Patient instructions imported medicines

Apart from forgetting the function of the two (or more) inhalers, patients will also forget to take their inhaler on occasion. In a study of parents of asthmatic children (33), 60% said they sometimes forget to give their child s medicine. Indeed, it seems a normal human characteristic to forget to take medicine on occasion. It will only be the exceptional patient who takes medicine exactly as instructed every day without fail. An absence of clear instructions in the self-management plan about what to do when a dose is forgotten is an important omission. 

Storage instructions that are important for the usage period should be on the label (e.g. Keep refrigerated, or Store at room temperature). Sometimes only the pharmacy stock needs to be kept in the refrigerator, while this is not necessary for the short period the patient uses the medicine. Examples are Acetic acid Ear drops and Atimos or Foradil aerosol. Both ear drops and preparations for inhalation should be at least at room temperature when used, because low temperatures can be unpleasant for the patient. 

Swallowing problems often make patients ask for a liquid dosage form of (licensed) medicines that are on the market only as a tablet or capsule. Or worse, they may crush tablets that are to be taken as a whole. The careful choice of active substance and dosage form is an important step in pharmaceutical care for this kind of patients. Instruction about easier swallowing may be worthwhile. But even then some adaptation of the medicine may be necessary. Any... 

MedlinePlus, an online resource from the National Library of Medicine, states that a person can even become addicted to sibutramine. It s extremely important that patients take this medication exactly as their doctor tells them, and for no longer than a doctor instructs. As with any drug, the risks of sibutramine may outweigh the benefits for many people. It s no simple fix. 

From the small number of writings which remain to us, it is apparent that these priests were skilled healers who possessed a materials science, much of which is still a mystery to us. There were always two parts to these sciences—one was mental/spiritual and the other physical. For example, the preparation of a medicine included the processing of a material accompanied by certain words, spells, incantations or rituals. And in prescribing, the patient was given the medicine with instructions to repeat a spell or prayer. The proper timing of these things was equally important. 

Instruction for the patient, to be written on container by the pharmacist. Here brevity, clarify and accuracy are especially important. It is dangerous to rely on the patient remembering oral instructions. The BNF provides a list of recommended cautionary and advisory labels for dispensed medicines representing a balance between the unintelligibly short and the inconveniently long, e.g. Do not stop taking this medicine except on your doctor s advice. ... 

When dispensing prescriptions. Here we need to clearly explain the prescriber s directions and any associated cautions that apply to a particular medicine. We need to ensure that patients understand complex dosage instructions, such as a reducing dosage for a course or oral steroids, or the importance of completing a course of antibiotics. 

In contrast to DPIs the basic design of MDI hardware is well described in the literature [23, 24]. Most MDIs apparently have a simpler design than DPIs and a key advantage of MDI systems is their low cost per dose. They are portable, convenient and have widespread acceptance by patients and clinicians. Basically they all have the same operational principle and furthermore all MDIs deliver a constant fine particle dose (independent of the flow rate). Whereas they have a relatively low resistance to airflow and this all makes the inhalation instruction less dependent oti the individual type of MDI. The most relevant differences between types are in the actuator design and medicine formulation (solution or suspension), in which the type of propellant and the presence of co-solvents play an important role because of their influence on the (plume) velocity with which the aerosol is released from the actuator and rate of droplet evaporation. 

Patients should also be instructed on the importance of refrigerating some kinds of medicines maintaining the cold chain, see Sect. 37.5. 

Many countries have websites where patients can find instmctions, or let them reproduce the instructions. Drug manufacturers give information on their websites and instmction videos for specific medicines. This product information is often not appropriate for drugs used in off-label situations, so in those cases the pharmacist s advice is even more important. Information for specific patient groups can often be found on websites specialising in their disease (e.g. cancer or diabetes patients). But not all people have access to internet to access that information. 

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