december 2014 volume 2/2014 pharmacy bulletinhpermai.moh.gov.my/sites/default/files/docs/bulletin...

PHARMACY BULLETIN VOL. 2/2014 DECEMBER 2014

Highlight Issue: Ebola

Medication Safety: Look Alike Medications

Adverse Drug Reaction: Methylphenidate

Your Medicine: Asenapine

Service in Pharmacy: Pharmacy Appointment Card

Counselling: Nicotine Patch

Pharmacy Event: Aktiviti– Aktiviti Kenali Ubat Anda 2014

Drug in Hospital Permai Johor Bahru: New drug in the formulary

Fun Corner: Pharmacy Word Search

December 2014 VOLUME 2/2014

PHARMACY BULLETIN

E D I T O R I A L B O A R D A D V I S O R :

N o o r R a t n a N a h a r u d d i n

C H I E F E D I T O R :

H a f i z a h b i n t i H a m i d i

N o o r a n i S a l i m a h b i n t i S a k h o n

C O - E D I T O R S :

C h u a Y e e M i n

F o o Q i n H a o

G a n S u L i n g

A b d u l H a k i m N o r d i n

N u r S y a f i q a h M a ’ o n

T P O S I C


EBOLA

Background of Ebola virus Ebola virus was first found in 1976 in Zaire (now known as the Democratic Republic of Congo). However,

the name of the virus was then changed to Ebola in 2010 which signifies a river there. There are 5 Ebola

virus subtypes namely: Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast, Ebola-Bundibugyo and Ebola-Reston.

Out of these virus subtypes, all except Ebola-Reston is dangerous to human.

Spread of Ebola Virus The first outbreak of Ebola started in West Africa in 4 countries (Guinea, Sierra Leone,

Liberia and Nigeria). The likely host are bats. Ebola virus disease only spreads when

people are sick so a patient must have the symptoms mentioned above to spread the

disease to others. After 21 days, if an exposed person does not develop symptoms,

they will not become sick with Ebola.

Means of spread of Ebola virus:

Contact with bodily fluid of a person who is sick with or has died from Ebola (blood, vomit, faeces,

urine, sweat, semen, spit or other body fluids).

Objects contaminated with the virus (needles, medical equipment)

Infected animals (by contact with blood or fluids or infected meat).

Ebola in Malaysia Malaysians were shocked with the news of a suspected Ebola virus disease case in Kuching, Sarawak in September 2014 but the Chief Director of Ministry of Health, Datuk Dr Noor Hisham Abdullah have confirmed that after close investigation, the patient is clear of Ebola virus.

Symptoms of Ebola virus If any of these symptoms develop,

seek immediate medical attention and

inform of previous exposures such as

previous visit to the affected regions

such as West Africa, close contact with

an infected person, handled the

remains of someone affected or

recently travelled in the same carrier as

someone who is suspected or infected

with Ebola virus

Prepared By : Chua Yee Min Page 1

Highl i gh t I s sue :


Patient Management Supportive care: the most important aspect of supportive care

involves preventing intravascular volume depletion, correcting

profound electrolyte abnormalities and avoiding the

complications of shock.

Careful haemodynamic monitoring needed and intravenous

fluid depletion requirements may be high (5 to 10 liters per

day). Ebola virus disease may result in reduced effective

arterial blood volume despite extracellular fluid volume

overload (third spacing)

Patients may develop significant electrolyte disturbances

(eg, hyponatremia, hypokalemia) and may require frequent

repletion of electrolytes to prevent cardiac arrhythmias.

Patients may require nutritional support.

Isolation room (single patient room containing a private

bathroom) with the door closed. Facilities should maintain a

log of everyone entering the patient’s room.

Intensive nursing may be required in order to respond to patient’s changing clinical situation.

Additional measures: correction of severe coagulopathy and symptomatic management of fever,

nausea, vomiting, diarrhea and abdominal pain.

