PKD Melaka Tengah Bulletin pharmacy - Selamat...
Transcript of PKD Melaka Tengah Bulletin pharmacy - Selamat...
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pharmacy Bulletin
PKD Melaka Tengah
ADVISOR
Dr. Rusdi Bin Abd. Rahman
EDITOR-IN-CHIEF
Lee Mei Lin
EDITOR
Chew Poh Chiong
EDITORIAL TEAM
Michelle Lim Bee Ping
Noorafinah
Foo Swee Yen
Syahirah
EDITORIAL BOARD
Edition 2/2015
What’s Inside
Vaccination in Children
page 02
Needle Prick Injury
page 07
Value Added Services (VAS)
of Dispensing Medicine
page 12
Antiretroviral Drug Dispensing in Prison
page 19
Drug Comparison:
PPI and H2-antagonist
page 21
Updates in the Categories of Drugs listed in
MOH Drug Formulary 2015
page 23
Truth @ Myths:
Vitamin C Injection for
Enhancement of Beauty
page 24
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What is immunization? Immunization is an attempt to replace the anticipated
natural primary contact between the human body and
a hostile organism, with a safer artificial contact, so
that any subsequent natural contact takes place in a
state of heightened immunity.
Introduction Vaccines have helped save millions of children’s lives
compared to other public health or medical initia-
tives. Just a few generations ago, people lived under
the constant threat of deadly infectious diseases, like
smallpox, polio, hepatitis, measles, etc. Centers for
Disease Control and Prevention estimates that vacci-
nations prevent more than 21 million hospitalizations
and 732,000 deaths among children born in the last
20 years in United States alone. While in Malaysia,
incidence of pertussis has been less than 1 per 100
000 populations for the past 15 years according to
Disease Control Division, Department of Public
Health, Ministry of Health (2010)(1). It is attributed by
the good immunization coverage. There were signifi-
cant reduction in mortality and morbidity in Malaysia.
Rising of anti-vaccines group However, the anti-vaccine lobby gains ground and
tends to voice out their protests recently. According
to Dr. Suhaimi, a Family Management Specialist from
Ayer Keroh Health Clinics; the anti-vaccines group in
Malaysia is increasing in number but their impact on
society is minor. The rise of anti-vaccine group is
mainly due to misunderstanding of the information
they are given about vaccines and influences from so-
cial media. Anti-vaccines groups existed because they
have a principle that vaccines are harmful to their
children. Dr. Suhaimi also mentioned, in order to
help the anti-vaccines groups understand the impor-
tance of vaccines, we should educate them by provid-
ing correct information with the aim to prevent the
spread of negative things about vaccines.
The Benefits of Vaccine Far Outweigh
the Risks (2)
1. Vaccination saves lives.
The primary benefit of vaccination is that it pre-
vents disease. In one year, vaccines prevent more
than 8,500 child hospitalizations in Colo-
rado, 33,000 deaths in the U.S., and between 2
and 3 million deaths worldwide.
2. Vaccination protects the people you care
about.
Vaccinated community helps to protect those
who are not vaccinated, a concept known as
“herd immunity” or “community immunity.”
When a person is vaccinated, they prevent dis-
ease from being spread to others in the commu-
nity, including:
Babies too young to receive vaccines
Unvaccinated children and adults
Pregnant women
The elderly
Individuals with weakened immune sys-
tems (chronic illness or chemotherapy
patient)
Individuals who are allergic to vaccine
components
3. Vaccines are cost effective.
It is always cheaper to prevent a disease than to
treat it. The routine childhood immunization
program in one birth cohort saves $13.6 billion in
direct costs.
4. Vaccines are safe.
Vaccines undergo rigorous safety testing prior to
being approved by the Food and Drug
Administraton (FDA) and are
continually monitored for safety.
by Aqilah bt. Abd Rahman & Nurul Nadia Bashir
Vaccination
In Children
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ABOUT
VACCINATION (3)
Fact 1: Vaccines interact with the immune system to produce an immune response similar to that pro-
duced by the natural infection, but they do not cause the disease or put the immunized person at risk of
its potential complications. In contrast, the price paid for getting immunity through natural infection might
be mental retardation from Haemophilus influenzae type b (Hib), birth defects from rubella, liver cancer
from hepatitis B virus, or death from measles.
