PHARMACY NEWSLETTER VOL 30 JULAI-OGOS 2015
Advisor
PUAN SAIDATUL RAIHAN
BT IBRAHIM
PN.HAZLINDA ABU HASSAN
CIK TAY EEK POEI
Editor
IZZAH SYAZWAN ISMAIL
Contributors
GERALDINE TAN
CHONG MIN NA
PN. SYAMSIAH BT. SHARIFF
PN. JULIA BT. SHAMSUDIN
Editorial Board
HOSPITAL MELAKA
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Topic of Current Interest
Dengue Fever
Page 5 - 6
Complementary Medicine
Traditional Chinese Medicines
Page 7
Drug Comparison
Gynoflor vs Premarin cream
Drug Safety
Domperidone
Page 10 - 11
Counselling
Pre– chemotherapy
Drug Profile
Gefitinib 250mg Tablet
Pharmacy Jokes
Activities & Announcement
Pharmacy Night 2015 Ceramah Motivasi dan Sambutan Hari Raya Methadone
Jamuan Hari Raya
Page 15 - 16
Page 14
Page 3 - 4
Page 12 -13
Page 8 - 9
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Geraldine Tan
Topic of Current Interest
Dengue viruses, mosquito-borne members of the Flaviviridae family,
are the causative agents of dengue fever. Dengue is the most
important emerging viral disease of humans that in recent decades has
become a major international public health concern. The symptoms of
dengue fever include high fever, rash, and a severe headache (dengue
triad). Additional symptoms include severe joint and muscular pain
(breakbone fever), nausea, vomiting, and eye pain. Although dengue
fever itself is rarely fatal, it can be an extraordinarily painful and
disabling illness and may become epidemic in a population following
the introduction of a new serotype. Dengue fever is usually a
self-limited illness, and only supportive care is required. No vaccine is
available for the prevention of dengue infection.
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Geraldine Tan
Topic of Current Interest
Flower pot saucers and
vases should be emptied
and scrubbed at least
once a week to destroy
mosquito eggs.
Cut down and remove
all bush, and clear
overgrown lots that can
harbor mosquitoes
Cover all water tanks, barrels
and storage containers with
tightly fitted covers
Spray dark corners in
home with aerosol
insecticide to kill any
adult mosquitoes that
may be resting in those
References:
1. Murthy JM, Rani PU. Biological activity of certain botanical extracts
as larvicides against the yellow fever mosquito, Aedes aegypti L. J
Biopest. 2009;2:72–76.
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Chong Min Na
Complementary Medicines
Traditional Chinese Medicine (TCM)
Traditional Chinese Medicine (TCM) is a holistic system of healthcare with its
very own unique theories. The treatment of illness is based on the
differentiation and diagnosis of syndromes meanwhile the understanding of the
human body is based on a holistic viewpoint.
Chinese Medicine or ‘Zhong Yi’ has a broad range of medicine practices which shares common theoretical concepts developed in mainland China. It is a
tradition of over 2000 years with various forms.
4.
Ancient beliefs
1. The human body is a miniature version of the larger, surrounding
universe.
2. Harmony between two opposing yet complementary forces, called yin
and yang, supports health, and disease results from an imbalance
between these forces.
3. Five elements: fire, earth, wood, metal, and water symbolically
represent all phenomena, including the stages of human life, and
explain the functioning of the body and how it hangs during disease.
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Chong Min Na
Complementary Medicines
Benefits Risks
Predicting occurrence, nature, trends of diseases
Simple, inexpensive, safe and durable
Restoration and maintenance of harmony, bal-ance and order to the individual.
