PHARMACY NEWSLETTER VOL 30 JULAI-OGOS 2015

Advisor

PUAN SAIDATUL RAIHAN

BT IBRAHIM

PN.HAZLINDA ABU HASSAN

CIK TAY EEK POEI

Editor

IZZAH SYAZWAN ISMAIL

Contributors

GERALDINE TAN

CHONG MIN NA

PN. SYAMSIAH BT. SHARIFF

PN. JULIA BT. SHAMSUDIN

Editorial Board

HOSPITAL MELAKA

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Topic of Current Interest

Dengue Fever

Page 5 - 6

Complementary Medicine

Traditional Chinese Medicines

Page 7

Drug Comparison

Gynoflor vs Premarin cream

Drug Safety

Domperidone

Page 10 - 11

Counselling

Pre– chemotherapy

Drug Profile

Gefitinib 250mg Tablet

Pharmacy Jokes

Activities & Announcement

Pharmacy Night 2015 Ceramah Motivasi dan Sambutan Hari Raya Methadone

Jamuan Hari Raya

Page 15 - 16

Page 14

Page 3 - 4

Page 12 -13

Page 8 - 9

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Geraldine Tan

Topic of Current Interest

Dengue viruses, mosquito-borne members of the Flaviviridae family,

are the causative agents of dengue fever. Dengue is the most

important emerging viral disease of humans that in recent decades has

become a major international public health concern. The symptoms of

dengue fever include high fever, rash, and a severe headache (dengue

triad). Additional symptoms include severe joint and muscular pain

(breakbone fever), nausea, vomiting, and eye pain. Although dengue

fever itself is rarely fatal, it can be an extraordinarily painful and

disabling illness and may become epidemic in a population following

the introduction of a new serotype. Dengue fever is usually a

self-limited illness, and only supportive care is required. No vaccine is

available for the prevention of dengue infection.

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Geraldine Tan

Topic of Current Interest

Flower pot saucers and

vases should be emptied

and scrubbed at least

once a week to destroy

mosquito eggs.

Cut down and remove

all bush, and clear

overgrown lots that can

harbor mosquitoes

Cover all water tanks, barrels

and storage containers with

tightly fitted covers

Spray dark corners in

home with aerosol

insecticide to kill any

adult mosquitoes that

may be resting in those

References:

1. Murthy JM, Rani PU. Biological activity of certain botanical extracts

as larvicides against the yellow fever mosquito, Aedes aegypti L. J

Biopest. 2009;2:72–76.

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Chong Min Na

Complementary Medicines

Traditional Chinese Medicine (TCM)

Traditional Chinese Medicine (TCM) is a holistic system of healthcare with its

very own unique theories. The treatment of illness is based on the

differentiation and diagnosis of syndromes meanwhile the understanding of the

human body is based on a holistic viewpoint.

Chinese Medicine or ‘Zhong Yi’ has a broad range of medicine practices which shares common theoretical concepts developed in mainland China. It is a

tradition of over 2000 years with various forms.

4.

Ancient beliefs

1. The human body is a miniature version of the larger, surrounding

universe.

2. Harmony between two opposing yet complementary forces, called yin

and yang, supports health, and disease results from an imbalance

between these forces.

3. Five elements: fire, earth, wood, metal, and water symbolically

represent all phenomena, including the stages of human life, and

explain the functioning of the body and how it hangs during disease.

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Chong Min Na

Complementary Medicines

Benefits Risks

Predicting occurrence, nature, trends of diseases

Simple, inexpensive, safe and durable

Restoration and maintenance of harmony, bal-ance and order to the individual.

