HOSPITAL KUALA KUBU BHARU
PHARMACY BULLETIN
1st edition /June 2016
HIGHLIGHTS:
Middle East Respiratory Syndrome - Coronavirus (MERS-CoV) : Page 1— 3
Immunisation Program in Malaysia : Page 4-6
PHARMACY EDUCATION
Oral Contraceptive : Page 7- 9
EDITORIAL BOARD
ADVISOR
Ratna Suny bt Mohamed Esa
CHIEF EDITOR
Noor Haslina bt Zainor Abidin
EDITOR
Ainur Fadlina bt Mohd Nadzir
Nur Shazwani bt Mokhtar
CONTRIBUTORS
Mohamad Shafawie bin
Mohamad Sidik
Murni bt Mohammed Ariffin
For further enquiries, please
contact us at :
PHARMACY RESOURCES
INFORMATION CENTRE
(PRIC)
Pharmacy Unit,
Hospital Kuala Kubu Bharu,
44000 Kuala Kubu Bharu,
Selangor
03-60641333 ext 279
INTRODUCTION
MIDDLE EAST RESPIRATORY SYNDROME -
CORONOVIRUS (MERS– CoV)
Middle East Respiratory Syndrome (MERS) is an
illness caused by a virus (more specifically,
a coronavirus). MERS affects the respiratory system
(lungs and breathing tubes). About 3-4 out of every
10 patients reported with MERS have died. Most of
the people who died had an underlying medical
condition. Some infected people had mild symptoms (such as cold-like symptoms) or no symptoms
at all; they recovered.
HISTORY
Health officials first reported the disease in Saudi Arabia
in September 2012. Through retrospective
investigations, health officials later identified that the
first known MERS cases occurred in Jordan in April
2012. So far, all cases of MERS have been linked
through travel to or residence in countries in and near the
Arabian Peninsula. The largest known outbreak of
MERS outside the Arabian Peninsula occurred in the
Republic of Korea in 2015. The outbreak was associated
with a traveler returning from the Arabian Peninsula.
Prepared by : Noor Haslina binti Zainor Abidin
fever
cough
shortness of breath
gastrointestinal symptoms
(diarrhea, nausea, vomiting)
SYMPTOMS
Pneumonia
Kidney failure
COMPLICATION
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people with pre-existing medical conditions (diabetes; cancer; and chronic lung, heart, and kidney
disease)
Individuals with weakened immune systems
** the incubation period for MERS (time between when a person is exposed to MERS-CoV and when they
start to have symptoms) is usually about 5 or 6 days, but can range from 2-14 days.
PREVENTION
WHO HAS HIGH RISK OF GETTING MERS-COV
Non-human to human transmission Camels are likely to be a major reservoir host for MERS-
CoV and an animal source of infection in humans.
Human-to-human transmission Spread from an infected person’s respiratory secretions and is
droplets. MERS-CoV has spread from ill people to others through close contact, such as caring for or
living with an infected person. Infected people have spread MERS-CoV to others in healthcare settings,
such as hospitals.
TRANSMISSION
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Avoid any unnecessary contact with camels. Travelers should practice good general hygiene
measures.
Risk assessment of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) with soap and
water at all times, but especially before and after visiting farms, barns or market areas.
Avoid raw camel milk and/or camel products from the Middle East. More generally, travelers are
also advised to avoid consumption of any type of raw milk, raw milk products and any food that may
be contaminated with animal secretions unless peeled and cleaned and/or thoroughly cooked.
Travelers returning from the Middle East with severe respiratory symptoms should seek medical
advice and must report their travel history so that appropriate infection control measures and testing
can be undertaken. People who are acutely ill with an infectious disease are advised not to travel.
TRAVEL ADVICE
REMINDER TO ALL HEALTHCARE STAFF
1) https://www.cdc.gov/coronavirus/mers/
2) http://www.who.int/mediacentre/factsheets/mers-cov/en/
REFERENCES
There is no specific antiviral treatment recommended for MERS-CoV
infection. Individuals with MERS can seek medical care to help relieve
symptoms. For severe cases, current treatment includes care to support
vital organ functions.
TREATMENT
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IMMUNISATION PROGRAM IN MALAYSIA
Immunisation is the process of giving vaccine to the person with the intention of
stimulating the body own’s immune system against infectious disease. Immunisation
protects the individual and community from disease outbreaks
HOW DO VACCINE WORKS?