Empiric antimicrobial treatment should be considered

when patients develop vomiting, diarrhea and/or other

signs of severe gastrointestinal dysfunction and/or signs

of sepsis.

Prevention Always wash your hands with soap and rinse thoroughly

with water

Always cook your food properly.

If any of the symptoms of EVD develop, seek immediate

medical attention.

Do not touch people with signs of Ebola or have died from

Ebola.

Do not touch clothes and beddings of people who have

died from Ebola.

Do not touch the bodily fluids of people who have symp-

toms of Ebola.

Do not play with monkeys and baboons.

Do not eat fruits that have been eaten by bats.

References:

Centre of Disease Control and Prevention (CDC) United States of America on Ebola, retrieved 11 November 2014.

World Health Organisation (WHO) on Ebola, retrieved 11 November 2014.

UpToDate 2014 on Ebola and management of Ebola, retrieved 11 November 2014.

Ministry of Health Malaysia, retrieved 11 November 2014 (http://kpkesihatan.com/category/communicable-disease/ebola/)

Prepared By : Chua Yee Min Page 2


Look Alike medications

Left: T. Folic Acid 5mg

Right: T. Vitamin B complex

Left: T. Paracetamol 500mg

Right: T. Lithium Carbonate

300mg

Up: T. Clozapine 25mg Down: T. Chlorpheniramine 4mg

Up: T. Hyoscine Butylbromide 10mg

Down: T. Chlorpromazine 25mg

Left: T. Olanzapine Zydis 5mg Right: T. Olanzapine Zydis 10mg

Left: T. Prolase

Right: T. Dothiepin 25mg

Up: T. Albendazole 200mg

Down: T. Co-Trimoxazole

Up: T. Indomethacin 25mg Down: T. Atomoxetine 25mg

Left: T. Atenolol 100mg Right: T. Ascorbic Acid 100mg

Up: T. Fluoxetine 20mg Down: T. Haloperidol 5mg

Prepared by : Foo Qin Hao Page 3

Medication Safety:


The U.S. Food and Drug Administration (FDA) is warning that methylphenidate products, one type of central nervous system stimulant drug used to treat attention deficit hyperactivity disorder (ADHD), may

in rare cases cause prolonged and sometimes painful erections known as priapism. Priapism is a

condition where when blood in the penis becomes trapped, leading to an abnormally long-lasting and sometimes painful erection. This can occur in male patients of any age. Patients who take methylphenidate and develop erections lasting longer than four hours should seek immediate medical treatment. If not treated right away, priapism can lead to permanent damage to the penis. Review of post marketing reports by FDA showed that priapism usually developed some time after patients started tak-ing the drug, after an increase in dose, or during a period of drug withdrawal.

Safety Alert

Currently in Malaysia, there are 12 registered products containing methylphenidate. It is listed in the Ministry of Health Drug Formulary under category A (to be prescribed by consultants or specialists only).

The Drug Safety Monitoring Centre, National Pharmaceutical Control Bureau (NPCB) has received a total of 32 ADR reports related to methylphenidate with 48 adverse events. There were no reports of priapism or related events in Malaysia. Adverse events reported included nausea, vomiting, rash and other skin reactions, increase in liver enzymes and psychiatric disorders such as agitation. Direct Healthcare Professional Communications (DHPCs) have been approved by the NPCB in April &July 2014 to inform healthcare professionals regarding this safety issue. A directive has also been issued for the package inserts of all products containing methylphenidate to be updated with in-formation on the risk of priapism.

Background

Local Setting Advice to healthcare

providers

There is a rare risk of priapism associated with the use of methylphenidate.

Patients using methylphenidate should not stop taking it without first talking to their healthcare professionals.

All male patients and their caregivers should be counselled on the signs and symptoms of priapism and the importance of seeking immediate medical treatment if this occurs.

All ADRs suspected to be related to the use of methylphenidate use should be reported to the Drug Safety Monitoring Centre, NPCB.

