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1
Advisors
Puan Saidatul Raihan Ibrahim
Editor
Atiqah Mohamad Ali
Contributers
Chong Li Wen
Tan Su Ping
Loo Sui Yin
Editorial Board
Ms Tay Eek Poei
Puan Syamsiah Haji Shariff
Puan Julia Shamsudin
PHARMACY NEWSLETTER H O S P I TA L M E L A K A ● VO L 3 1 : S E P T — O K T 2 0 1 5
2
NO TOPICS PAGES
1
~ HAZE
How it happen?
Impact
Precautions
2 ~ Naturopathy
3 ~ Rivaroxaban Versus Dabigatran in Atrial Fibrillation
4 ~ Sevelamer Carbonate 800mg Tablet
5 ~ Medic Alert
6
~ Metoclopromide
7 Laughter is the best medicines
8 ~ Sambutan Hari Keluarga 2015
“ Keluarga Bahagia, Organisasi Cemerlang”
3
The haze we see in our city skyline is caused by tiny particulates
suspended in the atmosphere resulting in diminished horizontal visibility. The
haze that affected Malaysia was the worst since 2005, starting with the Air
Pollution Index (API) hitting 172 on 19 June 2015.
Sumatera and Kalimantan possess large area of peatlands, which is highly
combustible during dry season.
Peat, which is made up of layers of dead vegetation and other organic matter,
contributed heavily to carbon emissions because of the substance's density.
Fires caused by firms and farmers who engage in illegal slash-and-burn practices
as a relatively inexpensive means of clearing land resulted in haze.
The El Niño phenomenon which has caused drier conditions, allowing the fires
to spread more. Thus, the haze has been more severe in 2015
By : Tan Su Ping
4
Children and the elderly in general are more likely to be
affected.
Persons with medical problems like asthma, chronic lung
disease, chronic sinusitis and allergic skin conditions such as
eczema are likely to be more affected by the haze and they
may experience more severe symptoms
1. It is important to take medication regularly.
2. Do not skip the dose.
3. Minimize outdoor activities.
PERSON UNDER MEDICAL TREATMENT
1. Are advised not to engage in outdoor sporting
activities if the PSI is above 100.
2. Should always ensure that medications are on hand
and readily available.
PERSONS WITH CHRONIC HEART AND LUNG
PROBLEMS
1. Drink plenty of water to stay hydrated
2. Persons who are feeling unwell, are advised to seek
medical care.
3. Use mask if for persons who has to be outdoors for
several hours when air quality is in the hazardous
range ( PSI > 300 )
GENERAL PUBLIC
References
1. Impact of Haze on Health, Health Board Promotion, 14 September 2015, http://hpb.gov.sg/HOPPortal/health-article/HPB051226
2. "South East Asia haze: What is slash-and-burn?". BBC. 24 June 2013. Retrieved25 September 2015.
3. Chew Hui Min (15 September 2015). "Malaysia and Indonesia begin cloud seeding to fight haze: How cloud seeding works". The Straits Times. Retrieved 15 September 2015.
4."What causes South East Asia's haze?". News. BBC. 16 September 2015. Retrieved16 September 2015.
5
Principle of naturopathy
Naturopathic medicine is a
distinct primary health care
profession, emphasizing
prevention, treatment, and
optimal health through the
use of therapeutic methods
and substances that
encourage individuals’
inherent self-healing process.
Naturopathy, or naturopathic
medicine, is a system of
medicine based on the
healing power of nature.
There are 2 areas of focus in
naturopathy:
one is supporting the body's
own healing abilities, and the
other is empowering people
to make lifestyle changes
necessary for the best
possible health.
While naturopathic doctors
treat both short bouts of
illness and chronic conditions,
their emphasis is on
preventing disease and
educating patients.
The following principles are
the foundation of
naturopathic medical
practice:
The Healing Power of
Nature (Vis Medicatrix
Naturae): Naturopathic
doctor trust in body inherent
wisdom to heal itself.
Identify and Treat the
Causes (Tolle
Causam): Effectively identify
and remove the
underlying causes of illness
rather than eliminate or
suppress symptoms.
First Do No Harm
(Primum Non Nocere):
Seek to utilize the most
natural, least invasive, and
least toxic therapies first.
