: Lindu Garner !O4. []arclay Close, lllack fulountain 3231, Vic.
l isinB rhe above

Ey

tv--f,--1

c4

, A'ra"'t"**/ qr fro

I
o

Bi"ak ldo,un.{l^ 323,,


V ic-

^J,

,'a:,-i f (

22- to , 7.o E
L;nd.o G*rr^__. _ I o1 , Ro.o/ay C los,_.t
V,-c

Krri-*

$"sed-

a e

gl^rk Hou,,7,"in-zz3t,

D-e-on Mrs. &r..*,n,

a
o

f "r ivz

.-'r,'Jil9 lhis -ln#:rr *., Oas|rc 3o ulnJ, -lo

tbu.\ J,r-fr!^

o&is" ffa*-o,a.

:I @k+a&W@fu-Gywr^
/on
glaot^t r\ ol'\g

a . i\ o .A** gooz^,t.

k'trffi"k"ffiHi
F

x -A-,,"t, fo 4 f- la:lo V" Lrr,r.. pl^-, pr'l"ot*;; {osS-ez . -Tf- JIr* .e-,nol;lion,.r^ror.s-e,r^5 - aa 4.L-- Jr
{,,
-Sr

s*.4,*'

a a e o
'a
)

|,^ro

u:'.11,r-

Qr-:L, dlcul*ig-^.dr.. Tor- r^.".&-

ghe,,..,.r

T p*erj'^*r1
L\r

lpl Cr.ai^! b"iU a'J Co"l.s-J Tl"- S.,L^{lon Str1o*\} b. t*rrJ.* .^4 ..*r,'^ Jt=1 "-fr=tS- p-r", {. f, O-r".oi. *d SoL.'{to,^ Tcrz.aatl'nruq cr.n !*u" - o.0{r-^,- fcCor+{t'{,..^fic^- S.h.* lr* d,rscs,,asl , Tt* S.{,.^{; -hta1 b, +o"l -}o=f /^ {'' ', {Y-&,rA r7^1or" i,*,r,-l,,"ld a'${-a*Wsal.yl15tio:o,l*,-t 5( glttrJ tn a fa(n'*raalo.U it"r.rtadr'-!9 ..a&a*rcsr,loyllotio:o, 0-..tt-, ,^o1 b* f< Cl,,*t {;{*k / u-drt *,^fi--c,jt*^Jr*-/,. . al)-A
J--

o
,

rlt^ ^o*{
A1

rr

Yo"'
1

h/''
*.{

fohn Gallant ha.s just read in a magazine about AlternaGel Antacid liquid. He has milcl heartburn and lvishes tr) get more information about AlternaGel.-'

'vl"
D.ug
Factual

AlternaGe! Antacid Liquid LZ f7 oz (360 ml)

lnformarion Indication ^o use tor

r\lternagel contairu no sugar and is dietetically sodium free and provides a greater d6ncentration ofautacid per teasPoon.
.

.'.,

High potency antagitl that provides fast, effective relief in


rronI

xirti ve forp(u la.

[lfective relief of heartburn, acid indigestion, sour stomach with these a nd symptom-f u.ps et stomac! .associated ffitn food or drink. conditions, or @
Direcrions Ingredients
I

Shake u,ell be_fore use.

lv-e

nl

",r"-PI-u;:

Ac'.ive lngredients: Each te#oonful (5ml) conrains: Aiuminum Hydroxide (600 mg) I nactive Ingredients: Birrylparaben, Carboxymethylcellulose, Pota.ssium Cirrate, P rr'rpylparaben, Purifi ed Water, Simethicone, $orbitol

t-$'."

.1.

)oV"

"'''D'rrglnteracrion
Precautions:

..\

nt:ici<is may iuteracr

with cenain prescription d*gt. If you

Y:-

are presenrly taking a prescription dnrg, do not take this product rvithout checking lvith your physician or other heakh professional.

a-Dosage
o

Take 1-2 teaspoonfuls berrveen meals, at bedtime or rlirectecl by a physician.

as

Warnings

Do not take - iV1ore rhan 18 teaspoonfuls in a 24-hour period, or use the mrximum dosage for more than two weeks. - If ,rou have kidney disease, do not use except under tl'riclviie and supervision of a. docror'

- Ivlay cause consripation.

yrrigrgg-bk
Using the above drug information, write a letter ro Mr. Gallant at 36Iflest Hgn Stud, \\'t'st FrrJ 36.1'l,Summlrri.'itt,l inftrrnution rl''ottl then and how ' to take the drug and u,hat side effects to be aware of'

35

I-J r,r-.t- t, .5 v\Ar r!._J f I

Wegl El\d -

At-e-ib^"tc-r Q "*d

L<h*,^

R*(q{

,^o 2l
lf/\-I.!-

Lr-.
3L

."2a:.8-. -- \,rJ*s-l Ho,,* - S-l"d


o

W.$

E'r"e
l,tr-".

36 +*

G-{i;,

3
.4"

,it
.1:

*o

-;.

,il
tii
t:

rf
io

lll

e
1D

I-

t/orr.r

i- :)-.- V- ol d*..a*^ aaorrla,yrct-,

S*"C"^r/9

rQ1,euz-

W un k,^,-^

PP\*r"^^.^;{

a
o o !.
*

TsP,r! v+u\, t
D
o

!-<-

1*

tr.a S.&.
English Tesr Wri
ri rre

o'tt'n tlorr f.
P

pr
1_-

t'C.

e.*

Test: pharrr.acisrs

f t\'^

"1.

Time a.llorved: 30 minutes


Read the case notes below and comprete the
o

G,- J:.."

