Supplement

Proceedings of the Pharmacy Scientific Conference 2001 21-23 October 2001 Summit Hotel, Petaling Jaya, Selangor Jointly organised by the Malaysian Pharmaceutical Society (MPS), Selangor State Pharmacy Division and the Department of Pharmacy, Faculty of Medicine, University of Malaya Supported by the Pharmacy Division of the Ministry of Health, Malaysia Scientific Committee: Assoc. Prof Dr. Samsinah Hj Hussain Pn. Junidah Amir Assoc. Prof. Dr. Chung Lip Yong Dr. Chua Siew Siang Dr. Leong Chuie Wuei Dr. Michael James Christopher Buckle En. Mohd Azmi Ahmad Hasali En. Mohd Ibrahim Noordin Pn. Syireen Alwi Miss Teh Lay Kek Mr. Anthoun Nathan .

Table of Contents S1 Putting together pharmacoeconomics and pharmaceutical care into practice: a reality or

delusion? M I M Ibrahim

S1 Pharmacy education-future direction and challenges L N Sansom

S1 Clinical aspects in oncology pharmacy practice T S Wu

S2 Central Intravenous Admixture Service (CIVAS), its implementation, cost benefits and clinical aspects S Lim

S3 Advanced drug delivery systems: relevance to the local pharmaceutical industry K H Yuen

S3 Impact of pharmacogenomics in pharmacotherapy Rusli Ismail

S4 The allergic march Abdul Razif Abdul Razak

S4 An update on regulatory contro l Hasnah Ismail

S4 Prescribing trend of NSAIDs usage and total cost: a nationwide perspective S Bahri, M H Hj. Ahmad, M W Wong, H Othman, L C Han, S Ewan, Z Kamaruddin, R Md Din, R Zainal, M M Manan

S5 Pharmacoeconomic evaluation of community-acquired pneumonia management in paediatrics: a comparison study between single regimen IV ampicillin versus combination regimen with IV ampicillin plus gentamicin Mohamed Azmi AH, S A S Sulaiman, M I M Ibrahim, Jameela A H

S6 Inappropriate medication in elderly patients leading to adverse drug reactions in medical wards of Ipoh Hospital K S Thong, C V Ram

S6 An evaluation of clinical outcomes in hospitalised geriatric patients with community acquired pneumonia B S Ilyas, S A Syed Sulaiman, M I M Ibrahim, C Doeck e

S7 Pharmaceutical care - can it be electronically provided? N H Othman, R Awang, M I M Ibrahim

S7 Patients’ knowledge on anticoagulation therapy : a survey in Hospital Melaka N A Kadir, C Y Khua, B Z Sher Jang Khan, L F Chin, A M Abd. Aziz, N Abdullah

S8 Pharmacists’ contributions towards pharmaceutical care: perception of health care providers C Y Cheah, S Alwi, M S Abdullah

S8 Evaluation of mechanical and bioadhesive properties of Chitosan - Eudragit transdermal films Irsan Lim, K K Peh, Yvonne TF Tan

S9 Structural, release and stability investigations on semi-solid matrices based on polyglycolised glycerides N Abdul Karim Khan, Duncan Q M Craig

S9 Thermal characterization of a selected blend of palm kernel oil components compared to cocoa butter M I Noordin, H Hashim, L Y Chung

S10 Chemical constituents of the essential oils of Cinnamomum cordatum Kosterm. and C. vimineum Nees B H Au, I Jantan

S10 Toxicity study of the essential oils and methanol extracts of Malaysian plants on Aedes aegypti larvae O P Wong, I A Abdul Rafi, S Devi Visuvalingam, N Wasi Ahmad, I Jantan

S11 The effect of adrenergic drugs on renal haemodynamics in cardiac failure-induced and normal Sprague Dawley and spontaneously hypertensive rats S A Abbas, A S Munavvar, A P M Yusof, N A Abdullah, EJ Johns

S11 Acyl glucuronides – an interesting mechanism for their elimination by the kidney? R W Milne, H Khalil, R L Nation, A M Evans

S12 Influence of Gingko biloba on hepatic drug metabolism A Hj Hussin, Z Mustaffa

S12 Biopharmaceutic evaluation of two diclofenac formulations in the pig M V Lu, R C H Fishlock, L N Sansom, E Kostewicz, T Kuche1

S13 N-Oxidation of dietary-derived trimethylamine in ethnic Malays and Malaysian Chinese and Indians M S Abdullah, Ching Y Ng, Lyaquatali A Damani

S13 Access to community pharmacies in Malaysia Y Y Soo, S S Chua, S Y Yip, R Dorall

S14 Detection and assessment of risk factors for coronary artery disease in a Malaysian population group J Singh, A Lai, H Kaur, S Nair, S Lim

S14 Public usage of oral lecithin : to reduce plasma cholesterol? B K Tan, S S Chua, L K Teh

