CONTRIBUTORS : - Anida Hamzah - Nur Nadiah Marzuki - Ng Sin Yee - Erwany Md Dewa - Amreet Kaur Gill - Teh Wan Yuan - Loh Tze Min - Tan Siong Guan - Mohd Solleh Rahim - Noridarabiaton Ali Akbar - Ku Yee Kun

Edition 01/2014

PEJABAT KESIHATAN DAERAH JASIN, MELAKA

Pharmacy Bulletin

EVENTS 2 MEDICATION ERROR REPORTING

4

NITROGLYCERIN PRODUCT

6

NEW DRUG IN PKDJ 8

INSUMAN 10

STAFF UPDATES 13

POSITIVE THINKING 14

SUPPLEMENTS 12

MTAC Medication Therapy Adherence Clinic (MTAC) is an ambulatory care service by certified pharmacists in collaboration with physicians with the aim of empowering patients in disease control. It was introduced in 2004 as part of the Clinical Pharmacy Services of the Ambulatory Clinic System, emphasizing on medication management to improve quality, safety and cost-effectiveness of patient care. This year, Klinik Kesihatan (KK)Selandar, KK Jasin and KK Merlimau have started conducting diabetes MTAC (DMTAC). KK Umbai will begin in October 2014. DMTAC’s aim is to help diabetic patients improve their medication adherence level and glycemic control. The patients enrolled in this clinic will be followed up for a minimum of eight (8) visits where they will receive a number of services including medication adherence assessment, medication counseling, and diabetes education by pharmacists. Apart from that, pharmacists will also assess patients and address their needs as well as scheduling appointments for them. Any pharmaceutical related issues and changes will be noted in both the MTAC review and the patient’s case notes. Patients will be discharged provided he completed all the necessary education modules and showed excellent diabetes control.

EDITORIAL BOARD ADVISOR : Chan Bee Leng EDITOR: Lio Ee Lee

Inside this issue:

On 29th April 2014, a methadone programme was organized by Klinik Kesihatan Selandar. The event was held in Dewan Parameswara from 8.00 am to 1.00pm.

The objectives of the programe include: • To strengthen the bond between patients and staffs • To reinforce the inclusion and exclusion criteria and to highlight the

essential rules • To give vivid explanation to the methadone clients regarding the order

to stop supplying takeamway doses • To introduce the Methadone 1 Malaysia (M1M) service to all the

clients as an approach to encourage DOT. At the end of the session, several prizes were given away to those who

won the lucky draw and a special reward was presented to the best methadone client in Klinik Kesihatan Selandar for Year 2014. Before adjournment, a Q&A session was dedicated for the clients to share related issues and clarify their doubts regarding the MMT programme. The programme ended successfully with co-operation from the medical officers, pharmacists, medical assistants, staff nurses as well as the methadone clients.

Page 2 Events KK SELANDAR - METHADONE PROGRAMME

Inside Story Headline

BIL TARIKH MASA TEMPAT

1 13/1/2014 8.30-12.30 KK Merlimau

2 13/1/2014 2.30-4.30 KK Umbai 3

23/4/2014 8.00-12.00 SMK Dato Abd

Rahman Yaakub

4 29/4/2014 8.00-12.00

KK Selandar

5

24/5/2014 8.00-5.00

MINI Stadium Jasin

6

25/5/2014 8.00-1.00

Japerun Serkam

7 20/6/2014 8.00-12.00

KK Umbai

8

21/6/2014 8.00-1.00

Sek Keb Tehel

9 22/6/2014 8.00-12.00

Balai raya Kg. Alai

AKTIVITI

Pameran QUMC

Pameran QUMC

Pameran QUMC

Ceramah & Pameran QUMC

Pameran QUMC Sempena Karnival Pendidikan & Kerjaya Pameran QUMC Sempena Program Kesihatan Cegah Kanser Servik &Payudara Pameran&Ceramah Sempena Program Nafas Baru Bermula Ramadhan Pameran & Ceramah QUMC sempena Program Doktor Muda

Pameran & Ceramah QUMC

BIL PESERTA

55

40 60

40

43

100

35

200

77

Events Quality Use of Medicine-Consumer (QUM-C ) Jan - June 2014

Page 3

What is a medication error? A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient or consumer. Such an event may be related to professional practices, healthcare products, procedures and systems including prescribing, order communication, product labelling, packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use. Although many medication errors may not cause grave harm to patients, some medications are known to carry a higher risk of harm than other medications. Errors in the administration of these medications can have catastrophic clinical outcomes.