Lack of validity in regulation of herbs
Limited safety data. Possible contamination of
herbal products and interaction with drugs
Complications from the use of
acupuncture resulted from the use of non-sterile
needles or improper
delivery of acupuncture treatments
References:
1. Traditional Chinese Medicine Therapies & Wellness Practices. http://healthcaremalaysia.com/news-info-2/traditional-chinese-medicine
2. Traditional Chinese Medicine Information Page. http://www.tcmpage.com/
3. Traditional Chinese Medicine: An Introduction. https://nccih.nih.gov/health/whatiscam/chinesemed.htm
Types of Modality i) Breathing therapy/‘Qigong
A component of Chinese martial arts in accumulation, circulation, and working with qi, breathing or energy within the body
Restores the orderly information flow inside the network through the regulation of Qi
ii) Remedial massage/‘ Tuina’
Application of hand techniques like roll/press, knead, rub, and brush
Strengthen body's resistance against disease for disease prevention
iii) Chinese Herbs
Herbs are used as a complement to various physical diseases/conditions or for wellness, based on the Chinese community beliefs and Chinese 'Materia Medica'
Maintain a person's health and restoring the balance of yin-yang by acting on the human body (specifically the internal organs).
iv) Acupuncture
Technique of inserting and manipulating fine filiform needles into specific points on the body to simulate the meridians or channels in the body,
Relieve pain or for therapeutic purposes to facilitate healing and maintain a person's health and restoring the balance of yin-yang.
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Drug Comparison - Gynoflor vs Premarin Cream Izzah Syazwan Ismail
Gynoflor® Tablet
(Lactobacillus Acidophilus 100million / 0.03 mg Estriol)
Premarin® Vaginal Cream (0.0625mg conjugated estrogens/g)
Indication
Restoration of the physiological vaginal flora after local or systemic treatment with anti-infectives or chemotherapeutic agents
Vaginal infections caused by mixed flora
Atrophic vaginitis
Co-medication to systemic hormonal therapy
Atrophic vaginitis
Kraurosis vulvae
Relief of vaginal dryness due to menopause
Dose 1 – 2 vaginal tablets daily for 6-12 days fol-lowed by a maintenance dose of 1 vaginal tablet at 1-2 days/week
0.5-2g daily intravaginally in cyclic regimen (21 days and then off for 7 days)
Mode of action
Lactobacillus acidophilus (Lactobacillus bacterium) is the indicator organism for a healthy vaginal flora. It ferments glycogen from the vaginal epithelium to lactic acid.
Estriol stimulates the epithelium of the vagina, cervix and vulva, and selectively induces the restoration of the vaginal epithelium
Estrogens are responsible for the development and maintenance of female reproductive system and secondary sexual
characteristics.
Act through binding to nuclear receptors in
estrogen-responsive tissues.
Act to reduce the elevated levels of
gonadotrophins seen in postmenopausal women
Pharmaco-kinetic
Absorption: As soon as Gynoflor comes into contact with vaginal secretion, the tablet disintegrate. Distribution: Plasma concentrations of estriol rose slightly and reached maximum after 3 hours—8 hours Metabolism: Lactobacilli resume their metabolism within a few hours and bring about a reduction in pH Excretion: Estriol is excreted in the urine
Absorption: Conjugated estrogens are water soluble and well-absorbed through the skin, mucous membranes and gastrointestinal tract. Distribution: Widely distributed in the body and found higher in sex hormones target organs. Largely bound to SHBG and albumin in the blood. Metabolism: Application in the vaginal circumvents first-pass metabolism. Excretion: Estriol, estrone and estradiol are excreted in the urine.
Stability Store in refrigerator 2-8°C Store at room temperature (15°C—30°C)
References:
1. www.mims.com
2. Full prescribing information on Prmearin Cream. Wyeth Pharmaceuticals.2012.
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Izzah Syazwan Ismail
Drug Safety
Overview
National Pharmaceutical Control Bureau had done a risk-benefit assessment on domperidone due to the report published by European Medicines Association (EMA) that suggest to limit the
usage of domperidone due to its serious adverse effects on cardiovascular system.
