Topic of current
interest:
MERS-COV
Drug comparison:
PEGASYS vs
PEGINTRON
Focus:
Vaccine Immunization
PHARMACY
NEWSLETTER 2015
Jabatan Farmasi dan Bekalan,
Hospital Melaka
Complementary
medicine:
AYURVEDA
VOL 29:
MAY-JUNE 2015
EDITORIAL BOARD:
PN.HAZLINDA ABU HASSAN
CIK TAY EEK POEI
PN. SYAMSIAH BT. SHARIFF
PN. JULIA BT. SHAMSUDIN
EDITOR:
MUHAMMAD
AZIZE
CONTRIBUTORS:
MELISSA JOAN
IZYAN
ADVISOR:
PN. SAIDATUL
RAIHAN BT.
IBRAHIM
FOCUS
VACCINE IMMUNIZATION
TOPIC OF CURRENT INTEREST
MIDDLE–EASTERN RESPIRATORY
SYNDROME CORONAVIRUS
(MERS-COV)
THE USE OF ANTIBIOTIC IN POST
SPLENECTOMY
DRUG COMPARISON
PEGASYS VS PEGINTERFERON
DRUG SAFETY
JINGZHI YINQIAO & DERMACEUTIC
SPOT CREAM
COMPLEMENTARY MEDICINE
AYURVEDA
PHARMACY JOKES
ACTIVITY
KURSUS THERAPEUTIC DRUG MONITORING
3-4 5-6
7-8
9
10-11
12-13
14
15
Vaccination
What is pertussis?
REFERENCES
http://infomed.com.my/vaccination-in-malaysia.
http://emedicine.medscape.com/article/967268-overview
http://www.vaccines.gov/diseases/pertussis/#
Early symptoms
can last for one to
two weeks and
usually include:
Runny nose
Low-grade fever
Mild, occasional cough
Apnea – a pause in breathing (in infants)
Whooping Cough
Symptoms Pertussis most commonly affects infants and
young children and can be fatal, especially in
babies less than 1 year of age.
Prevention through
immunization remains the
best defense in the fight
against pertussis.
Ministry of health of
Malaysia
recommendations for
vaccination are as
follows:
DTaP vaccine:
Recommended at
the ages of 2, 3, 5,
and at 18 months.
Bordetella pertussis
Pertussis
By: Izyan
Global Pertussis Initiative Stresses Vaccination in Pregnancy Troy Brown, RN
May 12, 2015
Medscape Medical News
"A high priority should be given to achieving a complete
cocoon, defined as full immunization of the family, since the
robustness of protection against pertussis is a function of the
number of infant contacts vaccinated," the authors write. "If
a complete cocoon is not possible, then the next priority is
vaccination of both parents, followed by the mother only."
"It is reasonable to assume that pertussis
immunization during pregnancy, which
has been steadily increasing since its
emphasis in California beginning in 2010,
has contributed to the reduction in infant
deaths."
As whooping cough grows, study finds vaccine wanes
Originally published May 3, 2015 at 9:44 pm Updated May 4, 2015 at 1:13 pm
“Despite the waning protection, Acosta and other health
officials said pertussis immunization remains important.
It reduces the severity of illness when people do get sick
and, when given to pregnant women, can induce
immunity in newborns who are most likely to develop
serious complications.”
MIDDLE-EASTERN RESPIRATORY
SYNDROME CORONAVIRUS
(MERS-COV)
MERS-CoV belongs to the coronavirus family. Human
coronaviruses were first classified in the mid 1960s. There are
currently six coronaviruses that can affect humans including
Alpha coronaviruses which are Human coronavirus 229E and
Human coronavirus NL63 (HCoV-NL63, New Haven
coronavirus). Beta coronaviruses would include Human
coronavirus OC43, Human coronavirus HKU1, SARS-CoV and
Middle East respiratory syndrome coronavirus (MERS-CoV).
CAUSES OF MERS-COV
The cause of MERS-CoV is not yet fully understood. Although
not confirmed, the infection could be primarily zoonotic in
nature, with limited human-to-human transmission. It is thought
that mammals play a role in the transmission of the virus - bats
and camels remaining a high contender.
Camels are a probable source of infection transfer to humans,
while bats may be the ultimate reservoir of the virus. The high
infectious dose would require very close contact between an
infected camel and humans for instigation of human MERS-CoV
infection by camels. It has been suggested that the virus could
infect humans by air, via camel milk or meat.
Centre for Disease control and
Prevention (CDC),US reported that the
1st case was in Saudi Arabia on
September 2012
Through retrospective investigations it
was identified,that the first known case
of MERS occurred in Jordan in April
2012.