S15 Assessing factors contributing to inconsistent use of oral contraceptive pills (OCP) among Malays Z M Yusoff, M L Tan, S Othman, M I M Ibrahim

S15 Medication problems among geriatrics at the outpatient pharmacy setting in Hospital Universiti Sains Malaysia (HUSM), Kelantan: economic and clinical impact A Mat, D Che Abdullah, M I M Ibrahim, Mohamed Azmi H

S16 A comparative study between direct supply and constituted supply of medicine at the Intravenous Admixture Unit, Pharmacy Department, Hospital Universiti Sains Malaysia (HUSM) D Che Abdullah

S16 Awareness of hepatitis infections among residents in Kuala Lumpur and Selangor H C Lim, H Rashwan

S16 Patients’ knowledge of warfarin Winston T K Tay, S Alwi, L K Teh

S17 Granulocyte colony stimulating factor in paediatric neutropenia secondary to acute lymphoblastic leukaemia M A Adliah, M B Bahari, R Jamal

S17 A review of management of diabetes mellitus on the elderly in a teaching hospital S Balan, S Alwi, S Hj. Hussain, R Pendek

S18 Comparison of once versus multiple daily dosing of gentamicin in paediatric patients W C Ong, S Alwi, M S Abdullah

S18 A review on the management of hypertension in a teaching hospital N A Bakar, S Alwi, M S Abdullah

S19 A review on the management of hyperlipidaemia in a teaching hospital J Tamotharan, S Alwi, S S Chua

S19 Bleomycin-technetium-99m for tumour imaging A Hakim, A Zakaria

S20 Prospective study: aminoglycoside utilization review S Shamsuddin, N Abd Aziz, Y Hassan, R Yahaya

S20 Prospective study: vancomycin utilization review S A Mohd Hidzir, N Abd Aziz, Y Hassan, R Yahaya

S21 A prospective study to evaluate the rational use of antiseptics in wound management and the factors that can affect wound healing M Syukri S, Rosnani H, Satiapoorany S, Intan Nureslyn S

S21 Factors affecting mother’s choice of infant supplementation in children aged 5 years and below Noraiza Maria M H, Faizah Safina B, Adlina S, S Hj. Hussain

S22 Oral Contraceptives: How Much Do the Users Know? A L Lay , S S Chua , J Amir

S22 Flora used by local Chinese and Indian traditional medicine practitioners in treating heart diseases S M Long, S F Yew

S23 Effects of Terminalia chebula on the isolated perfused rat heart S M Long, S F Yew

S23 The influence of micellar solubilization on the phototoxic action of bergamote oil on the guinea pig skin H Marchaban

S24 Hematoporphyrin (HP) as an alternative photosensitizer in photodynamic therapy (PDT) of malignancies : the study of distribution of HP in mice Low K S, Chan H K, Jayalakshimi P, Yip C H, Sinniah A

S24 Teaching pharmacy by using the internet instead of the white board S W Yeong, D Quah, Brian J Chapman

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Plenary lecture 1

Putting Together Pharmacoeconomics and Pharmaceutical Care into Practice: A Reality or Delusion? M I M Ibrahim School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang The profession of pharmacy in certain parts of the world has begun to champion the concept of pharmacy care. With the adoption of this concept, the responsibilities for quantifying the value, which is the trade-off of costs versus clinical and humanistic (i.e. quality of life, satisfaction) outcomes of products and services, becomes greater than before. Through the provision of pharmacy care, pharmacists must be concerned not only with offering and providing patients and health care consumers the highest quality of care (i.e., assuring the best outcomes for patients), but also with providing this quality to a cost-conscious patient. The combination of quality and cost is the underlying principle of pharmacoeconomics and pharmacists have an important position and function to play in these analyses. Recent trends in health care, such as the movement toward strengthening the public health sector and an increased emphasis on healthy settings and cost containment, indicate that quality and cost containment are concerns not only at the individual level but also at the community, state and national levels. If pharmacists are to take up this important role, they must understand the principles of pharmacoeconomics and be able to apply them in their pharmacy care practice either in the hospital or the community settings. Pharmacists must be prepared to document the value of the products and their professional services in terms of costs versus clinical and humanistic outcomes. The lesson for pharmacists is clear: to continue to grow and be a viable part of the present and future health care system, pharmacists must recognize and act on customer wants and needs and not be satisfied with the status quo. Plenary lecture 2

Pharmacy Education-Future Direction and Challenges L N Sansom University of South Australia, Adelaide, Australia