*idog task wLich folrows.


of

James, the son of.one of yotrr customers, has just brought *' you a prescription h is fa th er's c.n ta ining ro*"

* ua ilo,io"r,r". ;;-d;"

' fathe io *^ri^^r: , takringhis medications and is taking.rpi;;;sread. -t(., r^o-cA9*lrtr t u'i !.'.-., 1,-l< rza^ i;,.'i'"r,)-1, . rl :1o'a,-.... ,..u,r -t-tgteg ^J.',rf,*r" 11^s y:.. .. o ( -"j rc_--] d>4 , l. Current problem Unstable angina
He also informed you that his

Definition
Characteristics

syndrome that is intermediate between stable arigina and myocardial infarction.


f1z''a'''l )voo*

._ x

, - Crescendo

,
symptoms

pattem of chestpain. or with lms exertjonr"l - Less responsive to mejic]E6iT- Ogcurs at rest

)/

- Chest

oacx-l-ecc. 3t/
1

pain that ma y radiate.to the shoulder, arul, jaw, neck or

Tests

-Tighhess, squeezing, crushing or aching in the chest. - ,*q


- ph.ysical examination to check for arrhythmias.

q ( (Y

, t . ^l' 'l -l "f' I l'.4


Risk factors
g

coronary angiography. Blood tests; CP(, cpx-rraB, Troponin Myoglobin

1,

Troponin T and

- Ivlale gender. cigarette smoking. 1g* - High cholesterol. - High blood pr"sr*". - Diabetes. - Sedentary Iifestyle. - Being 30% overweight. - Overwhetmingskess.
.->

Cr"piotr"!.
loprJo5r"l

L*

Treatment

Prescribed m6dication

'; Chlopiclorgel more effective than aspirin to reduce heart attacks. l-- 9u"be used together with aspirin T" be taken during heart attaiks. { 'l- Iluporir, and Nitroglycerin are taken sublinpnrally or rv.

s--

pomplication-r
Recommendation

d ,.vty oC hr.l .,- Stop smoking.

"r--,..,a-91-. Progression to an acute myocardial irrruotior,.

*'t

tt'*'%

L.^sc&

\ - Losing weight. ,/ - !1"tr9l blood pressure, diabetes and cholesteror to prevent the ( riEk of any arterial blockages. - Taking the drug in rimes and regularly.
,l .t
::
.t

Writing Task

\ lott ., I 1- po4..'^l.7.. -!,'oelt.u-? j \- (t,,+ o ho!Prl*("r o(7^,'t,":3 #-',lt'<t

Using the above case notes, write a letter to Mr. Peter Maroon at 36 Aloxander Road, Lincoln Z1W,strrnrnarizing information abouthis illnss and agairut the complications of angina.

?.:

lU

grr,(^ rvvt Dl.r'v.rrr)f

r1

135 Al-to-dor-(6'-d L incs\tn

k^ru,^ PoJ"*- 7,4")


)AlFJr-/

a fu*-J a h6 AIet ^'J",rLo

#A1AL

-4
_,
.

_..t

Li^ coltn

a e F :G ,l

#o,^n,oJqr,--{,
N*:

Mr . M*o.r^, !a r^ ,ari1i71 ih,y Lt^

Disr

1"12"

f ,'JIZ ol !*+^Uf* o*r*\vto,, u-1,t"l^r,-"dYrl& b


T+ --o ce-b-d .. a"l--g eo*lrr-iltr,*/.rd*oi" .t 6 LLro t]r.,po"{sdq 1=.. *r<,".1

aaf sr , ' rln

vf

oa

l rf

a a
e

D^ry
"h.,
fl,^{;

+t*
0

oilo.L ,

o :,; (/v
$

-.{J^ .(tla -Asfirr^*-cLfttlq#.( t4t"norr" 'p,)*ahff,^.Q,t'^qrd"dr-4 6 r^or* ,//#rr" +tv"'^ n cPld (,. raC^ct,ru /d o.\4otk . .1.h,2-4-.-ua- t o".L 4".rlrtJ '- A'^d"1 )ror-a "!^* . Ao4*rin aaoJ_-rfil*rf ,& r, o , .1toL" -o t^t,,', tt,
'

p#u! -oJ;J'{;on is "lk aqq,'oqrj'6n { .Ti.,-, y^oAt

b,nrn;^g

or orl^,,a

trrtl !-"1 d*,rl n-.bo& 91,"^6, J* "r" ,'*&


.gb,,.,

lU .d*l ,*q--ocar-

Jr*ro.lr^4re@-

Yr^ sh"*d S{of 5r^sl<,tg , .loso..


,-.rl^l

a t;

c!

lwcre,ot

*rl--rro! Li-rk-# y^

o .J

rnl *;e hospj{*k-E"3r.n lr. '? a'bhc'ra ' .f,n LE4L o1 fi"1---&,b^,bY:1 -fo ocrJ I ,r \\\ Oro4]o, G o;,t4[n o f g t ca/^ u* -l'r . /,*n*.- ,"At
J,^a:f .H. t\e"'tJ
F{

You,t=r 9r'^.&,l{'r

SU-*.^.rr1

'

.Jat

t. -4gE

lqr!

..a.g{!r+rg\-r,Jl.

'f ime 4lowed:.40.Fjnu res


'ii ,l:
!

i';

pacieur is depressed, he sends his sister along

Your parieor is a trineteD okl srudeat. The patient was diaguosed E'ith syrnirlo$s of depression aud his cloctor suggesg rhe essentialiry of drug therapy. Ar.yoL

with the prescription

tg-Eet

rhe

medication for him. You believe t}'at a leuer Drug: Common


Uses:

will

be valuable ro your patient.

Alprazolam( al-praz-oh-larn)

-+ r4-oAlq4{lon

Tlris medicine is a benzodiazepine used to treat anriety "nd panic disorder.


:

Inreractions

A special moniroring is teeded wlren rakin6 clozapine, neftrzodone, rifampin, oral autifungal ageots, HfV protease inhibiror or any medicine for seizure.

Directions:

- Stoie r&is nredicine at room temperahue away from heat


and

light.

' Iaregulir

)'t"
Caucions:

dosage, take your piII as sootr as possible if you ever forger or miss to take ie D or Sn+ Do nor rake rwo doses at ouce.

{#""I
I

Do nor take this drug more or longer rhao prescribed. Long usage rhan prescribed may be a habit for:ming; I Do nor drive afr.er akicg this dmg as itcauses &osrsinedi. In case of pregnancy, this:drughes showa some harafut,'.rl'., effects over the ferus. Do nor breasr feed while t-l..g thi3 medicine.

,:i

.l:
.

if
ir

dt

Side

ii
- [xccssivc dayr:ime dr<rwsiness and li;rj,thcadedness.
- Unu.sual weakness and - I{eadache, clumsiaess or unsteaditress.
..::. .!d1

[{Iecrs:

LI
,

Cizziness

'1i' 1., ,4

.iI .a_
{'o "!-4

.{

Add

itional Informatio

:.ri

n:

.{

- Do nor share this dmg wirir orher for whom it was uot prescribed. - Do noc use rhis drug for orher healtli condirions. - Keep this medicine our of rhe reach of children.
Explaia rle term depression co the parieut and say that the <rru restore the balance of chemical substances in the brain to

TK
1ft.

