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FARMASI
Buletin
HOSPITAL KUALA KRAI
Edisi Jan-Jun 2014
 Methadone is a synthetic agent
that works by “occupying” the brain
receptor sites affected by heroin and other
opiates.
 Methadone replacement therapy,
a program in which addicted individuals
receive daily doses of methadone, as part
of a broad, multicomponent treatment
program.
Methadone maintenance treatment has important
benefits for addicted individuals and for society.
These benefits include:







Reduced or stopped use of injection drugs
Reduced risk of overdose and of acquiring or
transmitting diseases such as HIV, hepatitis B or C,
bacterial infections, endocarditis, soft tissue
infections, thrombophlebitis, tuberculosis, and STDs
Reduced mortality
Possible reduction in sexual risk behaviors, although
evidence on this point is conflicting
Reduced criminal activity
Improved family stability and employment potential
Improved pregnancy outcomes.
For any drug enquiries, kindly contact us:
Pharmacy In patient: 1352 Pharmacy Out-patient: 1348
ADVISOR
CHIEF EDITOR
Azmi Abas
Dir Rathna Masni
Kamaruddin
MEMBERS
Fatihi
Idham
Qayyum
Nadiah
Zafirah
Irfan
EDITORS
Hashimie Baddruddin
Tuan Fauziah Tuan Roslli
Adibah Jamdin
Abidah Ismail
Nadzirah
Hafizah
Redzuan
Zulhafiz
Munirah
CONTENT
Methadone Repla
cement Therapy
(MRT)
MADRAC-Malaysian Ad
verse Drug Re
actions Advisory Comm
Adverse Drug React
ion Report
ittee
Home Medication Rev
iew
Stroke Visit
8 th Pharmacy
R&D Conferen
ce
Abstracts
Aktiviti Unit Farmas
i
Santai Farmasi
3
5
7
8
8
10
11
12
14
What is Methadone Replacement
Therapy (MRT)?
Methadone Replacement Therapy (MRT) is one of the "Harm
Reduction" program established for opioid abusers. The aim of
this program is mainly to prevent blood-borne viral infections
(HIV, Hepatitis C, Hepatitis B) due to needles sharing.
Methadone Replacement Therapy takes place when a patient is prescribed with
Methadone by a Medical Officer, and the consumption is supervised by a Pharmacist.
Methadone is given to replace other opioids such as
heroin and morphine in order to reduce the cravings
and withdrawal symptoms experienced by patients.
In Malaysia, the Methadone Maintenance Therapy
(MMT) programme to treat opioid dependence was
started in mid 2005.
Now it has become a national programme and one of
the government’s strategies to combat this problem.
The Ministry of Health Malaysia has directed that
methadone be a heavily regulated medicine to
prevent potential negative implications.
MRT di HKK
Perkhidmata
n
Methadone d Rawatan Terapi Gantian
iH
sejak Disemb ospital Kuala Krai berop
erasi
e
Sehingga Ju r 2013.
n2
berdaftar untu 014 seramai 10 orang te
la
k
HKK. Perkhid menjalani rawatan ini di h
matan ini dib
u
9.00 pagi hin
gga12.00 ten ka pada jam
gahari setiap
bekerja.
hari
Rajah 1: Kadar Retention Rate.
-3-
Retention rate on Methadone
What is retention rate?
Percentage of
patient
remaining in
the program.
3
4
5
6
1
2
The low retention rate was probably
due to the low daily maintenance dose
of methadone of patients got.
High doses suppress illicit heroin use
and improve retention and outcomes.
Dole's original research discovered
that 80 to 120 milligrams of methadone per
day, on average, was an effective dose.
A study by Strain et al also concluded that patients receiving 80 mg or more methadone
per day had significantly greater decreases in illicit opiod use.
In terms of using methadone daily doses greater than 80 mg as a predictor of a
successful outcome for MMT , found that the positive predictive value of doses greater
than 80 mg a day to predict retention was 80% and its negative predictive value was
93%.
This means that, in terms of predicting retention, a daily dose exceeding 80 mg will
have a probability of 0.8 in accurately predicting that the patient will be retained in
treatment.