Lack of validity in regulation of herbs

Limited safety data. Possible contamination of

herbal products and interaction with drugs

Complications from the use of

acupuncture resulted from the use of non-sterile

needles or improper

delivery of acupuncture treatments

References:

1. Traditional Chinese Medicine Therapies & Wellness Practices. http://healthcaremalaysia.com/news-info-2/traditional-chinese-medicine

2. Traditional Chinese Medicine Information Page. http://www.tcmpage.com/

3. Traditional Chinese Medicine: An Introduction. https://nccih.nih.gov/health/whatiscam/chinesemed.htm

Types of Modality i) Breathing therapy/‘Qigong

A component of Chinese martial arts in accumulation, circulation, and working with qi, breathing or energy within the body

Restores the orderly information flow inside the network through the regulation of Qi

ii) Remedial massage/‘ Tuina’

Application of hand techniques like roll/press, knead, rub, and brush

Strengthen body's resistance against disease for disease prevention

iii) Chinese Herbs

Herbs are used as a complement to various physical diseases/conditions or for wellness, based on the Chinese community beliefs and Chinese 'Materia Medica'

Maintain a person's health and restoring the balance of yin-yang by acting on the human body (specifically the internal organs).

iv) Acupuncture

Technique of inserting and manipulating fine filiform needles into specific points on the body to simulate the meridians or channels in the body,

Relieve pain or for therapeutic purposes to facilitate healing and maintain a person's health and restoring the balance of yin-yang.

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Drug Comparison - Gynoflor vs Premarin Cream Izzah Syazwan Ismail

Gynoflor® Tablet

(Lactobacillus Acidophilus 100million / 0.03 mg Estriol)

Premarin® Vaginal Cream (0.0625mg conjugated estrogens/g)

Indication

Restoration of the physiological vaginal flora after local or systemic treatment with anti-infectives or chemotherapeutic agents

Vaginal infections caused by mixed flora

Atrophic vaginitis

Co-medication to systemic hormonal therapy

Atrophic vaginitis

Kraurosis vulvae

Relief of vaginal dryness due to menopause

Dose 1 – 2 vaginal tablets daily for 6-12 days fol-lowed by a maintenance dose of 1 vaginal tablet at 1-2 days/week

0.5-2g daily intravaginally in cyclic regimen (21 days and then off for 7 days)

Mode of action

Lactobacillus acidophilus (Lactobacillus bacterium) is the indicator organism for a healthy vaginal flora. It ferments glycogen from the vaginal epithelium to lactic acid.

Estriol stimulates the epithelium of the vagina, cervix and vulva, and selectively induces the restoration of the vaginal epithelium

Estrogens are responsible for the development and maintenance of female reproductive system and secondary sexual

characteristics.

Act through binding to nuclear receptors in

estrogen-responsive tissues.

Act to reduce the elevated levels of

gonadotrophins seen in postmenopausal women

Pharmaco-kinetic

Absorption: As soon as Gynoflor comes into contact with vaginal secretion, the tablet disintegrate. Distribution: Plasma concentrations of estriol rose slightly and reached maximum after 3 hours—8 hours Metabolism: Lactobacilli resume their metabolism within a few hours and bring about a reduction in pH Excretion: Estriol is excreted in the urine

Absorption: Conjugated estrogens are water soluble and well-absorbed through the skin, mucous membranes and gastrointestinal tract. Distribution: Widely distributed in the body and found higher in sex hormones target organs. Largely bound to SHBG and albumin in the blood. Metabolism: Application in the vaginal circumvents first-pass metabolism. Excretion: Estriol, estrone and estradiol are excreted in the urine.

Stability Store in refrigerator 2-8°C Store at room temperature (15°C—30°C)

References:

1. www.mims.com

2. Full prescribing information on Prmearin Cream. Wyeth Pharmaceuticals.2012.

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Izzah Syazwan Ismail

Drug Safety

Overview

National Pharmaceutical Control Bureau had done a risk-benefit assessment on domperidone due to the report published by European Medicines Association (EMA) that suggest to limit the

usage of domperidone due to its serious adverse effects on cardiovascular system.