The next decade will see significant developments in therapeutics resulting from the human genome project and a greater understanding of the molecular basis of disease. These developments will require the availability of pharmacists with knowledge of the physical, biological and biomolecular sciences including formulation science. These new therapeutic agents will bring challenges of cost and cost effectiveness and the delivery of health care will need to be re-examined to ensure equity of access and the ability of governments to keep pace with increasing demand and costs. Pharmacists with expertise in public health and the quality use of medicines and an understanding of pharmacoeconomics and the social aspects of health will be required. Pharmacy education must be proactive in preparing pharmacy graduates for the future and new approaches in curricula design and delivery must be urgently developed if the emerging health care systems are to benefit from the active participation of pharmacists. Plenary lecture 3

Clinical Aspects in Oncology Pharmacy Practice T S Wu National University Hospital, Singapore

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Just as pharmacy practice has evolved from drug dispensing to patient focused clinical pharmacy services, so has oncology pharmacy practice. It is even more so in this area where specialized knowledge and skills are needed to practice. However, it is pertinent to mention that pharmacist expertise in cytotoxic reconstitution and the operational aspects of ensuring safe handling is still relevant and needed. This talk will focus primarily on pharmacists’ involvement in and provision of clinical oncology pharmacy services. It will include monitoring of efficacy and toxicities of drug treatments, management of symptoms/toxicities associated with cancer treatment, management of cancer pain, and pharmacist participation in clinical drug trials and clinical research. Patient education and staff (doctors, pharmacists and nurses) training will also be covered. As cancer treatment regimens become more complicated with the discovery and availability of complex molecules and sophisticated drug delivery systems, patient and staff education take on a new dimension. Challenges and opportunities facing the modern day oncology pharmacist with respect to providing clinical oncology services will be expounded. Plenary lecture 4

Central Intravenous Admixture Service (CIVAS), its Implementation, Cost Benefits and Clinical Aspects S Lim Pharmacy Department, King Edward Memorial and Princess Margaret Hospitals, Subiaco, WA 6008, Australia

CIVAS was initiated at the Pharmacy Department in Princess Margaret Hospital, a paediatric hospital, in 1998. The aims of implementing the CIVAS were to achieve savings in drug costs and in staff preparation time whilst providing quality products with less likelihood of dosage and reconstitution error, and greater likelihood of sterility at the time of injection. The following indicators were agreed with the Hospital Best Practice Unit for use in evaluating the success of CIVAS. • Drug usage and cost in preparing intravenous (IV) products at ward level compared to its

preparation in the pharmacy. • Pharmacy staff time and costs in preparing IV products compared to nursing staff preparation at

ward level. • Number of IV products prepared in a specific period and the annual savings. • Number of patients treated at home and number of products prepared. Drug wastage at ward level was found to be between 5 and 21%. Wastage of diluents used to prepare powdered drugs was not evaluated. In the CIVAS operation, wastage is eliminated almost entirely due to the centralised arrangement and preparation under aseptic conditions, resulting in little drug being left over at the end of the day and the ability to store this till required. Annual savings on drug cost equate to more than $250,000 per year. Nurses took an average of 9.8 minutes to prepare an injection whereas pharmacists/technicians only took 2.5 minutes. Batch production in CIVAS further reduces the time spent in preparation of the injection. Nursing time saved averaged 330 hours per month. Based on a 40-hour week this equates to a potential workload reduction equivalent to 2 FTE (Full Time Equivalent). Thirty patients (Cystic Fibrosis, Cellulitis, Osteomyelitis, Oncology patients) were treated annually at home (Hospital-In-The-Home concept) and 6 different types of antibiotics totalling more than 800 individual doses were prepared. Savings to the hospital would be more than $100,000 annually (and also a saving of 222 in-patient days). The total annual savings from CIVAS amounts to $300,000 (savings on (A) drug budget; (B) nursing time; (C) home care patients). CIVAS also provides high quality clearly labelled sterile products of guaranteed accurate doses, in a form ready to use in patient care. It is a cost effective way of preparing individualised patient doses of parenteral drugs. CIVAS has a random sampling plan where a random product is tested for sterility for every 100 products produced. So far none of these products tested has shown a positive culture (contamination). It is a risk management strategy to improve patient safety and reduce the likelihood of adverse outcomes from dosing errors, phlebitis or infection resulting from poor preparation technique. Due to the cost saving nature of this CIVAS, the management in this hospital has since increased the staffing level in CIVAS by 4 (2 pharmacists and 2 technicians) and confirmed the CIVAS as a core part of the Pharmacy Service.