Doctor as Teacher
(Docere):
Naturopathic doctor educate
their patients and encourage
self-responsibility for health.
Treat the Whole
Person: : Total health
includes physical,
emotional, mental, genetic,
environmental, social,
spiritual, and other factors.
Prevention:
Encourage and emphasize
disease prevention and
focus on promoting health
and wellness.
Introduction
By : Cheong Li Wen
6
There is little depth research on the
effectiveness of some therapies,
supplements or herbs. Although
some are validated by the use of
these remedies in a thousand years.
Sometimes the dose in each patient
is a matter of trial and error to
adjust the dose.
Further studies are needed on the
interaction between natural
One of the main disadvantages of
natural medicine that is not as
efficient as the allopathic to treat
medical emergencies and even less
if severe.
Natural remedies are slower to seek
healing and calm the symptoms, but
at any given time is a disadvantage
because these symptoms can be
very aggressive and require rapid
elimination.
remedies and allopathic medicines
since in some cases may detract
from some or / and others or even
cause some inconvenience.
Disadvantages
Advantages
Naturopathic practitioners use many different treatment
approaches. Examples include:
Dietary and lifestyle changes
Stress reduction
Hydrotherapy
Herbs and other die-
tary supplements
Acupuncture
Homeopathy
Manipulative therapies
Exercise therapy
Practitioner-guided detoxification
Psychotherapy and counseling.
Some practitioners use other methods
as well or, if appropriate, may refer
patients to conventional health
care providers.
References:
1. http://www.naturopathic.org/content.asp?contentid=59
It aims to treat the root cause of your illness, not just the symptoms
It is a totally natural and drug free treatment method
Used for maintaining wellness once the initial condition is rectified
Naturopathy is safe and effective for both adults and children
7
Rivaroxaban Dabigatran
Indication in AF
Reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
Prevention of stroke and systemic embolism associated with nonvalvular atrial fibrillation
Dose
● CrCl >50 mL/min: 20 mg/day PO ● CrCl 15-50 mL/min: 15 mg/day PO ● CrCl <15 mL/min: Avoid use ● If acute renal failure develops while on rivaroxaban, discontinue treatment
● CrCl >30 mL/min: 150 mg PO BD ● CrCl 15-30 mL/min: 75 mg PO BD ● CrCl <15 mL/min or dialysis: No data available; not recommended
Mode of Action
● Factor Xa inhibitor that inhibits platelet activation by selectively blocking the active site of factor Xa without requiring a cofactor (eg, antithrombin III) for activity
● Prevents thrombus development through direct, competitive inhibition of thrombin (thrombin enables fibrinogen conversion to fibrin during the coagulation cascade) ● Inhibits free and clot-bound thrombin and thrombin-induced platelet aggregation
Pharmacokinetic
● Absorption - Bioavailability: 80-100% - Peak plasma time: 2-4 hr ● Distribution - Protein bound: 92-95% (mainly albumin) - Vd: 50 L ● Metabolism - Metabolized by the liver via oxidative deg-radation catalyzed by CYP3A4/5 and CYP2J2 - hydrolysis ● Elimination - Half-life: 5-9 hr; 11-13 hr (elderly) - Excretion: Feces (21% as metabolites; 28% unchanged), Urine (30% as metabolites; 36% unchanged)
● Absorption - Bioavailability: 3-7% - Peak plasma time: 1 hr ● Distribution - Protein bound: 35% - Vd: 50-70 L ● Metabolism -Prodrug dabigatran etexilate (substrate of the effux transporter P-gp) is converted to dabigatran - Not a substrate, inhibitor, or inducer of CYP450 enzymes ● Elimination - Half-life : 12-17 hr - Excretion : Urine (80%)
Storage
Store at 25⁰C
Store at 25⁰C
Price
● Rivaroxaban 15mg Tablet - RM 213.80 / 30 Tab ● Rivaroxaban 20mg Tablet - RM 213.80 / 30 Tablet
●Dabigatran Etexilate 75 mg Capsule - RM 5.95 / 30 Cap ●Dabigatran Etexilate 110 mg Capsule - RM5.95 / 30 Cap ●Dabigatran Etexilate 150 mg -RM5.95 / 30 Cap
By : Atiqah Ali
RIVAROXABAN VERSUS DABIGATRAN IN ATRIAL FIBRILLATION
References : 1. http://online1.mimsgateway.com.my/
2. http://reference.medscape.com/
8
● Sevelamer carbonate is a polymeric phosphate binder used to treat
hyperphosphatemia in ESRF patient undergoing hemodialysis.