Domperidone was registered in Malaysia since 1987

There are about 25 products containing domperidone that is 18 products of 10mg tablets and 7 products of 1mg/ml oral suspension

Category of prescriber that can prescribe domperidone is B* (medical officers)

Types of Cardiac Adverse Effects

QTc prolongation

Torsade de pointes

Serious ventricular arrhythmias

Sudden cardiac death

High risk groups

Aged more than 60 years old

Receiving more than 30mg of domperidone per day

Taking QT-prolonging drugs or CYP3A4 inhibitors on

the same time

Indications

Nausea and vomiting of functional, organic, infectious or dietary origin

Nausea and vomiting induced by:

Radiotherapy or drug therapy

Dopamine agonists (such as L-dopa and bromocriptine) used in the treatment of Parkinson’s disease

New Contraindications

In patients who have known existing prolongation of cardiac conduction intervals, particularly

QTc, patients with significant electrolyte disturbances or underlying cardiac diseases such as

congestive heart failure

co-administration with QT-prolonging drugs

co-administration with potent CYP3A4 inhibitors (regardless of their QT-prolonging effects).

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Izzah Syazwan Ismail

Dosage and Administrations

Adults and adolescents ≥ 12 years and weighing ≥35 kg and children weighing ≥ 35 kg

The dose of domperidoneshould be the lowest effective dose for the individual situation (typically

30 mg/day) and can be increased if necessary to a maximum daily oral dose of 40 mg.

Neonates, Infants and children < 12 years of age and weighing < 35 kg, and adults and

adolescents weighing < 35 kg

The dose of domperidone should be the lowest effective dose. The total daily dose is dependent

on weight (see table below).

Formulation

(domperidone per unit)

Dosage Maximum dose per day

Film-coated tablets

(10 mg/tablet)

1 tablet three to four

times per day

40 mg

(4×10 mg tablet)

Oral suspension

(1 mg/ml)

10 mL three to four times

per day

40 mg

(40 mL of 1 mg/mL oral

suspension)

Formulation

(domperidone per unit)

Dosage Maximum dose per day

Oral suspension

(1 mg/mL)

0.25 mg/kg three to four

times per day

1 mg/kg but no more than

35 mL (35mg)

References

1. National Pharmaceutical Bureau. 2015. Makluman Berkenaan Isu-isu Keselamatan Terkini Bagi Produk Yang

Mengandungi Metoclopramide dan Domperidone.

Drug Safety : Domperidone

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Counselling - Pre Chemotherapy Chong Min Na

Nausea and Vomiting

Antiemetic should be taken before

and after treatment to reduce vomiting

risk.

Inform doctor if cannot tolerate food or water be-

cause of severe nausea and vomiting to prevent de-

hydration and electrolyte imbalance.

Dental Health

Complete dental checkup and cleaning

before chemotherapy to reduce mouth

sores and dry mouth.

Reproductive Health

Chemotherapy may affect fertili-

ty. Options should be discussed for

preserving fertility before treat-

ment.

Women should take precautions to

avoid pregnancy

during treatment as

the treatment will

cause harm to the

fetus.

Hair

Hair loss may affects people who

receive treatment.

Consider keep head covered using

wig or head coverings, such as turbans, hats, or

scarves.

Heart Health

The therapy may affect

heart.

Heart health should be

measured before treat-

ment for comparison.

Eg: echocardiogram

(ECG)

Preparations Before Chemotherapy

What is chemotherapy?

Chemotherapy is a cancer

treatment using cytotoxic

medicines.

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Counselling Points

Chemotherapy Regime

- No. of cycles

- No. of days in 1 cycle

- No. of chemo drugs

- Route of administration

(IV/Oral)

What if missed dose?

- Contact doctor for advice if

missed dose.

- Take missed dose as soon

as possible. Do not

take a double dose.

