Download outbreak of disease in kl: leptospirosis and h1n1

Vol 2, 2013
Issue 2, Oct 2012
Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
CARA PENGAMBILAN UBAT GTN
Update of Treatment:
Management of Depression
OUTBREAK OF DISEASE IN KL: LEPTOSPIROSIS AND H1N1
By: Fety Rozina and Nur Khairunisa Manaf, KK Bandar Tun Razak
Leptospirosis adalah penyakit berjangkit
yang disebabkan oleh bakteria Spirochete
daripada genus leptospira yang disebarkan
secara langsung atau tidak langsung
daripada haiwan kepada manusia (penyakit
zoonotik). Dengan simptoms klinikal yang
tidak spesifik, pesakit mungkin hanya
mengalami simptoms jangkitan seperti
flu ringan sehinggalah kepada simptoms
yang sangat teruk seperti pendarahan dan
kegagalan organ dalaman. Malangnya,
jangkitan boleh menyebabkan kematian jika
pengurusan yang agresif tidak dimulakan
pada peringkat awal. Patogen Leptospires
tergol ong dal am s p e s ie s L e p t os p ir a
interrogans, yang dibahagikan kepada lebih
daripada 200 serovars dengan 25 serogrup.
Secara semula jadi, Serovars Leptospiral
wujud di dalam tubul renal tikus, haiwan liar
dan domestik. Jangkitan Leptospirosis
biasanya bermula pada awal musim hujan
dan berkurang selepas musim hujan berakhir.
Jangkitan boleh diperolehi melalui hubungan
antara kulit, mukosa / konjunktiva dengan air
atau tanah yang sudah tercemar dengan air
kencing tikus dan binatang yang berpenyakit.
Pengambilan air yang tercemar juga boleh
menyebabkan jangkitan. Namun setakat ini
tiada dokumentasi jangkitan antara manusia
kepada manusia boleh berlaku. Klinikal
diagnosis adalah sukar. Ini adalah kerana
simptom yang pelbagai dan tidak spesifik dan
kekeliruan dengan penyakit-penyakit lain,
misalnya denggi, demam denggi berdarah,
malaria, kepialu, melioidosis, influenza dan
lain-lain.
H1N1 (kadang-kadang dipanggil “swine flu”) adalah
virus influenza yang menjadi pembawa penyakit
pada orang ramai. Pada permulaannya, virus
baru itu dikesan pada penduduk-penduduk
di Amerika Syarikat pada April 2009.
Virus ini merebak dari satu orang kepada
yang lain di seluruh dunia. Ia merebak dalam
cara yang sama yang sama seperti virus
influenza bermusim merebak. Pada 11 Jun
2009, Pertubuhan Kesihatan Sedunia (WHO)
mengisytiharkan bahawa wabak 2009 H1N1
sedang merebak dan berlaku.
Serangan terbaru H1N1 yang berlaku adalah
di Sekolah Menengah Agama Wilayah
Persekutuan pada 18/2/2013. Seramai 20
orang pelajar sekolah tersebut telah datang
ke Klinik Kesihatan Bandar Tun Razak (KKBTR)
untuk berjumpa dengan pegawai perubatan
bagi mendapatkan rawatan. Oleh sebab
bilangan pelajar adalah ramai, MOIC KKBTR
telah membuat aduan kepada Pejabat
Kesihatan Daerah Cheras. Setelah siasatan
dilakukan di sekolah tersebut, PKD Cheras
telah mengarahkan medical team melakukan
lawatan di sekolah tersebut bagi memastikan
outbreak tersebut. Pada 19/2/2013, pegawai
perubatan dari KKBTR telah pergi ke sekolah
tersebut untuk memberi rawatan dan ubatubatan pada pelajar-pelajar tersebut tetapi
mereka tidak dikuaratinkan. Namun yang
demikian, pada 28/2/2013, seramai 110
orang pelajar telah dikuarantin kerana masih
lagi mempunyai tanda-tanda influenza.
Selama 2 1 ha ri da ri t a rik h 1 9 / 2 / 2013
sehingga 11/3/2013, lawatan telah dilakukan
sebanyak 10 kali. Dalam lawatan tersebut
beberapa Pegawai Kesihatan, Pegawai
Farmasi, Penolong Pegawai Kesihatan dan
Jururawat Masyarakat telah terlibat. Pada
4/3/3013 sekolah tersebut telah ditutup buat
sementara waktu bagi pihak Kawalan Infeksi
(IK) menjalankan siasatan dan melakukan
kerja-kerja pembersihan di sekolah tersebut.
Setelah 3 hari sekolah tersebut ditutup
akhirnya pihak membenarkan sekolah
tersebut beroperasi semula. Dalam serangan
ini tiada kematian dilaporkan.
IN THIS ISSUE
1Outbreak of Disease in KL:
Leptospirosis and H1N1
2 Klinik 1 Malaysia Terminal
Bersepadu Selatan (K1m Tbs)
3 Buprenophine/Naloxone (Suboxone®)
4 Updates on Drugs:
Liraglutide (Victoza®)
5 Update on Drugs:
Roflumilast (Daxas® 500mcg)
6 Bisoprolol Tablet
7 Pengubahansuaian Cara Hidup
Pesakit Kencing Manis
8 Kawalan Ubat-Ubat Di Dalam Islam
9 Cara Pengambilan Ubat Gtn
10 What is G6pd Deficiency?
11 Topical Preparation Dosage
Forms and Corticosteroids
12 Update of Treatment:
Management of Depression
14 Updates on Thalassaemia Treatment
15 Update of Treatment: Management of
Systemic Lupus Erythematous (Sle)
16 Management of Acne
17 Update of Treatment:
Management of Genital Herpes
18 Perubatan Tradisional dan
Komplementari
20 Update of Pharmacy Profession:
Zoning System of Community
Pharmacy
24 How to report a fake medicine
or unregistered product to the
authorities
EDITORIAL TEAM
ADVISORS:
PN ROSNAINI BT KAMARUDDIN
TUAN SYED FADZLI BIN SYED SAILUDDIN
EDITOR:
DANIEL LIEW CHING YIEN
CO-EDITORS:
CHUA SIN WEE
NURUL SYAHIDAH
MEMBERS:
1
GRACE LIEW KAI HAO
DENNIS CHONG
NOR KHAIRUNISA
NG SIEW WUI
ANGELA WONG
NABILAH BT MOHD SHOHAIME
NORULHUDA BABA
Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
KLINIK 1 MALAYSIA TERMINAL BERSEPADU SELATAN (K1M TBS)
by: Ashley Kek Lih Ching, KK Bandar Tun Razak
Klinik 1 Malaysia merupakan sebuah projek yang dilancarkan oleh Perdana Menteri Malaysia, Datuk Seri Najib Tun Razak untuk
membantu golongan kurang berkemampuan dan menepati gagasan 1Malaysia iaitu ‘Rakyat Didahulukan Pencapaian
Diutamakan’. Klinik 1 Malaysia Terminal Bersepadu Selatan (K1M TBS) ditubuhkan pada 12 Disember 2012 di bawah jagaan
Klinik Kesihatan Bandar Tun Razak.
K1M TBS menyediakan pelbagai perkhidmatan untuk orang awam seperti saringan HIV tanpa nama, PAP SMEAR dan
kesihatan. Selain itu, Unit Farmasi juga menawarkan perkhidmatan tambah nilai seperti SMS Take & Go, Sistem Pendispensan
Ubat Bersepadu (SPUB) dan Kaunseling secara temujanji.
SMS TAKE & GO: Sewaktu mengambil ubat, pesakit harus memaklumkan pegawai farmasi yang bertugas dan pegawai
itu akan memberikan informasi yang lengkap kepada pesakit. Pesakit hanya perlu menghantar pesanan ringkas atau pun
membuat panggilan ke Unit Farmasi Klinik Kesihatan Bandar Tun Razak 3 hari bekerja sebelum hari pengutipan ubat susulan
mereka.
Sistem Pendispensan Ubat-ubatan Bersepadu (SPUB): Pesakit perlu maklum pada pegawai farmasi yang mereka berminat
mendapatkan bekalan ubat susulan di K1M TBS. Pegawai bertugas akan mengisikan borang dan preskripsi asal dicopkan,
selepas itu pesakit boleh mendapatkan bekalan ubat susulan di Kaunter Farmasi K1M TBS pada tarikh yang ditetapkan.