Fact 2: Scientific evidence shows that giving several vaccines at the same time has no adverse effect on a
child’s immune system. Children are exposed to several hundred foreign substances that trigger an im-
mune response every day. Key advantages of having several vaccines at once is fewer injection and fewer
clinic visits, which saves time and money, and children are more likely to complete the recommended vac-
cinations on schedule.
Fact 3: Vaccines are very safe. Most vaccine reactions are usually minor and temporary, such as a sore arm
or mild fever. Very serious health events are extremely rare and are carefully monitored and investigated.
Benefits of vaccination greatly outweigh the risk. You are far more likely to be seriously injured by a
vaccine-preventable disease than by a vaccine. For example, in the case of polio, the disease can cause pa-
ralysis, measles can cause encephalitis and blindness, and some vaccine-preventable diseases can even
result in death.
Fact 4: Thiomersal is an organic, mercury-containing compound added to some vaccines as a preservative.
It is the most widely-used preservative for vaccines that are provided in multi-dose vials. There is no evi-
dence to suggest that the amount of thiomersal used in vaccines poses a health risk.
Fact 5: There is no evidence of a link between MMR vaccine and autism or autistic disorders. The 1998
study which raised concerns about a possible link between measles-mumps-rubella (MMR) vaccine and
autism was later found to be seriously flawed, and the paper has been retracted by the journal that pub-
lished it.
Fact 6:Many infections can spread regardless of how clean we are. Better hygiene, hand washing and clean
water help protect people from infectious diseases. But if people are not vaccinated, diseases that have
become uncommon, such as polio and measles, will quickly reappear.
Fact 7: Although vaccine preventable diseases have become uncommon in many countries, the infectious
agents that cause them continue to circulate in some parts of the world. These agents can cross geo-
graphical borders and infect anyone who is not protected.
Myth 1: It is better to be immunized through disease than through vaccines. --- FALSE
Myth 2: Giving a child more than one vaccine at a time can increase the risk of harmful side
-effects, which can overload the child’s immune system. --- FALSE
Myth 3: Vaccines have several damaging and long-term side-effects that are yet unknown.
Vaccination can even be fatal. --- FALSE
Myth 4: Vaccines contain mercury which is dangerous. --- FALSE
Myth 5: Vaccines cause autism. --- FALSE
Myth 6: Better hygiene and sanitation will make diseases disappear, vaccines are not neces-
sary. --- FALSE
Myth 7: Vaccine-preventable diseases are almost eradicated, so there is no reason to be
vaccinated. --- FALSE
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Immunisation Schedule in Malaysia (4)
NEW UPDATE!
The schedule for the additional dose of DtaP-IPV-HiB 5-in-1 vaccine mandatory for infants in
Malaysia at 18 months has been deferred to 24 months due to the shortage of the vaccine. (5)
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Types of Vaccines(6)
Immunisation Details
BCG BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease.
Many foreign-born persons have been BCG-vaccinated. BCG is used in
many countries with a high prevalence of TB to prevent childhood tubercu-
lous meningitis and miliary disease.
Hepatitis B Hepatitis B is a contagious liver disease that ranges in severity from a mild
illness lasting a few weeks to a serious, lifelong illness. It results from infec-
tion with the hepatitis B virus. The best way to prevent hepatitis B is by
getting the hepatitis B vaccine. The hepatitis B vaccine is safe and effective
and is usually given as 3-4 shots over a 6-month period.
Diphteria Diphtheria is a respiratory disease caused by bacteria that causes a thick
covering on the back of the throat. The symptoms include, gradual onset of
sore throat and low-grade fever
It can lead to breathing problems, paralysis, heart failure, and even death..
Diphtheria is spread person-to-person by coughing and sneezing.
Hib Hib bacteria (Haemophilus influenzae type B) can cause severe infections
such as meningitis and is spread through contact with mucus or droplets
from the nose and throat of an infected person, often by coughing or
sneezing. Most of the time, Hib is spread by people who have the bacteria
in their noses and throats but who are not ill (asymptomatic).