● When taken with meals, it binds to dietary phosphate within intestinal
lumen, limiting absorption and decreasing serum phosphate
concentration without changing calcium, aluminum, or bicarbonate
concentrations.
● Sevelamer carbonate is currently marketed by Sanofi under the trade
names Renvela
Pharmacokinetic : Sevelamer carbonate is orally administered
and not systemically absorbed, according to results of a mass
balance study using 14C-sevelamer hydrochloride in 16 healthy
volunteers. No absorption studies have been conducted in patients
with kidney disease. It is excreted via feces.
Maintenance dose
Dosage adjustment based on serum phosphate
concentration (goal 1.13-1.78 mmol/L)
Serum PO4 [>1.78 mmol/L]: Increase dose by 400
-800 mg per meal
Serum PO4 [1.13-1.78 mmol/L]: Maintain current
dose
Serum PO4 [1.13 mmol/L]: decrease by 400-800
mg per meal
Initial dose
Serum PO4 [>2.91 mmol/L]:
1600 mg PO q8hr with meals
Serum PO4 [2.42-2.91 mmol/L]:
1200-1600 mg PO q8hr with
meals
Serum PO4 [1.78-2.42 mmol/L]:
800 mg PO q8hr with meals
DRUG PROFILE SEVELAMER CARBONATE
By : Loo Sui Yin
9
Pharmacodynamics:
● Sevelamer carbonate, a non-absorbed phosphate binding cross-linked polymer, free of metal
and calcium.
● It contains multiple amines separated by one carbon from the polymer backbone.
●These amines exist in a protonated form in the intestine and interact with phosphate molecules
through ionic and hydrogen bonding.
● By binding phosphate in the dietary tract and decreasing absorption, sevelamer carbonate
lowers the phosphate concentration in the serum.
● Sevelamer does not contain calcium and decreases the incidence of hypercalcaemic episodes
as compared to patients using calcium based phosphate binders alone.
● The effects of sevelamer on phosphorus and calcium were proven to be maintained throughout
a study with one year follow-up.
References;
Renvela (sevelamer carbonate) Product Monograph Page 10 of 22
Barna, M. M., Kapoian, T., & O'Mara, N. B. (2010). Sevelamer carbonate.Annals of Pharmacotherapy, 44(1), 127-134.
Fan, S., Ross, C., Mitra, S., Kalra, P., Heaton, J., Hunter, J., ... & Pritchard, N. (2009). A randomized, crossover design study of sevelamer carbonate pow-der and sevelamer hydrochloride tablets in chronic kidney disease patients on haemodialysis. Nephrology Dialysis Transplantation, 24(12), 3794-3799.
Finn, W. F., Joy, M. S., & Hladik, G. (2004). Efficacy and safety of lanthanum carbonate for reduction of serum phosphorus in patients with chronic renal failure receiving hemodialysis. Clinical nephrology, 62(3), 193-201
Finn WF.Lanthanum carbonate versus standard therapy for the treatment of hyperphosphatemia: safety and efficacy in chronic maintenance hemodialysis patients. SPD 405-307 Lanthanum Study Group. Clin Nephrol. 2006;65:191-202
evaluated long term (2 years)
safety and tolerability of
lanthanum carbonate.
Lanthanum is demonstrated
to be as effective and
tolerable as the standard
therapy (any approved
phosphate binder), with
lower serum calcium levels
and improved PTH levels.
Lanthanum carbonate has
similar efficacy to sevelamer in
reducing phosphate levels, with
the initial dose of 750mg or
1500mg/day and titrated
according to serum phosphate
levels.
An open-label, parallel-group
active comparator-controlled
trial involving 1566 patients
Alternative:
Lanthanum carbonate is also
free of calcium and aluminum.