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Plenary lecture 5

Advanced Drug Delivery Systems: Relevance to the Local Pharmaceutical Industry K H Yuen School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang In recent years, the pharmaceutical industry has given much emphasis to the research and development of novel or advanced drug delivery systems. This in part is fuelled by the biotechnology explosion, which has resulted in the emergence of a new therapeutic class of macromolecules that require specialised delivery systems for their administration. Just as important as the drug itself, the delivery system should introduce the therapeutic agent into the body at the required rate and amount, to elicit the desired response at a specific site. For molecules that are readily absorbable, this would entail controlling the absorption rate and hence the time course of the drug in the body. However, if the molecules fail to meet the necessary physicochemical characteristics for the passage across biological membranes, the system should facilitate and enhance their entry into the body or into specific organs/cells. Examples of advanced delivery systems include oral controlled release products, transdermal and ocular therapeutic systems, bioenhanced systems for poorly bioavailable molecules, lymphotropic systems for lipophilic drugs and systems for site specific targeting such as in gene therapy. While sophisticated in design and construction, some of the technologies behind such devices are not beyond the capabilities of the local pharmaceutical industry. It is noteworthy that some local manufacturers are already engaged in research and development activities of such nature. The present paper attempts to give an overview of the development of advanced drug delivery systems, the technological approaches involved and their relevance to the local industry, together with examples of efforts undertaken locally. Plenary lecture 6

Impact of Pharmacogenomics in Pharmacotherapy Rusli Ismail Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan Pharmacological variability causes patients to respond differently to drugs. Pharmacogenetics is “the study of the hereditary basis for differences in a population’s response to a drug” and pharmacogenomics “describe the commercial application of genomic technology in drug development and therapy”. The most important cause of variability linked to genetics is the variability due to DMEs (drug metabolising enzymes). Many DMEs, like CYP1A1, 1A2, 2A6, 2C9, 2C19, 2D6, 2E1, NAT1, NAT2 and NQO1 exhibit genetic polymorphism and lead to population differences in pharmacokinetics. The genetic polymorphism of DMEs is a Mendelian trait that exists in the normal population in at least two phenotypes, each with a frequency of more than 1%. Poor metabolisers (PM) possess the homozygous autosomal recessive allele and the extensive or rapid metabolisers have the heterozygous or homozygous dominant allele. The clinical consequences vary. With some TCAs, pronounced and prolonged effects can occur with an increased likelihood of adverse drug reactions in PMs given a normal dose. On the other hand, the analgesic effect of codeine is due to morphine formed from demethylation of codeine by CYP2D6 and PMs thus obtain less analgesia from the drug. CYP2D6 (debrisoquine hydroxylase) is best known in terms of genetic polymo rphism. It is involved in the metabolism of 20% of drugs. About 5-10% of Caucasians and 0.9% of Asians metabolise debrisoquine and other substrates of CYP2D6 at a markedly decreased rate. Polymorphism in Malaysia is variable. PMs are found more among Indians than in Malays. None was detected in the Chinese. In our study of patients on metoprolol, a CYP2D6 drug, predicted plasma levels were not obtained with metoprolol doses, and plasma levels were higher among patients with defective genes. Log pMR showed a moderate inverse correlation with log metoprolol clearance and a simple normogram was developed to estimate metoprolol plasma clearance based on CYP2D6 genotypes.

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Plenary lecture 7

The Allergic March Abdul Razif Abdul Razak Pusat Pakar Utara Pumpong, Alor Setar, Kedah The Allergic March is the emergence and progression of different manifestations of allergic disorders throughout an individual’s lifespan. Some allergic manifestations disappear over time while others last till adulthood. A few reasons have been given for the appearance of allergic diseases. Among them are genetic predisposition, environmental factors and "the hygiene theory". Our knowledge on the etiologic mechanism of allergic disorders is still not conclusive. Attention has been given towards reducing the incidence of allergy through allergen avoidance. Measures instituted right from the intrauterine period (abstaining from smoking) till infancy (removal of allergens from carpets in the infant’s bedroom) has not been promising. A novel idea to prevent the allergic march would involve identifying high-risk individuals and treating them before the appearance of the full-blown disease. Presently, there are results that suggest that early treatment of the atopic child may be able to stop the progress of the allergic march. Plenary lecture 8

An Update on Regulatory Control Hasnah Ismail Product Evaluation and Safety Division, National Pharmaceutical Control Bureau, Kuala Lumpur The promulgation of the Control of Drugs and Cosmetics Regulations 1984 marked the beginning of the regulatory control of pharmaceutical products including traditional medicines and cosmetics in Malaysia. The objective of the regulatory control is to ensure that all pharmaceuticals and cosmetic products marketed locally are safe, efficacious and of quality. To achieve these objectives, the National Pharmaceutical Control Bureau (NPCB) as the Secretariat to the Drug Control Authority (DCA) undertakes several activities which include evaluation and registration of products, quality testing, licensing of premises, monitoring of adverse drug reaction (ADR), post- marketing surveillance and dissemination of information. The drug regulatory process has dramatically changed during the last 17 years. Some of the regulatory requirements have been reviewed to adapt with current needs such as reinforcing pharmaceutical Good Manufacturing Practice (GMP), upgrading traditional GMP, emphasizing therapeutic efficacy, promotion of clinical trials, on-line ADR reporting and legislative reviews. The presentation will address the achievements and the future directions of regulatory control in Malaysia. Oral presentation 1

