buletin farmasi 10/2013

7/27/2019 Buletin Farmasi 10/2013

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Methadone ialahubat yang ter-

golong di dalamkumpulan opioidyang digunakansebagai terapigantian untuk mer-awat ketagihanheroin dan lain-lainketagihan opioid.

Opioid dikelaskansebagai ubat-ubatpenekan(depressant drugs)kerana ia memper-lahankan sistemsaraf.

Kesan methadoneadalah lebih lamadaripada heroin(kesan heroin han-

yalah selama be-berapa jam sa-

haja).PerkhidmatanRawatan TerapiGantian Metha-done di Klinik Kesi-hatan Batu Gajahberoperasi sejakMac 2011. Ber-mula denganhanya seorangpesakit, kini(sehingga Jun2013) seramai 25orang telah berdaf-tar untuk menjalanirawatan ini di KKBatu Gajah.

Perkhidmatan inidibuka pada jam

9.00 pagi hingga10.00 pagi setiaphari bekerja. Padahari minggu dancuti am, parapesakit akan keHospital TanahMerah untukmeneruskan rawa-tan mereka.

Pesakit untuk ke luar negara perlu mengemukakan permohonankepada Pegawai Farmasi atau Pegawai Perubatan/Pakar, se-kurang-kurangnya 1 bulan sebelum tarikh lawatan.

Setiap pesakit yang menjalani rawatan terapi gantian

methadone hanya perlu mengambilnya sekali sehari

sahaja.

Tahukah anda?

Sirap Methadone adalah selamat digunakan untuk ibu hamil danmenyusukan anak.

Sirap Methadone yang telah di-cairkan (mengikut garis panduan) adalah stabil selama 7 hari pada suhubilik.

Pendispensan methadone 1

Sidang pengarang 2

Statistik methadone KK Batu Gajah 2-3

History of Methadone 3

Methadone Dispensing Policy 4-6

Benefits MMT for Clients 7

Myths & Facts About Methadone 8

BCG Does Not Only A Vaccine 9

The Rise in Bed Bugs 9

Taking Your Meds Safely 10

Eczema & Topical Steroids 11

Aktiviti Farmasi Kesihatan Tanah 12

Isi kandungan

P K D T A N A H M

E R A H

U N I T

F A R M

A S I

OKTOBER 2013

BULETIN FARMASI

Tempoh lawatan ≤1 minggu

Dalam kepekatan Dos Bawa Balik(dicairkan)

Tempoh lawatan >

1 minggu

Dalam kepekatan asal. Pesakit perlu diberi

maklumat pencairan Sirap Methadone se-cara bertulis



PN. ZUNAIDAH MAT JUSOH

NABILAH ISMAIL

MD FARHAN AB RAHMAN

DINA AZWIN BAHARUDIN

RABIATUL ADAWIYAH ADNAN



II but not as much as antici-pated.

The German patents onmedical drugs werevoided at the end of WorldWar II.

In 1947, Dolophine, thetrade name for metha-done, was released in theUnited States as a painreliever.

Soon it just becameknown as methadone.

In the 1960's, heroin usewas growing.

Initially as a marketing planto sell it, methadone, a“legal” drug, was promoted

as a replacement for heroin,an illegal drug.

Because methadone wastaken orally and not intra-venously or by snorting, itwas not only legal butalso less likely to causeother diseases and con-ditions.

In order to regulate the

use of methadone as a“treatment” for heroin, theDrug Enforcement Agency (“DEA”) issuedthe Controlled Sub-stances Act in 1970.

This act established strictrules for methadone clin-ics, or Narcotic Treat-ment Programs (NTPs).

Methadone - The predomi-nant painkiller used in Ger-many, and most of the world,

in the 1930's for injuries andfor wounds.

Since it appeared that awar was coming, the Ger-man government realizedthat it would need sup-plies of painkillers andthat their access to rawopium might be inter-rupted, and thus encour-

aged the development of alternative painkiller drugs.

Methadone was devel-oped in the late 1930's inGermany by the I.G. Far-ben company.

Methadone is almost aseffective if taken orally asif injected.

Named Amidon, methadone

was used during World War

INFO

Bilangan daftar pesakit metha-done sehingga Jun 2013

adalah seramai 25 orang tidaktermasuk kes „transfer in‟.

Semua pesakit methadone diKK Batu Gajah adalah „DOT‟(directobservetherapy)dan tiada„DBB‟(dos

bawabalik).