Prepared by: Foo Qin Hao Page 4

Methylphenidate Adverse Drug Reaction:


Asenapine (Saphris®) is a new atypical

antipsychotic indicated for manic/ mixed

episodes associated with bipolar I disorder and

schizophrenia. Asenapine is available in 5 and

10mg fast-dissolving sublingual tablets

ASENAPINE — A NOVEL ANTIPSYCHOTIC FOR

SCHIZOPHRENIA AND MIXED OR MANIC EPISODES OF BIPOLAR

Introduction

Pharmacokinetics

Bioavailability 35% (Sublingual),

reduced to 2% (if

swallowing)

Time to onset of

action

3 minutes

Time to peak plasma

concentration

30-90 minutes

Half life 24 hour

Time to steady state 3 days

Dosage

Indication Initial dose Maintenance dose

Schizophrenia 5mg BD 10 mg BD

Bipolar 10mg BD (5mg BD if

use with lithium/

valproate)

10 mg BD

Dosage adjustment

renal or mild -moderate hepatic impairment Not required

severe hepatic impairment Avoid Asenapine

adverse effect not tolerated reduced to 5mg twice daily

Elderly (dementia) Contraindicated

Prepared by: Gan Su Ling Page 5

Adverse Effects

The commonly reported adverse effects are somnolence, dizziness, extrapyramidal side effects,

restlessness, oral hypoesthesia, weight gain, elevated prolactin and QT prolongation. In a 52 weeks

double-blind study by Shoemaker et al, the metabolic effect of Asenapine was studied where the

differences from baseline in total cholesterol and glucose levels were found to be not significant. The

study also showed that the proportion of other side effects is lower in patients taking Asenapine as

compared to other atypical antipsychotic such as olanzapine and risperidone.

Your Medicine:


Drug Interactions

Drugs Description

CYP1A2 Inhibitor Fluvoxamine

Imipramine

Increase asenapine concentration

QT prolongation agents

Amiodarone Quinidine

Chlorpromazine Ziprasidone

Avoid use in combination

In conclusion, Asenapine is a new atypical antipsychotic which could be advantageous, among

non-compliant or acutely agitated patients, due to its readily-dissolved and rapidly-absorbed sublingual

formulation. Asenapine also poses treatment advantage in patients who are unable to tolerate the

metabolic side effects which are common concerns for majority antipsychotics.

References

Cetin M. Asenapine: A novel hope in the treatment of schizophrenia and manic and mixed episodes of bipolar I disorder. Bulletin of Clinical Psychopharmacology. 2013. 23(1): 99-106.

Drug Information Handbook. 22th ed. Hudson, Ohio, Lexi-Comp, Inc.;2013:17

Prepared by: Gan Su Ling Page 6

Counselling Points


Prepared by: NurSyafiqah Ma’on Page 7

Bahagian Perkhidmatan Farmasi telah

menawarkan Perkhidmatan Tambah Nilai melalui

Sistem Temujanji Farmasi (STF) di hospital-hospital

kerajaan dan klinik-klinik kesihatan selain daripada

Sistem Pendispensan Ubat Bersepadu (SPUB),

SMS & Ambil, Pandulaju dan Ubat Melalui Pos

(UMP) bagi meningkatkan penggunaan ubat-ubatan

secara berkualiti dalam kalangan rakyat Malaysia.

Perkhidmatan ini membolehkan pesakit mengambil

bekalan ubat susulan di kaunter farmasi pesakit

luar tanpa perlu menunggu lama kerana ubat

pesakit akan disediakan terlebih dahulu sebelum

tarikh kedatangan pesakit. Pesakit akan dibekalkan

dengan sekeping kad temujanji (rujuk Gambar 1)

sebagai rujukan tarikh pengambilan ubat di kaunter

farmasi. Perkhidmatan ini disediakan bagi pesakit

kronik yang stabil, yang telah dibekalkan dengan

tempoh preskripsi melebihi sebulan.

Walaubagaimanapun, pembekalan ubat untuk bu-

lan pertama masih lagi perlu dilakukan seperti biasa

di kaunter farmasi pesakit luar.