,r

t0
)n 't _lt

t$ u

{t ff,

"o"troiE

fl
a
l,{

llrrite

lener to MarL Pearce( 35 Wtite Nesr FIouse, Flami;rgtcrn Road, Ashtou AS', 4 6 LG) to advice hir:r on how and when to uke rhis dnrg and what side effects lie' should be aware of. ,'
a
7

:{r

s'

'tl t

t.
II
trl .ri
ir.r

{.'

f,
:',
,

f3yr,run's trht"t-rr"rj i 3 s t\U ro,*,ct lL" *J A g l^-io^

lb-rr,,*^,

R.^dq-t

iD

L2. o &. 2"0 I


3 s r^J J. (je. Sl-l{o^s. F l"-,^" t,V't"" .-( no{1.,,:

!'Ij-r1

I
,

Ast"1.X

As A I
t
f---+

L.&
'/

t
lO
lt

ta4g

e)

Afpr*Zto,^Plpr*zto,^f

t--{''rh cow{rst qa\ o *J . -t'ro[ - ,}1,,.*rhe-- -l4ao -ro^. I

ts *ll*.J,* B

rn-_r-el...

O y: -.(t
t

L*r^

,!,fi"f: ol'too.

r-

,^^Bs

{" +,lu

c.t

o v
)

alp<-r;<nu Sorr,^,-olOe*: SnY-r, , dta= iv,o-14 , --urro,ur*r,.L--r-\tod)ua , t. Y "* ^^",.s{ no{ *^|a. -{l^rs drg Ja^^r-< &, l"m *tr 41,,r.^ pruoihA __,*X_b 7o* u"Y"s{ r^oJ --otn;<.te *,{J." -+^,@-dor

Yr.^

' ' o)4r"+. t:l*,, Jadtt + ''


,t ,

e(,F

ttu;; y, t,

3-

.:

a
,

r*,r+t*t*F6,*f c I cy,\ l* aLr!*At*^ (l


fouus
3;nc-u,$ ,

o a
3"

Ephr-^^r"1

3
{

Wi'alitrtrdEffi
o

tii,t*"itrifiailtruWW:ffi

d-

As Petricls, the son of Mr. sieve Muray, has recently finished -s_ his medical training course, he now calls requesting more infsrmation abouFhow to give. Adenosine to his father.

Drug
Action

:.Adenosine

T*,,

Adenosine reduces the normal flow of the electrical impulses througl', tiie atriovenfricular (AV) node of the heart without causing ncgar ti vc cf fccts.
,,.n!,?-Adenosi.e .^ ^,

is usecl to restore a normal hearfrate agdguths whe. you ur" I',u.r,rrg on hr.ur.lie.

{o

Slo,^; \.ts

-!ru*t rJ^

upt

Mechanism

,/ Adenosine can be very effective at slowing or eneling a rapid heart ihe problem is iaused by an abnorrial electricar pathvuay irr ) :,:a.,if " the heart. Adenosine will not work if the fast heart rate ha.s a x f \ diffcrcrrt catu.sc.'l'ltc't'clot'u, it rrray lravc tirnitccl valuc in ttiagripsipg

\ tachycarclia or hclping iclcntify thc location'of rhc la.st 6earrl ratc.

Metabolism

) wall. (
*
(

enters the circulation, it is brokerr c{own by t adeno.sirre cleatninasc, wlrich


i.s

J" hlhdn adenosine

prc.sent irr rerl cells anrt t6c vc.s.$gl

Dipyrirlarnole, a* i'hibitor,f ade*osine c{eaminase, allows \ ') adenosi'e to accumulate in the blood skeam. This causes an
^

Side

effects
-i

increase in coronary vasoclilatation.

t'-n ,1"'' . .^,,r. .4 --' L--Y


n ja

D*,,, i

rr.Parffi,,Jizrin.ffi ti.' ' .Hearlache.


r -'

'Sr

loss

of'consciousness, .ligLl

h"ldeclness and

! .. r--.. !. r-

.,., .r,

.. "':

,,_t1,, n. N ^.'N

-r .'lprri{'Ol-ts. 'Palpitatiolls.

.Hypolension
tNausea. ':1ry'

.BlGmrisio.. a,*_d. =--\.S6ortness -..-.SIfOftngSS


--

.,',"'
.,

!, , .'1, t-. .
sk

t . -J,^ 'y::i:tlTl'i'"+\* ractori


ye r
No prir-riL.nt

.Fr.TFmSmiA ' . rutaste. 'Metallic

of bf Of breath.

,*r*1H"I.,rT^^

y* q-Y"ff-"
icuiai
ine,^^

fffi.:ffinffi[ffii:':f'f::#I'ir'[,]',il;:,TllI

I ^

even decaffeinatecl [eas or coffee can cause rr'rpr.u"rrt tacl-rycarc{ia episoeie

'.ri\r.Y'

1.l'.-.:..',,,itha[corrtainit.i*.,Io,rtssl-rt:uItIaIso 'i '\ .l.l..'-hbeavoitititl@olirre(suclrasAfrirrandtlther brancis) anti pseurJoephec{rine ("suclr as Sutlafed, Actiferl. alr.l otl-r(}r 'r,.6" !,tl*)J,: '\ i '' brane{s). Doctors alstl warn against using nonpreticription diet pills -,:,... I . ,..
t: I I

""

banil,;.|1, uprltr:r"lrinu, tlru hurb

,iltrriffior

otlrur slirrrrrl6rrt,.i.

/
Do3'[ge and

o\

administration

It is very q minute).

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al-glo :5

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lasts only a short

or

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is l$:lbT over 1-3 se'c. The se-cond lzmgdose

lffiebions"
if

PUSfl ra

closc to veirr obse*uaffi

Limitations

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symproms.you may drive if the arrhythmia was keated (and either cured o, controllecl) tnd has .ot recurred. Do not drive if the arrhythmia not conkolled If you have an arrhythmia that cioes not cause significant symptoms, you do not have to stop or rimit ctrivf,ig. However, people with arrhythmias tlrat cause confusion, dizziness, _e?r"

l1"o!**imum'-q^Tg you may drive

"t''E,," ;i,-,-l thJ;[fyir,*iu6ul';";;rr.

may[@."rgJ

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lightheacledness, or loss of consciousness may not be allowed to drive-at least temporarily-because of the risk of an'bcciclent

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You nray be ablc to start crrivi.g again i,r,,r,.liur.ry after rraving your pacernaker implanted, you may neetl to waiifor 6.months'or more after radiofrequency abtation or the implanErtion of an ICD (implantable careiiovcrrer clefibrillabr) to show that you arc free oI syrnptoms.