All children younger than five years of age should be vaccinated with Hib
vaccine, because infants and very young children are most vulnerable to Hib
disease. There is little risk of getting disease after age five.
OPV Poliomyelitis (polio) is a highly infectious disease caused by a virus that in-
vades the nervous system. Polio is an infectious disease caused by a virus
that lives in the throat and intestinal tract. It is most often spread through
person-to-person contact with the stool of an infected person and may also
be spread through oral/nasal secretions (such as saliva).
Measles Measles is a respiratory disease caused by a virus. Measles starts with fever,
runny nose, cough, red eyes, and sore throat. It’s followed by a rash that
spreads over the body. It can lead to complications, such as ear infection,
diarrhea, pneumonia, brain damage, and death.
MMR MMR is a safe and effective combined vaccine that protects against three
separate illnesses – measles, mumps and rubella (german measles) – in a
single injection.
Measles, mumps and rubella are common highly infectious conditions that
can have serious, and potentially fatal, complications, including meningitis,
swelling of the brain (encephalitis) and deafness.
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Immunisation Details
Rubella Rubella is an infectious disease caused by a virus. It is also known as German
measles or three-day measles, but it is not the same disease as measles. Young
children who get rubella usually have a mild illness, with symptoms that can in-
clude a low-grade fever, sore throat, and a rash that starts on the face and
spreads to the rest of the body. Older children and adults are more likely to
have a headache, pink eye, and general discomfort before the rash appears.
Tetanus Tetanus is an infection caused by bacteria. When the bacteria invade the body,
they produce a toxin, or poison, that causes painful muscle contractions. Teta-
nus infection mainly affects the neck and abdomen. Tetanus is also called
"lockjaw" because it often causes a person's neck and jaw muscles to lock, mak-
ing it hard to open the mouth or swallow. It can also cause breathing problems,
severe muscle spasms, seizures, and paralysis.
References
1. Case Investigation and Outbreak Disease Control Division, Department of Public Health, Ministry of Health, 2010, 1st Edi-tion
2. Colorado Children’s Immunization Coalition (CCIC). Benefits vs. Risks. Of Vaccination [Retrieved on 10 December 2015 from http://www.immunizeforgood.com/fact-or-fiction/benefits-vs.-risks ]
3. WHO. What are some of the myths – and facts – about vaccination? [Retrieved on 10 December 2015 from http://www.who.int/features/qa/84/en/]
4. WHO. (2002). Fakta Imunasasi Kanak-kanak bagi Kakitangan Kerajaan. [Retrieved from http://www.infosihat.gov.my/infosihat/media/garis_panduan/I/pdf/03_imunisasiKanak_BM.pdf]
5. The Malaysian Insider. Schedule for additional dose of 5-in-1 immunisation deferred to 24 months. [Retrieved on 10 De-cember 2015 from http://www.themalaysianinsider.com/malaysia/article/schedule-for-additional-dose-of-5-in-1-immunisation-deferred-to-24-months#sthash.uC6fJDUc.dpuf ]
6. U.S. Department of Health and Human Services. Types of vaccines. [Retrieved on 10 December 2015 from http://www.vaccines.gov/more_info/types/]
7. Infomed Malaysia. Vaccination in Malaysia. [Retrieved on 10 December 2015 from http://infomed.com.my/vaccination-in-malaysia]
(7)
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Needle Prick Injury by Low Li Ying
INTRODUCTION
Needlestick injury is the most common form of injuries amongst healthcare workers (HCW). In Malaysia, Occupa-
tional Health Unit of Ministry of Health had reported an incidence rate of 4.7 needlestick injuries per 1,000 HCW in
2005. All HCW are at risk of bloodborne infections after an occupational exposure, such as Hepatitis B Virus (HBV),
Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) infection. National Institute of Occupational
Safety and Health (NIOSH, 1999) reported that the rate of HBV transmission to susceptible HCW ranges from 6% to
30% after a single needlestick exposure to an HBV-infected patient. Prospective studies of HCW exposed to HCV
through needlestick injuries have found that the incidence of anti-HCV seroconversion averages 1.8% (range 0% to
7%) per injury. For HIV infection, the average risk of post needlestick exposure to HIV-infected blood is 0.3% or 1 in
300 (CDC 1991).