Kaunseling Secara Temujanji: Pesakit yang menghadapi masalah ataupun pertanyaan mengenai ubat-ubatan boleh
membuat temujanji untuk mendapatkan kaunseling susulan dan penerangan yang sempurna di K1M TBS. Pesakit perlu
menetapkan waktu dan tarikh dengan pegawai farmasi, pada hari yang ditetapkan pegawai yang bertugas akan
memberikan kaunseling susulan kepada pesakit.
Pada 8 July 2013, Pn Faridah dan Pn Rahmah telah mendapatkan ubat susulan mereka melalui perkhidmatan SPUB di K1M
TBS. Pada hari yang bersejarah ini, disertai oleh Puan Hjh Rosnaini bt Kamaruddin, Timbalan Pengarah Kesihatan Negeri
(Farmasi), Tuan Syed Fadzli bin Syed Sailuddin (Ketua Penolong Pengarah Kanan Bahagian Farmasi), Dr Haliza (Pegawai
Kesihatan, Penyelaras Pegawai Kesihatan Pejabat Kesihatan Cheras), Dr Aziah Itam (Pegawai Perubatan Y/M KKBTR),
dan Puan Ashley Kek Lih Ching (Pegawai Farmasi Y/M KKBTR). Sebagai tanda penghargaan, cenderahati telah diberikan
kepada 2 pelanggan tersebut. Menurut Pn Faridah Bt Ahmad dan Pn. Rahmah Bt Arifin, mereka amat berpuas hati dengan
perkhidmatan yang ditawarkan kerana mereka boleh mendapatkan ubat susulan berdekatan dengan rumah mereka.
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BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 2, 2013
BUPRENOPHINE/NALOXONE (SUBOXONE®)
By: Nurhidayah Binti Mohd Taufik, KK Cheras
Suboxone is a sublingual tablet containing buprenorphine hydrochloride and naloxone hydrochloride in a ratio 4:1. It is
available in two dosage strength: 2mg buprenorphine and 0.5mg naloxone, and 8mg buprenorphine and 2mg naloxone.
Buprenorphine is a derivative of the morphine alkaloid, and is a partial (m) opiod receptors in the nervous system. Buprenorphine
blocks the effects of the opiod agonist due to higher affinity for (m) opiod receptors than full opiod agonist.
Naloxone is an antagonist of (m) opiod receptors. It has minimal pharmacological activity when administered orally
or sublingually due to first pass metabolism. However, if it is to be administered intravenously, it produces marked opiate
antagonist effects and opiate withdrawal. Thus, combination product Suboxone is less abuse by intravenous route.
The prolonged duration at high doses enables alternate days, and even 3 days a week dispensing regimes.
Contraindication
1.
Hypersensitivity to buprenorphine
2.
Pregnancy and breastfeeding
3.
Depressant and sedatives; Alcohol, other opiods, benzodiazepines, barbiturates, tricylic antidepressant, sedating
antihistamines, and major tranquillizers.
Commencing Buprenorphine from heroin use
The first dose should be administered when patient experiencing early features of opiod withdrawal and preferably 12 hours
after last heroin use. Appropriate dose to achieve on the first day is 2-8mg. Prescribers should aim to achieve 8-16mg/day by
day 3.
Commencing Buprenorphine from Methadone use
Patient should be on methadone less than 40mg for at least one week prior to receiving first dose of suboxone. The optimal
dose prior to transferring may be below 30mg/day.
Methadone Dose (mg)
Buprenorphine initial dose (mg)
<30 mg
4mg
30-40mg
2mg
>40mg
Not recommended
The first dose of suboxone should be initiated al least 24 hours after last methadone dose.
Optimal dose after stabilization (end of first week) is 8-24mg/day. Dose can be increase or decrease between 2 and 8mg/
day. Patient who missed more than one week of dosing should be reinducted.
Administering buprenorphine
1.
Inspect patient mouth cavity
2.
Place tablet under tongue
3.
DO NOT chew or swallow the tablet
4.
DO NOT swallow saliva until the tablets have dissolved (3-5min)
5.
Give cup to patient and ask patient to tip the contents under the tongue.
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Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
UPDATES ON DRUGS: LIRAGLUTIDE (VICTOZA ®)
By: Mariam Binti Rushdan, KK Sentul
Diabetes mellitus is a serious condition with potentially devastating complications that affects all walks of life worldwide. There
is no “cure” for diabetes, although there are many ways of keeping diabetes under control. Diabetes treatments are design
to help the body control the sugar levels in the blood.
In January 2010, The Food and Drug Administration (FDA) approves Novo-Nordisk’s Diabetes drug Victoza® (liraglutide [rDNA
origin] injection). It is a non-insulin once daily injectable medicine that may improve blood sugar in adults with type 2 diabetes
when used along with diet and exercise.
Liraglutide is a long acting analog of human glucagon-like peptide-1 (GLP-1) (an incretin hormone) which increases glucosedependent insulin secretion, decreases inappropriate glucagon secretion, increases B-cell growth/replication, slows gastric
emptying, and decreases food intake. Liraglutide administration results in decreases in hemoglobin A1c by approximately
1%. It is not recommended for first line therapy.
However, there are a few warnings and precautions when using Victoza®, especially patients with or a family history of
medullary thyroid cancer and in patients with multiple endocrine neoplasia syndrome type 2. Liraglutide is not for use in
people with diabetic ketoacidosis. Use in cautions in patients with a history of pancreatitis, cholelithiasis and/or alcohol abuse.
The most common side effects with Victoza® include headache, nausea and diarrhea. Other side effects are dose related
and gradually decrease with time. These include hypertension, upper respiratory infection, constipation, hypoglycemia etc.
References:
•
Can J Diabetes 37 (2013) S1-S3
•
Diabetes Research Wellness Foundation.net (portels)
•
Drug Information Handbook, 21st Edition
•
MIMS Malaysia http://www.mims.com/malaysia/drug/info/Victoza
•
www.victoza.com
•
www.drug.com
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BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 2, 2013
UPDATE ON DRUGS: ROFLUMILAST (DAXAS® 500McG)
By: Leow Chuan Ying, KK KAMPUNG PANDAN
Chronic Obstructive Pulmonary Disease (COPD) is a disease state characterized by chronic irreversible airflow limitation. WHO
estimated 210 million people has COPD worldwide and about 40 percent people has moderate to severe COPD. By year
2030, COPD is the third major cause of death.
On March 2011, USA Food Drug Administration (FDA) has approved Roflumilast, a prescription medication used in treating
severe COPD (GOLD 3) associated with chronic bronchitis in adults with history of frequent exacerbations as add-on to
broncholilator treatment. It is a phosphodiesterase (PDE4) inhibitor, a nonsteroid, anti-inflammatory agent designed to target
both the systemic and pulmonary inflammation associated with COPD and and it works by decreasing swelling in the lungs.
Advantages of Roflumilast 500mcg over inhaler therapy are that it is an oral tablet and only needs to be taken once daily with
or without food. It is only prescribed to adults (18 years old and above) and is not used in patients with liver impairment and
sudden attacks of breathing problems. The safety and effectiveness of Roflumilast was demonstrated in two Phase 3 clinical
studies that included more than 1,500 patients ages 40 and older who received roflumilast. From these studies, Roflumilast
500 mcg daily improved lung function and reduced exacerbations in patients with more severe COPD, especially those with
chronic bronchitis, frequent exacerbations, or who required frequent rescue inhaler therapy in the placebo-controlled trials.
It also improved lung function and reduced exacerbations in patients with moderately severe COPD treated with salmeterol
or tiotropium.
The common adverse effects were diarrhea, nausea, dizziness, headache, back pain, muscle spasm, weight loss and
uncontrollable shaking of a part of your body. The majority of these adverse reactions were mild or moderate. Roflumilast
may have interaction with carbamazepine, cimetidine, enoxacin, erythromycin, fluvoxamine, ketoconazole, phenobarbital,
phenytoin, rifampicin and certain oral contraceptives pills. There have recently been a number of reports saying that
Roflumilast may cause potential risk of mental health problem, suicidal thoughts and behavior. It would be advisible that
patient suffered from mental problem and suicidal and depression needs to inform the healthcare provider immediately.
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Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
BISOPROLOL TABLET
By: Ong See Wan, Hospital Rehabilitation Cheras
Available Dosage: 2.5mg & 5mg
ADVERSE DRUG REACTIONS:
Gliddiness,
headache,
fatigue,
bradycardia.
Nausea,
MDC Code:
vomiting, diarrhoea or constipation, stomach discomfort,
C07AB07000T1001XX & C07AB07000T1002XX
mild ocular stinging, photophobia, keratitis, decreased
sexual ability. GI disturbances, dyspnoea, cold extremities,
INDICATIONS:
insomnia, hallucination, drowsiness and mood alterations.