Home care

Horne care inclucles monitori.g your supra,uentricular tachycarr{ia and trying io slow vour heart *hun a fait heart rarc, occurs.ifo monitor your co.ditio,, you rnay finrJ it helpful to kcep a cliarv oi your heart rate and your symptorns

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9l*k your pulse whe. you rravc syrnptoms and rccord trrc info:matio. in your diary. Be aware ttlat if your heart is beating rapidty,.ir may be difficurt to feer your pursl an,l get an accurate v count of your acfual heart rate.
By. keeping a tliary of yclLrr heari rate and symptoms, you may be able to icierrtify stressors as lack of sie"p arinli*g arc.rror, -such or overeatirrg- that triggcr c;_riscltk:s-

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medication and what si;le effects to be aware of.

uying tha drug information, write a letter to patrick at lgg Russell sheet, Alberh, 3\?i, summarizing intorrrtation on whcn antt h,'w to aclmisistt:r

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Mrs. Coie, in her-[gg.]Qg is a regular customer of yours. Her daughter brings in a prescription for you to dispense. You rec.ignize thar themedication is for ueatment of Clrolesterol.-

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Accordingtoyour. diaberic patienr.


Prescription

iW6ol , , eh&4 #ur (r*g'

Dr. Simon Sea6ull 188 High Street Swanson 1222 Ph: 789 22 43
ivirs. Victoria Core
1a

.----4F

Allerr $rreet

Srvanson

'

D*g Advicor Sig: nocte pc "'' I'd:;;';


Drug Ibuprofen ' Sig: I nocte pc

q( {cr F..{

Prescribing inforrration for

d*g Advicor
'cha'r

Acri'ns :?:l:":iJ"'5J;llJfi::Tx:l;il:T;1,Tffa'lion
cholesrerol levels. Indicarior,s

significantly improve both your LDL ('bad") and HDL ('good") Your doctor may prescribe ADVICOR0 along wirlr-a'dieland gxercePlggram to improve your cholesterol levelil

for

use

ot.
Conrraindicarions

'>i if You have liver problems, sromach ulcers, or a serior:s breeding " problem.

You should not take ADVICOR if you are pregnanr or nur$ing or

PrecauLions

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I

Maintainiag the right balance of cholesterol levels is imporrant for reducing your risk ofheart disease.
Do nor subsrirure ADVICOR, for any orher may cause damage to your

+ . \l 1

liver.

niaiin products

as

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oi i wirh vr'rur docror's apProval, take a.spirin or ibuprofen about 30 L-gl ngg!_U"foru rrki" g ADre
i

Adverse reactions

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This sensarion usually occurs when you srarr t"king ADVICoR or wl'ren your ADVICOR dose is increased.

I .

- Flushing (warmth, redness, itching, and./or ringling of the skiu) is the mosr common side effect. You may feel it in your frce, neck, chest, and/or back.

- Ii

flr.rshing should wake you up and you wanr ro ger out of bed, be sure ro take your rime and stand up slowly-

. . ' , -*
Interact-ion

- Rapid or pronounced heartbeat, shortness of breath, swelling, srvearing, chills, drliness, and/or fainting. Other common side effecrs may include weakggss, flu symptoms, headache, infection, pain, diarrhea, nausea, itching, "rrdE3h. *
- AD\,'ICOR@ may cause an increase in blood zugar levels. If yoir have diabetes, you should carefully check your blogd sugal$gls and report any changes to your doctor.

,
7"

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| - Avoid alcoholic

(fhe follorving have

been reporred:-

beverages, hot beverages, and spicy foods

near the time ofrakingADVICOR. IVilamin supplements

T.U your d.octor abour any other medications y6u are. taking:

XI I

r- Especially

anribiocics, anrifungals, HIV protease inhibirors, blood pressure medications, anridepressants, fibrates, bile acid binding resins, or ryclosporine.

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Ad,:rinisration

Adminisrered - Adminisrered B0 minutes afteraqpiria or Ib,uprofeu, -Take ADVICOR ar bedrime with * l*r-fr, snac&. .
-

orally.

WridngTask
a lemer b Mry, c,ote ro u4rise 1.uq o;;o*.ro medication, what side efhcts to be aware ofand how to cope wth then mention whar rhe patient shourd do to get the optimum results of tbe dnrg,

,*tnt her

th. d*g information write

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Tirne allowed: 40 minutes

uccupatrIOnaI ungJ.].sn Ies ,'.i': u*;ig ilgs t: Pharrnacis is

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Introduction Mrs. Ba-rns is a cuscomer of yours who has jusL called you in Eo get more informaeion abouE uouth Eorea and. how to riranage this problem. After your conversation with her, you conclude EhaL l:er current sympEoms are not
conEagious.

Your records reflect the bglow information:

Address: L28 Regent StreeL, Regent 6G55 Age: 62 years old.

CusE,omer's name: Joanne Barns

- Heav..r smoker - Moderate aleohol drinker - Doesn'tr suffer any illnesses

Read the foTTowing case notes then expand Lnlo a Jetter f ormax. Fact

file

- Various t1ryes of sores appear around the mouth including inner cheeks, gllms, tongn:e. lips or palate. - Women get canker sores more often than men due to hormonal. changes.
cont,agious. Camker soreg

Types of sores

Cold sores - Caused by herpes simplex virus and are very

- NoE. contagious. - Appear as a single pale yeL1ow ulcer with red outer ring. May be relate4 to - A virus. A t,bmporary weakness in the immune system
Hormonal changes. St,ress and low level of vitamin B-L2 or

folate.

Conunon

Biting cheek.
A sharp brqken t,ooth or poorly fitting
Chewing Eobacco. Braces denEures.

causes

o-

Burning E,he mouLh wich hot, food and drinks. Drugs include: cancer chemotherapeutic, aspirin. barbituraees tfor insomnia), golcl (f or rheumatoid arthrit,is ) or peniciliin. Mout,h sores lasL form 10-14 days sometime.q up to 6 weeks.

5yift*.'_ f :i.-]

rr,-ii-..;-

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-,--jg..rp',;-ri,

-.,

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Herpes sores begin as blisters and then crust

over.