Prescribing Trend of NSAIDs Usage and Total Cost: A Nationwide Perspective S Bahri1, M H Hj. Ahmad1, M W Wong1, H Othman1, L C Han1, S Ewan1, Z Kamaruddin1, R Md Din1, R Zainal1, M M Manan2 1Pharmacy Practice and Development Committee, Pharmacy Division, Ministry of Health of Malaysia, Kuala Lumpur 2Hospital Sultanah Aminah, Johor Bahru This study determined the usage trend, total cost and safety profile of NSAIDs prescribed in the outpatient clinics of the Ministry of Health of Malaysia. This was a prospective study where data on the usage of nine oral NSAIDs were obtained from 26,171 prescriptions taken from outpatient pharmacies of 108 hospitals

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from 14th to 19th December 1998. The prescriptions were sorted into Group 1 (duration of treatment < 7 days) and 2 (> 7 days). Total cost price of each NSAID was based on the pricelist of Hospital Tengku Ampuan Rahimah, Klang. The safety profile of the NSAIDs was compared with the safety classification system developed by Barbara Kaplan et al., 1993. One-way analysis of variance (ANOVA) was used to test for differences between groups. Statistical significance was set at a p value of 0.05. Mefenamic acid, indomethacin and ibuprofen were the most frequently prescribed NSAIDs in both groups. The NSAIDs with the highest total cost in Group 1 were mefenamic acid, indomethacin and ibuprofen. Ketoprofen, naproxen sodium and mefenamic acid were the three most expensive NSAIDs used for Group 2 prescriptions. The survey also showed that the prescription pattern did not follow any cost-effective or published safety profile. The present study highlights the need for a consensus or practice guideline on the use of NSAIDs. It is proposed that guidelines based on the safety profile of NSAIDs be developed for the prescribing of NSAIDs. Oral presentation 2

Pharmacoeconomic Evaluation of Community-Acquired Pneumonia Management in Paediatrics: A Comparison Study Between Single Regimen IV Ampicillin Versus Combination Regimen with IV Ampicillin Plus Gentamicin Mohamed Azmi AH1, S A S Sulaiman2, M I M Ibrahim2, Jameela A H3

1Department of Pharmacy, University of Malaya, Kuala Lumpur 2 School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang 3Hospital Tengku Ampuan Jemaah, Selangor The purpose of this study is to identify the best treatment for paediatric patients who suffer from pneumonia with consideration of cost and clinical outcomes of the treatment modalities. It is a challenge for small hospitals with paediatric patients with community acquired pneumonia (CAP) since drug choices are limited and expertise is lacking in the related field, therefore there is a need for treatment protocols that are simple and cost-effective. In this study, a pharmacoeconomic approach has been utilized between two treatment modalities (monotherapy versus combination) using I.V. ampicillin (A) alone versus I.V. ampicillin plus gentamicin (AG). The outcome of this study shows that I.V. ampicillin alone is more cost-effective than the combination therapy in terms of days of hospital stay where the ampicillin alone - treated group needs only 3.85 days of hospitalisation versus 4.8 days for the combination group (p=0.001). The total cost for overall treatment also shows a significant difference between the two treatment modalities where the total cost for the ampicillin alone - treated group is RM 143.55 versus RM 222.86 for the combination drug group (p=0.00). Clinical parameters such as fever clearance time also shows better improvement with monotherapy than with the combination therapy (A=1.5 days versus 2.15 days for AG, (p=0.046). The time taken to switch to oral therapy is much shorter in the ampicillin alone - treated group compared to that of combination therapy (A = 3.8 days versus 4.8 days for AG, p = 0.00). The overall savings per patient per admission is RM 79.31 with monotherapy. Cost effectiveness analysis (CEA) shows that treatment with ampicillin alone gives a lower CEA ratio in terms of hospital stay than with the combination therapy (A = RM 37.99 per day versus RM 46.52 for AG, p= 0.00) and the CEA ratio for the time to switch to oral therapy is shorter in the ampicillin treated group compared with the ampicillin plus gentamicin treated group (A = RM 38.29 per day versus RM 46.52 per day for AG, p = 0.00). The conclusion of this study is that there are significant differences between the two treatment modalities. Monotherapy yields better outcomes both clinically and economically compared to the combination therapy. The endpoint of this study can be used in decision-making especially when formulating the hospital’s formulary and hospital’s drug budget. Besides that, this study can be used to indirectly evaluate the resistance pattern in the hospital.