In terms of predicting failure to retain, it has a probability of 0.93 in making an accurate
prediction.
Drug
ons
i
t
c
a
r
e
t
In
METHA-
!
You should not take any
over the counter (OTC)
medications for cough
and cold or pain killers
without discussed with
your doctor or
pharmacist.
Here are list of medications that have possible interaction with Syrup Methadone:








Alkohol
Antiepileptics
Cimetidine
Ciprofloxacin
Efavirenz
Fluoxetine
Fluvoxamine
Nicotine





Rifampicin
Tricyclic Antidepressants
Urine acidizing such as
Vitamin C
Urine alkalinizing such as
sodium bicarbonate
Zidovudine
Methadone was metabolised in
liver by cytochrome CYP3A4,
CYP2B6 and CYP2C19 by
N-demethylation. Drugs that
interact with Methadone may increase or
decrease the metabolism of Methadone.
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MADRAC UPDATES
Frisium®(clobazam):
Update to include serious
skin reactions in package
insert for Malaysia
25 April 2014
 Serious skin reactions, namely
steven Johnson Syndrome &
toxic epidermal necrolysis was
reported associated with
Frisium®.
 This product should be
discontinued at the first sign of
rash, unless the rash is clearly
not drug related.
 Patients should be closely
monitored for signs & symptoms
of SJS/TEN, especially during the
first 8 weeks of treatment or when
reintroducing therapy.
Erythropoetin Stimulating
Agents (ESA): Association with Pure
Red Cell Aplasia (PRCA) Adverse Events.
 The report summarizes all cases received in Malaysia from
year 2002 up to 2013 involving 5 brands of ESAs currently
registered in Malaysia:
1.
Epoetin-alfa (Eprex®, Johnson & Johnson)
2.
Epoetin-beta (Recormon®, Roche)
3.
Darbepoetin (Nesp®, Smart Medicine)
4.
Methoxy polyethylene glycol-epoetin beta
(Mircera®, Roche)
5.
Biosimilar epoetin alfa (Binocrit®, Novartis).
 NPCB will continue to monitor the situation
and requests all healthcare professionals to report any
suspected ADR related to ESAs to the National Centre.
Nizoral® (Ketoconazole): Discontinuation of oral
ketoconazole (tablets only) for antifungal treatment
47 adverse events related to oral ketoconazole. Eight of the reports (30%)
were related to hepatotoxicity, with adverse events including jaundice (6),
hepatitis (2), cholestatic hepatitis, and abnormal liver function test results.
The remaining reports mainly involved skin disorders and allergic reactions
such as rash, itching and photosensitivity. There were no reports with a fatal
outcome.
Nizoral tablet will not be available in Malaysia effective March 2014.
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MADRAC ANNUAL REPORTS
AND STATISTIC
Graph 2: National Annual ADR reports received by MADRAC from 2000 - 2012.
ADR (Adverse Reports) ,AEFI (Adverse Event Following Immunisation)
Graph 3: Reporters of ADR by profession.
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ADR In HKK Jan Jun 2014
Suspected Drugs
ADR Description
Cap Amoxycillin
Syr Diphenyhydramine
Shortness of breath,
Chest tightness,
Swollen eyes
Tab Griseofulvin,
Tab Cephalexin
Facial puffiness
IV Ceftazidime
Rash
Cap Indomethacine
Swelling of lips
Dtap/Hib/HPV
Fever, less active (Paed)
Tab Perindopril
Urticaria rash
Gutt. Cyclopentolate
Rashes on face, pale
IV Penicillin
IV Cloxacillin
Urticaria Rash &
Numbness
IV Benzylpenicillin
Erythema
IV Benzylpenicillin
Maculopapular rash
IV Cefotaxime
IV Ceftriaxone
Steven Johnson Syndrome
Cap Cloxacillin
Urticaria rash
Tab Amlodipine (Vamlo)
Severe tension Headache
IN Benzylpenicillin
IV Cefotaxime
Maculopapular rash
Tab Perindopril
Nausea + Vomiting
Tab Betahistine
Myalgia + Dizziness
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UNIT FA RMA SI
HOSPI TAL
KUA LA KRAI
HOME MEDICATION
REVIEW
H.M.R
Introduction
H.M.R
HMR
OBJECTIVE
Improve health
outcomes and
quality of life of the
patient by
emphasizing quality
use of medication
through appropriate,
safe , judicious and
proper use of
medication in the
home setting.
is a patient
focused process which
advocates the optimal
and quality use of
 Involves systematic assessment of the
medication at the
patient’s medication in order to identify and
patient’s home.
meet the medication-related needs as well
as to identify, resolve and prevent drug
related problems.