Suggested

treatment

- Gargle wieh cool water or eat eopsicles for mouth burns- Avid hot beverages, spicy and salty foods. - Take pain relievers fi*e'aceEaminophen.
*?or canker ggrea. - Rinse ;rrfi;lGrer. -'Mix one part hydrogen peroxide wi.th 1 parE waEer and apply this mixture to the lesions us j.ng a coEton swab.

- BlisLex or Campho-phenique may provide some relref of canker sores and fever blisters. - Take L-Iysine Eablets. i.ids
Treatment
&

r,redication

FuII examinatlon of mouth and tongue by the denE,ist. Topical anesEhet.ic applied to a localized area of E,he slin sueh as liodocaine. anti vira1ffi st esions Antibiotics for severe or persistent canJcei:
sores.

Helpful
hi.nEs

- Decrease smokj_ng and limiE alcohol - Reduce stress and adopt relaxation
, techrrigues.

misfi.tting dentures Ask your doct,or for folate and vitamin bLz to prevent canker sores outbreak. Fish, chicken, eggs for cold sores or take L-Iysine (buu not. in hypert,ension cases). Writinq Tasli
using Lhe a-bove information, write a reEter to Mrs. Barns Lo answer her helow Iist.ed questions;
What
Why
Hor+

Avoid very hot drinks or foods. Use a soft toothbrush and chew slow1y. DenEaI visits for broken teeth or

are canker sores? do women geE it often?

can she manage canker sores problem?

-?

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Dr. Mark Swazi has just called you i1 requesting that you write a letter to one of his
patients whom he has just
caDsules.

prescribc{FiiicFetrf*:
lor
14 davs.

r\ction

'-- Over-the-counter Prilosec OTC should be taken once every

i f

24 hours

if

needed.

Indication for use

Prilosec is used to treat ulcers, gastroesophageal reflux diseass (OEIID or heartbunl), and other conditions involving excessive stomach acid production.

Precau tions

- Do not stop_taking Prilosec even if you begin to feel better - Do not take: " More than one tahlet per day or repeat treatment more ollcu tlrun cvcry 4 nrorrtlrs. " Ilyou Jrtd hcartbum t'or over S rnonths. " lt'you had lrcartburn rvitlr sweating, lightheadedness, dizziness, chest, shoulcler, neck, jaw, or arm pain.

Contra indications
Side

(. Wartarirr (Cournaclin). h )' Digcxin (Lanoxin, Lanoxsrcaps).


\

{ " A niedicine for insomnia or arxiety.

j.

Effects

Drorvsiness, dizziness, or headache. \. Diarrhea. increased gas. or bloatirrg. /" ttcfring. I' irtyor""*perience an allergic reaction (difficulty breathing; hives), I closing ol'the throat; swelling of the tips, tongug or face; or taking attcntion. Prilosec nredical antl seek ernergency islop Syrnptorns of an Prilosec overdose include drowsiness, seizures, shortness of breath. and de$reased body ternperature.
en before meals.

Overdose

o Adminlstration

omces),of water. Do not'crush, Prilosec UT,C chew, over-the-counlcr orbrealgthe " _-9bJrts. S.r,val o+t, therrf whole o il'you have difliculty swallowing. lhe prescription Prilosec
I

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capsules can be opened and the cordenb sprinld.d onlo

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fask,

ablcryoonfulofapplccarrce. - rI " The applesaucc *ould not bc hot and shoutd bc soft-caoug! to bc swallowed wi*rout chowing" t . -:' ' rr :
q

Using the above dnrg ctrccker, write a lstter to Mi. Tom Bailcy at 36 Almond St, Browning, advisirg how to take his mdication and what sidc cffects to bc arryare of.

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aiit'iokplete the writiag rwk whicb follows'

of yours' Parienr Peter Brown, a regular cusromer

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David, -ffio,ouil'Youreceiveaprescriptiorrf.rorrrltiss()ll,uaY1o,

l:: :.-":-::lY 1::t@

Yorr''uto"t

also show rhar he hut

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Q.{*4i-n}}p,*,^,d on
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I.agledtents.

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Usase

sod iu m' ACTONEL (active ilgredient): riscdronat'e oxide,red (35 mg and ACTONEL (inacrive ingredierrus): crospoviclon*'{u]:" r'rulirl' yellow (5 mg end 35 mg tabit:t^c 7.5 mg rablets only), f.iit o'iau r:reuhyicellulose' lact'bse hyclroxypropyl c*,ttuiose, hytlroxyProPyl monohydrate(Srng,30mgunctil5rngtahletsorrly)'mag'nesiurnstear-ale' and r"io"] polyeth yllne glycol' silicon dioxide' microcrystalliue "of titanium dioxide'

itr

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r''' r osreo po rosi: d rrea :.lry::' ih men witlitileoPfro6:') (- To increase bonc mass ii n ' dratis LTea osteoPoros$ Itr t >- To DrevenE and Lreat as prednisoqg= --'-^^ )m 6n i *,,,, n "r"t.rrf]iffi[Ih rnen a - To crear Pal6EE6sease of bone in ou*n *

an - 'f prevent s"{ o PlsY!,rL lL,

t':':yt

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differenr tlan ior this leaflet doTttot,o'::it: ACTONEL of v' rype ditre; L, LllllgtEsL t'u have Pagee's'disease' ask your ACTONEL for Paget's disease' If you ireakh cate p'ovid"r how to use ACI'ONEL '

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!-rr stopping ctrrnninp mc more loss of boue aud - l^.. loss by reverse bone may \acroXal drough they mosr p"tp" *1-"- al<e it' eveu f increasing bone srreugth in helps lower the risk ;":::3':-"ur" ,o ,.u oi f""t. ;;r;nce. ACY.NEL lhe healt-:r care provider may measure of brakisg bones (fractures)' Your ro check youi ill.ngress' ol:your bones or do orher resrs

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bstegoorosis oiteoporosis is a diseasc Ih,r c;lusc$ bonc$ t(] bc(.ornc thinner. .l.hin horre,s can break easily. Mosr peopre rrrink of their bones as being solid tike a rock. Acnrally, bo*e is living rissur., jusr lite -Lo, orrrer parrs rrl.the - your rreurr. borT , or skin, for ecampre. Bone jrrst happens to be a hardtr type of tissue. Bone is always changing. yo,r bo<iy keup" you, br:nes,"rrg;iJ;*r, 'by replacing old bone wirh new bone.
.