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Oral presentation 3

Inappropriate Medication in Elderly Patients Leading to Adverse Drug Reactions in Medical Wards of Ipoh Hospital K S Thong, C V Ram Pharmacy Department, Hospital Ipoh, Ipoh The objective of this study was to determine the prevalence of inappropriate medication in elderly patients and the level which may contribute to adverse drug reactions (ADR). A cross-sectional study was carried out in the medical wards of Ipoh Hospital from March to April 2001. A total of 117 newly admitted patients aged 65 years and above were selected randomly and their medical notes reviewed. There were a total of 29 cases (25%) with inappropriate medication and 24 cases with ADR respectively. Eighteen cases of the ADR were due to inappropriate medication. The percentage of patients inappropriately medicated within the same age range was highest in patients between 75 – 79 years and age 80 years and above (both 33%). Majority of patients were treated with 4 – 6 drugs (58%). Diuretics were the most commonly prescribed treatment. For patients who were treated with more than 9 drugs, 75% were inappropriately medicated. The most common type of inappropriate medication was an unnecessarily given drug (31%). A total of 32 drugs were associated with inappropriate medication and antidiabetics were the most affected (34%). Many drugs were discontinued, withheld or had to have their dosage altered, and antidiabetics were involved most (33%). The main reason for drug discontinuation/withholding/dosage alteration was because it was unnecessary or because the dose was inappropriate (55%). Conclusion: Inappropriate medication leading to ADR was comparatively high in this study. This should be of concern to all heath professionals in order to reduce drug- related problems and enhance the quality of life in elderly patients. Oral presentation 4

An Evaluation of Clinical Outcomes in Hospitalised Geriatric Patients with Community Acquired Pneumonia B S Ilyas , S A Syed Sulaiman , M I M Ibrahim, C Doecke School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang Pneumonia is the tenth leading cause of mortality in Malaysia with the elderly comprising the majority. The lower reporting of symptoms in geriatric patients is the cause for delay in diagnosis and treatment. This study was carried out to determine the clinical patterns of geriatric patients both at Hospital Universiti Sains Malaysia (HUSM) and Royal Adelaide Hospital (RAH). This retrospective study included 146 geriatric patients from RAH for a duration of six months and 40 from HUSM for a duration of one year. Patients from RAH comprised of 47.7% males and 52.3% females while patients from HUSM comprised of 54.3% males and 46% females. The mean age of patients at RAH was 81.2 years while that for HUSM was 72.5 years. Patients from HUSM comprised of 82% Malays and 18% Chinese. 78.8% of patients at RAH and 68.2% of the patients at HUSM presented with one or more co-morbidities. The most common co-morbidity was altered mental status (38.4%) for RAH and congestive heart failure (29.5%) for HUSM. The most common signs and symptoms were cough (81.5% for RAH, 79.5% for HUSM) and crepitations (78.1% for RAH, 84.1% for HUSM). The mean length of stay at HUSM was 8.5 + 5.66 days and 9.6 + 8.36 days at RAH. The 30-day mortality for both RAH and HUSM was 16% and 13%, respectively. Co-morbidities were largely present in geriatric patients with very few obvious signs and symptoms. Recognition of these factors is important so that our treatment modalities match our patient demographic patterns.

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Oral presentation 5

Pharmaceutical Care - Can it Be Electronically Provided? N H Othman, R Awang, M I M Ibrahim National Poison Centre, Universiti Sains Malaysia, Pulau Pinang Pharmaceutical care (PC) is a philosophy of practice that calls for pharmacists’ responsibilities in patient outcomes. There are many barriers to pharmaceutical care provision in the local public hospital setting. They include lack of pharmacists, lack of training, insufficient information, logistic problems and probably apathy. Because PC requires documentation of practice and data retrieval, it becomes cumbersome when carried out manually. Information and communication technology has made inroads into practically every field. Within the pharmaceutical services, there are at present computer systems for drug inventory management and, supply and dispensing. These systems are administrative in nature and do not provide for pharmacist-patient encounters. The delivery of pharmaceutical care through the Web can provide a platform for the interaction between patients and health care providers, especially the pharmacist. The Internet also provides an opportunity for patients to make informed choices on their own health with the help of a health care professional. This will empower patients to be more responsible for their own health. Another advantage of an Internet-based pharmaceutical care system is that documentation and retrieval of patient health information are better and faster. This will greatly enhance the delivery of PC. This presentation will discuss the development of a Web-based Pharmaceutical Care Information System and the usefulness that can be derived from it. Oral presentation 6

Patients’ Knowledge on Anticoagulation Therapy : A Survey in Hospital Melaka N A Kadir, C Y Khua, B Z Sher Jang Khan, L F Chin, A M Abd. Aziz, N Abdullah Pharmacy Department, Hospital Melaka, Melaka