- Balance diet

- Avoid uncooked food

(Ulam-ulam, sushi)

- Hygiene of food and

beverages

- Wash vegetables and fruits

DIET

1. Hair Loss

2. Dry and darken of skin

3. Nail hyperpigmentation

4. Nausea, vomiting, loss of

appetite

5. Infection

6. Anemia/fatigue

7. Neuropathy

8. Bruises/gum bleeding

9. Mucositis

Depends on regimen and patient condition

POSSIBLE SIDE EFFECTS

Traditional

Medicine

Concomitant

taking with

chemo drugs

may have

- Drug– herb

interaction

- Kidney or liver

failure

Principles

1. Safe handling

- Flush 2 x, wash hands with

soap and water after using

the toilet

- Pregnant caregivers should

not handle patient body

waste

- Wear disposable gloves

when handling sheets/

clothes that stained with

body waste

2. Storage

- Store drugs at room

temperature, away from

excess heat and moisture

- Keep in its original

Others…

- Anthracycline

group may cause

red urine

- Inform doctor if

experience pain

during injection

References:

1. Oral chemotherapy fact sheet. http://http://www.dana-farber.org/Health-Library/Oral-

chemotherapy-fact-sheet.aspx

2. Position statement on safe practice and the pharmaceutical care of patients. https://

www.nice.org.uk/guidance/ta100/documents/british-oncology-pharmacy-association-22

3. What to expect when having chemotherapy. http://www.cancer.net/navigating-cancer-

care/how-cancer-treated/chemotherapy/what-expect-when-having-chemotherapy

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Drug Profile Geraldine Tan

INDICATION

DOSE

Patients with locally advanced or

metastatic non-small cell lung cancer

(NSCLC) who have previously failed

chemotherapy, and who have

activating mutation of epidermal

growth factor receptor (EGFR).

250mg orally once daily with or

without food.

MECHANISM OF

ACTION

Greater binding affinity for EGFR

exon 19 deletion or exon 21 point

substitution mutation

Inhibits IGF and PDGF-mediated

signaling at clinically relevant

concentrations

Inhibition of other tyrosine kinase

receptors has not been fully

characterized.

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Drug Profile Geraldine Tan

COST

RM 4,493.45 per box for 30’s

ALTERNATIVE

Erlotinib

PHARMACOKINETICS

Cpss: 3-7 hours

Time to Cpss: 10 days

Half-life: 6-49 hours

Terminal half-life: mean 41 hours

Clearance: 500ml/min

Volume of distribution: 1400L

References:

1. Lexicomp Drug Infomation Handbook 21st Edition

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PHARMACY JOKES

Customer gets a topical cream.

Pharmacist: Apply locally two times a day. Customer: I can't apply locally, I'm going overseas.

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Pharmacy Night 2015

Pada 31 Julai 2015, Jabatan Farmasi dan

Bekalan telah menganjurkan ‘Pharmacy

Night 2015” di Avillion Legacy Melaka.

Ucapan Timbalan Pengarah Kesihatan

Negeri (Farmasi) —Tuan Haji Abd Aziz

Ahmad

Barisan Pegawai Farmasi Provisional (PRP) yang

mempersembahkan sketsa pada malam tersebut.

Antara cabutan bertuah yang

dimenangi Puan Hazlinda.

Menghargai dan mengiktiraf sumbangan

anggota farmasi

Menyuntik semangat anggota farmasi untuk

meneruskan kecemerlangan dalam

meningkatkan kualiti perkhidmatan Jabatan.

Meraikan para anggota Jabatan ini yang telah

dan akan bersara pada tahun 2015.

Wajah-wajah ceria anggota Jabatan

Farmasi dan bekalan pada malam tersebut.

OBJEKTIF

Anggota yang akan bersara Cik Tai Soon

Mei menerima saguhati kenang-

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CERAMAH MOTIVASI SIRI 1/2015 DAN SAMBUTAN HARI RAYA

METADON

30 JULAI 2015

SAMBUTAN HARI RAYA PERINGKAT HOSPITAL

MELAKA

14 OGOS 2015

Antara klien metadon yang khusyuk mendengar

ceramah motivasi yang diberikan.

Puan Srima dari Jabatan Kesihatan Negeri Melaka

dijemput sebagai penceramah sesi motivasi kali ini.

Gerai Jabatan Farmasi dan Unit Inovasi yang

meriah dengan pelbagai jenis bubur manis. Menerima hadiah tempat ketiga gerai

terbaik.