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osieoporosis causes rhe body ro rernoye more bone ,t,oo i, repraces. This means rhar bones gct weaker. wearc bonr:s are more rikery to break. osteoporosis is a b'rrc disslsc trrei is uoirrr,rirr, c.speciaily i'ora., women. However, you'g pe.ple arrrl '.iniri.. ;nei. cun ri..e.rekrJr,rr,uop.rrosis, trxr. osteoporosis can be prevenrccr, an,J with propr:r drerapy it can be reatcd. You may not have any paia or orher sympion* when osteoporosis begins. - You are more likell, ro break (fiacture) a bone op".i"Iry if , you fall because ostcoporosis nrakes your hrrnrx w.rker. you are most likely to break a bone in your back wrist, or nlP. ,usr u.tLA (spine), hip. \sPlrre/, wrlst, You maf ,shrink" (gec sho.rter). You may guc n ,'hump. ("u*.j in your back. You may have bad back pain rhar makes you srop some acriviries.

i t '\'

things put people at risk ibr osteoporosis.'rrre forowing peopre have a higher cbance of gerting osrcopo?,)sis: Women Who: - Are going drrough or rvho are pasr meoopause (rhe change). - Arc white (Caucasia:.r) or Asian.
PeoPle

M*y

Tl*
-

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H::TJ"::,",::r
Smoke'

Have a family nrenrber vrirh osteoporosi.s, carcium or viramin r).

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Drink alcohol often. Take. bone rhinning mc.dicines (rike ;:rednisone or orher
corrii:o.rtertrids) ltrr a krng [ir.ur,.

Contraindications

Actonel should nor be used if:-

, i -,:
:^

- llave low blood calcitrnr (hylxlcalcenria)


- Caanot sit or srand up for 3O minurcs - Ilave kidneys rlrat work peror.ly aa allergy co ACToNEL. The accive ingredienr in ACTOML is T*."
nsedronare

sodiurn.

tr
:,'r.

m"
't:{,

ffi

and lactarion

Db not use 1o - You ere pregnalrr I prL*ranr. We rlo nor know if AC.I.ONEL \ Lr^::,rr,lecome can harnr your unborrr child. ,t - You are breasE-feeding or plan to I breasr_leed. We rIo nor know if Actonel can pass rhrough your milk nrrd if ir can harrn yuu, U"iy. \ - You have kidnev probrems.
I

if,

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Interacdon-

ric,ol.rrl;"il;; llt

r"ryo".

- Tell your doctor about a, rhe medicines you raks, including prescriprion and non-prescription rner,icines, vitarnirs en;r herbal suppreme'rs. AcroNEL can interacr '.virh ocher rnedicines. Keep a Iist of arl rhe medicines you rake. Slrow ir r<, all yo,,, t,outrf, ,.r,* p-riaers, including your denrist and pharrnacisq each rime you. gel a new medicine. The following insrrucrioirs are ibr ACTgNlil. 5rna (clgilyl ACTONI?I. B5g&

\r t

Dosage and

adminisuarioq_

'..,i|.IQ39=.u1,us9,.olACI.ol.lEl.zsn..g6TffiiveDayseachIvIorrtlr):
I

o^@
gii'ni3s
o.cep

the,ror'ing

before

eat or

dri

Do uot Lk. i, - swallow ACT.NEL rvhoie. Do nor chew rhe rahrer or keep it in your mouth ( ro mel; or dissolve.

jl

.,,!,

+. A'fter taking ACT.NEL you rnusr rvait at Ieast 30 rninutes BEF.RE: lttlg down. \,ou i:, srand, cr ilo aormal abtiviries lik paper or takc a walk. '-ieautrg or

ffiru

when you ta!.eACTONEL.


Keep aking rclls you.

AQT.NEL for

as long as

your'ealrir

care provider

. FoTACTONEL ro t

osteporosis,r;;i"'"":J'#.T:::ffi :;:*?J.T&omgeeing

,k

.o

suppiemeats aad co ecercix,.

-{$
-.,.-.

'''lL' rl;, I

--6-

"or.Q*.r,aui*#n n

t.,

1;'
E:: .

ri :i

li;,;

11
Actgnel Sciredule If yourdocrorhsE.Br-eqc_!.ibed

ji;'IOIIJitfu

rBetcily_br-ellqwlablE*

if

i,t!i..

i';

Take I AC1'O}\rEL 5 rng cabl,:r evt:r1, ciuy irr the morning. Ilt you miss il rtoss of yotrr AcII'oNnr, .; 1116 in the morniug, ct6 '.r rake ir larer i, ri,c rluy. 1'ake only l Ac'roNEL 5 mg ubler. rhe'exr morniog and corrri*ue 1,orrr usual r,-r:hcdulc of r tabrer a clay. Dil *or take 2 tabler on che same rlay.t
(err.l:.r.Ut&r]

If your ctosq haq.lllsr,;rLIlsd_AqIONEL-1i5.1119 (.)xce-a-Wee]<


ables);

Ctroose t duyp!,tfg**!!ar you wjll.remember and rhar besr lirs yollss-he{u-lg_qo

I\CTONEI.35 mg rubler in tlre morning,,nlirrif,iEr, doy. If you miss a dose of your ACTONEI.35 mg in rhe rnoraing, do nor rake it larer i' tht: duy. 't'ake rinly I A(:'l'( )N[L 35 mg rabler rhu
next rnoroing and continue your usual schedule of 1 tabler on your chosen day of rhe .areek. Do nor rake 2 tablets on the same day.

r@

If ),our doctor has prgr(ri!291l..ri:"-l_e$U.,, rl5-r1ll_l-ryll Consecutive_Ddyg.,,r,.!r .':;r |'l .. Monrh (a Pink tabler):

-'''

ir ir tuvr duriug thc murrltr rh:rr besr.firs your schcrdule and rhar you will remember ro rake your ACTONEL 75 mg. Take r ACTONEL z5 mg rabler in rrre moming .f your firsr chosen day. Take rhe second tabler: in rhe morning of ,the rililowing day. ACTONEL 75 mgrablers should be uken on rhe same rwo cousecudve days each mon;]r.
CLroose 2 days

If you

o,e or borh ublers of your dose of coNTEL rnorning, do not rake ir later in rhe day.
miss
d,:ses are

75 nrg

i* the

-If the nexr mondg_Sedlled iollowing:


:
tl.

mefLT day$l&y-do thg

misseil, rake the lirst l\cl'oNEI. 75 nrg rabler on the rnorning after the ciay iu is remenrircred arrd the second tabler on the next consecutive mofiring.

if borh ublers were

If only one rablet is missed, the day ir is remernbered.

cake rbe srissecl rablet on rhe morning after

You should rhen continri(..r/crlr r.suel sr:lrr:dulc tli i\cl'oNEl.75 mg on iwo conseculi'ye days each nor:ch.