There is one reported case in Malaysia
in March 2014
References
http://www.medicalnewstoday.com
/articles/262538.php?page=2
http://www.cdc.gov/coronavirus/m
ers/risk.html
http://www.medscape.com/viewarti
cle/838947
•WHO's MERS-CoV Summary and
Literature Update, June 11, 2014
By: Melissa
Image of MERS-CoV
TREATMENT & PREVENTION
According to the US Centers for Disease Control and Prevention (CDC) and WHO (World Health
Organization), there are no specific treatments for patients who become ill with MERS-CoV infection.
Recommended suggestion includes supportive medical care to help relieve the symptoms.
Supportive care means providing treatment to prevent, control or relieve complications and side
effects, as well as attempting to improve the patient's comfort and quality of life.
Travel advice has been provided to reduce the risk of MERS-CoV infection among travelers, which
includes information such as:
There is an increased chance of illness for those travelers with pre-existing chronic conditions
Frequent hand-washing is advised with soap and water
Avoid undercooked meat or food prepared under unhygienic conditions
Ensure fruit and vegetables are properly washed before consumption
If a traveller develops acute respiratory illness with fever, they should minimize close contact with
others, wear a medical mask, sneeze into a sleeve, flexed elbow or tissue (making sure it is
disposed of properly after use)
If during 14 days after returning from travel acute respiratory illness with fever develops; medical
attention should be sought immediately
SIGN AND SYMPTOMS
Fever 100 degrees F or higher,
Cough, Breathing difficulties,
Chills, Sore throat, Malaise
(a general feeling of being
unwell), Headache, Diarrhea,
Nausea/Vomiting, Runny nose
WHO IS MOST AT RISK?
Patients with chronic diseases:
diabetes
chronic lung disease and
heart conditions
The elderly
Organ transplant recipients
who are on
immunosuppressive
medications
Other patients whose
immune systems are weak,
such as cancer patients
undergoing treatment.
Antibiotic Prophylaxis
It is stated that the use of life-long prophylactic
antibiotics disease directed against pneumococcal disease has been the policy for more than 20 years
“But clearly, failures of both vaccination and
antibiotic prophylaxis are well documented…”
The use of Antibiotic in Post Splenectomy
Following splenectomy there
is a small but significant
lifelong susceptibility to
sepsis, particularly involving
Streptococcus pneumoniae.
The majority of infections are due to S.
pneumoniae (50-60% in most series)
followed by Haemophilus influenzae
(particularly in children).
General Info Risk of infection is
related to age, the
underlying reason for
splenectomy and elapsed
time since splenectomy
prevention through vaccination and
antibiotic prophylaxis is the basis of
the management of patients who have
had splenectomy or have
hyposplenism.
Images of S. pneumoniae
References:
1. Davies JM, Lewis MP, Wimperis J, Rafi I, Ladhani S, and Bolton-Maggs PH. 2011. Review of guidelines for the prevention and treatment
of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology
by a working party of the Haemato-Oncology task force. Br J Haematol ;155(3) :308-17.
2. Read RC and Finch RG. 1994. Prophylaxis after splenectomy. J Antimicrob Chemother ; 33: 4–6.
3. Keenan R.D., Boswell T., and Milligan D.W. 1999. Do post-splenectomy patients take prophylactic penicillin?. British Journal of Haema-
tology, 105 (2); 509-510.
4. Gaston M.H., Verter, J.I., Woods,G., Pegelow, C, Kelleher, J.Presbury, G. et al. 1986. Prophylaxis with oral penicillin in children with
sickle cell anaemia. New England Journal of Medicine, 314; 1593-9.
5. Waghorn D J. 2001. Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J
Clin Pathol, 54 :214–218.
By: Izyan
In hyposplenic
patient up to aged
16 years and
those over 50
years
Patient who have
inadequate
responses to
pneumococcal
vaccination
Patient who have had a previous
episode of invasive pneumococcal
disease
Finally, it is suggested that we should emphasize on patient education
regarding the prevention measures and infectious risk to optimize
patient's compliance.