Domperidone was registered in Malaysia since 1987
There are about 25 products containing domperidone that is 18 products of 10mg tablets and 7 products of 1mg/ml oral suspension
Category of prescriber that can prescribe domperidone is B* (medical officers)
Types of Cardiac Adverse Effects
QTc prolongation
Torsade de pointes
Serious ventricular arrhythmias
Sudden cardiac death
High risk groups
Aged more than 60 years old
Receiving more than 30mg of domperidone per day
Taking QT-prolonging drugs or CYP3A4 inhibitors on
the same time
Indications
Nausea and vomiting of functional, organic, infectious or dietary origin
Nausea and vomiting induced by:
Radiotherapy or drug therapy
Dopamine agonists (such as L-dopa and bromocriptine) used in the treatment of Parkinson’s disease
New Contraindications
In patients who have known existing prolongation of cardiac conduction intervals, particularly
QTc, patients with significant electrolyte disturbances or underlying cardiac diseases such as
congestive heart failure
co-administration with QT-prolonging drugs
co-administration with potent CYP3A4 inhibitors (regardless of their QT-prolonging effects).
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Izzah Syazwan Ismail
Dosage and Administrations
Adults and adolescents ≥ 12 years and weighing ≥35 kg and children weighing ≥ 35 kg
The dose of domperidoneshould be the lowest effective dose for the individual situation (typically
30 mg/day) and can be increased if necessary to a maximum daily oral dose of 40 mg.
Neonates, Infants and children < 12 years of age and weighing < 35 kg, and adults and
adolescents weighing < 35 kg
The dose of domperidone should be the lowest effective dose. The total daily dose is dependent
on weight (see table below).
Formulation
(domperidone per unit)
Dosage Maximum dose per day
Film-coated tablets
(10 mg/tablet)
1 tablet three to four
times per day
40 mg
(4×10 mg tablet)
Oral suspension
(1 mg/ml)
10 mL three to four times
per day
40 mg
(40 mL of 1 mg/mL oral
suspension)
Formulation
(domperidone per unit)
Dosage Maximum dose per day
Oral suspension
(1 mg/mL)
0.25 mg/kg three to four
times per day
1 mg/kg but no more than
35 mL (35mg)
References
1. National Pharmaceutical Bureau. 2015. Makluman Berkenaan Isu-isu Keselamatan Terkini Bagi Produk Yang
Mengandungi Metoclopramide dan Domperidone.
Drug Safety : Domperidone
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Counselling - Pre Chemotherapy Chong Min Na
Nausea and Vomiting
Antiemetic should be taken before
and after treatment to reduce vomiting
risk.
Inform doctor if cannot tolerate food or water be-
cause of severe nausea and vomiting to prevent de-
hydration and electrolyte imbalance.
Dental Health
Complete dental checkup and cleaning
before chemotherapy to reduce mouth
sores and dry mouth.
Reproductive Health
Chemotherapy may affect fertili-
ty. Options should be discussed for
preserving fertility before treat-
ment.
Women should take precautions to
avoid pregnancy
during treatment as
the treatment will
cause harm to the
fetus.
Hair
Hair loss may affects people who
receive treatment.
Consider keep head covered using
wig or head coverings, such as turbans, hats, or
scarves.
Heart Health
The therapy may affect
heart.
Heart health should be
measured before treat-
ment for comparison.
Eg: echocardiogram
(ECG)
Preparations Before Chemotherapy
What is chemotherapy?
Chemotherapy is a cancer
treatment using cytotoxic
medicines.
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Counselling Points
Chemotherapy Regime
- No. of cycles
- No. of days in 1 cycle
- No. of chemo drugs
- Route of administration
(IV/Oral)
What if missed dose?
- Contact doctor for advice if
missed dose.
- Take missed dose as soon
as possible. Do not
take a double dose.