Di Hopital Permai Johor Bahru, kad

temujanji banyak digunakan bagi pesakit-pesakit

yang datang dari rumah jagaan, rumah kebajikan,

atau penjara atau pesakit dari Clozapine Klinik.

Sistem Kad Temujanji

Farmasi Pesakit Luar

Contoh Kad Temujanji Farmasi Pesakit Luar

Beri penerangan tentang Kad Temu-janji selepas pendispensan ubat

Maklumkan kepda pe-sakit tarikh pengambi-lan ubat akan datang Pesakit setuju?

Isi keterangan pesakit pada Kad

Maklumkan kepada pesakit tarikh

Serahkan Kad Temujanji dan pris-kripsi asal kepada pesakit

Simpan salinan preskripsi ke dalam ‘Fail Kad Temujanji’ dan rekod

maklumat pesakit dalam ‘Buku Rekod

Tidak

Ya

Terima Kad Temujanji di kaunter

Cari ubat pesakit yang telah dise-diakan mengikut no. rujukan Kad

Temujanji

Pembekalan penuh?

Simpan priskripsi asal dan pulangkan Kad

Temujanji kepada pe-sakit untuk digunakan

Catat tarikh temujanji yang se-terusnya pada preskripsi asal dan

kembalikan kad temujanji dan pris-kripsi asal kepada pesakit

Ya

Tidak

Carta alir pemilihan pesakit untuk pembekalan ubat menggunakan Kad Temujanji

Carta alir proses pendispensan ubat untuk Kad Temujanji


Nicotine Patch Nicotine has been used as a smoking cessation aid for the relief of nic-

otine withdrawal symptoms and to ease craving1,2. It works by supplying ‘clean’

nicotine to the body. It contains around one-third to half the amount of nicotine

found in most cigarettes2. There are five types of NRT which are available and

approved by FDA, which are gum, nasal spray, inhaler, lozenges and patch2.

For nicotine patch, its nicotine delivery is

through transdermal system over either 16

or 24 hours, and the strength of nicotine

patch depends on individual body size and

smoking habits1,2,5.

Recommended starting dose5,6:

≥10 cigarettes a day and weight >45 kg: 21

mg/24 hour or 15 mg/16 hour patch

<10 cigarettes per day OR weight <45 kg

OR cardiovascular disease: 14 mg/24 or 10

mg/16 hour patch

Storage

Keep all the pouches in the box until immediately before use.

Store nicotine patch at temperatures below 25°C. Storage in a car in hot weather

may cause damage to the patch.

Keep nicotine patch out of reach of children.

Prepared by: Abdul Hakim Nordin

Counselling:

Side effects

Usually minor and transient, some

such as sleep disturbance,

dizziness, weight gain and

headache may be related to

stopping smoking

Application site reactions may

occur: redness, itch, rash – stop if

severe

Vivid dream (especially 24-hour

patch)


Counselling points1,3,4:

References

1. Australian Medicines Handbook 2014, Australian Medicines Handbook Pty Ltd; Adelaide.

2. Pahaki, NA 2013, Nicotine Replacement Therapy, Buletin Penawar, pg. 2, viewed 13 November 2014, < http://

hsajb.moh.gov.my/versibaru/uploads/farmasi/coverbuletin.pdf >

3. Pharmacia & Upjohn Pty Ltd, 1997, Nicorette Patch, brochure, Pharmacia & Upjohn Pty Ltd, Rydalmere.

4. Pharmaceutical Society of Australia (PSA) 2009, Fact Card Booklet 2009 (Pharmacy Self Care), ACT.

5. Sansom LN, ed, Australian pharmaceutical formulary and handbook, 22nd edition, Canberra: Pharmaceutical Society of

Australia, 2011.