The study aimed to investigate patients’ knowledge on oral anticoagulation therapy (warfarin). A prospective, cross-sectional survey was carried out among outpatients receiving warfarin at the Specialist Outpatient Pharmacy, Hospital Melaka. Convenient sampling was done by trained pharmacy personnel, while data collection was by questionnaire interview. The total number of patients enrolled into the survey was 100, of which 53% were females, and majority (59%) was in the 50-69 years age group. The study showed that patients surveyed knew the duration of treatment (99%), had good knowledge of warfarin’s indication (94%) and 66% of them knew its mechanism of action. However, patients had inadequate knowledge on the target range of INR (21%). Only 29% knew of food-warfarin interaction and 11% were concurrently prescribed drugs that could interact with warfarin. About half of the patients (52%) could not name any symptoms of warfarin toxicity. Among those who could, only 4% of them was able to mention four or more symptoms of warfarin toxicity such as nose bleed, blood in urine, gum bleed and bruising, 30% was able to state three symptoms, and the remainder two symptoms or less. This study also revealed that patients took the drug at different times of the day. When asked if patients had missed a dose, 3% of them replied that they had doubled the dose to make up for the previous. Pharmacists should counsel all patients on warfarin to increase patients’ understanding and knowledge of its potential toxicity and interactions.

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Oral presentation 7 Pharmacists’ Contributions Towards Pharmaceutical Care: Perception of Health Care Providers C Y Cheah, S Alwi, M S Abdullah Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life. This involves cooperation between pharmacist, patient and other health care providers. This study aimed to establish baseline data on pharmacists’ contributions in a teaching hospital. Perceptions of doctors and nurses on pharmacists’ contribution frequency and importance were surveyed. Questionnaire survey was employed. Similar questionnaires were distributed to pharmacy personnel to determine whether or not doctors, nurses and pharmacy personnel were in agreement. A total of 237 questionaires were returned, giving a 70% response rate. Majority of the respondents graduated in Malaysia and have been practising for less than 5 years. Prescription related inquiries were the main reason for interaction between pharmacy personnel and other health care providers. More than 80% of the total respondents sought drug information from pharmacists. Nurses considered certain pharmacy services such as consultation in patients' therapy, drug manufacturing, and therapeutic drug monitoring of high importance. It was also perceived that pharmacists' contribution towards these services were low and inadequate. This study was valuable in identifying the area(s) in pharmacy service that require(s) improvement in order to optimise the overall health care provision. Oral presentation 8

Evaluation of Mechanical and Bioadhesive Properties of Chitosan - Eudragit Transdermal Films Irsan Lim, K K Peh, Yvonne TF Tan School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang The aim of the study is to formulate and evaluate the mechanical and bioadhesive properties of chitosan-Eudragit transdermal films containing diclofenac sodium. Transdermal films consisting of 0.5-1.25% chitosan and 0.5-1.25% Eudragit EPO in lactic acid solution were prepared by the casting method. The mechanical and bioadhesive properties of the films were investigated using a texture analyser (TA-XT2). Chitosan-Eudragit bioadhesive films containing diclofenac sodium were successfully formulated using different percentages of chitosan and Eudragit EPO in lactic acid solution. Evaluation was performed using response surface and contour plot. Decreasing the Eudragit concentration while increasing the chitosan concentration generally increased the elongation at break. This was caused by the formation of a less elastic film at a higher percentage of Eudragit. The tensile strengths of the films were more significantly affected by the chitosan concentration. When the Eudragit concentration was less than 0.65%, an increase in chitosan caused an increase in tensile strength. However, when the Eudragit concentration was more than 0.65%, an optimum tensile strength region of 5.5 N/mm2 was reached, any further increase in chitosan concentration only resulted in a decrease in tensile strength. At 1.25% concentration of both Eudragit and chitosan, film formation became more difficult. Increasing the percentage of both Eudragit and chitosan generally increased the peak detachment force and work of adhesion with maximum values at 1.25 % chitosan and 1.25% Eudragit. The mechanical and bioadhesive properties of chitosan-Eudragit films can be modified by varying the concentration of chitosan and Eudragit.

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Oral presentation 9

Structural, Release and Stability Investigations on Semi-Solid Matrices Based on Polyglycolised Glycerides N Abdul Karim Khan1, Duncan Q M Craig2

1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang 2School of Pharmacy, The Queen's University of Belfast, Belfast BT9 7BL, United Kingdom. The variety of components within a particular family of excipients that is made up of polyglycolised glycerides, can result in complex carrier characteristics ranging from polymorphic changes to the interaction of added drugs with the carrier components. Hot-Stage Microscopy (HSM) coupled with a Differential Interference Contrast (DIC) facility and Differential Scanning Calorimetry (DSC) showed that the addition of a model drug caused a marked change to the matrix by stabilising the lowest melting form of the gelucire whereas the addition of an alternative model drug did not significantly affect it. A difference in the contributions of erosion and diffusion as mechanisms of drug release arose due to the different drugs added and mathematical fittings of the results correlated well with physical matrix measurements during dissolution tests. A correlation could thus be drawn between the macromolecular structure and drug release behaviour. Storage at a temperature which is near to the first melting range of the polyglycolised glycerides tempered the matrices to a more stable form. Ageing resulted in higher drug release rates being obtained during dissolution due to a greater contribution of erosion as the release mechanism. Scanning Electron Microscopy (SEM) studies revealed that the addition of a sterically compatible emulsifier such as sorbitan monostearate inhibited the blooming of stable crystals on the surfaces of the matrices, which may protect the integrity of controlled-release coatings during storage. Oral presentation 10