Treatment of stable chronic heart failure with reduced systolic
left ventricular function in addition to angiotensin-converting
Potentially Fatal: AV block, bradycardia. Rare but may occur
enzyme (ACE) inhibitors and diuretics, and optionally, cardiac
in patients with pre-existing cardiac disease. Includes severe
glycosides.
bronchospasm, hypoglycaemia, hypotension, orthostatic
hypotension, bradyarrhythmias. ‘Rebound phenomenon’
DOSAGE:
leading to unstable angina or MI on sudden withdrawal.
Hypertension / Angina pectoris
Adult: 2.5-10mg daily as a single dose. Max: 20mg daily.
PREGNANCY CATEGORY (US FDA)
CrCl <40ml/min: Initial dose should be 2.5mg daily
Category C
CrCl <20ml/min: Max: 10mg daily
Category D - In 2nd& 3rd trimesters
Hepatic impairment: Severe impairment: Initially, 2.5mg daily.
PHARMACOKINETICS
Max: 10mg daily.
Bisoprolol selectively and competitively blocks β-1 receptors
Heart failure
but has little or no effect on β-2 receptors except at high
Adult: Initially 1.25mg once daily doubled after 1 week if
doses.
tolerated, then increased gradually 1-4 week intervals. Max:
Absorption: Absorbed completely from the GI tract (oral);
10mg daily.
Renal/Hepatic impairment: Dosage reduction may be
peak plasma concentrations after 2-4 hrs.
necessary.
Distribution: Protein-binding: 30%
Metabolism: In the liver.
ADMINISTRATION:
May be taken with or without food.
Excretion: Excreted in urine. 10-12 hrs (elimination half-life).
CONTRAINDICATION:
Reference:
Low cardiac output and uncompensated cardiac failure;
Drug Formulary Ministry of Health Malaysia No. 1/2013
sinus bradycardia, 1st degree heart block, cardiogenic
http://online1.mimsgateway.com.my/Malaysia/drug/info/bisoprolol/?type=fu
shock, bronchospasm; severe haemorrhage. Pregnancy.
ll&mtype=generic#Dosage
http://www.merck.co.kr/en/company/Copy_of_merck_korea/
Pharmacueticals_areas/concor/concor.html
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BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
PENGUBAHSUAIAN CARA HIDUP PESAKIT KENCING MANIS
Oleh: Grace Liew Kai Hao, KK Pantai
Pemakanan
•
Pengawalan pemakanan adalah penting untuk
mengawal diabetes. Pemakanan yang betul bukan
setakat mengelakkan makanan dan minuman yang
manis sahaja.
•
Pesakit kencing manis harus makan 3 kali sehari setiap
hari pada masa yang ditetapkan. Pesakit tidak patut
tertinggal masa makan.
•
Makanan yang mengandungi kandungan fiber yang
tinggi seperti roti jagung, mi, oat, biskut kraker yang tidak
dimaniskan, lentil dan sayur-sayuran harus diambil.
•
Pengambilan lemak tepu harus dikekalkan pada paras
minimum kerana peningkatan pengambilan lemak
akan meningkatkan risiko serangan penyakit jantung.
•
Pengambilan garam dan makanan yang masin harus
dikurangkan. Elakkan makanan seperti kerepek dan
kacang tanah.
•
Pengambilan alkohol perlu dikekalkan pada paras
minimum atau dielakkan kerana alkohol akan mengubah
paras glukosa darah.
Senaman
Senaman berfungsi dengan tiga cara iaitu membantu
menggunakan kalori yang lebih yang mungkin dimakan,
membantu mengurangkan berat badan dan akhir sekali
dapat juga menambahkan kesihatan jantung dan paruparu kita. Senaman membolehkan insulin untuk bertindak
dengan lebih baik dan mengekalkan badan yang cergas
dan pesakit menjadi lebih sihat.
Penjagaan kulit
•
Gunakan agen pembersih yang bersifat asid, dengan
pH 5.5. Ini memastikan fungsi perlindungan kulit yang
semula jadi dikekalkan.
•
Gunakan air suam untuk mencuci.
•
Elakkan daripada menggaru kulit kerana kulit
yang
pecah
akan
menggalakkan
jangkitan. Semasa mandi, berikan tumpuan kepada kawasan
ketiak, kemaluan dan kelengkang, lipatan kulit dan
kawasan di antara jari kaki.
Penjagaan kaki
•
Pesakit kencing manis harus membersihkan kaki mereka
setiap hari dan mengeringkan kaki dengan sempurna,
khususnya kawasan di antara jari kaki.
•
Bagi kekeringan kulit, pesakit kencing manis haruslah
membubuhkan sedikit krim pelembap.
•
Kuku jari kaki harus dipotong lurus untuk mengelakkan
kecederaan kepada kulit. •
Kasut haruslah selesa dan tidak terlalu ketat. Pesakit
kencing manis haruslah memastikan bahagian dalam
kasut bebas daripada sebarang gerigit atau objek kecil
sebelum memakai kasut.
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Vol 2, 2013
Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
KAWALAN UBAT-UBAT DI DALAM ISLAM
Oleh: Stor Integrasi
Islam sangat mementingkan kebaikan dan kesihatan. Dalam
aspek kesihatan, orang-orang Islam disuruh supaya menjaga
tubuh badan agar sentiasa berada dalam keadaan sihat, di
samping itu Islam menyuruh umatnya berikhtiar mengubat
apabila dijangkiti sesuatu penyakit.
b) Sumber Haiwan Darat dan Air
i.
Semua haiwan darat dan air yang halal
dimakan dapat dijadikan bahan ubat.
ii.
Sumber ubat dari haiwan darat dan air yang
haram dimakan adalah najis kecuali dalam
keadaan perlu dan tidak ada pilihan.
Definisi Ubat Yang Halal
c) Sumber Tumbuh-Tumbuhan Dan Mikro-organisma
Ubat-ubatan yang halal (atau perkataan yang semakna
dengannya) bukan sahaja mesti menepati definisi ubat seperti
yang telah diterangkan tetapi sebagai tambahan mesti
menepati ciri-ciri berikut:
i. Sumber tumbuh-tumbuhan dan mikroorganisma di darat dan di air, hasilnya
adalah halal digunakan, kecuali yang
beracun dan berbahaya.
d) Sumber Tanah Dan Air
a) Bukanlah terdiri dari atau mengandung bahan dari
haiwan yang orang Islam dilarang oleh hukum syarak
menggunakannya atau memakannya ataupun tidak
disembelih mengikut hukum syarak.
b) Tidaklah mengandung bahan yang dihukum sebagai
najis mengikut hukum syarak.
i.
Semua sumber tanah dan air dan hasilnya
(termasuk bahan-bahan galian) adalah
halal digunakan kecuali yang beracun dan
berbahaya.
e) Sumber Sintetik
i.
c) Tidak disedia, diproses, dikilang atau di simpan dengan
menggunakan apa-apa alat yang tidak bebas dari
bahan-bahan najis mengikut hukum syarak.
d) Tidaklah, apabila menyedia, memproses, mengilang
atau
menyimpannya
itu,
bersentuhan
atau
berdekatan dengan apa-apa bahan yang tidak
memenuhi kehendak-kehendak perenggan (a), (b)
atau (c) ataupun apa-apa bahan yang dihukum
sebagai najis mengikut hukum syarak.
Bahan ubat yang dihasilkan cara sintetik
adalah halal kecuali yang beracun,
berbahaya dan bercampur dengan bahanbahan yang najis.
Sumber Eksipien
Eksipien adalah bahan tambahan yang diguna untuk
memproses sesuatu bentuk/jenis ubat, contohnya kanji,
kulit kapsul, pelarut, gula, pewarna, perasa, pengawet
dan lain-lain. Bahan-bahan eksipien adalah halal jika tidak
mengandung bahan-bahan yang najis, haram, beracun dan
berbahaya. Tidak ada pengecualian dalam penggunaan
bahan-bahan eksipien tersebut.
e) Tidaklah, apabila digunakan dengan sengaja,
boleh
mendatang
kesan-kesan
yang
boleh
membahayakan.