PKD TAN AH ME RAH

18

22

25

1715 14

0

5

10

15

20

25

30

2011 2012 2013 (Jan-Jun)

Bilangan pesakit Methadone

KK Batu Gajah

Bil.Daftar Bil. Pesakit Aktif

http://c/Users/Farmasi%20KKBG%202/Desktop/Buletin%20Farmasi%20PKDTM/methadone-pain-management.php

http://c/Users/Farmasi%20KKBG%202/Desktop/Buletin%20Farmasi%20PKDTM/methadone-pain-management.php



1 – PREMISE

•Methadone dispensing to patients shall be carried out by pharmacists in a designated roomaway from other patients.

Control of methadone dispensing for treatment purpose ...no person unless he is a licensedpharmacist or a pharmacist in the public service – Regulation 17 of P(PS)R 1989

•Dispensing via counter is not allowed as patients need to be supervised and counselled dur-ing drug taking.

•Methadone shall be kept safely in a Dangerous Drug Cabinet under lock, and key movementsshall be recorded for purposes of trace.

•Pharmacies carrying out dispensing of Methadone shall adhere to guidelines as stipulated in

– „Garis Panduan Pendispensan dan Pemantauan Rawatan Terapi Gantian Methadone, Ba-hagian Perkhidmatan Farmasi, KKM‟.

–Panduan Kaunseling Methadone bagi Rawatan Terapi Gantian oleh Bahagian PerkhidmatanFarmasi, KKM

2 – DISPENSING SERVICE

PKD TAN AH ME RAH

Operating hours:

• Working days: eg: 8.00 - 4.30 pm

•Saturdays, Sundays dan Public Holidays: As stipulated by treatment centre.



VO LU ME 1, IS SUE 1

3 – RECORDS

Patient Records

•All Methadone prescription and dispensing records are confidential and must be kept for aminimum of 2 years.

•Prescription and dispensing records by private dispensing doctors shall be kept by supplyinghospital

Supply Records

•All records of Methadone dispensing and supply shall be in accordance to Poisons Act 1952and Poison Regulations (Psychotropic Substances) 1989

Patients Folder Methadone Prescription

Daily Dispensing Records DD Stock Record Book



4 – DISPENSING TO CLIENTS

5 – LABELING

6 – ADDITIONAL INFORMATION

•All pharmacists involved in the dispensing methadone shall be knowledgeable/ trained in as-pects of MMT.

PKD TAN AH ME RAH

•Dispensing of Methadone shall be done daily

by Direct Observe Therapy (DOT) in low con-centration liquid form.

•Must be consumed under the direct supervi-sion of a health professional

•Approval for take-aways will be subjected toterms and conditions.

Daily Dosing

Take-Away

•Must be clear and readible

•Auxillary label to be affixedas follows:




Maintaining opioid dependent individuals on

methadone has many benefits:

Reduced illicit drug use

Improved health status as a result of access totreatment

Decreased transmission of HIV, HCV,HBV

Decreased illegal activity

Increased employment

KERATAN AKHBAR

Without (subtitution) therapy,

the only things waiting for drug

users are over-

dose, prison, HIV,

other diseases,

homelessness

and the grave!!!



OKTOB E R 2 0 13

MYTH: Methadone is harm-ful to your immune system. FACT: Methadone does notdamage the immune system.In fact, several studies sug-gest that HIV-positive pa-tients who are taking metha-done are healthier and livelonger than those drug userswho are not on methadone.

MYTH: The lower the dose of metha-done, the better. FACT: low doses

will reduce with-drawal symptoms,but higher doses

are needed to block the ef-fect of heroin and-most im-portant-to cut the craving for heroin. Most patients willneed between 60 and 120milligrams of methadone aday to stop using heroin. Afew patients, however, will

feel well with 5 to 10 milli-

grams; others will need hun-dreds of milligrams a day inorder to feel comfortable.Ideally, patients should de-cide on their dose with thehelp of their physician, andwithout outside interferenceor limits.

MYTH: Methadone causesdrowsiness and sedation. FACT: All people sometimesfeel drowsy or tired. Patientson a stabilized dose of methadone will not feel any

more drowsy or sedatedthan is normal.(1)

(1) Catania,Holly JD, About Methadone,Herlin Press,INC. 2000 (drugpolicy.org)

methadone are non toxic,yet both can be dangerous if taken in excess- but this istrue of everything, from aspi-rin to food. Methadone issafer than street heroin be-cause it is a legally pre-scribed medication and it istaken orally.