*"

'. r
:,

.. ,

,,.1

i:.

,Do
.

nor rake rnore rhan rwo ZS mgrablets wir.hin 7


glgyg

dqys. 1\

,,
i, .

l' ' ,', :: .,;i ; ; :il:. i ::

"ir; ;

, ,.:,, ;;. i,.:, i. :; rj

ile[-eE-ereJ-Eo.J away, you sbould wair r next month'. r"r.a,.*J;;;lffin;;r;'ffiffi'"lT;H1*fi1 undr ;i'.'j;EE
;

. '. .,.,i1..;tj

o,' rwo consecutive

da.vs lsLs --!' v each

rnontb .r

as

originaily schedured.

:,; ,,iri,iii
side

..\lrovider who will

be abre

;;;;;"r.

Effbcrs' . ,i .L ,, , ' , vil; ,:ii1


'.

ACToNEL r,,,v rarco.

; .- @Iffiffi,i,;

pain gr trouble swallowine (rlysphagia).

.rucrs ru your stomach anr! esnnhagus (the rube connecrs the mourh and the stomach).

--!ry-\r'

.*ly, rur"[ rkioElon 11i.occu1'ParienBm,yffiffitiotusuch,,,o,i,hives,or'inrare


.

healrh care may

,,'.:f; :: .:i
r"
;,,,,,*i

,-i','

.:;T::XI::t*"::rn

bu oich" r""", f": ; ripr, ronsue, or rhroar. which _"., trouble breatlring :: :.1, :l: or .swallowing.

;xl i:i*1il:

6; ;;;;il ;'#}; il,x.ff ,


u su:r

..:'ii:ioi=

rare cl cases, patrenrs pati taki r&& lnay l! ser eye infl arnmadon, 5 pain, redoess and seasitiviry,o :::_:::_"* lr.gbt.

ily

-'

'

ft:lyrofi:*H::il'":fi:,,"T
are
DoE

associared

wirh deraved and inrecdon,

l "trh.r" : .. ''l "'

' ' t'

side uE"*. Any time you .};:,".:mertical pr,,bt..u,'y.u ,f,,i* nrn, hc fionr A.,IONI.I., ralk to your

alr rhe possibre side effece ofAcroNEL. you can ask your h6alch care providu, o. phu.*r"i, ouo.r, other

)k'slgP. tt3*" ,ttlgNgLg,:d

_dl

T'.,i

t:
I

you h.ave very harl hcartburn or it docsu,t ,,f.t herrpr.

.
ii

.i.

t:,

Fi r

cDo uot ear gr drin,k

,f=
-

a@fore
turar

1r you take.@rd

i,.

- Dj:1trj.*n

l*t S0hir"r*.

-:
do notfake

f.

Food and some vitarrrin su body from al,sor5i

a-nd medicines can

ACTONEL

11trhgg_9_rLe_1Bian plain warer ar or n,nr the d@If rg:&us-o@

lffiEffi

{
(

1\,

o'

i-.,;

\1
.Do not eat or drink a for ar leasllQ_grinue

"Ro

yo" r"fu ic

Dj '

*, t.g"m f?Ias le& mroinurcs a


water ar or ncar the

f.

an-vth-Eg_o-t{@aI''iEI
ACTONEL.

---'-.i-:-'-----i

Food dnd sorne vilaurin supplcrncrrts and meclicines can sbp your absor6ing usi EL lterefore, F.dJfrom do aot

tiae

1\,

o'

c 'i

.\v' t

,l ,.r'r'.

--.r--

l-.'-\ \)

J J*.rc.rCl
uv

PCq'he1
:
:

\ri I
I I I

*llt*
Ii

,
r

Yo\^,hr!.^.\L)

(.

fir-r.--,j+v
i +.

>1r<t?

I
I

I I
I I I

.a \s, v.r,rr

t) .t
L-t

- ?..,!
s
--_-._-_-L_

f .+.,

[irr.r.a,
I

Lr g ,-.L.r< Argx,J+ i(; o"ltt',rf * 3\),r


I

__..r_

f.; tc^r'

1--\f 'l
.

[if

= -.J ^-

)
,

l^ow, *\ .d \l.$rt, -- ftC;<va


)

+lw,
.

(a a4 ari n"r (c'*cJ " I,'or1

ft.lur.( t

frr-r

+r,*p-

trr

'l- ..., i.'<

r rr{
C..
t-

i * br.*
t-'r-..

f , ..{-r.F.d (+r---.

loA, lci.-..r1 ol r.^ ir.,r.1 tlctf


,1ri:

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Io,

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qri

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ll.

r^ r .r rr I Qv'

w ln;

lt

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S*-nd$_1 . rf..._..rn __

h.

l^3 .t-q\-( J (. f: ,_,, t. * l. f "J'' \/


o

r'L w' 'r'-_ dcin.!gt.-.. r!.v.*{*ha *q Ll.t I ,-" i I !r.a_J._ c !! {$rrli"_J_ .,* t 'r^ \ L^-

vr

)
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:

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nii

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I

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\r\
L'c.--t-.*"-: y." (Vrr91\J
.. '' ".

'l--:I./ --- J"t'J"f'

--l-..-

. ?"1i L,\cr- ."ti lr)- .as'!----l i ) l;

i lcf\r,

-:--

il , -\ ,^..ror.r?l f-r-.o

r .'qr .'q

J-s-.rn.\'--.----.-a*6J-n-.ra.\'--.--_-.-o'!6'

* \e.grst- .l.o-.--+i-

i !a r*1,
\r) .-.
S'

Vilo-.roa; ."-.

.,-F--.-c..^Pg1e**-:t-,-y
"PAI-.'L p.r.*-L-.
-.

\a

r $n

\ rn

-\

.' tep-

- ix

t tyq..tl-

/!/t..c

,J-r oy f l-ie.t--.

Te

Llt o

q\.r-

ohey -u)a:lrAr--.

fi',

*/

o-JD i .ry*+a.rY.

v 9.
t

,,t/

S,,.*

,:

/y
.. :.

g^

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',{*

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;.5*r & 4 tu * rrl"irh


. ^t- --Lr

At$'

\,(
Occupational English Tesr

T a,pq qtfil:g *hS (.#^ i"


"Lou*

@
Tirnc allorvcdr 30 rnir:utes

A regular customer cf yours has just called you in after his son was diaguosed wiih breathing difficulty. The boy, Jack, was prescribed proren..;il inhalel:by do"to*

D{t1
f
r

li*

i 't,

Maior Symptoms

Dif fi cuJ ry* in breathin g

't

[,,,"a
-i!_.

wf,*:le
use

Ir

'ii
i. L'

'i-'r
.l

symPtoms

",:

,r{
'4.