Penjelasan Mengenai Pengecualian Dalam Penggunan
Sumber Ubat
Ubat-Ubatan
Pada umumnya sumber ubat boleh dibahagikan kepada
beberapa kelompok, iaitu sumber manusia, sumber haiwan,
sumber tumbuhan, sumber tanah dan air. Sumber-sumber
ini sering digunakan untuk menghasilkan bahan-bahan
yang boleh dimanfaatkan sebagai ubat. Namun begitu
meialui teknologi moden pada masa ini, kebanyakan ubat
menggunakan bahan sintatik Pada dasarnya untuk sesuatu
ubat itu dikelaskan sebagai ubat yang halal, bukan sahaja
sumber-sumber yang digunakan sebagai bahan ubat
mestilah halal seperti yang diterangkan di bawah, malah
bahan-bahan itu sendiri mesti suci dari najis mengikut hukum
syarak serta digunakan untuk tujuan perubatan yang sah.
Bahan-bahan yang haram dan najis adalah dilarang digunakan
sebagai ubat. Walau bagaimanapun dalam keadaan
tertentu, di mana tidak ada bahan yang boleh dijadikan ubat
bagi mengubati sesuatu penyakit, orang Islam diharuskan
mengambil bahan-bahan yang haram untuk pengubatan.
Pengecualian dalam hal ini berpandukan kepada nas-nas
seperti berikut:
Pengecualian dalam penggunaan bahan-bahan haram
sebagai ubat, hendaklah menepati syarat-syarat seperti
berikut:
a. Tidak terdapat atau sukar mendapatkan bahan
yang halal untuk mengubati penyakit yang
berkaitan.
a) Sumber Manusia
i.
Sumber ubat dari manusia adalah haram
digunakan, kecuali dalam keadaan perlu
dan tidak ada pilihan.
ii. Bahan-bahan ubat yang terbit dari
sumber manusia selalunya melibatkan
zat-zat tertentu seperti hormon, serum
dan sebagainya yang diambil dari tubuh
manusia.
b. Penggunaan bahan berkenaan hendaklah di
bawah arahan dan nasihat doktor.
c. Pengambilan ubat dari bahan yang haram
hendaklah sekadar yang diperlukan sahaja.
Source:
http://www.islam.gov.my/garis-panduan-bersama-kawalan-ubat-ubat-dalam-islam
8
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 2, 2013
CARA PENGAMBILAN UBAT GTN
Oleh: Amsyar, Cure & Care Sungai Besi
‘Glyceryl Trinitrate’ atau GTN digunakan untuk merawat sakit dada yang disebabkan oleh serangan jantung. Ia juga boleh
diambil sekiranya terdapat tanda-tanda awal serangan jantung.
Apabila mengalami sakit dada, pesakit hendaklah berhenti melakukan sebarang kerja, duduk dan bertenang. GTN perlu
diambil dengan meletakkan pil tersebut di bawah lidah sehinnga ia larut sepenuhnya. Ubat ini selalunya memberikan
kelegaan dalam masa 5 minit bagi setiap pengambilan. Sekiranya sakit dada tidak berkurangan selepas mengambil pil
pertama, ambil pil kedua. Jika sakit masih berterusan, pil yang ketiga boleh diambil. Sekiranya sakit dada masih terasa
selepas pil ketiga, segera berjumpa doktor di bahagian kecemasan hospital yang berdekatan.
Jangan sesekali menelan atau mengunyah pil GTN kerana
ianya boleh menghilangkan keberkesanan ubat. Apabila
pesakit meletakkan ubat GTN di bawah lidah, pesakit akan
merasa ubat tersebut berangin. Ini menandakan ubat
tersebut masih berkesan.
Ubat GTN hendaklah disimpan di dalam bekas kaca yang
gelap dan kedap udara. Jangan sesekali menyimpan ubat
GTN di dalam sampul surat ataupun bekas plastik kerana
ini boleh menyebabkan hilang keberkesanannya. Pesakit
hendaklah sentiasa membawa ubat ini bersama.
Untuk makluman lanjut, sila layari laman web
www.knowyourmedicine.gov.my.
9
Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
What is G6PD Deficiency?
By: Ahmad Fitri, KK Dato Keramat
Symptoms of G6PD :
- Sudden rise in body temperature
- Yellow coloring of skin and
mucous membrane
- Dark yellow-range urine
- Pallor, fatigue
- Heavy, fast breathing
- Weak, rapid pulse
G6PD Deficiency is a hereditary abnormality in the activity of an erythrocyte (red
blood cell) enzyme. This enzyme, glucose-6-phosphate dehydrogenase (G-6PD), is essential for assuring a normal life span for red blood cells, and for oxidizing
processes. This enzyme deficiency may provoke the sudden destruction of red
blood cells and lead to hemolytic anemia with jaundice following the intake of
fava beans, certain legumes and various drugs. The defect is sex-linked, transmitted
from mother (usually a healthy carrier) to son (or daughter, who would be a healthy
carrier too). This is due to the fact that the structure of G6PD is carried on the X
chromosome: As stated by Ernest Beutler, M.D., “in females, only one of the two X
chromosomes in each cell is active; consequently, female heterozygotes for G6PD
deficiency have two populations of red cells; deficient cells and normal cells.
Can it be cured?
The best cure is to avoid the prohibited
drugs and foodstuffs.
In case of hemolytic crisis, blood transfusion
is the most effective therapy. However,
in milder cases transfusion is not usually
required.
What precautions can I take to ensure my
health living with G6PD Deficiency?
- Do not take any of the foods or
medications listed in this brochure without
consulting a physician.
-Avoid fava beans
-Always tell any health provider you see
that you have G6PD Deficiency.
The list of drugs and foods to be avoided.
DRUGS
FOODS
Analgesics / Antipyretics
Sulfonamides / Sulfones
Safe to take
Fava Beans
Acetanilide ,
dapsone,
(In very small doses)
Few also avoid red wine,
acetophenetidin
sulfacetamide,
Acetaminophen
all legumes,
amidopyrine,
sulfamethoxypyrimidine,
Acetylsalicylic acid *
Blueberries
sulfasalazine
Aminopyrine*
[and yogurts containing these],
Ascorbic acid*
Soya products
antipyrine*,
aspirin*,
phenacetin, probenicid,
pyramidone
Antimalarials
chloroquine *,
Benzhexol
Miscellaneous
Chloramphenicol
alpha-methyldopa,
Colchicine
dimercaprol (BAL),
hydralazine,
primaquine, quinine *,
mestranol,
Diphenhydramine
Isoniazide
L-Dopa
methylene blue,
Cytotoxic / Antibacterial
nalidixic acid,
chloramphenicol,
naphthalene,
co-trimoxazole,
nalidixic acid,
nitrofurantoin,
para-aminosalicylic acid
Cardiovascular Drugs
procainamide *,
quinidine *
Camphor
Chloroquine *
ascorbic acid *,
hydroxychloroquine,
Tonic water
Phenylbutazone
Phenytoin
Probenecid
niridazole,
Quinidine, Quinine
phenylhydrazine,
Streptomycin
toluidine blue,
Sulfadiazine
trinitrotoluene,
Sulfaguanide
urate oxidase,
Sulfisoxazole
vitamin K * (water soluble),
Trimethoprim
pyridium, quinine *
Vitamin K*
10
*These drugs appear in lists
of medications to avoid, and
medications
to
be
taken
in small doses. Avoid them
altogether if possible. If you do
take these, take only normal
therapeutic doses.
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 2, 2013
TOPICAL PREPARATION DOSAGE FORMS AND CORTICOSTEROIDS
By: Daveena Balakrishnan , KK Jinjang
Topical Corticosteroids
Creams &
Ointments
Lotions*
Corticosteroid
cream/ ointment*
15-30g
100ml
15-30g
Both hands
25-50g
200ml
15-30g
Scalp
50-100g
200ml
15-30g
Both arms
100-200g
200ml
30-60g
Both legs
100-200g
200ml
100g
400g
500ml
100g
15-25g
100ml
15-30g
Body Part
Topical corticosteroids can be in the form of creams,
Face
ointments and lotions are used to suppress the inflammatory
reaction and relieve symptoms of skin conditions.2
Choosing the right potency
Trunk
Generally corticosteroids of the lowest potency are used to
Groins & Genitalia
control skin conditions.
Low potency corticosteroids are typically used when treating
Fingertip units and children
large areas or for long term application. They are more
suitable for children or areas of thinner skin .More potent
Once again one FTU is used to treat an area of skin on a child
corticosteroids are suitable for severe conditions and on
that Is equivalent to twice the size of the flat of an adult’s
areas that have thickened skin. 3
hand with the fingers together. The number of FTU that is
appropriate, corresponding to certain body parts is shown
as below.
Choice of formulation
Water miscible creams are suitable for moist or weeping
wounds. Creams are often preferred by patients as they
vanish when rubbed in making them cosmetically more
pleasant to use than ointments.2 Ointments are greasy and
remain on the skin even after rubbing it in. Ointments are
chosen for dry, thick and lichenified skin.4 Lotions are useful
for minimal application to a large or hair bearing area or for
treatment of exudative lesions.2
Occasionally urea or salicylic acid is included in the
preparation of topical corticosteroids to enhance its
penetration.