NEEDLESTICK INJURIES IN PHARMACY
Many medicines are administered by injection, particularly in hospitals, clinics and by patients themselves. These
medicines include intravenous infusions, insulin, etc. Although the incidence of needle stick injuries in pharmacy
profession is low, it is also crucial for pharmacy staff to take preventive measurements to minimize the risk of
needlestick injuries. Pharmacists are exposed to such risk when we counsel patient on insulin injection technique
where the use of insulin needle is required. Besides that, such injuries also often occurred when dealing with pa-
tient’s returned medication. Some patient might dispose their used insulin needles in the waste bag together with
their old medication. Hence, it is our responsibility to educate patients regarding safe disposal of sharps needles.
MANAGEMENT
Work Process on the Management of Occupational Exposures to HIV, HBV and HCV amongst HCW
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Guidelines for HIV PEP (Post Exposure Prophylaxis)
Determining the Need for HIV Post Exposure Prophylaxis (PEP) After an Occupational Exposure
STEP 1: Evaluation of the Exposure (Chart 1)
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STEP 2: Determine the HIV Status of the Source (Chart 2)
STEP 3: Determine the PEP Recommendation (Table 2 & 3)
Recommended HIV Post Exposure Prophylaxis (PEP) for mucous membranes exposures and non-
intact skin exposures (Table 2)
*The recommendation to “consider PEP” indicates that PEP is optional; a decision to initiate
PEP should be based on a discussion between the exposed person and the treating clinician re-
garding the risks versus benefits of PEP.
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Recommended HIV Post Exposure Prophylaxis (PEP) for percutaneous injuries
(Table 3)
Regimen Category and Drug Regimen
HCW should be advised:
(a) Not to donate plasma, blood, body tissue, breast milk or sperm
(b) To protect sexual partners by adopting safe sexual practices (e.g. use of condoms)
(c) To consult the Head of Department regarding the need to modify work practices involving
EPP if he/she develops clinical or serological evidence of HIV infection.
During the follow up, the HCW should be retested for anti-HIV (ELISA) at 6 weeks, 3 months and
6 months.
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RECOMMENDED POST EXPOSURE PROPHYLAXIS (PEP)
FOR EXPOSURE TO HEPATITIS B VIRUS
PREVENTION 1. All HCW should be informed, educated and trained on the following:
a. The possible risks and prevention of blood borne infections after an occupational exposure.
b. The measures needed to prevent blood borne pathogen exposures: Implementation of standard precautions. Provision of personal protective equipment and safety devices. Implementation of safer procedures.
c. HBV vaccination. d. The principles of post-exposure management and the importance of seeking im-
mediate advice following any occupational exposure. 2. All HCW should be informed and trained on the above matters before they are allowed
to handle sharps, blood and hazardous body fluids.
REFERENCE: 1. Occupational Health Unit, DCD, MOH (2007). Guidelines on Occupational Exposures to
Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus and Recommendations for Post Exposure Prophylaxis (PEP).
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by Nurul Ain
Value Added Service
(VAS)
Of Dispensing Medicine
Introduction
I n line with the powerful slogan of MOH "Kami Sedia Membantu", pharmacy department has brought innovation
towards the transformation of service delivery systems and processes. Pharmacotherapy accessibility, especially for
patients with chronic diseases is a paramount importance to MOH in order to maintain quality of life and reduce
the cost of life long health. Therefore, it is crucial for Pharmacy department to maintain current system of drugs supply
to be compatible with the current facilities and meet the needs of people at an optimal level.
As to improve the Quality Use of Medicines (QUM) among the public, partial drug supply is given for a chronic diseases
prescription with one month and the next supply can be made using Value Added Services (VAS).