Medication Error Reporting Online

Page 4

Below are strategies that can be implemented by the facility in order to reduce the medication errors.

• Allergy card • Streptokinase card • Splenectomy card • General vaccination card • High Alert Medication Labeling • Unit Dose • Medication Therapy Adherence Cilinic (MTAC) • Medication Reconciliation / Pharmacist Discharge Planning • Medication Counselling • Medication History Taking • Tallman Lettering • Standard Medication Abbreviation • Medication Generic Name

Example of prescription with non-standard abbreviation:

The ‘MTF’ abbreviation is non-standard and cannot be used to prescribe a Metformin. The prescription can be mistakenly filled with MTX, which is the standard abbreviation of Methotrexate. In Malaysia, medication error reporting is at the moment on a voluntary basis.All the error detected can be reported online via http://mers.moh.gov.my/MERS. The main objective of medication reporting is to minimise the reoccurrence of errors and ultimately to improve patient safety.

Medication Error Reporting Online

Page 5

Reference:

Guideline on Medication Error Reporting. MoH. 1st ed. July 2009.

Nitroglycerin is a vasodilator,

a medicine that opens

blood vessels to improve

blood flow. It is used to

treat angina, a type of chest

pain or discomfort

that happens when there is

not enough blood flowing

to the heart. To improve

blood flow to the heart,

nitroglycerin opens up (dilates)

the arteries in the heart

(coronary arteries), which

improves symptoms and

reduces how hard the heart

has to work. Quick-acting

forms of nitroglycerin are used

to relieve angina or used just

before activities that typically

cause angina. Long-acting

forms of nitroglycerin are used

to prevent angina from happen-

ing. They are not used to stop

sudden symptoms of angina.

Type of Nitroglycerin Products

Nitroglycerin comes in quick-acting forms and long-acting forms.

1) Quick-acting forms:

• · The tablets are placed under the tongue (sublingual) or between the cheek and gum (buccal).

• · The spray is used on or under the tongue

• 2) Long-acting forms:

• · Extended-release tablet

• · Skin patches

Quick-acting Nitroglycerin A) Tablet The different types of nitroglycerin tablets

include sublingual and buccal tablets. Be-

fore using any type of nitroglycerin, pa-

tients should sit down, because it may

cause fainting or dizziness. The doctor may

instruct the patient to take a dose before

any physical activity that may cause angina

or as soon as the patient first notices symp-

toms. Some people may be instructed to

take a second dose after five minutes if the

first dose does not alleviate chest pain. A

third dose may be taken five minutes after

the second if needed. In the event that three

nitroglycerin tablets are ineffective at re-

lieving symptoms, patients will need to call

for an ambulancefive minutes following

the third dose. Buccal nitroglycerin tablets

should be placed in the mouth between the

gum and the cheek and allowed to dissolve

completely. Patients must avoid chewing

or swallowing these tablets.

Page 6

Fig. 1 GTN Spray. Fig. 2 GTN patch

B) Spray Those who have difficulty with nitroglyc-

erin tablets may take the drug in a spray.

Patients should avoid shaking the con-

tainer. After removing the cap, it should be

held upright and placed very close to the

patient’s open mouth. He may then press

the button once to release one dose. The

medicine should not be inhaled and pa-

tients must avoid spitting or drinking for

five to 10 minutes. To treat an angina at-

tack, use 1 to 2 sprays on or under the

tongue as directed by your doctor. Sit qui-

etly after using a dose. A spray may be re-

peated every 3 to 5 minutes as directed by

your doctor.

Do not use more than 3 sprays in 15 min-

utes unless your doctor tells you otherwise.

If chest pain continues after a total of 3

sprays, seek medical attention at once,

unless your doctor gives you different in-

structions. If you use nitroglycerin spray to

prevent angina caused by physical activity,

use it 5 to 10 minutes before activity.

Long-acting Nitroglycerin A) Extended-release Tablet Extended-release tablet of glyceryl trinitrate are used to prevent

the chest pain caused by angina pectoris. Angina occurs when

there is an inadequate supply of oxygen for the work the heart is

performing. The tablets will reduce the heart's work and will

release the medicine slowly giving protection over several

hours. Extended-release tablets are not suitable for treating an

attack that has already star ted as the tablets will take too long to

start working. One example of extended-release tablets available

in market is Sustac® Tablet.