Vaccination Schedule by the Ministry of Health Malaysia
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Prepared by : Mohamad Shafawie bin Mohamad Sidik
Disease Complication of the
disease Vaccine product Route of giving vaccine
Tuberculosis
Serious infections of the lung (pneumonia), the membrane
covering the brain (meningitis) and spread throughout the body
Weakened bacterium (BCG)
Beneath the skin in the arm
Diphtheria Blockage of the airway and
pneumonia Modified bacterial
toxin(D)
DTaP/ Hib/ IPV is giv-en together into the
muscle of the thigh (if less than 1 year old) or
arm (if more than 1 year old)
Tetanus Stiffness of body muscles and
inability to open the jaws (lock jaw) Modified bacterial
toxin(T)
Pertussis Severe cough (whooping cough), reduction of oxygen going to the
brain and pneumonia
Killed bacterium (aP)
Haemophilus influenza type B
Infection of the lungs (pneumonia), airway and covering of the brain
(meningitis)
Bacterial component (Hib)
Poliomyelitis Infection of the brain (encephalitis) and permanent weakness of the leg
muscles Ruled virus
Given as a liquid by mouth
Hepatitis B Acute and chronic liver damage and
predisposes the individual to liver cancer in later life
Viral component (Hep B)
Given as MMR into the muscle of the thigh
Mumps Infection of the brain (encephalitis)
and testis (orchitis) which can lead to infertility
Weakened virus (M)
Measles Infection of the brain (encephalitis)
and testis (orchitis) which can lead to infertility
Weakened virus (M)
Rubella
If the rubella virus circulates in the community, an expectant mother,
especially in the first three months of pregnancy may get the disease result-
ing in a baby with multiple birth defects. The baby may have mental
damage, hearing and visual problems and heart defect (usually a PDA
patent ductus arteriosus)
Weakened virus (R)
Cervical Cancer Reconcurrent virus Into the muscle of the
arm / thigh
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References:
1. http://www.myhealth.gov.my/en/
2. Paeds Protocol 3rd Edition
HERD
IMMUNITY
Occurs when a sufficient proportion of the group is immune. The
decline of disease incidence is greater than the proportion of
individuals immunized because vaccination reduces the spread of an
infectious agent by reducing the amount and/or duration of pathogen
shedding by vaccines, retarding transmission.
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Oral contraceptives or “the pill” are tablets taken once a day
to prevent pregnancy
Since 1960’s, the pill has been available and several changes
have occurred over time
One major change has been the reduction in the dose of the
hormones, estrogen and progestin.
The pill is an oral contraceptive that is 99% effective when taken properly
There are 2 main types of pills :
1. Combined pill - contains 2 female
hormones; estrogen and progestin
2. Mini pill - contains only progestin
The difference between brands is the amount of
estrogens and the type of progestin used.
WHAT ARE ORAL CONTRACEPTIVES?
ABOUT THE PILL
ORAL CONTRACEPTIVES Prepared by: Murni bin Mohamed Ariffin CHILDREN BY CHOICE, NOT BY CHANCE
DRUG INDICATION, DOSE
Norethisterone 350mcg
(NORIDAY)
Oral contraceptive: Progestin-only pill (POP)
1 tab daily starting on the first day of
menstrual bleeding
Can be taken with or without food
Desogestrel 150mcg,
Ethinylestradiol 30mcg
(DESOLON)
Oral contraceptive: Combined oral
contraceptive pill (COC)
1 tab daily starting on the first day of men-
struation without interruption for 21 days,
followed by 7 tab-free days.
Can be taken with or without food.
ORAL CONTRACEPTIVES AVAILABLE IN HKKB
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WHAT DO YOU NEED TO KNOW ABOUT TAKING THE PILL?
HOW DOES THE PILL WORK? One pill is taken every day for 21 days, followed by a 7-day break. When taken correctly
the hormones will cause the following changes in the body :
The ovaries stop releasing eggs. Without eggs, no pregnancy can occur.
The cervical mucus thickens to make the sperm more difficult to penetrate into the
cervix, making it difficult to reach the egg.
The lining of the womb (uterus) does not develop sufficiently for a fertilized egg to
implant
Reduces sperm transport in the upper genital tract.
1) When to start taking each pill
pack ?
Your first pill pack is started on the
first day of your period.
Each new pill pack be started on the
same day of the week, no matter when
your period starts or ends.
2) When to take your pills?
Remember to take your pill at the
same time everyday.
Choose the most convenient time,
when you first start taking the pill,
and then be sure to continue taking at
the same time.
3) Management of pills
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COMBINED ORAL CONTRACEPTIVES PILLS (COC) METHODS
Patient compliance is essential for best
protection
Missed pill period up to 12 hrs
Fertility usually returns quickly
Serious side effects are rare
Can be used by women of any age, whether
or not they have children
Help prevent anemia,menstrual cramps and irregular bleeding
Help to lower down risk of ovarian and endometrial cancers
Skin conditions such as acne can improve - has to be taken daily
In the first few months, some users may experiences side effects such as stomach
upset, bleeding between periods or spotting, mild headache, or moodiness.
Not suitable for women over 35 and smoke.
Mood of action : thickening of cervical mucus
Good choice for nursing mothers who want
pills beginning at 6 weeks after childbirth
Suitable for women who wants to avoid
estrogen
Effective during breastfeeding
Can be used as emergency method after unprotected sex
If used when not breastfeeding, bleeding changes are to be expected— especially
spotting and bleeding between period
Greater incidence of irregular bleeding & amenorrhea
PROGESTIN-ONLY PILLS(POP/MINIPILL) METHODS
REFERENCES:
Lippincott Williams & Wilkins, Koda Kimble and Young’s Applied Therapeutics: The
Clinical Use of Drugs, Tenth Edition.
MIMS Drug Dosage and Information at www.mims.com.
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