Objective 1. To give alternative means for patients to collect their medication
2. To ensure continuous supply of patient’s medication
3. To improve patient’s compliance towards medication
VAS is offered through various types of Pharmacy Appointment System (PhAS):
1. Integrated drug dispensing system / Sistem Pendispensan Ubat Bersepadu (SPUB)
2. Medicines by Post 1Malaysia/Ubat Melalui Pos 1Malaysia (UMP1M)
3. Appointment System / Sistem Temujanji
4. Drive-thru Pharmacy
5. Farmasi Susulan Secara Temujanji (FaST)
6. Letak dan Ambil
DELIVERY SELF COLLECTION COST
SPUB - Collect follow-up medicines at any MOH pharmacy according to patient’s preference.
-
UMP1M Follow-up medicines is deliv-ered to address given by patient.
- RM 5 shall be paid to Pos Malaysia staff upon deliv-ery of the package.
IMED - Collect follow-up medicines at date given where medicines will be pre-pared beforehand.
-
DRIVE-THRU - Collect follow-up medicines at Drive-thru pharmacy, Hospital Melaka. [Available at KK Peringgit only]
-
FaST - Collect follow-up medicines at Ba-hagian Perkhidmatan Farmasi, JKNM.
-
LETAK DAN
AMBIL
- Patient leave their prescription at phar-macy counter and collect medicines at convenience time.
-
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i) Integrated drug dispensing system / Sistem
Pendispensan Ubat Bersepadu (SPUB)
Integrated Drug Dispensing System (SPUB) is a standardized and
well-organized reference method for the partial supply of medi-
cations. Patients can get supplies of follow-up medicines at any
MOH pharmacy close to their homes or workplace and patients
will receive the same quality of service at any facility choice via a
standard reference method. By choosing this method of collect-
ing medicines, patient can save more time and money.
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ii) Medicines by Post 1Malaysia/Ubat
Melalui Pos 1Malaysia (UMP1M)
As a result of cooperation between MOH and Pos Malaysia Ber-
had, UMP1M is introduced to enable patient’s follow-up medi-
cations supply to be delivered directly to the patient's preferred
location with predetermined post charges. This service will save
patient’s time and money as patient no longer need to go over
the pharmacy counter to take the follow-up medicines. Hence,
patient will not experience parking problem as well. However,
this services is limited to certain medications, where only medi-
cine in tablet or capsules dosage form, with no special storage
condition and non-psychotropic drugs are allowed.
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iii) Appointment System / Sistem Temujanji
Appointment system, also known as instant medicine (IMED) in PKDMT allows patient to collect
their balance medications on the appointed date. This service offers shorter waiting time for pa-
tients as their medications will be prepared before the appointment date. Besides that, this service
can reduce congestion in pharmacy waiting areas during peak hours.
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iv) Drive-thru Pharmacy
This service has been introduced in selected hospitals and health clinics for patient’s convenience
because patient can claim their medications directly at drive-thru pharmacy counter with no wor-
ries of parking space availability. Patient also can get their medica-
tion faster because their medications was pre-prepared before pa-
tient’s appointment date. Hence, this service can avoid congestion
in pharmacy waiting areas. To date, in Malacca, this service is avail-
able only in Klinik Kesihatan Peringgit and Hospital Melaka.
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v) Farmasi Susulan Secara Temujanji (FaST)
This service enables patients to take their follow-up medication supply at Bahagian Perkhidma-
tan Farmasi, Jabatan Kesihatan Negeri Melaka. This service is only applicable for patients from
hospitals or klinik kesihatan in Melaka with prescriptions more than one month supply who lives
or work nearby Jabatan Kesihatan Negeri Melaka. Health facilities that refer patient will prepare
medications together with SPUB form and send it to Jabatan Kesihatan Melaka on Monday and
Tuesday, while medications are ready to be collected from Wednesday to Friday.
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vi) Letak dan Ambil
This service enables patients to take their medication supply without waiting for a long time. Af-
ter taking a number, patient can leave their prescription at pharmacy counter (letak) and collect
their medications later when convenience (ambil). This service is able to reduce congestion in
pharmacy waiting areas during peak hours and provides flexibility to patient to collect their
medication at convenient time.