MYTH: Metha-done harmsyour liver. FACT: The liver metabolizes

(breaks downand processes)methadone, butmethadone does not "harm"the liver. Methadone is actu-ally much easier for the liver to metabolize than manyother types of medications.People with hepatitis or withsevere liver disease cantake methadone safely.

MYTH: Methadone gets intoyour bones and weakensthem.

FACT:Methadone does not

"get into the bones" or in anyother way cause harm to theskeletal system. Althoughsome FACT: Methadone pa-tients report having aches intheir arms and legs, the dis-comfort is probably a mildwithdrawal symptom andmay be eased by adjustingthe dose of methadone.

MYTH: It's harder to kick methadone than it is to kick a dope habit. FACT: Stopping methadone

use is different from kickinga heroin habit. Some peoplefind it harder because thewithdrawal lasts longer. Oth-ers say that although it lastslonger, it is milder than her-oin withdrawal.

MYTH: Taking methadonedamages your body.

FACT: People have beentaking methadone for morethan 30 years, and there hasbeen no evidence that long-term use causes any physi-cal damage. Some peopledo suffer some side effectsfrom methadone-such asconstipation, increasedsweating, and dry mouth-butthese usually go away over time or with dose adjust-ments.

MYTH: Methadone is worse

for your body than heroin FACT: Methadone is notworse for your body thanheroin. Both heroin and

HIV-positive patients who are

taking methadone are healthier

and live longer than those drug

users who are not on methadone.



Role of the Pharmacist

Due to the rapid resurgenceof bed bug in-festations, it islikely that phar-macists will en-counter patientswith questions and concernsabout bed bugs. It is impor-tant for pharmacists to appro-priately educate their patients

about bed bugs and offer strategies for their identifica-tion, eradication, and preven-tion. Patient counseling for itching due to bed bug bitesincludes bathing in cool or lukewarm water rather thanhot water, using a humidifier,and using mild and low pHcleansers and moisturizers. Itis important for pharmacists

to understand and recom-

mend appropriate sympto-

matic treatment and counsel-ing for cutaneous and sys-temic reactions to bed bugbites

Conclusion

Bed bugs are small, elusiveinsects that can be very diffi-cult to detect and eliminate. Acombination of physical andchemical means is generallyneeded to eradicate bedbugs. Infestations are becom-ing increasingly more com-mon in the U.S. The clinicalresponses to bed bug bitesvary and are generallytreated symptomatically.Eradication of the bed bugs,thereby preventing futurebites, is the primary goal of

therapy.[Adapted from Medscape News

Bed bugs have been a

known human pest for thou-sands of years. They aresmall, wingless insects with aflat body that is ideal for hid-ing in cracks and crevices inheadboards, mattresses, andbox springs. They feed exclu-sively on the blood of humansor warm blooded animals.Their bites can elicit variouscutaneous and systemic reac-tions in humans and are gen-erally treated symptomati-cally.

Bed bugs can be verydifficult to eradicate since theyhave developed resistance tomany chemical treatments.Not only can bed bugs createan emotional effect, but theyhave a significant impact on

public health.

Bacillus Calmatte-Guerin (or BacilleCalmatte-Guerin,BCG), a vaccine against tu-

berculosis, prepared from astrain of the attenuated(weakened) live bovine tu-berculosis bacillus, Myco-bacterium bovis

2, can also

be used to treat bladder can-cer

4. It is the only agent ap-

proved by the US Food andDrug Administration as theprimary therapy of carci-noma in situ (CIS) in the mid

1980s1

. When instilled intothe bladder, BCG eradicatesexisting tumors, reduces thefrequency of tumor recur-

rences, delays stage pro-gression to invasion and im-proves survival compared toother local treatments

3. It is

most often used after thecancer has been removedfrom the bladder using tran-

surethral resection surgery.When it is used to treat blad-der cancer, BCG is giventhrough a urinary catheter

(intravesically) into the bald-der

4.

Reference:1.http://emedicine.medscape.com/article/1950803-overview

2.http://en.wikipedia.org/wiki/Bacillus-

Gu%C3% A9rin

3.http://pdn.sciencedirect.comscenceob=MiamiImageURL& cid=273470&pii=S0022534707022884& check=y&origin=search& origin=search%zone=rslt list item& coverDate=2008-01-31&wchp=dGLzVIS-zSkzk&md5=c224eted17111b052ca76db601321a1b/1-s2.0-S0022534707022884-main.pdf

PKD TAN AH ME RAH

http://emedicine.medscape.com/article/1950803-overview


http://en.wikipedia.org/wiki/Bacillus-Gu%C3%A9rin




http://pdn.sciencedirect.comscence/

http://pdn.sciencedirect.comscence/







OKTOB E R 2 0 13

Most of us have probably been nagged by our mothers not to take medicines with coffee, tea

or juices. Most of the time, we just follow them without questioning the reason. But our moth-

ers are right! It is not advisable to take medicines with caffeinated drinks and citrus and grape-

fruit juices. Here are the reasons;

Grapefruit juice or fresh grapefruit

Increases the blood concentration of certain drugs.