High-risk groups need careful counselling and follow up to ensure
adherence to antibiotic prophylaxis
Preventative strategies continue to be based on education of staff and
patients, appropriate immunization schedules and chemoprophylaxis
The Positive
For children with sickle cell disease
which are rendered functionally asplenic
but are not absolutely comparable,
penicillin prophylaxis can reduce
risk of pneumococcal septicaemia by
more than 80%
The Negative
Postoperative antibiotic prophylaxis
(eg; Phenoxymethyl-penicillin
(Penicillin –V) is prescribed for two
years minimum and lifelong
prophylaxis should be offered to high
risk of pneumococcal infection patient
For WHO?
lack of good clinical data
demonstrating its efficacy in
asplenic patients
Increasing antimicrobial
resistance has provoked
concerns over continuous
antibiotic prescription
patient compliance
difficulties
S.pneumoniae insensitivity to
antibiotic
Conclusion
“We should emphasize
on patient education
regarding the
prevention measures
and infectious risk to
optimize patient's
compliance …”
Pegasys
(Peginterferon Alpha-2a)
PegIntron
(Pegylated interferon Alfa-2b)
Indication (a) Chronic Hepatitis B: Pegasys is indicated
for the treatment of both HBeAg-positive
and HBeAg-negative chronic hepatitis B in
non-cirrhotic patient with compensated liver
disease.
(h) Chronic Hepatitis C: Pegasys alone or in
combination with copegus (ribavirin) in
non- cirrhotic and cirrhotic patient with
decompensated liver disease.
Chronic hepatitis B
Chronic hepatitis C
Dosage (a) 180 mcg weekly SC for 48 weeks
(b) 180mcg weekly SC with ribavirin
800mg daily for 24 weeks ( depending
on genotype)
(a) 1.15mcg/kg once weekly for at least 24 weeks up
to 52 weeks
(b) monotherapy: SC at a dose of 0.5 or 1 mcg/kg
once weekly for at least 6 months.
Combination: 1.5mcg/kg for at least 24 weeks and
up to 52 weeks
Blood Test Support blood test (genosys) viral load Do not support any blood test viral load
Mechanism of
Action
They possesses the in vitro antiviral and antiproliferative activities of alpha interferon. interferons
will bind to specific receptors on the cells surface initiating a complex intracellular signaling
pathway and rapid activation of gene transcription. Interferon-stimulated genes modulate infected
cells, inhibition of cell proliferation and immunomodulation.
Pharmacokinet-
ics/
dynamics
Half life elimination: Terminal- 50-150 hours;
increased with renal dysfunction.
Half life elimination: ~40 hours
Excretion: ~30%
Storage Store in refrigerator at 2C – 8 C.
Do not freeze or shake.
Prior to reconstitution, store at 2C to 8C.
Price RM533.86 RM569.90 (120mcg); RM544.00(80mcg)
Administration 180mcg Prefilled syringe (PFS). Allow PFS to
come to room temperature for a few minutes
before injection.
Ready to be used, no reconstitution and dial
adjustment needed.
50mcg, 100mcg, 150mcg and 120mcg Redipen
(single use prefilled pen)
Reconstitution: to mix the prefilled pen, keep the
prefilled pen upright, press top half of pen
downward toward hard, flat surface until “click”
sound is heard.
Dial the dose. Hold pen firmly, then pull dosing
button out as far as it will go. Then turn the dosing
button until prescribed dose is lined up with the
dosing tab.
10% -
Central nervous system: Headache (54%), Fatigue (56%),
fever (37%).
Dermatologic: Alopecia (23%), pruritus (12%)
Gastrointestinal: (nausea and vomiting (24%), diarrhea (16%)
Hematologic: Neutropenia (21%), lymphopenia (14%), anemia (11%)
Hepatic: ALT increase 5-10 x ULN during treatment (25%)
Neuromuscular: Weakness (56%), myalgia (37%)
Adverse reactions
References
MOH Medicines Formulary 2014
Drug Information Handbook (21st Edition)
By: Azize
The National Adverse Drug Reaction Monitoring
Centre, National Pharmaceutical Bureau (NPCB) is
alerting and advising the public against buying and
using product labeled as “ Jingzhi Yinqiao Jiedu
Tablet 260 Mg ”
Jingzhi Yinqiao Jiedu Tablet 260
Mg is registered as tradisional
medicine for fever, headache, sore
throat, cough and runny nose.
Reference
http://portal.bpfk.gov.my/newsmaster.cfm?&menuid=52&action=view&retrieveid=369
Products contain paracetamol which is
controlled under the Poison Act 1952.
Continuous use without any health
professional supervision is dangerous as
may lead to liver toxicity.
Some of the signs for liver
toxicity includes nausea and
vomiting, tea coloured urine,
yellowish eye and skin and
lethargy.
By: Azize
The Health Ministry of Malaysia has advised consumers in
the country against buying two specific cosmetic products,
Dermaceutic Spot Cream and Dermaceutic Spot Cream
claiming they both contain potentially toxic ingredients.
Dermaceutic is an Ireland-based brand that is generally
distributed by dermatology professionals worldwide.