Suitable quantities for prescribing
*For twice daily application/week for an adult
One fingertip unit (FTU) is the amount of topical steroid that is
squeezed out from a standard tube along an adult’s fingertip
Should topical corticosteroids be applied before or after
assuming the tube has a standard 5 mm nozzle. A fingertip is
emollients?
from the very end of the finger to the first crease on the finger
(pic). One FTU is enough to treat an area of skin twice the size
The NICE guideline for managing eczema in children advises
of the flat of an adult’s hand with the fingers together. One
that if both are applied, an interval of several minutes should
FTU is equivalent to 0.5 g of topical steroid.
be left in between the application of both.5
However which preparation should be used first is debatable.
However, one guideline suggests that the emollient should
Example :
be applied first because 6:
To treat an area of the skin that is the size of eight adult
Topical drugs may become more effective when used after
hands, four FTU will be needed per dose.
emollients
4FTU= 2g of topical corticosteroid per dose.
Corticosteroids may be diluted or transferred to areas that do
Assuming the frequency used is once a day, then a 30 g tube
not require treatment if emollients are applied immediately
should last about 15 days.
on top of them.
11
Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
UPDATE OF TREATMENT: MANAGEMENT OF DEPRESSION
By: Gan Yan Nee, KK Cheras Baru
Major depressive disorder, also known as
clinical depression can be identified according
to DSM-IV TR criteria in which 5 symptoms or
more including depressed mood or loss of
interest persisting for at least 2 weeks confirms
a diagnosis. Treatment of depression considers
the severity of disorder, characterised by the
number and severity of symptoms and the
degree of functional impairment. Generally,
people with mild depression would benefit more
from low intensity psychological interventions
rather than pharmacological treatment.
First generation antidepressants used in the past
include tricyclic antidepressants (TCAs) e.g.
amitryptiline and imipramine; and monoamine
oxidase inhibitors (MAOIs) e.g. moclobemide.
Newer second generation antidepressants are
mainly selective serotonin reuptake inhibitors
(SSRIs) e.g. escitalopram, sertaline, fluoxetine,
and fluvoxamine; noradrenergic and selective
serotonergic
antidepressants
(NaSSa)
e.g.
mianserin and mirtazapine; and serotonin and
norepinephrine reuptake inhibitors (SNRIs) e.g.
venlafaxine. Despite similar efficacy, second
generation antidepressants are preferred due
to better tolerability profile.
12
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
The choice of antidepressant is dependent on the
anticipated adverse events such as side effects or
discontinuation symptoms and whether the patient
has chronic physical health problem considering
the potential interactions with concomitant illness
or medication(s). Generally, TCAs have multiple
side effects and greatest risk of overdose whereas
SSRIs are associated with risk of bleeding. Fluoxetine
and fluvoxamine have higher propensity for drug
interactions wheras sertraline has less drug interactions
and should be considered for people with chronic
physical health problem. Mirtazapine and venlafaxine
are associated with high incidence of discontinuation
symptoms. Venlafaxine should be avoided in people
who are at significant risk of suicide as it has risk of
death from overdose.
Combination of antidepressant with high-intensity
psychological
intervention
such
as
cognitive
behavioural therapy is found to be effective in
moderate to severe depression. In cases where
inadequate response is observed following dose
optimization or switching antidepressants, treatment
may be augmented with lithium, antipsychotics or
other antidepressants after due consideration of sideeffect
burden,
contraindications
and
monitoring
requirements. Management of depression requires
close monitoring and constant review of patient’s
adherence and tolerability towards medication in
order to achieve remission and prevent relapse.
13
Vol 2, 2013
Vol 1,
2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
UPDATES ON THALASSAEMIA TREATMENT
By: Teow Wei Chien, KK Petaling Bahagia
Thalassaemia, also known as sickle cell disorder, is a curative and preventable human
inherited haemoglobin disorders.1,2 The main treatment of thalassaemia involves combination
of blood transfusion and iron chelation therapy. The involvement of iron chelation therapy is
needed as blood transfusion causes iron overload. Iron overload can lead to complications
such as cardiac, liver or endocrine toxicities and if untreated, is fatal in the first or second
decade of life. This can be avoided using the iron chelation therapy.1,2
There are 3 commonly used iron cheating drugs; 1) desferrioxamine (DF), 2) Deferiprone
(L1), and 3)Deferasirox (Exjade).1,2 Desferrioxamine (DF) was the first iron chelator available
and has been use for more than 30 years. It has high iron chelating efficiency, but must be
administered either subcutaneously or intranevously. In cases where patient do not tolerate
desferrioxamine or ineffective, oral iron chelator should be used.2
Deferiprone (L1) is licensed for treatment of iron overload in patients with transfusion-dependent aneamis when deferoxammine
is contraindicated or inadequate. It may be taken orally with meals to reduce nausea. Due to the small size and lipophilic
nature, it has higher cell penetration and better iron chelating from organs like hearts. While deferiprone has selectivity for
cardiac iron, desferrioxamine is more effective in chelating iron from liver.2
Deferasirox (Exjade) appears similar to deferoxamine in lowering liver iron and serum ferritin levels in a dose-dependent
manner. The usual starting dose is 20 mg/kg/per day. It comes in a dispersible form that can be suspended in water, apple
juice, or orange juice. It should be taken on an empty stomach 30 minutes before or after eating. Table below is the summary
of comparison between 3 iron chelators.2
Properties
Desferrioxamine
Deferiprone
Deferasirox
Route of
administration
• Slow infusion: subcutaneous / intravenous
• Oral
• Oral
Plasma half-life
• Short
• 20 minute
• Moderate
• 2-3 hours
• Long
• 8 – 16 hours
Usual Dosage
• 40-60 mg/kg, over 8-12 h, 5 days per week
• max rate 15mg/kg/hr
• 50-100 mg/kg/day in 3 divided doses, certain • start with 20mg/kg/day and adjusted dose based
studies suggested that dose of > 75mg/kg/day is on clinical response and iron stores.
more effective than lower doses1
• Max: 30mg/kg/day, in certain cases up to 40mg/
kg/day
Iron chelating
efficiency
• High
• Low
• Moderate
Advantages
• Long-term experience
• Effective chelator
• May be combined with deferiprone
• Easy to be taken (Oral)
• Established safety profile
• Better at removing cardiac iron
• May be combined with deferoxamine
• Easy to be taken (Oral)
• Once a day dosing
Disadvantages
•Prolonged parenteral infusions
• Eye, ear, bone, growth toxicities
•Agranulocytosis, GI symptoms and joint pains • Limited, long-term data on safety profile
requiring weekly monitoring
• Close monitoring of renal function
Table taken from ’Guidelines for the Clinical Care of Patients with Thalassemia in Canada’ and edited.
1. Kontoghiorghes et al., 2000, Lucas et al., 2000, Rombos et al., 2000, Barman Balfour & Foster, 1999, Addis et al., 1999.
Bone Marrow Transplantation or Stem cell Transplantation (HSCT) should be done whenever possible (if there is a HLA
compatible sibling/ family member).1,2 HLA-matched from unrelated and alternative donors can also be offered where
indicated but are associated with higher treatment-related mortality (5-30% in some series). Acute and chronic graft-versushost disease is also a major complication found more commonly in unrelated donor cases.2
Also, there are ongoing studies on new drugs/ areas to treat thalassaemia, for example: newer chelators deferitrin,
modification on previous chelators (starch attached to desferrioxamine), use of hydroxyurea and 5 Azacytidine (5-AzaC)
to increase hemoglobin level and gene modification therapy. However, there is insufficient evidence and safety data to
recommend any of these options. Taking care of thalassaemia patient is a life long commitment. Apart from standard blood
transfusion and drug therapies, medical care by multi-disciplinary team, medical counseling, as well as psychosocial support
are important in making sure patient have a good quality of life.2
Reference:
1.
Health Technology Assessment Unit, Medical Development Division, Ministry of Health Malaysia. Report of Health Technology: Management of
Thalaessaemia. Malaysia: Ministry of Health Malaysia; 2003.
2.
Dr Sayani F, Dr Warner M, Dr Wu J, Wong DR, Humpherys K, Dr Odame I. Guidelines for Clinical Care of Patients with Thalassemia in Canada. Canada:
Anemia Institute for Research and Education, Thalassemia Foundation of Canada.