CARTA ALIR AKTIVITI LETAK DAN AMBIL
PF/PPF
PF/PPF
PF/PPF
PF/PPF
Pesakit mendaftar dan mengambil nombor di kaunter
dan memaklumkan kepada petugas untuk mendapatkan
ubat kemudian.
Petugas memberi nombor kaunter khas dan menghantar
preskripsi untuk diisi dan dilabel.
Ubat yang telah disiapkan akan diasingkan di dalam
kotak khas serta nama pesakit didaftarkan di dalam buku
daftar. Nombor giliran pesakit akan ditekan terlebih da-
hulu walaupun ubat pesakit masih belum dituntut.
Ubat pesakit diserahkan apabila pesakit datang membuat
tuntutan ubat. Bagi ubat yang tidak dituntut, pesakit akan
dihubungi selepas 3 hari untuk datang mengambil ubat.
Ubat yang tidak dituntut akan disimpan sehingga tempoh
2 minggu sebelum dikembalikan semula ke rak ubat.
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HIV Treatment Program is currently available at Sungai Udang Prison. This program is led by
Dr. Nor Hayati binti Shaharuddin, Infectious Disease Specialist from Hospital Melaka. The team con-
sists of Infectious Disease (ID) Specialist, Medical Officers (MO), Infectious Disease Trained Counsel-
lors, Medical Assistants (MA) and Pharmacists. For the time being, visits are scheduled 2 times in a
month, which start at 9.00 am and finish at noon around 1.00 pm.
The objectives of the program in the view of pharmacy are:
i) To optimize the therapy of HAART and other therapies related to HIV patients.
ii) To help patient to recognize and manage adverse drug effects.
iii) To serve as information resource.
iv) To collaborate with other healthcare professionals in managing HIV patients.
It is prison’s policy that every new prisoner must be screen for HIV. HIV positive prisoners will be
identified by MAs and will be referred to either ID Specialist or MOs for further management. The
decision to start or continue HAART is done by doctors, depended on patient’s CD4 count. If there
are patients newly started on HAART, or switching to new regimen or identified compliance prob-
lems, they will be referred to pharmacist.
By Mohamad Hatta & Saiful Adlan
P risons are a high-risk institution for human immunodeficiency virus (HIV) transmission
where drug use, high-risk sex and rape is common. Yet, prisoners’ wellbeing are often ne-
glected and overlooked. HIV treatment program are rarely made available to them, thus making
many prisoners with HIV unable to access to their antiretroviral medications.
Cooperation from all team members of HIV Treatment Program is crucial to
ensure best treatment outcome. It is extremely important that counselling
for HIV positive patients is done properly so that patient receive optimal
HAART management. Compliance and adherence have been the main
challenges in HAART management. Strict adherence to HAART is the key
to sustained HIV suppression, reduced risk of drug resistance, improved
overall health, quality of life, and survival.
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Pre packing All the drugs will be pre packed into weekly basis.
Dispensing Dispensing will be done to patients newly started on HAART and Isoniazid
Preventive Therapy (IPT), while those already on treatment will be supplied
by Medical Assistant.
Counselling Counselling will be given to new patients, patients requiring changes in
HAART regimen and patients with adherence problems. Counselling sessions
will basically cover pre-HAART, HAART, post-HAART and IPT
(occasionally).
Supplying
medications
Pharmacists will make sure that patients’ medication supplies are enough at
all times.
Providing drug
information
Pharmacist will assist other healthcare professionals in term of drug informa-
tion whenever needed.
Stock
procurement
Pharmacist will order HAART medications from Hospital Melaka whenever
needed.
Roles of pharmacist in HIV Treatment Program:
The counselling are usually divided into 3 parts:
Review case notes
Document in case
notes
Counsel patient
Assess data & medi-
cation history
Assess readiness for
HAART
Reassess beliefs, percep-
tions and compliance
End
Pre HAART
Review case notes
Document in case
notes
Counsel patient
Assess data & medi-
cation history
End
HAART
initiated
Review case notes
accordingly
Document in case
Counsel patient
Assess data & medica-
tion history
Assess compliance &
adherence
Patient review by
doctor
End
Post HAART
Select patient to be
counselled
REFERENCES: 1. MOH (2011). Guideline for The Management of Adult HIV Infection with Antiretroviral Therapy 2. MOH (2010). Retroviral Disease (Medication Therapy Adherence Clinic and Ward Pharmacy). 1st Ed.