The products have been marketed in the country as
multifunctional skin care creams, targeting both skin
lightening, as well as for the treatment of skin lightening.
The ministry cited the reason for ceasing sales of these
products is being that both products contain hydroguinone
and tretinoin, which are both said to be potentially toxic,
even for topical use.
Cancellation of cosmetic product— Dermaceutic spot cream
Reference:
1.http://portal.bpfk.gov.my/newsmaster.cfm?&menuid=52&action=view&retrieveid=473
2. http://www.cosmeticsdesign-asia.com/Regulation-Safety/Malaysia-Health-Ministry-advises-consumers-against-two-
cosmetic-products
INTRODUCTION
Ayurveda, also known as Ayurvedic Medicine, is the traditional
medicine of India, which originated there over 5,000 years ago.
Ayurveda emphasizes re-establishing balance in the body through
diet, lifestyle, exercise, and body cleansing, and on the health of the
mind, body, and spirit .
HOW DOES IT WORK? Just as everyone has a unique fingerprint, according to Ayurvedic
beliefs, each person has a distinct pattern of energy whereby it is a
specific combination of physical, mental, and emotional
characteristics. There are three basic energy types called doshas,
present in every person:
A) Vata : energy that controls bodily functions associated with
motion, including blood circulation, breathing, blinking, and
heartbeat. When vata energy is balanced, there is creativity and
vitality. Out of balance, vata produces fear and anxiety.
B) Pitta :energy that controls the body's metabolic systems,
including digestion, absorption, nutrition, and temperature. In
balance, pitta leads to contentment and intelligence.
C) Kapha : energy that controls growth in the body. It supplies
water to all body parts, moisturizes the skin, and maintains the
immune system. In balance, kapha is expressed as love and
forgiveness. Out of balance, kapha leads to insecurity and envy.
References
http://altmedicine.about.com/cs/2/a/AyurvedaDef.htm
http://umm.edu/health/medical/altmed/treatment/ayurveda
By: Melissa
Ayurveda is a holistic health system which aims at bringing about
harmony in the body, and harmony of humans with nature. It looks
at not just body, but health of mind and soul as well.
The most important advantage of course, is that it uses only
natural substances derived from plants, fruits, vegetables and
natural minerals. Alternatively, it uses the plant extracts in
combination to produce required medicines. The side effects are
minimal when compared to other forms of medicine, as natural
substances can't really do your body much harm.
A look at the disadvantages would show that the popularity of the system of medicine declined because
of the fear of adulteration and toxic substances mixed with the Ayurvedic formulae available in the
market today. Also, reliability of the medicines and the physicians practising it has been questioned. One
must not forget that Ayurveda was used ages ago, and today the numbers and kinds of diseases and
illnesses have increased multifold, and newer methods of medicine are being relied on for treatment
and therapy.
AYURVEDA– THE SCIENCE OF LIFE
ADVANTAGES & DISADVANTAGES
On your first visit, the practitioner will
take a detailed medical history, check
your pulse, feel your abdomen,
examine your tongue, eyes, nails, and
skin, and listen to the tone of your
voice. The practitioner will also ask
you questions about your general
health, paying special attention to
your lifestyle, diet, habits, and
surroundings. Practitioners draw from
more than 20 types of treatment, but
the most commonly prescribed
include:
1. Pranayama -- breathing exercises.
Practicing pranayama helps you feel
calm.
2. Abhyanga -- rubbing the skin with
herbal oil to increase blood circulation
and draw toxins out of the body
through the skin.
3. Rasayana -- using mantras
(repeated words or phrases) during
meditation combined with certain
herbs to rejuvenate a person.
4. Yoga -- combining pranayama,
movement, and meditation. Yoga has
been shown to improve circulation
and digestion, and to reduce blood
pressure, cholesterol levels, anxiety,
and chronic pain.
5. Pancha karma -- cleansing the body
to purify it and reduce cholesterol.
Practitioners use methods that cause
sweat, bowel movements, and even
vomit to cleanse the body of toxins.
6. Herbal medicines -- prescribing
herbs to restore a balance.
METHODS
By: Izyan
On 6th of June 2015, Pharmacy Department of Hospital Melaka had organized
Therapeutic Drug Monitoring, 2015 course at the Auditorium Sri Baiduri,
Hospital Melaka .The ultimate objectives of the course are to strengthen the
knowledge of TDM and to promote TDM services at the Melaka Hospital. A
total of 72 participants attended this course . This course managed to instil
interest in TDM and helped to improve knowledge at the same time.. Over-
all, it was a successful event.
ACTIVITIES...