14
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 1,
2, 2013
Update of Treatment: Management of Systemic Lupus Erythematous (Sle)
By: Grace, Faiz & Wan Shihabuddin, KK Tanglin
Systemic Lupus Erythematosus (SLE) is a chronic, occasionally life-threatening,
multisystem disorder. It is an autoimmune disease, which means the body’s immune
system mistakenly attacks healthy tissue. This leads to long-term inflammation.
SLE is much more common in women than men. It may occur at any age, but
appears most often in people between the ages of 10 and 50. African Americans
and Asians are affected more often than people from other races. People with
lupus often have disease flares, in which symptoms worsen, followed by a period
of remission, in which symptoms improve. Symptoms vary from person to person,
and may come and go. Usually the peoples with SLE have joint pain and swelling.
Some develop arthritis. The joints of the fingers, hands, wrists, and knees are often
affected. There are other common symptoms such as chest pain, fatigue, fever,
hair loss, mouth sores, sunlight sensitivity, butterfly rash and swollen lymph nodes.
There is no cure for SLE. However, treatments are available to reduce symptoms,
to reverse inflammation, and to minimize organ damage. Although the pattern
and severity of organ involvement determines specific drug therapy, a number of
general issues are applicable to every patient with SLE.
Patient should be advised to wear protective clothing, sunglasses, and sunscreen
when in the sun.
Appropriate immunizations should be given to patients prior to the institution of
immunosuppressive therapies. Influenza vaccine and pneumococcal vaccines
are recommended for people with lupus. In contrast, vaccines that contain live
vaccines (eg, measles, mumps, rubella, polio, varicella, and smallpox) are not
recommended for people with lupus, especially if you currently take prednisone.
A number of medications are known to worsen lupus. You should not take these
medications if there is an acceptable alternative. Sulfa-containing antibiotics are
examples of medicines that should be avoided.
A number of medications are commonly used in the treatment of lupus for specific
organ, including nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarials,
glucocorticoids, and immunosuppressive agents.
NSAIDs are generally effective for musculoskeletal complaints, fever and headaches
caused by lupus-related arthritis and inflammation. Antimalarial medication such
as hydroxychloroquine (Plaquenil®) is found to be useful for people with lupus with
skin symptoms and joint pain that have not fully responded to NSAIDs. Antimalarial
therapy may also help to protect the body from lupus-related major damage to
the kidneys and central nervous system while reducing the risk of disease flares.
Glucocorticoids may be used alone or in combination with immunosuppressant.
Exa mpl e s o f i m mu nos up p r e s s iv e m e d ic ine s inc lu de met ho t rex a t e,
cyclophosphamide,
azathioprine,
mycophenolate,
and
rituximab.
These
treatments are generally reserved for people with significant organ damage,
particularly of the renal, blood, lungs, or nervous system, or for those needing high
doses of glucocorticoids to treat their condition. The benefit of glucocorticoids and
immunosuppressive medications must be weighed against the risks because these
treatments have potentially serious side effects such as weight gain, worsened
diabetes, osteopenia and osteoporosis, and an increased risk of infection. A
number of other treatment approaches for lupus have been tried or are under
investigation. These include bone marrow transplantation, anti-B cell antibodies
(including rituximab and epratuzumab), and others.
15
Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Management of Acne
By: KK Putrajaya P9
The aims of acne management are:
• To induce clearance of lesions
• To maintain remission and prevent
relapse
• To prevent physical and psychological
complications
Acne can be treated pharmacologically
with induction and maintenance
therapy. Induction therapy is a phase
of treatment aims to reduce acne
remission which can be achieved
using topical or systemic agents.
Maintenance therapy is important as
to prevent recurrence of acne lesions
after successful treatment. The mainstay
of maintenance treatment is topical
therapy.
Drug
Dosage
Common Adverse Effects
Topical benzoyl
peroxide
Apply once to twice daily
Contact dermatitis, dryness, skin discoloration,
skin rash, transient local oedema.
Topical tretinoin
Apply once in the evening
Skin irritation, stinging, oedema, erythema,
scaling, photosensitivity, temporary hypo/
hyperpigmentation.
Topical adapalene
Apply once daily after washing in the
evening
Mild skin irritation, scaling, erythema, stinging,
burning, dryness, pruritus.
Topical clindamycin
Apply twice daily
Irritation, dryness, stinging, erythema, contact
dermatitis.
Topical erythromycin
Apply twice daily
Dryness, erythema, burning, pruritus.
Topical salicylic acid
Apply once to thrice daily
Irritation, sensitivity, excessive dryness.
Topical sulfur and its
combinations
Apply OD to BD daily. Initiate with once
daily, then increase gradually.
Skin irritation, dermatitis.
Topical azelaic acid
Apply twice daily
Skin irritation, mostly burning or itching,
occasionally erythema and scaling.
Oral tetracycline
500mg -1g daily in 2 divided doses
GIT disturbances, discoloration of teeth and nails,
photosensitivity, visual disturbances.
Oral doxycycline
50mg -100mg once to twice daily
GIT disturbances, photosensitivity, hypersensitivity,
permanent staining of teeth, rash.
Oral erythromycin
Erythromycin ES (EES): 400-800mg BD
Erythromycin Stearate: 250-500mg BD
GIT disturbances, rash, headache, dizziness.
16
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 2, 2013
Update of Treatment: Management of Genital Herpes
By: Joanne Ong Yen Nee, KK Batu
By: Juanah Garabus & Ku Mardiana, KK Tanglin
Genital herpes is a sexual transmitted disease caused by herpes simplex virus (HSV). It is a chronic, life-long viral infection
caused by two types of virus, HSV-1 and HSV-2. Most recurrent cases of HSV are caused by HSV-2 virus.1,2,3 Treatment of genital
herpes will depend if infection is for the first time (primary infection) or recurrent outbreaks.1,3 Antiviral chemotherapy offers
clinical benefits to most symptomatic patient and is the mainstay of a management. Counseling regarding the natural
history of genital herpes, sexual and perinatal transmission and methods to reduce transmission is important to be integrated
with clinical management. Systemic antiviral drugs can be used to treat first clinical and recurrent episodes or when used
as daily suppressive therapy. However, these drugs do not eradicate latent viruses nor affect the risk, frequency or severity
of the recurrences after drug is discontinued. Randomized trials have indicated that 3 antiviral medications have provided
clinical benefits to genital herpes: acyclovir, valacyclovir and famciclovir. Valacyclovir is the valine ester of acyclovir and has
enhanced absorption after oral administration. Famciclovir also has high oral bioavailability. Topical therapy with antiviral
drugs offers minimal clinical benefit and often its use is discouraged.1
Newly acquired genital herpes can cause prolong clinical illness with severe genital ulceration and neurologic involvement.
Therefore patients with first episodes of genital herpes should be started with antiviral therapy. Almost everyone with
symptomatic first-episode of genital HSV-2 infection subsequently experience recurrent episodes of genital lesions; recurrence
are less frequent after initial genital HSV-1 infection which is a clinical silent infection. Antiviral therapy for recurrent infection
can be administered following a suppressive therapy regimen to reduce the frequency of recurrent or episodically to
ameliorate lesions.1 If outbreak is experienced more than 6 times per year, suppressive therapy is recommended as in Table
1.1,3 If recurrent outbreaks are less than six times in a year, episodic therapy is applied.3 Acyclovir, famciclovir and valacyclovir
appear equally effective for episodic treatment of genital herpes. However famciclovir appears somewhat less effective
for suppression of viral shedding. Ease of administration and cost are important considerations for prolonged treatment.
Recommended episodic regimen is as shown on Table 2.1
Intravenous (IV) acyclovir should be given for severe HSV disease or complications that require hospitalization (e.g. disseminated infection, pneumonitis, or hepatitis) or CNS complications (e.g. meningoencephalitis). The recommended regimen is
acyclovir 5-10mg/kg IV for 8 hours for 2-7 days until clinical improvement is observed, followed by oral antiviral therapy to
complete at least 10 days of total therapy. Acyclovir dose adjustment is required for patient with impaired renal function.1
Table 1
Table 2
Recommended Suppressive Regimens
Recommended Episodic Regimens
Acyclovir 400 mg orally twice a day
Acyclovir 400 mg orally three times a day for 5
days
OR
Acyclovir 800 mg orally twice a day for 5 days
OR
Acyclovir 800 mg orally three times a day for 2
days
OR
Famciclovir 125 mg orally twice daily for 5 days
OR
Famciclovir 1000 mg orally twice daily for 1 day
OR
Famciclovir 500 mg once, followed by 250 mg
twice daily for 2 days
OR
Valacyclovir 500 mg orally twice a day for 3 days
OR
Valacyclovir 1 g orally once a day for 5 days
OR
Famiciclovir 250 mg orally twice a day
OR
Valacyclovir 500 mg orally once a day*
OR
Valacyclovir 1 g orally once a day
* Valacyclovir 500 mg once a day might be less
effective than other valacyclovir or acyclovir
dosing regimens in patients who have very frequent
recurrences (i.e., ≥10 episodes per year).