B) Skin Patches Apply one patch every 24 hours. It is usual to apply the patches

to your chest or upper arm, but this may vary depending upon

which brand of patches you have been given. Use a different

area of skin each time you apply a patch. When you use GTN all

the time, your body becomes used to it and then it has much less

of an effect. To overcome this tolerance, you may remove the

patch before you go to bed, to leave your blood free of nitrate in

the early hours when you are asleep.

Page 7

References:

1) Glyceryl Trinitrate for Angina. Available online: http://www.patient.co.uk/medicine/glyceryl-trinitrate-for-angina

2) Nitroglycerin. MedlinePlus, National Institute of Health. Available online : http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601086.html

3) Nitroglycerin Spray. Available online: http://www.drugs.com/cdi/nitroglycerin-spray.html

New Drugs in PKDJ 1. GLICLAZIDE 60MG MODIFIED RELEASE TABLET

INDICATION As monotherapy or in combination with other oral anti-diabetic agents in type 2 diabetes when • Dietary measure • Physical exercise • Weight Loss

2. BENZOYL PEROXIDE GEL BP 5%

INDICATION • Mild to moderate acne vulgaris

Page 8

3. INSUMAN COMB (biphasic) INSUMAN BASAL (intermediate acting) INSUMAN RAPID (short acting)

INDICATION Same indication as insulin from Novo Nodisk

4. INSULIN GLARGINE 300IU/3ML INJECTION

INDICATION Diabete mellitus type 1 in adult and child over 6 years Diabetes mellitus type 2 in adult

New Drugs in PKDJ Page 9

COMPARISON BETWEEN INSUMAN AND NOVO NORDISK INSULIN

Product Novo Nordisk Insulin

Recombinant human in-sulin

√ √

Type of insulin

NPH Intermediate Insulin

Insulatard

Insuman® Basal

Regular Insulin

Actrapid

Insuman ® Rapid

NPH Premixed Insulin

Mixtard

Insuman ® Comb 30

Page 10

Time of admini-stration

NPH In-termediate Insulin

1 hour before bedtime 45-60 min before meal; can be once (evening or bedtime) or twice-daily (plus in the morning)

Regular Insulin

30 min before meal 15-20min before meal

NPH Pre-mixed In-sulin

30 min before meal (twice daily)

30-45 min before meal (twice daily)

Method of admini-stration

Subcutaneously.

Subcutaneously.

Insulin Pen Novopen 4 ALLSTAR™

Re-suspension Insulatard and Mixtard need to be resuspended before injection.

Insuman® Basal and Insuman® Comb 30 need to be resuspended before injection. Insuman® Basal and Insuman® Comb 30 Cartridges have three metal bullets that allow an efficient mixing procedure

Product Novo Nordisk Insulin

Page 11

A dietary supplement is intended to provide nutrients that may otherwise not be consumed in sufficient quantities. Supplements as generally understood include vitamins , minerals , fiber, fatty acids, or amino acids , among other substances. They are marketed in dose form as pills, tablets, capsules, or liquid in measured doses.

Page 12

No. Products Supported goal 1. Amino acids powder / capsules

Increase energy

2. Fish oils soft gels with omega 3 essential fatty acid

Health & Wellness Support healthy heart function , joint

flexibility, cell production

3. Garlic tablet Improve immune system , fight germs of all sort , and reduce the risk for

heart disease

4. Gingko Biloba An Herb Improve blood circulation, which

might help in brain , eyes, ears, and legs function better

5. Alfafa Complex High in protein , calcium, and miner-

als. Also use in herbal medicine to stimu-late appetite and improve digestion

problems

6. Lecithin Capsules Lecithin is a source of choline, an essential nutrient

Benefit in acne , in improving liver function , and in lowering cholesterol

7. Vitamin B Complex Health & Wellness Help to metabolize protein, fats, and

carbohydrates into energy

8. Vitamin C Tablet Health & Wellness Improve immune system ,

Supporting the body natural antioxi-dant

Supplements

Page 13

Noridarabiaton Ali Akbar (PF U41, KK Kemendor)

Tham Ngan Yin Nor Haniza Bt Khairudin

Nor Liza Bt Rabbu

New staff in PKDJ

Pharmacist

Teoh Sook Yee (PF U44, KK Selandar)

Pharmacy Assistant

Qurratu' Aini Bt Kaber ( PPF U29, KK Kemendor)

( PPF U29, KK Umbai) ( PPF U36, KK Jasin)

( PPF U29, KK Umbai)

Page 14