This agent has no known
biotransformation and does
not have and known local or
systemic drug interactions. It
does not cross blood-brain
barrier and thus has a low
potential for central venous
system effects.
Adverse effect:
Most frequently occurring adverse reaction in short term, 8 weeks, cross over study were nausea and
vomiting. In long term studies, the most common adverse events included vomiting, nausea, diarrhea,
dyspepsia, abdominal pain, flatulence and constipation.
SEVELAMER CARBONATE
10
What Is MedicAlert® And What MedicAlert® Does?
MedicAlert®
By : Cheong Li Wen
MedicAlert® is a device or a system that is used to send out an alert in case one has a medical emergency like a
fall, an injury or a sudden attack by a disease like a heart attack or asthma. MedicAlert® Foundation helps these
people by providing them through their doctors, with “MedicAlert®” pendants or bracelets on which their special
disabilities are engraved, so that when the need arises, attending doctors will be able to provide the correct
treatment which may help save their life.
Ambulance paramedics and health care professionals are trained to look for genuine MedicAlert® emblems.
The bracelets and pendants have a reputation for accurate information and high product standards ensuring
correct diagnosis and identification. It can be the only source of identification for patients who are unconscious,
disoriented or unable to speak.
● a bracelet or pendant customized engraved with vital
emergency information,
● a 24 hour hotline number and a member ID number;
the information on the bracelet or pendant alerts health
care professionals to medical conditions, allergies and
special instructions which would all speed diagnosis and
treatment,
● the 24 hour confidential emergency telephone
hotline, providing additional medical/personal details
from confidential computerized records, including
medication, physician’s and emergency contacts,
● all registrations include a membership card
providing additional protection and identification
Who needs it? ● Person with any medical problems such as
~ diabetes, allergies or epilepsy
~person with pacemakers or artificial hips need such a medical
information system.
~ Under normal circumstances they would be able to inform doctors of
their condition, but in times of emergency or when they are unconscious
or otherwise unable to speak, MedicAlert® speaks for them.
● The MedicAlert® emblem, worn on the wrist or round the neck, is
recognized the world over. It incorporates the symbol on one side (the
snake round a stick), and the medical problem of the wearer on the
other side, along with a telephone number of the 24-Hour hotline
maintained by the foundation.
MedicAlert® comprehensive services are:
11
How to apply?
Membership Plan
1. Ordinary Plan: 5 Years of membership including emblem and wallet card
2. Life Plan: Life time membership including emblem and wallet card
Benefits Includes
1. Faster treatment and care, especially in emergencies
2. Reduced risk of complications or uncertainties
3. Assurance of personal information security while safeguarding your life
4. Reduced fear and anxiety for you and your loved ones
What Do You Get ?
1. MedicAlert® emblem—A high quality MedicAlert® emblem is personalized with free engraving and recognized by emergency responders around the world.
2. Emergency Wallet Card—Your wallet card is personalized and includes our live 24-hour emergency response number
The Step By Step Guide To MedicAlert®
Step 1 | Fill in the downloadable registration form and make sure it is
approved by a certified doctor.
Step 2 | All details of new member will be recorded in the
MedicAlert® main database.
Step 3 | Medical details of new member will be engraved at the back
MedicAlert® bracelet/pendant.
References :
1. http://www.medicalert.org/
2. http://www.medicalert.org/
101 Menara Mutiara Majestic,
15 Jalan Othman,
46000 Petaling Jaya, Selangor Darul Ehsan,
Malaysia.
MedicAlert® Foundatio
n
Phone: +603-77820515
Fax: +603-77820515
Hotline: +6012-3411137
E-mail: [email protected]
We’re on the web
medicalert.com.my
Help to protect and save lives.
ORDINARY LIFE RENEWAL
MEMBERSHIP FEE RM 100
( for 5 years )
RM 500
( for a lifetime)
RM 100
( for 5 years )
BASIC EMBLEM
COST
RM 50 each RM 50 each RM 50 each
12
The European Medicines
Agency’s Committee has
reviewed the benefits and
risks of the antiemetic
metoclopramide. The review
confirmed the well-known
risks of neurological effects
such as short-term
extrapyramidal disorders
and tardive dyskinesia.