 Involving pharmacists
in the implementation of
HMR services will ensure
better therapeutic outcome
in the overall management
of the patient.
Pharmacist will be
responsible for provision of
information and advising
patient or caregivers with
regard to medications and
therapeutic devices.
Stroke visit:
what a pharmacist can contribute
1
2
To maximize the benefits of medication and minimise the
adverse effect and complications resulting from the medication.
To improve patient’s adherence towards medication and post stroke
management, to increase patient’s understanding towards their illness
medication through education.
3
To enhance awareness & risk factor on prevention of recurrence stroke
through education on healthy lifestyle and risk factor management by
collaborating with other MTAC programs and other facilities.
Home Medication Review( HMR).Protocol. 1st Edition 2011.Pharmaceutical Service Division Ministry Of Health
Malaysia
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Home Medication Review, HKK
Pre visit:
 Identify patient/ trace record
 Prepare the related tools
 Patient’s HMR file
During visit:
 Interview patient / caregiver
 Access compliance and knowledge
 Pharmacotherapy management
 Ensure proper storage of medicine
COMPARISON
BEFORE
AFTER
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Aktiviti
Dan Pencapaian
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KNOWLEDGE, ATTITUDE AND PRACTICE ON
DRUGS FOR MINERAL AND BONES DISORDER IN
HEMODIALYSIS PATIENTS IN HOSPITAL KUALA
KRAI
M. Muhammad Affiq, I. Abidah, G. Nurul Fauzaniy, C.
I. Nur Diyana, W. A. Wan Nor Azira, I. Nurul Azerah
Pharmacy Unit, Hospital Kuala Krai
Mineral and bone disorder is one of the complications that arise from Chronic Kidney Disease. This
KAP surveys was conducted with the aim to know the level of knowledge, attitude and practice regarding drugs for mineral and bones disorder in haemodialysis patients. This cross sectional study involved
all haemodialysis patients at Haemodialysis Unit in Hospital Kuala Krai from May 2013 to August 2013.
KAP validated and modified questionnaire was used for this purpose. We excluded patients that were
on these medications for less than 6 months and patient that 100% depend on caregiver.
Patients were group into good knowledge (score>70%), good attitude (score >3) and good practice
(score >7) for each category. Data was analyzed using SPSS version 17.0. Altogether, 41 patients
were evaluated for this study. Majority of patients (95 %) had good knowledge and 36.6 % had
good attitude. However, only 7.3 % had good practice. There were significant associations between educational level and concomitant disease with attitude (p <0.05). There were weak positive
correlation between knowledge and attitude (r= 0.157), knowledge and practice (r=0.196), as well as
attitude and practice (r=0.143). Majority of patients had good knowledge but only 36.6 % had good
attitude and 7.3 % of them had good practice. Patients with good knowledge showed moderate attitude but poor practices toward drugs for mineral and bone disorders. There were significant associations between educational level and concomitant disease with level of attitude. No significant association between other demographic factors and KAP.