References:
1.
Centre of Disease Control and Prevention 2011, Sexually Transmitted Disease Guidelines: Diseases Characterised by Genital, Anal or Perianal Ulcers,
Centre of Disease Control and Prevention accessed 3rd June 2013, <http://www.cdc.gov/std/treatment/2010/genital-ulcers.htm#hsv>.
2.
The New Zealand Herpes Foundation 2013, Patient’s Information: Genital Herpes-The Facts, The New Zealand Herpes Foundation accessed 3rd June
2013, <http://www.herpes.org.nz/patient/facts.htm >.
3.
NHS Choices 2012, Genital Herpes-Treatment, NHS United Kingdom accessed 3rd June 2013, <http://www.nhs.uk/Conditions/Genital-herpes/Pages/
new_Treatment.aspx>.
17
Vol 1,
2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Perubatan Tradisional dan Komplementari
Oleh: Nadiah, Hospital Putrajaya
Malaysia sebagai sebuah negara yang, kaya dengan pelbagai warisan amalan perubatan tradisional, yang mana
setiap amalan tersebut berasal dari kumpulan etnik yang berbeza. Menyedari kepentingan dan penggunaan Perubatan
Tradisional dan Komplementari (PT&K) yang meluas, Kementerian Kesihatan Malaysia (KKM) telah melancarkan Polisi
Perubatan Tradisional dan Komplementari pada tahun 2001. Pada 2008 terdapat 3 buah hospital telah terpilih untuk merintis
pembentukan Unit PT&K. Hospital tersebut adalah Hospital Putrajaya, Hospital Kepala Batas (Pulau Pinang) dan Hospital
Sultan Ismail (Johor Bharu). Rawatan yang ditawarkan adalah sebagai melengkapi (complement) perubatan moden, dan
bukanlah bagi menggantikannya.
Rawatan yang ditawarkan di Hospital Putrajaya adalah:
Urutan Melayu Dan Akupunktur
Rawatan urutan Melayu dan akupuntur disediakan untuk pesakit pasca strok dan sakit kronik.
Ia bertujuan untuk
membantu meningkatkan pemulihan pesakit strok dan mengurangkan rasa sakit yang dihidapi oleh pesakit sakit kronik.
Sakit kronik yang dimaksudkan merupakan sakit yang berpanjangan seperti migrain, sakit lutut, sakit belakang dan lain-lain.
Walaubagaimanapun ia bukanlah untuk merawat penyakit kronik seperti kencing manis, darah tinggi dan sebagainya.
18
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 1,
2, 2013
Herba Onkologi
Rawatan herba pula ditawarkan kepada pasakit kanser sebagai tambahan ataupun sokongan (adjunct) kepada
rawatan kanser konvensional. Rawatan herba yang diberikan adalah bertujuan untuk mengurangkan kesan sampingan
yang dihadapi setelah selesai menjalani rawatan kemoterapi dan radioterapi mahupun kesan sampingan daripada
barah itu sendiri. Antara contoh kesan sampingan ialah penurunan berat badan, tiada selera makan, keguguran
rambut dan lain-lain.
Urutan Selepas Bersalin
Perkhidmatan yang disediakan adalah penjagaan
payudara dan penjagaan perbidanan. Urutan payudara
bertujuan untuk meningkatkan aliran susu badan,
meningkatkan penghasilan susu badan, dan mengelakkan
pembengkakan payudara. Amalan penjagaan perbidanan
di Unit PT&K pula merangkumi urutan seluruh badan,
bertungku dan berbarut untuk ibu yang bersalin secara
normal.
Objektif penjagaan perbidanan adalah untuk mengesan
awal komplikasi selepas bersalin, menggalakkan amalan
Melayu tradisi penjagaan perbidanan yang selamat dan
baik dan memberikan kesedaran mengenai penggunaan
herba yang selamat dalam tempoh pantang.
Penjagaan perbidanan tidak dijalankan ke atas ibu yang
bersalin secara Caesarian.
Kini perkhidmatan ini juga ditawarkan di Pusat Bersalin
Berisiko Rendah 1Malaysia MAIWP-Hospital Putrajaya, Presint
8 Putrajaya.
19
Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Update of Pharmacy Profession: Zoning System of Community Pharmacy
By: Intan An-Nisaa’ Binti Ismail, Klinik Kesihatan Putrajaya Presint 3
As of 31st January 2013, the number of qualified registered pharmacists in Malaysia has increased to 10,250. In Malaysia, the
ratio of pharmacist to people is 1:2947, with a total of 4010 or 39.12% pharmacists in private sector. In order to encourage
more pharmacists to venture in the private sector, also filling the gaps that now exist in community pharmacy, the new policy
has shorten the period of compulsory services from 3 years to 1 year [1]. On 26 November 2012, Dato’ Seri Liow Tiong Lai, exMinister of Health, said there are only 1834 community pharmacies in Malaysia, with the most in Selangor with 433, followed by
Penang with 213, Kuala Lumpur (201) and Johor (157). This figure shows that community pharmacies are more concentrated
in urban areas compare to rural areas[2]. This scenario is common in all of the developing countries and developed countries
across the globe [4]. According to the Malaysian Community Pharmacists Association, there are about 30 rural districts in dire
need for a private community pharmacy [4]. As a result, there is a necessity of a pharmacy zoning system, essentially to ensure
an even distribution of pharmacies throughout the country and to drive penetration of community pharmacy services having
similar standards experienced in the urban areas to the rural community [3].
Figure 1. The number of pharmacies within an 800 m road travel distance of census dissemination blocks in Hamilton, Ontario
In order to avoid the overflowing of community pharmacies in urban areas, a few solutions had been suggested. These
include legislating the requirement of setting up pharmacies in the rural areas and giving incentives for newcomer. For
example, dimensioning the distribution of community pharmacies per population, a town of 30,000 people will require 3
private community pharmacies, complementing and working side-by-side with public or hospital pharmacy designated for
the area. Even though some areas do not have public clinics, private community pharmacies has been found to be capable
of filling the requirements of the community by complementing the services provided by the government’s rural clinic [3].
Establishment of an authority body should be taken into consideration to ‘unravel this riddle’, as practiced in Australia. The
Australian Community Pharmacy Authority, a body authorized under the National Health Act of 1953 is responsible in making
recommendation on new pharmacy setup and the relocation of existing pharmacy. For that purpose, a set of rules was
established. For instance, the relocation of a pharmacy in a distance of less than 1.5 kilometer from the present address
provided that there is no other pharmacy within 500 meters zone upon on their recommendation [4]. Ministry of Health will
be collaborated with the Malaysian Pharmaceutical Society (MPS) to develop the Malaysia Healthcare Providers Mapping
Service. This service displayed 10 types of healthcare service providers, which assist in finding the nearest pharmacies in
a convenient way. This service may be used to improve the distribution of pharmacies in both urban and rural areas [5].
According to the Pharmaceutical Services Division Senior Director, Dato’ Eisah A. Rahman, individuals intending to open a
pharmacy is required to obtain an approval from the pharmacy division. Advice will be given to relocate to another strategic
location if the area applied for has an existing pharmacy. This is to avoid competition that can exist if pharmacies are too
close, and eventually ensures that the public is able to receive services from a community pharmacy that is within reach [5].