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Drug Comparison:
PPI and H2-antagonist
By: Woon Su Ann
H2-antagonist Proton pump inhibitor (PPI)
Ranitidine Omeprazole Pantoprazole
Mechanism of action (MOA)1
Competitive inhibition of histamine at H2-receptors of the gastric parietal cells, hence reduce gastric acid secretion. Does not affect pepsin se-cretion, pentagastrin-stimulated intrinsic factor secretion or serum gastrin.
Inhibit H+/K+ ATPase en-zyme in gastric parietal cells, hence suppress gastric acid secretion.
Inhibit H+/K+ ATPase enzyme in gastric parietal cells, hence suppress gastric acid secre-tion.
Prescriber category2
B A/KK A*
Indication & Dosage2
Reflux oesophagitis
150mg BD or 300mg ON for 8-12weeks
Reflux oesophagitis
20-80mg OD/BD up to 8-12weeks
Erosive and non-erosive re-flux oesophagitis (GERD & NERD) 20-40mg OD for 4 weeks
Zollinger-Ellison syndrome
150mg up to max 6g/day
Zollinger-Ellison syndrome
Adult: 20-120mg OD
Child: 0.4-0.8mg/kg/day
Zollinger-Ellison syndrome
40mg BD. Max:240mg OD
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H2-antagonist Proton pump inhibitor (PPI)
Ranitidine Omeprazole Pantoprazole
Indication & Dosage2 Benign gastric & duo-
denal ulcer
150mg BD or 300mg ON for 4-8weeks. Mainte-nance:150-300mg OD
Benign peptic ulcer not responding to conven-tional therapy
20mg OD for 4-6weeks
Peptic ulcer disease
40mg OD for 2-4 weeks
Non-ulcer dyspepsia
150mg BD or 300mg ON for 8-12weeks
Helicobacter pylori eradication
20mg BD with combina-tion of 2 antibiotics (clarithromycin 500mg BD, amoxicillin 1g BD or metronidazole 400mg BD) for 1-2weeks
Helicobacter pylori eradication
40mg BD with combina-tion of 2 antibiotics (clarithromycin 500mg BD, amoxicillin 1g BD or metronidazole 400mg BD) for 1-2weeks
Prevention of NSAID induced gastropathy
20mg OD
(Not recommended in children)
Administration1 Unaffected by food Before meals Before meals
Onset of action1 - 1hour (anti-secretory) -
Time to peak1 Oral: 2-3 hours
IM: <15minutes
Within 2 hours Oral: 2.5 hours
Common side effect1 0-10% Cardioavascular:
Bradycardia (<4%) hypotension (<4%) palpitation(<4%) Central nervous sys-tem: headache (<6%) confusion (<4%)
1-10% Central nervous system: headache (7%) dizziness (2%) Gastrointestinal: ab-dominal pain (5%), diar-rhea (4%)
1-15%
Central nervous system: headache(12%), dizzi-ness (4%) Cardiovascular: facial edema (4%)
Price2 RM 0.13/tab RM 0.50/capsule RM 0.50/tab
Cost per 6 weeks of therapy
RM 10.92 (150mg BD) RM 21.00 (20mg OD) RM 21.00 (40mg OD)
Reference:
1. William J, Matthew A, Morton P et al. American Pharmacists Association. Drug Information Handbook, Lexicomp
Drug Reference Handbook. 22nd ed.