EFFECT OF ERYTHROPOIETIN ON BLOOD PRESSURE AMONG
HAEMODIALYSIS PATIENTS IN HOSPITAL KUALA KRAI
W. A. Wan Nor Azira, Y. Rozida , T.R. Tuan Fauziah, K. Dir Rathna Masni, A.R.
Rosnani
Pharmacy Unit, Hospital Kuala Krai
Anemia is among the most important complications of chronic kidney disease. Erythropoietin
(EPO) may improve anemia, but it can cause hypertension in these patients. We aim to investigate
the effect of EPO on blood pressure (BP) at 0, 15 and 30 minutes among patients undergoing haemodialysis in Haemodialysis Unit (HDU), Hospital Kuala Krai (HKK) and effect of two different doses
of EPO. A prospective study of EPO-alpha (Eprex) therapy on haemodialysis patients was conducted from April to August 2013. BP was measured at 0, 15, and 30 minutes after EPO injection. Paired
t-test and Repeated Measure ANOVA were used to analyze continuous data while Chi-square test
was used to analyze categorical data. Among 36 patients that were evaluated, 32 patients
showed significant incremental of MAP (>4mmHg) after 30 minutes of EPO injection (107 ± 12 to
119 ± 16mmHg, p=0.001). Patient receiving EPO 4000IU/dose had higher mean MAP at 30 min (105
to 128 mmHg) compared to 2000IU/dose (108 to 116 mmHg) with p=0.03. No significant association between demographic factors (age, gender, race, hemodialysis duration, family history of
hypertension, existence of hypertension, and number of antihypertensive used) with the incremental blood pressure. EPO showed significant incremental of MAP in majority of haemodialysis patient
in HKK. Patient receiving EPO 4000IU/dose had significantly higher mean MAP compared to
2000IU/dose. In addition, no significant associations were found between demographic factors
and increase of blood pressure.
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Aktiviti
Unit Farmasi HKK
SAMBUTAN MAULIDUR
RASUL PERINGKAT HKK
Sambutan Maulidur Rasul Peringkat Hospital Kuala Krai disertai oleh pelbagai jabatan di
Hospital Kuala Krai.
Jabatan Farmasi juga turut serta
bagi menjayakan program sambutan Maulidur Rasul ini.
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Aktiviti
Unit Farmasi HKK
Birthday Celebration
JAN—FEB
MAC-APRIL
MEI-JUN
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SANTAI
SANTAI--SANTAI FARMASI
HOSPITAL KUALA KRAI 2014
AKU SEORANG AHLI
FARMASI
Pagi dan petang hidupku tentang
ubat
Ke mana pun aku pergi
Tidak kira masa dan ketika
Dengan pekerjaanku ini
Aku akan sentiasa dicari dan
ditanya mengenai ubat
Kerana apa
Kerana aku seorang ahli farmasi
Empat tahun menuntut ilmu di
universiti
Berkat doa mak ayah
Gigihnya para pensyarah
mengajar tanpa jemu
Usaha serta tawakal kepada Allah
Kini aku menjadi apa yang aku
inginkan
Iaitu seorang ahli farmasi.
Kerana telah tertulis
Di Luh Mahfuz
Takdirku sebagai ahli farmasi
Aku gembira dan aku berazam
Akan memberikan perkhidmatan
terbaik
Buat masyarakat sekeliling.
PANTUN FARMASI
Hari ini, esok, lusa dan
selamanya
Moga Allah sentiasa
mengiringiku
Di setiap langkahku
Di setiap usahaku
Mereka memerlukanmu
Kerana apa
Kerana aku seorang ahli farmasi
Jalan – jalan ke dusun nyonya,
Pohon duriannya berbuah lebat,
Jangan malu untuk bertanya,
Agar jelas cara pemakanan ubat.
Hati berkenan kepada Cik Lucy,
Cincin diberi sebagai tanda,
Selamat datang ke farmasi,
Tempat mengambil ubat anda.
Kaki bengkak tersepak besi.
Besi disepak dengan kuat,
Dapatkan nasihat ahli farmasi,
Sebelum menggunakan sebarang ubat.
Hati gembira bergurau senda,
Bergurau dengan anak Pak Mokhsan,
Mari kenali ubat anda,
Agar ianya selamat, berkualiti dan
berkesan,
Singgah di kedai makan Pak Mamat,
Ingin membeli sebungkus rojak,
Simpanlah ubat ditempat yang selamat,
Itulah tanda pengguna ubat yang bijak.
Bukan mudah untuk kuharungi
hidup ini
Sungguh kukatakan
Bukan mudah mengharungi alam
pekerjaanku ini
Namun kugagahkan jua
Kerana mana ada kerja yang
mudah di dunia ini
Semuanya memerlukan pengorbanan
Kekuatan dan kesabaran.