\!'Acn to

Given for shortness pf breath due tc

rrh""riug. 0*A2t

ti' (r.

;:,

Dose
Possible side

(2 puffs initially (may repeat in 1 to 2 hours if necessary then 2 I d" S* y', | euerv.4 hours as need.ed for continued . -+ -td, wheezing. v 'i I
ill

effects Tremor, palpitarions,

fast heart

rate,

it,
ral

' . Sh.k" rhe inhaler back and. forrh. ,f , *1" tt41 1L\s ;'n h-tor, ?)-'.\ ' Talce a Ceep breath and exhale nornrally. ,i Slow'iy ralce zurother deep breach. li ' rl ' Seal mouth around inhaler rube and squeeze to discharge $. while inhali.g then hold. breath for several.seconds tlen ' 'i' -, -- ---' 'i o<hale normally. t: ' Repeat same directions for the sec,:nd puff. i :'g , ' Fact fi.le Shortness of breath may be a symprora of a chronic lung " condition, or a sign of acute changes in tlre course.of a
.i

f. tL

proaressive illness. Noticeable rapid ,:r labored lreatling may also be accompanied by ot reslessness. Air hunger may be a frig,htening erperieuce foi both the sick person and the observer.

.o"ehGF"e@

Deterrr,ine if shortness of breath is rc:lated to unrelieved pdin or other unmet physiological or emo:ionai needs.

i:.
: i'
!l

*i
F 4,
1

i*/
;,

lH'

t#.

,
,,1

'i

,[
Rapid, shallow brearhing may be <jue to pain. , =.j l"i.li,i Orrygen requirements will be increasea j"{r"g resdessness. pain medication.has a r:almr"e ,o Iessen air hunger and the sense of ,iisuess.ir"*yiili"rf. ,, available, keep ir on at all times at ;he pr"r"ribea"flow raqe.

.',

{,,. ,.,. , t..'

*.

,i#

""*i!+*a t#;i #i'i-&

:'s
fl
H:

tfi
,t,, rh,

During episodes of acute shortness of breath, do the foilorying,

' ri'

t
tl

IA
! I I

t, 'ii' l,

I I i J

'l

terminulillness.
''fhis

'

Labored breathing com,ronly occurs in the end. stages of a'

-"..

may be the mosr dii'cult aspecr of r\e ayiug prcigi-ss, -thc observer/care giver. j::

fo,
t

Generally, the dyrng is less aware of this qrnrptoln dui to.the dirninished level of consciousness that prevail,Jat
O:rygen may be prescribed. as a cornfo,t *"rrrrr,i.frt"t$g,r. aoL alvral'e a necessary trearnent ard it does
l
I

'

'

thi,

i*g"
':'j

norp;;ildfu.
t

i,

't

r wnring Task
the above given intbrmation, wrire a lerter,:f adyice ,:r Mr. Y:i"g 202 Maple srreer, Harow j]]3ess, how to use the inhaler

.,.

3266,yi".to@nn*i6& r"O

s"o* ti.xoblii u,

hic;;f::.:'
,,

l:

./

'.

i+':

lr'

?, r.''
I

vt
bqo, ffprhon , ,, [' '16*{ i ^1/.'' 5 C* e+'-ny Io.r l, r ,l ,,-3 in f z2f or cc. {3A - w eH,:3 ',-s ''vr Vr Lr-^-lar e,-iv-j,'o' ^1 nrXfr* .

lhut

a,

/., (,d n,nr-

1:t" &,:--.o+t*

*rru+n"{ i*""1''^, t":''t' ' '"'1,u,"!i::,'l*"1Y;.;-t: :* ": {,,\s 4!'tJ r '-Jl"{:3 oL^"r19 ,d^,*,
'y

"J

co,..uo*

lu,

b.s -,^, elh ,tg

{,4

-s nry^*L! blur,Lalr1., s{r4,.s ,


.r cs.\o{f*iol

d,^,;.

A \ Bo_l - ,,rilry i9 , lrnore Cov.rrr t":,' b"J, a^'e oflttJ'*". r^rlt, .!n-,tnr-*,'f*"U hsg{o'3 . ar boJ ., ,,,1L^n4. , -' "':r, ., t .,i ro* >r(sr'\cr r<r.o,p +r,-f , ir ga*r ea:ur" ftt, rd,ba"hw ba,hw &*e4o tt, &u 41 s,,trvo,,*:jr T:: tr"rn sri:.y<r*ri,+1,_. il * :j , ^ 'l fvoblo-* o:'-i tte *"'"t; srrsr(-o-- ih,r ;"^;1, C"-vr j,^l 'to- d*.r.. in +\! (nllo*,.=g c,-+q,. ,^.b; -A*,fruyt..lr.r

]*:o ,d-.*y*,,r
s

d:u(

h's t'-4rvro1'l5e' o{*,ly rr Jfu ;*ttr"^''{y

ko+r^, atl-, % urrila' !*o" -ru-' fuxr.,

H',

-'l ,9.1*ool

ltk p^''{*(,^-.r,{1*".,

-ao, p,,6 0r si x 7+srt s.ca,, : ^(Jrr. o^ pap.,66f oli 6.rtr ,{I3 J itt{.r. t'r,,.th.u^i

Frrs I

, ff,*

uirrvl

a*lr=r

.-

{Lr,r+ er^. *r,u .

t-.t-

Yow dn ca:lel't o{o"io, *0Jrt,rr^,-o_-rro{

"T';;::
IP
,S *l

Tt"+'

^,^r";;;:f;X".;*',

e\'' ots,**'" c,*,.^!u-, ii;a,*-rn..n- Ii, ,1r..^f, ;g i "-r, ota*^r talr'*r 'i. r.rr*..^l^,il ---' r *i_,o,#.

- ,}i,.rrs{,r,t.J^-.

l- tu *r.* +",*.'rrr;
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orr, Jf. _ F tq k.. s Lp. t*;^-JJl /r* do,t", !{'**, J G',". "',[ *, d^i"

,T'-,

;*: ^ ff ';V J
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bddq^vc./

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ron

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ug& "{4rs

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