1

Inside this

issue:

INTRODUCTION OF

PhIS

1-2

HOT ISSUE:

THINGS TO KNOW ABOUT

ZIKA

3

MEDICATION SAFETY:

HIGH ALERT MEDICATION

4-5

MIMS GATEWAY 6

DRUG COMPARISON:

ARB AVAILABLE IN

PKDMT

7-8

TRUTH @ MYTHS:

GARCINIA CAMBOGIA

SAFE FOR WEIGHT LOSS?

9-10

PHARMACY BULLETIN

ISSUE 2 year 2016

PKD MELAKA TENGAH

Editorial Board

Advisor:

Dr. Rusdi bin Abd.

Rahman

Chief Editor:

Halisah binti Kasdi

Editor:

Chew Poh Chiong

Contributors:

Foo Swee Yen

Nurul Atika binti Wahab

Michelle Lim Bee Ping

Nursyahirah binti Abd

Raof

INTRODUCTION

Pharmacy Information System (PhIS) is an initiative between Pharmaniaga and Minis-

try of Health with the aim to improve quality of service of healthcare through improve-

ment in information and communication technology. The system allows patient infor-

mation, medical profile and drug prescription to be available online.

The agreement was signed on the 16th March 2011 and it will last for 10 years start-

ing from 1st December 2009 up to 30th November 2019.[1] The development of PhIS

took two years starting from 16th March 2011 up to 15th March 2013.[1]

The diagram below shows where the PhIS system in pharmacy setting.

By: Lim Chun Yian

FULL-BASED vs PHAMACY-BASED PhIS SYSTEM

Full-Based PhIS system involves all department in a healthcare facility where registra-

tion clerk, doctor, nurses and pharmacist take part. However, PhIS system in Melaka

currently involves Pharmacy-Based only. There are several limitations regarding the

implementation of pharmacy-based only system as compared to a full-based system

such as patient registration only takes place when the patient is at the pharmacy de-

partment, as opposed to be done once the patient arrives at the healthcare facility.

Source of image [2]

2

3) PHARMACY INVENTORY

Provides functionally for finance management, procurement, stock management &

tracking of products movement from receiving up to the supply end point (close loop)

Inventory management

Alerts when quantity of products is out-of preset threshold, products near expiry, prod-

ucts recalled, back order not delivered or exceeding specified delivery dates

Generates goods issue notes, back order lists, floor stock lists, report and labels

4) MEDICATION COUNSELING

Provides documentation for medication counseling activity

Enables scheduling for counseling appointment

REFERENCES:

1. Projek Pharmacy Information System & Clinic Pharmacy System (PhIS & CPS). Pharmaniaga. 10 Jun 2015

2. Pharmacy Information System. Ministry of Health. [Pamphlet]

PhIS

Modules involved with PhIS in Klinik Kesihatan[2]

5) ADVERSE DRUG REACTION

Allows healthcare providers to report Adverse Drug Reaction cases and integrates with

Malaysian Adverse Drug Reaction Centre (MADRAC) system

1) ORDER MANAGEMENT

Electronic medication order for outpatients

Interfaces to external drug databases to provide drug alerts function (drug interaction,

contraindication, allergies, adverse drug effects, overdose & therapeutic duplication)

while prescribing

Maintaining patient complete medication profile

Multilevel access for prescribing and authorization of list A/A* type drugs

Drug codes in compliance with Malaysian Drug Code (MDC) standards

2) OUTPATIENT SERVICES

Monitoring of patient queue

Screening of medication orders

Preparation and filling of medication orders

Printing of labels and fill list

Dispensing of medication

Management and monitoring of Sistem Pendispensan Ubat-ubatan Bersepadu (SPUB)

and value added services

3

Zika virus is a mosquito-borned flavivirus which

was first discovered in

Uganda,1947. Since then there has been multiple

outbreaks in Africa,

Americas, Asia and the

Pacific.

In February 2016, World

Health Organization

(WHO) declares an outbreak , by then the

virus had quickly spread

to multiple parts of the world. Malaysia has

reported its first Zika

case on 1st September of

2016.

What is Zika Virus?

Sign and symptoms:

B y : N i r h o s h a a A / P M o h a n

ZIKA VIRUS

Method of transmission: Transmitted to humans through the same Aedes

mosquito that transmits dengue and chikungunya virus

i.e. Aedes aegypti and Ae. Albopictus.

These mosquitos bites throughout the day being most active during daylight hours.

Can also be transmitted through blood transfusion,

perinatal transmission and sexual transmission. However, these modes are very rare.

Incubation period between 3 – 12 days.