Consuming certain medications, such as some cholesterol lowering statins, with grapefruit

juice or fresh grapefruit may result in too much of the medication staying in the body. This in-

creases the risk of liver damage and kidney failure caused by muscle breakdown.

Reduces the absorption of certain drugs.

For certain drugs like fexofenadine (an allergy medication), when taken with grapefruit juice,

only half of the dose is absorbed into the bloodstream as compared when it is taken with wa-

ter. It has also been reported that apple and orange juices may also block the effects of some

drugs.

Milk or dairy products

If you are taking an antibiotic such as tetracycline, it is recommended that you avoid

milk or dairy products for 2-3 hours before or after taking the medicine.

Caffeinated drinks

Tea and coffee contain tannic acid, which can react chemically with a range of medications. It

can either make the medication less effective or make it quite dangerous. For ex-

ample, if you take levothyroxine (the synthetic medication) for thyroid hormone re-placement with coffee, the absorption of the drug may be reduced by 25-27%. It is

recommended waiting 60 minutes after taking levothyroxine before drinking coffee.

Alcohol

If you are taking any medications, it is recommended that you avoid alcohol as it

can either increases or decreases the effect of many drugs.



Dry, itchy, inflamed skin – the hallmark symptoms of a flare-up

that every eczema sufferer dreads. While a cure for this disorder

remains elusive, current management strategies can control

symptoms effectively.

This typically involves the use of topical steroids, but the miscon-

ceptions shrouding these medications have unfairly generated a lot of flak for a very effective

management tool.

How steroids help

To treat eczema, dermatologists often prescribe steroid creams to reduce inflammation and to

relieve dryness and itching. By controlling flare-ups, skin is given a chance to recover.

However, the use of steroid preparations does come with the risk of side effects and the one

that is of most concern is the thinning of skin. This may scare off those whose doctors have

prescribed a topical steroid to help manage eczema.

Experts agree that this fear is unwarranted because steroid applications are very effective in

relieving eczema flare-ups when used correctly. This means you should benefit from steroid

treatment as long as you follow your doctor‟s instructions with regards to the following:

Using a steroid preparation with the appropriate strength.

There are many types of topical steroids and they vary in terms of strength. Your doctor will

prescribe the one that best matches the severity of your symptoms.

Using it on the appropriate area of the body.

Skin thickness varies across the body: for instance, facial skin is thinner than that of the limbs.

If your eczema affects multiple parts of your body, your doctor may prescribe topical steroids

of varying strengths. Use them according to the appropriate site.

Using the recommended amount of topical steroids.

Your doctor will show you how much cream or ointment to apply to a specific site of skin. If you

use too much, you may incur side effects, while using too little may not be effective.

Using topical steroids for an appropriate time.

Steroids are typically prescribed for a specific length of time. If you continue to use

them for longer than intended, you may be exposing yourself to the risk of side ef-

fects.

PKD TAN AH ME RAH



OKTOB E R 2 0 13

Jutaan terima kasih diucapkankepada kakitangan yang telahberkhidmat di unit Farmasi PKDTanah Merah. Semoga anda se-mua dapat meneruskan tugas den-gan cemerlang.

1. Wan Safura Wan Ibrahim-U32(Berpindah ke Hosp. TanahMerah)

2. Zubaidah Yusoff@Daud-U29

(Berpindah ke Hosp. Pasir

Mas)

Selamat datang kepada kakitangan yangbaru bertugas di unit Farmasi PKDTanah Merah. Semoga dapat berkhidmatdengan jayanya.

1. Rabiatul Adawiyah Adnan-U41(Dari HUSM(PRP))

2. Mohd Syahmy Mohd Arifin-U29(Dari KK Pusa, Betung, Sarawak)

3. Nor Zarodi Ismail-U29(Dari KK Ayer Lanas, Jeli)

3. Siti Mardhiah Ramli –U29(Dari KK Bakri, Muar)

4. Ahmad Faizul Muhammad-U29(Dari KK Chiku 3, Gua Musang)

5. Ho Lee Siang –U29

(Dari Hosp. Jerantut)



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buletin farmasi 10/2013

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