Pergi ke pasar mencari siput,
Siput diimport dari Laut Sulawesi,
Jika ubat tamat tarikh luput,
Sila pulangkan ke farmasi.
Jangan fikir yang bukan-bukan,
Apabila gelas pecah berderai,
Peringatan tulus ikhlas kami hulurkan,
Dari ahli farmasi Hospital Kuala Krai.
Kerana aku seorang ahli farmasi
Maka pekerjaanku memerlukan
ketelitian
Ini soal nyawa manusia
Tidak harus salah dalam memberikan ubat
Pastikan mereka mendapat apa
yang sepatutnya
Sebagai seorang pesakit.
Ini tanggungjawabku
Berat bagaimanapun
Aku harus galas
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INILAH DUNIA FARMASIKU’
‘
Daripada Usamah bin Syarik berkata: Ketika aku bersama-sama Rasulullah SAW, datang
sekumpulan orang-orang Badwi, bertanyakan Baginda, apakah boleh kami mengubati penyakit.
Jawab Rasulullah SAW:“ Ya, wahai hamba-hamba Allah berubatlah kamu sesungguhnya Allah SWT
tidak menjadikan sesuatu penyakit itu melainkan dijadikannya juga untuknya penawar melainkan satu
penyakit sahaja”. Mereka bertanya apakah penyakit itu wahai Rasulullah? Baginda menjawab: “Tua”.
(Riwayat Imam Ahmad)
Apabila sebut sahaja mengenai farmasi, pasti satu perkataan akan terlintas di fikiran anda iaitu
ubat. Ya, memang itulah tugas kami. Kami harus tahu serba serbi mengenai ubat. Pasti anda terpikir
bagaimanalah kami nak mengingati banyak tentang ubat. Ubat dahla banyak.. InsyaAllah.. Berbekalkan
kerajinan, usaha dan tawakal pada Allah, ilmu yang diberi semasa belajar di universiti dahulu serta
pengalaman bekerja akan menjadikan kami seorang ahli farmasi yang anda boleh jadikan tempat
rujukan untuk sebarang pertanyaan mengenai ubat.
Di sini ingin kucoretkan sebuah kisah bagaimana kehidupan
kami sebagai seorang Pegawai Farmasi Provisional (PRP).
Mungkin tidak semua yang kucoretkan di sini memang betulbetul berlaku dalam kehidupan ahli farmasi. Namun, apa yang
ingin kusampaikan... inilah kehidupanku sebagai PRP di Hospital
Kuala Krai yang indah nian ini. Ceritaku bermula di sini....
Jam loceng yang telah ku ‘set’ kan malam tadi telah berbunyi.
‘Arghhh.. malasnya nak bangun...’ getusku di dalam hati.
Walaupun berat mata ni, kugagahkan juga untuk bangun dan
melihat jam di telefonku itu. “Ha?!! Dah pukul 6.30 pagi?”
teriakku dalam hati. Aku bingkas bangun dan terus mencapai
tuala mandiku. Usai mandi dan mengerjakan solat subuh, aku
bersarapan dan terus ke tempat kerja. Dalam perjalanan aku
memanjatkan doa kepada Illahi
InsyaAllah.. semoga hari ini lebih baik dari semalam. Setelah tiba di
tempat kerja dan selesai urusan ‘punch card’ aku pun bersiap sedia ke kaunter
pesakit luar. Kaunter farmasi pesakit luar adalah tempat yang agak ‘hectic’.
Sebagai ahli farmasi, anda harus bersiap sedia mental dan fizikal. Aku pun
meneliti mana-mana ubat yang perlu di ‘top-up’ pagi itu supaya tak kelam
kabut masa pesakit dah ramai nanti. Selesai urusan mengambil dan menyusun
ubat, kulihat dah ada 10 pesakit sedang menunggu. Jam di tangan dah
menunjukkan pukul 9 pagi. “Sekejap lagi, ramaila ni,” getusku dalam hati.