Most people infected often appear asymptomatic. Symptoms that may appear which lasts few days to

weeks:

Other symptoms include muscle pain, headache and

often accompanied by maculopapular rash.

As symptoms are often mild, they are often overlooked.

Zika virus usually lasts only up to a week in an infected

person’s blood.

Real danger is however to the pregnant mothers as in

any point of pregnancy the mother is infected, the virus

is transmitted to the unborn child via placenta, causes congenital birth defects such as microcephaly and

several fatal brain defects.

In adults, it also triggers Gullain-Barré syndrome

Diagnosis: Based on patient’s recent travel history,

symptoms and test results.

Testing methods:

- Viral nucleic acid detection

- Serological testing

Samples collection:

- Saliva or urine samples (first 3 to 5 days after symptom onset) - Serum/blood samples

(first 1 to 3 days after symptom onset)

Treatment:

There is no treatment or vaccine yet. Only supportive treatment to treat fever, joint pain,

rash, conjunctivitis.

Drink fluids to prevent dehydration

Reference:

Zika. Centre for disease control and prevention. Available URL: https://www.cdc.gov/zika/

Zika Emergencies. World Health Organization. Available URL: http://www.who.int/emergencies/zika-virus/history/en/

HOT ISSUE

4

HIGH ALERT MEDICATION

HIGH ALERT MEDICATIONS By: Tan Jien Lee

WHAT ARE HIGH ALERT MEDICATIONS?

Medications that exhibit an elevated risk of causing significant patient injury when errors occur

whilst handling these medications

INTRODUCTION

Errors in the administration of these high-risk medications may potentially lead to dire consequenc-

es.

The handling and administration of these medications require heightened vigilance and special pre-

cautions must be employed with their overall management.

A list of High Alert Medications comprising of 20 categories produced by Pharmaceutical Services

Division, Ministry of Health Malaysia specifies the need for special steps and precautions to be tak-

en when handling these medicines to reduce the incidence of unwanted errors.

Strategies to minimize these risks include streamlining the ordering, storage, preparation and ad-

ministration processes of these products and also improving accessibility to the drug’s information.

Adrenergic agonists, IV

(eg adrenaline, noradrenaline)

Glyceryl Trinitrate injection

Adrenergic antagonists, IV

(eg propranolol, labetalol)

Inotropic medications, IV

(eg. Digoxin, dobutamine, dopamine)

Anaesthetic agents, general, inhaled and IV

(eg propofol, ketamine)

Insulin, subcutaneous and IV

Antiarrythmias IV

(eg lignocaine, amiodarone)

Magnesium sulphate injections

Antifibrinolytics, hemostatic Moderate sedation agents, IV

Antithrombotic agents

(eg warfarin, heparin, tenecteplase, streptokinase)

Neuromuscular blocking agents

(eg atracurium, rocuronium)

Antivenom

(eg Sea snake, cobra, pit viper antivenom)

Opioids and Narcotics

Chemotherapeutic agents, parenteral and oral Parenteral Nutrition preparations

Dextrose, Hypertonic, 20% or greater Potassium salt injections

Epidural and intrathecal medications Sodium Chloride Solution

(greater than 0.9%)

CLASSES / CATEGORIES OF MEDICATIONS

5

REFERENCES

1. Guideline On Safe Use of High Alert Medications. First Edition. Pharmaceutical Services Division. 2011.

2. List of High-Alert Medications in Acute Care Settings. Institute for Safe Medication Practices (ISMP). United States of America. 2014.

HIGH ALERT MEDICATION

STORAGE All storage shelves, containers, product packages and loose vials or ampoules containing high alert

medications are required to have “HIGH ALERT MEDICATION” labels/stickers affixed.

Examples of high alert labels:

High alert stickers for containers or product

packages

High alert stickers for ampoules or vials

PRESCRIBING

Avoid using abbreviations when prescribing

High Alert Medications

Indicate doses in milligrams when prescribing

oral liquid medications

When prescribing, trailing zeros are discour-

aged.

Eg 1.0mg can be mistaken as 10mg

Specify the dose, route and rate of infusion

for High Alert Medications prescribed

IV Dopamine 5mcg/kg over 1 minute

ADMINISTRATION

Two appropriate persons should double

check the following particulars against the

prescription or medication chart:

Patient’s name and RN

Name and strength of medications

Dose

Route and rate

Expiry date

When no longer required, all unused or re-

maining specially formulated preparations

should be returned

Ordering of High Alert Medications verbally

is discouraged. Phone orders have to be

repeated and verified in cases of emergen-

cy.