6. QuitSA, n.d., Nicotine Replacement Therapy (NRT), brochure, QuitSA, SA.




AKTIVITI– aktiviti

KENALI UBAT ANDA 2014

13.02.2014

Penggunaan Kosmetik yang Bernotifikasi

Bilik Seminar Telepsikiatri, Hospital Permai

24.05.2014 Kenali Ubat Anda

Masjid Taman Anggerik, Kempas

11.06.2014

Kenali Ubat Anda (Ubat-ubat berdaftar)

Bilik Seminar Telepsikiatri, Hospital Permai

03.07.2014

Kenali Ubat Anda

Bilik Seminar CPU

12.10.2014

Kenali Ubat Anda (Bengkel Peningkatan Pesakit Ke Arah Penjagaan dan

Pemulihan di dalam Komuniti)

Bilik Seminar CPU

13.10.2014

Kenali Ubat Anda

Taman Sinar Harapan Jubli

16.10.2014

Kenali Ubat Anda

Auditorium, Kompleks Kementerian

Dalam Negeri, Setia Tropika

14.09.2014

Kenali Ubat Anda

Pertubuhan Kebajikan Insan

Istimewa Johor Bahru


28.10.2014

Pameran Secara Interaktif

Program Kesihatan Mental (Prokem) Bil 1/2014

Dewan Balai Polis Johor Bahru

11.06.2014

Pameran Kenali Ubat Anda

Foyer Kompleks Pesakit Luar Hospital Permai

16.10.2014

Pameran Kenali ubat Anda

Auditorium, Kompleks KDN, Setia Tropika

29.10.2014

Pameran Secara Interaktif

Program Kesihatan Mental (Prokem) Bil 2/2014

Foyer Perpustakaan UTM

23.11.2014

Pameran Secara Interaktif Program Kesihatan Mental

(Prokem) Bil 4/2014

Padang Kampung Pak Khalib, Pekan Nenas Pontian

4.11.2014

Pameran Secara Interaktif Program Kesihatan Mental

(Prokem) Bil 3/2014

Dewan Kolej Universiti Selatan

27.11.2014

Kenali Ubat Anda (Mental Health Karnival

anjuran Sapura Kenchana Holding

Mines, Selangor

25.04.2014

Pameran Kenali Ubat Anda

Ruang legar, Persada ICC

27.11.2014

Pameran Secara Interaktif Program Kesihatan

Mental (Prokem) Bil 5/2014

Ruang Legar Aras 3 HSIJB

AKTIVITI-aktiviti

KENALI UBAT ANDA 2014



New drug in the formulary

T. Agomelatine 25mg

T. Sodium Valproate Chrono 500mg

T. Desvenlafaxine ER 50mg

Prepared by: Foo Qin Hao

X Q E P S U R Y C V I C V E D I G L P Y

R Z R I K T K O G V P G J L E M A A W U

R V U W N D Z I H C I R O O G O M F F V

P Z T G P D N E E D L E S E V O L G F C

K P C N H P P N L J L E H G R R K F A R

H R N G A V C X T B S D P Q D V V U J X

F Z I L R U O O Y G Y T D C N I E V X K

V P T R M N W H M N L A I P P Y O O F F

S A A E A B C O M P U T E R R R Y F A J

A P I G C O L O U S O S G A E O S D B I

V P E I I H A D U I L U S X S T P Z D H

A D I Y S J N B B A J N N I C N J Z Q Q

N B K G T I R I B D E J K D R E L E Z P

N Z T J K A T J C P O N J N I V W J R F

I A A O N N A Q S I K N I G P N A B I L

H Q L D A C O I Q B A Z U C T I G A P H

A Z Y S K O D I G G E N E R I C K R X Q

A Y S E L U S P A C E Q I S O D X J T F

U B T W I R X I M Y Y U Y X N N E N F T

Y X R O X P T O Y L L H F R B H N M K Y

PILLS TECHNICIAN PHARMACIST

MEDICINE TINCTURE

COMPOUNDING IVROOM

ANTIBIOTIC NEEDLES

CAPSULES COMPUTER

STAT DISPENSARY

PRESCRIPTION HOOD

GENERIC GLOVES BRAND

INVENTORY

Words List

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