Aku bertugas di bahagian ‘filling’ ubat hari ini. Aku harus berlari-lari jugakla untuk mengisi ubat
untuk memastikan pesakit tidak menunggu terlalu lama untuk mengambil ubat dan juga pada masa
yang sama harusla mengisi ubat yang betul. Kadang-kadang pula aku akan bertugas di bahagian
‘screening’ iaitu memastikan ubat yang dipreskripsikan oleh doktor kepada pesakit mengikut dos dan
durasi yang betul dan seterusnya membuat label ubat.
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Di sini kepakaran perlu ada dan komunikasi yang baik dengan doktor juga perlu ada sekiranya
terdapat kesalahan preskripsi ubat. Di sini, kami harus berinteraksi bersama pesakit. Namun, sebelum bagi
ubat tu, kena pastikan ubat yang diberikan betul. Takut-takut berlaku kesalahan di bahagian ‘filling’ ubat.
Ahli farmasi pun manusia juga. Di bahagian pendispensan, ubat yang diberikan kepada pesakit perlu
diterangkan secara jelas cara pemakanannya. Di sinilah tugas farmasi itu sangat penting. Memastikan
konsep 5B itu diamalkan.
Senang cerita, sebelum ubat tiba ke tangan pesakit, slip ubat yang dibawa pesakit itu akan melalui
pelbagai fasa agar ubat yang diterima pesakit itu betul. InsyaAllah... Kami juga akan mengajar pesakit
menggunakan alatan ubat seperti ‘insulin pen, inhaler, turbuhaler dan banyak lagi.
Sejam kemudian, kulihat sudah ramai pesakit datang nak mengambil ubat masing-masing.
Kemudian, aku diarahkan untuk mengajak seorang pesakit ke bilik
kaunseling kerana pesakit itu baru pertama kali mengunakan
‘insulin pen’. Di bilik kaunseling itu, aku mengajar pesakit tersebut
bersungguh-sungguh agar pesakit tahu menggunakan insulin pen itu
setibanya di rumah nanti. Pukul 12 tgh hari memang waktu
kemuncak. Masa ini, pesakit memang ramai. Jadi, kami akan
bekerjasama untuk memastikan pesakit yang mengambil ubat
mendapat layanan yang baik dari farmasi. Beginilah rutinku di
farmasi pesakit luar sehingga ke pukul 5 petang. Selepas itu kawankawan yang kerja petang pula akan sambung tugasan di sini
sehingga malam nanti.
Sebenarnya banyak lagi yang ingin kukongsikan namun
cukuplah setakat ini yang dapat kucoretkan agar anda semua tahu
beginilah rutin kami sebagai ahli farmasi sekiranya di kaunter
pesakit luar. Ini pun sebenarnya baru sedikit sahaja. Belum habis
lagi mengenai farmasi pesakit luar. Ini tak sentuh lagi tugas-tugas
kami di bahagian farmasi pesakit dalam yang harus memastikan
bekalan ubat betul dan cukup kepada pesakit di ward, di bahagian
stor yang menguruskan urusan pembelian ubat, di bahagian galenikal yang menguruskan ‘preparation of
extemporaneous, cream dan lotion’ serta tidak dilupakan ‘ward pharmacist’ yang akan menjadi tempat
rujukan mengenai ubat semasa ‘ward round’. Inilah kehidupanku sebagai ahli farmasi. Apa pun pekerjaan
yang kita lakukan, kita harus lakukan dengan ikhlas kerana Allah agar pekerjaan itu bukan sahaja
memberikan kebaikan kepada kita di dunia tetapi juga di akhirat sana. InsyaAllah. Sampai di sini sahajalah
coretanku tentang kehidupan ahli farmasi yang dapat dikongsikan bersama semua. Sebelum aku berundur
diri, terimalah dua rangkap pantun dariku:
Balik sekolah hujan lebat,
Berhenti berteduh di pohon ciku,
Pagi petang tentang ubat,
Inilah dunia farmasiku.
Kalau ada sumur di ladang,
Boleh kami menumpang mandi,
Kalau ada umur yang panjang,
Boleh kita berjumpa lagi.
Hasil nukilan: PRP 2014
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