MONITORING

Vital signs monitoring should be routinely car-

ried out before and after administration of High

Alert Medications to patients. TRAINING

Before handling of High Alert Medications, all

personnel should be adequately trained to

avoid possible mistakes and enable them to

react immediately and appropriately when

errors do occur.

INFORMATION

References or dilution guide should be made

available and easy accessible within the wards,

pharmacy and health facility.

COMMON RISK FACTORS

Illegible prescriptions

Inaccurate dilution procedures

Confusion between various routes of ad-ministration for medications

Confusion between different strengths of the same medications

Written labels and instructions on the medi-cation that are unclear or vague

Incorrect infusion rate

Look alike or sound alike (LASA) product and similar packaging

STRATEGIES TO AVOID ERRORS INVOLVING HIGH

ALERT MEDICATIONS

6

MIMS GATEWAY

WHAT IS MIMS GATEWAY?

MIMS gateway is a drug directory available in desktop version which gives vital information to the

healthcare professionals. It has integrated the online drug and medical resources portal- MIMS.com and

print friendly publications. Hence, no more giant reference book to flip and we GO GREEN! It contains eas-

ily accessible, relevant and very responsive medical and drug information that helps the healthcare pro-

fessionals to improve the therapeutic and management of patients’ outcome.

By: Nur Asyikin Binti Rusli

WHAT ARE THE CONTENTS?

Identification

Drug Interaction & Allergy Check

Drug Disease Interaction

Pharmacology & Pharmacokinetic of Drugs

MIMS New Journal

Blue Book (FUKKM)

MICROMEDEX® Search

Medical Calculators

Malaysian CPG

MIMS Disease Chart

MIMS Clinical Tables

Product Image Identification

Reference:

1. http://www.mimsgateway.com/Home.aspx

2.http://online1.mimsgateway.com.my/Malaysia

HOW DOES IT LOOK LIKE?

So now you can

glance through all

of the information

under one roof!!!!!

7

DRUG COMPARISON

Drug Comparison:

By: Chang Ven Yee

Losartan Telmisartan Irbesartan Valsartan

Chemical

Structure

Prescriber

Category

B A/KK A/KK A/KK

Indication

(Blue

Book)

Patient intolerant to ACEi, only in the treatment of

1. Hypertensive pa-tient with left ventric-ular hypertrophy

2. Hypertension in diabetics with pro-teinuria or nephropa-thy

Hypertension in pa-tients who cannot toler-ate ACEi because of cough

Hypertension, diabetic nephropathy (in pa-tients who cannot toler-ate ACEi because of cough

Patient who cannot tolerate ACEi be-cause of cough, in

1. hypertension

2. Heart failure

3. Post myocardial infarction

Price Rm 0.09 (50mg and 100mg)

Rm 0.64 (40mg)

Rm 0.80 (80mg)

Rm 0.90 (150mg)

Rm 1.19 (300mg)

Rm 0.95 (80mg)

Rm 1.05 (160mg)

8

DRUG COMPARISON Losartan Telmisartan Irbesartan Valsartan

Dosage Hypertension:

50mg once daily (max:

100mg daily)

Intravascular vol-

ume-depletion:

starting dose 25mg

once daily

Renal protection in

Type 2 diabetic pa-

tients with pro-

teinuria and hyper-

tension: 50mg once

daily

(max: 100mg daily)

Hypertension:

40mg-80mg once

daily

Hypertension:

150mg-300mg daily

Hypertension:

80mg-160mg once

daily (max: 320mg

daily)

Heart failure: 40mg

twice daily (max:

320mg in 2 divided

doses

Post myocardial:

20mg twice daily.

(max: 160mg twice

daily if tolerated)

Administra-

tion

With or without food With or without food With or without food With or without food

Onset of

action

6 hours 1-2 hours 1-2 hours ~ 2 hours

Duration of

action

24 hours Up to 24 hours More than 24 hours 24 hours

Common

adverse

event

Angioedema, head-

ache, dizziness, cough

Headache, dizziness,

URTI and cough

Diarrhoea, dyspepsia

or heart burn, fatigue,

headache, URTI, an-

gioedema of the

face, lips and throat

Headache, dizzi-

ness, viral infection,

neutropenia, URTI,

hyperkaleamia,

cough, diarrhea, ab-

dominal pain, back

pain, fatigue, asthe-

nia, oedema, syn-

cope, rhinitis, sinusi-

tis, nausea, pharyn-

gitis, arthralgia

References:

1. MOH Medicines Formulary KKM 2014

2. Medscape Application ver5.4.2 last update 08/06/2016

3. Drug information handbook, Lexicomp 24th edition

4. Product insert Cozaar, Last revision: 06/2014

5. Product insert Approvel, Last revision: 09/2012

6. Product insert Micardis, Last revision: 30/12/2016

7. Product insert Novartis, Last revision: 05/2014

8. http://www.chemicalbook.com/productchemicalpropertiescb4266172_en.htm

9

TRUTH OR MYTH

Garcinia Cambogia :

Safe for

Weight Loss?