References:
1. Satu Ahli Farmasi 2000 penduduk, Ainul Asniera Ahsan, Utusan Malaysia, 25 February 2913
2. Health Ministry planning ‘zoning’ system for pharmacies, Nicholas Cheng, The Star, 26 November 2012
3. Pharmacy Practice in Malaysia, Wong Sie Sing, Malaysian Journal of Pharmacy, 2001 1:2-8
4. Pharmacy Zoning and Ownership, Malaysia Community Pharmacy Association
5. Move to increase pharmacies in rural areas, Wong Pek Mei, The Star, 25 February 2013
20
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 2, 2013
UBAT-UBAT YANG DILULUSKAN MASUK FORMULARI KKIA JKWPKL&P 2013
BIL
NAMA UBAT
KATEGORI
1
Betamethasone 17- Valerate 0.01-0.05% Cream
B
2
Bromhexine HCl 8mg Tablet
B
3
Calamine Cream
C
4
Cephalexin Monohydrate 250mg Capsule
B
5
Chlorpheniramine Maleate 4mg Tablet
C
6
Clotrimazole 500mg Vaginal Tablet
B
7
Diphenhydramine HCl 14mg/5ml & AmmoniumChloride 135mg/5ml Expectorant
C
8
Erythromycin Ethylsuccinate 400mg Tablet
B
9
Erythromycin Ethylsuccinate 400mg/5ml Suspension
B
10
Hydrocortisone 1% Cream
B
11
Lactulose 3.35g/5ml Liquid
B
12
Magnesium Trisilicate Mixture
C
13
Meclozine HCI 25mg & Pyridoxine 50mg Tablet
B
14
Methyldopa 250mg Tablet
B
15
Methyl Salicylate 25% Ointment
C
16
Miconazole 2% Cream
B
17
Neomycin 0.5% Cream
B
18
Nystatin 100,000 units/g Cream
C
19
Oral Rehydration Salt
C
20
Sodium Bicarbonate, Citric Acid, Sodium Citrate and Tartaric Acid-4 g per sachet (URAL/U-LITE)
B
21
Sodium Chloride 0.9% Eye Drop
C
22
Labetalol 100mg Tablet
B
23
Nifedipine 10mg Tablet
B
24
Potassium Citrate 3g/10ml & Citric Acid
C
NOTA: Ubat List B hanya untuk KKIA yang ada Pegawai Perubatan sepenuh masa
SENARAI BARU UBAT TROLI KECEMASAN KK JKWPKL&P 2013
BIL
NAMA UBAT
KATEGORI
1
Adrenaline Acid (Epinephrine) Tartrate 1 mg/ml Injection
B
2
Atropine Sulphate 1mg/ml Injection
B
3
Calcium Gluconate 10% Injection
B
4
Dextrose 50% Injection
B
5
Hydrocortisone Sodium Succinate 100mg Injection
C
6
Furosemide 20mg/2ml Injection
B
7
Water For Injection
C
8
Naloxone HCl 0.02mg/ml Injection
B
9
Hyoscine N-Butylbromide 20mg/ml Injection (*)
B
10
Lignocaine HCl (Lidocaine) 2% Injection (*)
B
11
Aminophylline 25mg/ml Injection (*)
B
12
Chlorpheniramine Maleate 10mg/ml Injection (*)
B
13
Terbutaline 0.5mg/ml Injection
Dikeluarkan
14
Sodium Bicarbonate 8.4% (1mmol/ml) Injection
Dikeluarkan
( * )Tambahan Ubat Baru Dalam Senarai Ubat Troli Kecemasan
21
Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
SENARAI BARU UBAT BILIK RAWATAN KK JKWPKL&P 2013
BIL
NAMA UBAT
KATEGORI
1
Diclofenac Sodium 75mg/3ml Injection
A
2
Mefenamic Acid 250mg Capsule
B
3
Paracetamol 500mg Tablet
C
4
Acetyl Salicylic Acid 300mg Soluble Tablet
C
5
Paracetamol 125mg Suppository
B
6
Lignocaine 2% Jelly
B
7
Pethidine HCL 50mg/ml Injection
B
8
Morphine Sulphate 10mg/ml Injection
B
9
Diazepam 10 mg/2 ml Injection (*)
B
10
Diazepam 5mg Rectal Solution (*)
C
11
Hyoscine Butyl Bromide 20mg/ml Injection
B
12
Ranitidine 50mg/2ml Injection
B
13
Magnesium Trisilicate Mixture (*)
C
14
Magnesium Trisilicate Tablet (*)
C
15
Metoclopramide HCL 10mg/2ml Injection
B
16
Prochlorperazine Mesylate 12.5mg/ml Injection
B
17
Haloperidol 5mg/ml Injection
B
18
Labetalol 100mg/20ml Injection
B
19
Hydralazine HCI 20mg Injection (*)
B 20
Benzathine Penicillin 2.4 mega units Injection (1.8 g)
B
21
Ceftriaxone 0.25 g Injection
22
Chlorpheniramine 10mg/ml Injection
B
23
Dextrose 10% Injection
B
24
Sodium Chloride 0.9% with Dextrose 5% Injection
C
25
Sodium Chloride 0.9% Injection
C
26
Heparin Sodium 50 Units in Sodium Chloride Injection
B
27
Oxytocin 5 units + Ergometrine Maleate 0.5mg/ml Injection (Syntometrine)
28
Promethazine HCL 25mg/ml Injection
B
29
Streptomycin Sulphate 1g Injection
B
30
Vitamin K1 Injection 1mg/ml
C
31
Tetanus Toxoid Injection
C
32
Sodium Chloride 0.45% Injection
B
33
Sodium Lactate Compound Injection (Hartmanns Solution / Ringer- lactate)
C
34
Cyanocobalamin 1 mg Injection
B
A/KK
22
C+
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 2, 2013
SENARAI BARU UBAT BILIK RAWATAN KK JKWPKL&P 2013 (cont..)
BIL
NAMA UBAT
KATEGORI
35
Vitamin B Complex 10ml Injection
B
36
Ipratropium Bromide 0.025% Inhalation Solution in UDV, 250mcg/ml
B
37
Ipratropium Bromide 0.5mg + Salbutamol 2.5mg Inhalation Solution in UDV
B
38
Salbutamol 0.5% Inhalation Solution
B
39
Procyclidine HCL 10mg/2ml Injection
B
40
Tuberculin PPD Injection
B
41
Fluphenazine Decanoate 25mg/ml Injection
B
42
Naloxone HCl 0.02mg/ml Injection
B
43
Flupenthixol Decanoate Depo 20mg/ml Injection
B
44
Water For Injection
C
45
Chloramphenicol 1% Eye Ointment
C
46
Fluorescein 1 mg Ophthalmic Strip (*)
B
47
Proparacaine HCl 0.5% Ophtalmic Drops (*)
B
48
Homatropine 2% Eye Drop (*)
B
49
Povidone Iodine 10% (equi to 1% iodine) Solution
B
50
Silver Sulphadiazine 1% Cream (*)
B
51
Magnesium Sulphate 50% Injection (*)
C
52
Nifedipine 10mg Tablet
B
53
Glyceryl Trinitrate 0.5mg Tablet (*)
C
1
Ergometrine Maleate 0.5mg/ml Injection
Dikeluarkan
2
Terbutaline Sulphate 0.5mg/ml Injection
Dikeluarkan
23
Vol 2, 2013
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
How to report a fake medicine or unregistered product to the authorities
By : Dennis Chong, Enforcement JKWPKL&P
The pharmacy enforcement division welcomes any complaints regarding the selling of fake medicine,
unregistered or adulterated products. Co-operation between the public and government bodies has been
identified as one of the ways to tackle the issue of widespread selling of unregistered products.
As of January 2013, there are around 400 pharmacies and 1300 clinics in Kuala Lumpur alone. This amount does
not include spas, saloons and hardware shops that have been springing up like mushrooms after rain. Lack of
manpower is the biggest challenge when it comes to the task of inspection. Increasing the amount of officers
is not the way to move forward. Thus, the public can act as eyes and ears of the authorities, reporting any
suspicious activities. Every state has its own pharmacy enforcement unit while the headquarters of pharmacy
enforcement division is located at Jalan Universiti, Petaling Jaya.
Reports or complaints can be lodged by person, through phone, email or even sms. Planning is being done
currently so that complaints can be lodged through online portal in the future. When a complaint has been
lodged, a notice of receipt will be given to the complainer. An officer will then be assign ed to ascertain on
the validity of the complaint before a feedback is given to the complainer within 14 working days. If the source
of complaint is believed to have solid grounds, further actions such as surveillance or raiding will be done.
Complaints can be lodge by the following methods:
JKWPKL Office Number:
03-2268 7333
National Complaint Hotline:
1800 88 6722
Email:
[email protected]
Lodge a complaint
Notice of receipt (within 3 working days)
Validity of complaint being ascertained
Feedback to complainer (within 14 working days)
Further actions
JAWATANKUASA PERKHIDMATAN MAKLUMAT UBAT & RACUN,
BAHAGIAN PERKHIDMATAN FARMASI, JKWPKL & PUTRAJAYA,
JALAN CENDERASARI, 50590 KUALA LUMPUR, MALAYSIA
FO R A N Y E N Q U I R Y O R F E E D B A C K P E R TA I N I N G TO D R U G S YO U M AY
CALL: NATIONAL PHARMACY CALL CENTRE: 1800-88-6722