2. Melaka Drug Formulary Committee. Pharmaceutical Services Division. Drug Formulary Melaka 2014/2015.
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by Nadiah Mohd Mohtar
Updates in the Categories of Drugs
listed in MOH Drug Formulary 2015
No. Generic Name Old Category
New Category
Indication Price (RM)
1. Atorvastatin 20mg, 40mg, 80mg Tablet
A* A/KK Hypercholesterolaemia and coronary heart dis-ease intolerant or not responsive to other forms of therapy
0.12(20mg), 0.22(40mg), 0.34(80mg)
2. Terazosin HCL 1mg, 2mg, 5mg Tablet
A A/KK a)1mg: Only for treatment of Benign Prostatic Hyperplasia. Not to be used for treatment of hyperten-sion
0.18(1mg), 0.21(2mg), 0.31(5mg)
b)2mg & 5mg:
i) Treatment of Benign Prostatic Hyperplasia. ii) Hypertension
3. Ketoconazole 2% Shampoo
A A/KK Resistant dandruff only
9.00
4. Ofloxacin 0.3% Otic Solution
A A/KK Acute otitis media with tympanostomy tubes, chronic suppurative otitis media with perfo-rated tympanic membranes and otitis externa
9.65
5. Omeprazole 10mg, 20mg Tablet
A A/KK Only for : i) Reflux oesophagitis ii) For eradication of Helicobacter pylori infec-
tion iii) Benign peptic ulcer not responding to con-
ventional therapy iv) Zollinger -Ellison Syndrome
0.29(10mg), 0.44(20mg)
6. Terbinafine HCL 250mg Tablet
A* A/KK Fungal infections especially onchomycosis caused by dermatophytes
1.00
7. Tretenoin 0.01% Gel
A A/KK Acne vulgaris, recalcitrant cases of acne (comedonal type)
20.70
8. Diclofenac So-dium 75mg/3ml Injection
A A/KK Pain and inflammation in rheumatic disease 0.36
9. Fenofibrate 145mg Tablet
A* A/KK As second line therapy after failed gemfibrozil in patients: i) Hypercholesterolemia and hypertriglyc-
eridemia alone or combined ii) Treatment of secondary hyperlipoproteine-
mias iii) Dyslipidemia in Type 2 Diabetes Mellitus
1.00
References: 1. Senarai FUKKM. (7 December 2015) [Retrieved from http://www.pharmacy.gov.my/v2/ms/apps/fukkm ] 2. MOH Drug Formulary 2014
***Changes do not reflect immediate inclusion into the district formulary. Such drugs will still need to undergo
assessment of usage by district JKTU.
24
Vitamin C Injection for
Enhancement of Beauty By Nur Farahin Abdul Jabar
Vitamin C is a commonly used nutritional supplement. It has numerous well-known health
benefits, include protection against immune system deficiencies, cardiovascular disease,
prenatal health problems and also eye disease. Hence, this causes the global market
flooded with Vitamin C fortified foods. Besides consuming Vitamin C orally, Vitamin C injec-
tion has received a great deal of attention on its role in enhancement of beauty.
POTENTIAL ROLE OF VITAMIN C INJECTION FOR ENHANCEMENT OF BEAUTY
POTENTIAL MECHANISM OF ACTION OF VITAMIN C
25
SAFETY AND EFFICACY STUDIES
There was no significant clinical evidence to prove that vitamin C injection can improve skin
elasticity (anti-ageing and anti-wrinkle) and whiten the skin. Although there was a laboratory
study that showed the potential effect of vitamin C to improve skin elasticity, the study was
low level of evidence. In additions, the safety of vitamin C injection for cosmetic purposes was
inconclusive due to lack of clinical data retrieved.
No USFDA approval of vitamin C injec-
tion for cosmetic purposes
Any kind of Vitamin C injection for cos-
metic used is prohibited by NPCB.
CONCLUSION
Vitamin C injection is not recommended to be used for cosmetic due to lack of clinical evidence and safety data.
REFERENCES
1. Vitamin C Injection for Cosmetic. Health Technology Assessment Section (MaHTAS), Medical Development Division, MOH. 011/2012
2. Park HJ, Ock SM, Kim HJ et al. Vitamin C Attenuates ERK Signalling to Inhibit the Regulation of Collagen Production by LL-37 in Human Dermal Fibroblasts. Experimental Dermatology. 2009; 19: e258-e264.
3. Padayatty SJ, Sun AY, Chen Q et al. Vitamin C: Intravenous Use by Complementary and Alternative Medicine Practitioners and Adverse Effects. PLoS ONE. 2010; 5(7): e11414.