By : Najihah Ahmad Termizi

Introduction [1]

Garcinia cambogia, a tropical fruit

also known as the Malabar tama-

rind, is a small, sweet tropical tree

fruit shaped like a pumpkin.

How It’s Work[2][3]

Garcinia Cambogia works by:

1) Halting fat production

2) Initiating fat burning

3) Suppressing appetite[4][5]

The active ingredient in the

fruit's rind, hydroxycitric acid,

or HCA, has boosted fat-

burning and cut back appetite.

Possible Side Effects [9]

When you take garcinia cambogia, you might

get:

Dizziness

Dry mouth

Headache

Upset stomach or diarrhea

In 2009, the Food and Drug Administration

warned everyone to stop using a weight-loss

product that contained garcinia cambogia be-

cause some people taking it got seri-

ous liver problems.

Interactions [10]

Garcinia cambogia may interact badly with:

Asthma and allergy medicines such

as Accolate and Singulair

Diabetes medicines, including pills

and insulin

Iron, for anemia

Pain medicines

Prescriptions for psychiatric conditions

Statins, drugs that lower cholesterol

Warfarin, a blood thinner

You definitely don't want to use it when

you're pregnant or nursing, or if you

have kidney or liver problems.

10

TRUTH OR MYTH

1998 study published in the Journal of the American Medical Association [6]

After a 12-week randomized, double-blind study of overweight men and women, research-

ers concluded that Garcinia cambogia did not produce significant weight or fat loss above

the placebo.

2013 review in the journal Complementary Theories in Medicine [7]

Researchers evaluated clinical trials that used plant extracts as potential treatment for obe-

sity, and found that the evidence was not convincing in most cases. One exception was a

combination of Garcinia cambogia taken with another herb called Gymnema sylvestre,

which showed a slight increase in weight loss results. It's a glimmer of hope, but surely,

more research needs to be done on the subject.

2005 study in the journal Food and Chemical Toxicology [8]

Researchers tested a high dose of Garcinia cambogia extract on obese male rats. The

good news? The rats lost weight! The bad news? Extremely high doses seemed to cause

testicular atrophy and toxicity.

Conclusion

People say it blocks your body's ability to make fat and it puts the brakes on your appetite. It

could help keep blood sugar and cholesterol levels in check, too. You'll find it in bottles on the

shelf at the store as well as mixed with other ingredients in diet products. Does it live up to its

hype? Maybe a little, but it might not be worth it.

References *1+ Deborah Enos, CN;”The Truth about Garnicia Cambogia” Live Science; 8 Nov 2015. *2+ Brunilda Nazario, MD “ Garnicia Cambogia : Safe for Weight Loss?” WebMD; 31 July 2014.

*3+ “Garnicia Cambogia Select Review – Fast and Efficient Fat Burner Supplement. Offer Valid Worldwide” World Loss Place.

*4+ Sullivan AC, Triscari J, Hamilton JG, Neal Miller O. Effect of (−)-hydroxycitrate upon the accumulation of lipid in the rat: appetite. Lipids.1973;9:129-134

*5+ Steven B. Heymsfield, MD; David B. Allison, PhD; Joseph R. Vasselli, PhD; et al; “Garcinia cambogia (Hydroxycitric Acid) as a *6+ Potential Antiobesi-ty AgentA Randomized Controlled Trial, JAMA. 1998;280(18):1596-1600. doi:10.1001/jama.280.18.1596

*7+ Katie J. Astell,Michael L. Mathai, Xiao Q. Su et al;“Plant extracts with appetite suppressing properties for body weight control: *8+ A systemic re-view of double blind randomized controlled clinical trials”, Science Direct; Complementary Therapies in Medicine Volume 21, Issue 4, August 2013, pages 407-416. *9+ M. Saito, M. Ueno, S. Ogino and et al;” High Dose of Garnicia Cambogia is effective in suppressing fat accumulation in developing male Zucker obese rats, but highly toxic to the testis” Science Direct; Food and Chemical Toxicology Volume 43, Issue 3, March 2005, pages 411-419. *10+Brunilda Nazario, MD “ Garnicia Cambogia : Safe for Weight Loss?” WebMD; 31 July 2014