- Balance diet
- Avoid uncooked food
(Ulam-ulam, sushi)
- Hygiene of food and
beverages
- Wash vegetables and fruits
DIET
1. Hair Loss
2. Dry and darken of skin
3. Nail hyperpigmentation
4. Nausea, vomiting, loss of
appetite
5. Infection
6. Anemia/fatigue
7. Neuropathy
8. Bruises/gum bleeding
9. Mucositis
Depends on regimen and patient condition
POSSIBLE SIDE EFFECTS
Traditional
Medicine
Concomitant
taking with
chemo drugs
may have
- Drug– herb
interaction
- Kidney or liver
failure
Principles
1. Safe handling
- Flush 2 x, wash hands with
soap and water after using
the toilet
- Pregnant caregivers should
not handle patient body
waste
- Wear disposable gloves
when handling sheets/
clothes that stained with
body waste
2. Storage
- Store drugs at room
temperature, away from
excess heat and moisture
- Keep in its original
Others…
- Anthracycline
group may cause
red urine
- Inform doctor if
experience pain
during injection
References:
1. Oral chemotherapy fact sheet. http://http://www.dana-farber.org/Health-Library/Oral-
chemotherapy-fact-sheet.aspx
2. Position statement on safe practice and the pharmaceutical care of patients. https://
www.nice.org.uk/guidance/ta100/documents/british-oncology-pharmacy-association-22
3. What to expect when having chemotherapy. http://www.cancer.net/navigating-cancer-
care/how-cancer-treated/chemotherapy/what-expect-when-having-chemotherapy
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Drug Profile Geraldine Tan
INDICATION
DOSE
Patients with locally advanced or
metastatic non-small cell lung cancer
(NSCLC) who have previously failed
chemotherapy, and who have
activating mutation of epidermal
growth factor receptor (EGFR).
250mg orally once daily with or
without food.
MECHANISM OF
ACTION
Greater binding affinity for EGFR
exon 19 deletion or exon 21 point
substitution mutation
Inhibits IGF and PDGF-mediated
signaling at clinically relevant
concentrations
Inhibition of other tyrosine kinase
receptors has not been fully
characterized.
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Drug Profile Geraldine Tan
COST
RM 4,493.45 per box for 30’s
ALTERNATIVE
Erlotinib
PHARMACOKINETICS
Cpss: 3-7 hours
Time to Cpss: 10 days
Half-life: 6-49 hours
Terminal half-life: mean 41 hours
Clearance: 500ml/min
Volume of distribution: 1400L
References:
1. Lexicomp Drug Infomation Handbook 21st Edition
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PHARMACY JOKES
Customer gets a topical cream.
Pharmacist: Apply locally two times a day. Customer: I can't apply locally, I'm going overseas.
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Pharmacy Night 2015
Pada 31 Julai 2015, Jabatan Farmasi dan
Bekalan telah menganjurkan ‘Pharmacy
Night 2015” di Avillion Legacy Melaka.
Ucapan Timbalan Pengarah Kesihatan
Negeri (Farmasi) —Tuan Haji Abd Aziz
Ahmad
Barisan Pegawai Farmasi Provisional (PRP) yang
mempersembahkan sketsa pada malam tersebut.
Antara cabutan bertuah yang
dimenangi Puan Hazlinda.
Menghargai dan mengiktiraf sumbangan
anggota farmasi
Menyuntik semangat anggota farmasi untuk
meneruskan kecemerlangan dalam
meningkatkan kualiti perkhidmatan Jabatan.
Meraikan para anggota Jabatan ini yang telah
dan akan bersara pada tahun 2015.
Wajah-wajah ceria anggota Jabatan
Farmasi dan bekalan pada malam tersebut.
OBJEKTIF
Anggota yang akan bersara Cik Tai Soon
Mei menerima saguhati kenang-
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CERAMAH MOTIVASI SIRI 1/2015 DAN SAMBUTAN HARI RAYA
METADON
30 JULAI 2015
SAMBUTAN HARI RAYA PERINGKAT HOSPITAL
MELAKA
14 OGOS 2015
Antara klien metadon yang khusyuk mendengar
ceramah motivasi yang diberikan.
Puan Srima dari Jabatan Kesihatan Negeri Melaka
dijemput sebagai penceramah sesi motivasi kali ini.
Gerai Jabatan Farmasi dan Unit Inovasi yang
meriah dengan pelbagai jenis bubur manis. Menerima hadiah tempat ketiga gerai
terbaik.
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