The risk of acute
neurological effects is
higher in children, although
tardive dyskinesia is
reported more often in the
elderly, and the risk is
increased at high doses or
with long-term treatment.
The conclusion of the review
was that these risks
outweigh the benefits in
long-term or high-dose
treatment. There have also
been very rare cases of
serious effects on the heart
or circulation, particularly
after injection.
The review has
recommended changes that
include a restriction to the
dose and duration of use to
help minimize the risk of
potentially serious
neurological adverse effects.
The risk of acute
neurological effects is
higher in children than in
adults.
By : Loo Sui Yin
Adults Paediatrics ( 1-18 years old )
Injection ● Prevention of post-operative nausea and
vomiting, symptomatic treatment of
nausea and vomiting, including nausea
and vomiting induced by migraine attacks.
● Prevention of radiotherapy-induced
nausea and vomiting.
● Prevention of delayed chemotherapy-
induced nausea and vomiting (CINV) as a
second-line option.
● Prevention of post-operative nausea and
vomiting (PONV) as a second-line option.
Oral ● Prevention of delayed chemotherapy
induced nausea and vomiting (CINV).
● Prevention of radiotherapy induced
nausea and vomiting (RINV) Symptomatic
treatment of nausea and vomiting,
including acute migraine induced nausea
and vomiting.
● Prevention of delayed chemotherapy
induced nausea and vomiting (CINV) as a
second line option.
Rectal ● Prevention of delayed chemotherapy
induced nausea and vomiting (CINV).
● Prevention of radiotherapy induced
nausea and vomiting (RINV).
● Not indicated.
Indication and dose of metoclopramide
1.INDICATION
13
References;
European Medicine Agency, 2013.
Biro Pengawalan Farmaseutikal Kebangsaan www.bpfk.com.my
2. RECOMMENDED DOSE
Adult Paediatrics ( 1-18 years old )
● The solution can be administered by the intravenous or intramuscular route.
● The intravenous doses must be administered as a slow bolus (for at least 3 minutes)
Injection
● 10 mg per dose, 1 to 3 times daily.
● The maximum recommended daily dose
is 30 mg or 0.5 mg/kg.
● Treatment duration when administering
by injection should be as short as possible
and a switch to administration via oral or
rectal route should be instituted as
quickly as possible.
● The recommended dosage is 0.1 to 0.15
mg/kg, 1 to 3 times daily, by intravenous
route.
● The maximum daily dose is 0.5 mg/kg.
(please refer to the dosing table for
paediatrics below)
Oral ● 10 mg, repeated up to 3 times daily.
● The maximum recommended daily dose
is 30 mg or 0.5mg/kg body weight.
● The maximum recommended treatment
duration is 5 days
● The recommended dose is 0.1 to 0.15 mg/
kg body weight, repeated up to three times
daily by oral route.
● The maximum dose in 24 hours is 0.5 mg/
kg body weight. For the prevention of
delayed CINV, the maximum treatment
duration is 5 days.
● For the prevention of PONV,the maximum
treatment duration is 48 hours.
● Tablet are not suitable for use in children
weighing < 30kg. (please refer to the
dosing table for paediatrics below)
Rectal A minimum interval of 6 hours between
two administrations is to be respected,
even if vomiting or rejection of the dose
occurs
Not indicated
Dosing for paediatrics
Age ( years old ) Body Weight (kg) Dose (mg) Frequency
1-3 10—14 1
Up to 3 times a day
3-5 15—19 2
5-9 20—29 2.5
9-18 30—60 5
15-18 >60 10
Generally, it is advisable to maintain the gap between the dose for at least 6 hours.
14
Can we just...
….get along??
Sources :
1. https://www.cartoonstock.com/directory/p/pharmacy.asp
2. https://sciencebasedpharmacy.wordpress.com
15
Tu dia… Semua ahli keluarga dalam Jabatan Farmasi ni
stabil dan fleksibel tau.
Salah satu aktiviti untuk adik—adik yang comel adalah
mewarna!
Antara wajah—wajah gembira keluarga besar Farmasi Hospital Melaka yang menghadiri Hari Keluarga
Aktiviti yang dinamakan Boling Kelapa Ini pula aktiviti tradisional menganyam ketupat