Thermal Characterization of a Selected Blend of Palm Kernel Oil Components Compared to Cocoa Butter M I Noordin, H Hashim, L Y Chung Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur Polymorphism can have a profound effect on the solubility, stability, and formulation features of any drug or excipient. In relation to any formulation, a polymorphic base can contribute to problems in both the manufacturing processes and the quality of the product. This is clearly illustrated with the use of theobroma oil (cocoa butter) in pharmaceutical dosage form. The cocoa butter thermal profile demonstrated the existence of 6 polymorphs, which concurs with the result of other studies disputing the earlier reports of only 4 polymorphs. The DSC thermogram showed the following events: The type I polymorph melted at about 16°C followed by the crystallization of type II before it melted at about 26°C. The type III crystallization then occurred before it melted at about 29°C followed by the crystallization of type IV before it melted at about 33°C. The type V crystallization then took place before it melt at about 35°C, with the stable VI polymorph melting at 36.6°C generating a predominantly taller and bigger peak compared to the others. Upon cooling, the repeat scan (re-melt) only produces one smooth peak formation with a melting point of 17.4 ± 0.4°C. This significant shift from the predominantly more stable polymorphic feature to a less stable one had been reported. However, the technique of using a re-melt to profile these changes has not been published before. The significance of this quick technique to detect polymorphic changes induced by temperature cycles during storage or transportation of the raw material or during product formulation is great. It provides a useful tool to predict such events. In the case of the palm kernel oil blend, the first scan demonstrated the existence of 3 possible polymorphs hence forth named as Type I (unstable), Type II (metastable) and Type III (stable) The second scan showed a single peak, close to the original Type III polymorph peak. The difference in the melting point of this peak compared to the Type III peak from the first scan is small (2.9 ±1.1°C). The evidently different thermal characteristics of the

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selected blends of the palm kernel oil components compared to cocoa-butter shows that this palm kernel oil blend may be a better alternative as there is not much significant changes as showed by the thermograms upon cooling and re-melting. As such, this provides a better stability profile and is less detrimental compared to the commonly available cocoa-butter base. Oral presentation 11

Chemical Constituents of the Essential oils of Cinnamomum cordatum Kosterm. and C. vimineum Nees B H Au, I Jantan Department of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur

The chemical composition of the essential oils of Cinnamomum cordatum Kosterm. and C. vimineum Nees. was investigated by gas chromatography on two columns of different polarity and retention indices, and also by GC-MS. Forty-seven compounds were identified in the leaf oil of C. cordatum and the major constituents were linalool (22.3%), (E)-methyl cinnamate (18.7%), β-phellandrene (9.0%), benzyl benzoate (7.6%), terpinen-4-ol (7.0%) and methyl eugenol (4.4%). The bark oil was made up almost entirely of methyl eugenol (93.0%). The leaf oil of C. vimineum contained β-bisabolol (14.3%), guaiol (9.8%), β-selinene (9.1%), β-tumerone (7.1%), epi-α-muurolol (6.7%) and hexadecanoic acid as the major components. Oral presentation 12

Toxicity Study of the Essential Oils and Methanol Extracts of Malaysian Plants on Aedes aegypti Larvae O P Wong1, I A Abdul Rafi1, S Devi Visuvalingam1, N Wasi Ahmad2, I Jantan1

1Department of Pharmacy, Faculty of Allied Health Science, Universiti Kebangsaan Malaysia 2Entomoly Division, Institute for Medical Research Kuala Lumpur

A total of 17 methanol extracts and 9 essential oils of Malaysian plants were investigated for their larvicidal activity against Aedes aegypti. Toxicity tests were carried out using the fourth instar larvae according to the WHO standard. Amongst the samples studied, the essential oils of Cinnamomum pubescens, C. microphyllum and Curcuma domestica showed significant effects with LC50 values of 13.7, 20.6 and 20.9 µg/ml, respectively. Except for Zingiber cassumunar, the essential oils of the other species were also effective against the larvae with LC50 values less than 200 µg/ml. Of the methanol extracts, Garcinia praniana, G. griffithii, Labisia pumila var. alata, L. pumila var. pumila and Mitragyna speciosa showed relatively high activity with LC50 values ranging from 103 - 271.3 µg/ml. The methanol extracts were generally less effective than the essential oils with most extracts exhibiting LC50 values greater than 500 µg/ml.

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Oral presentation 13

The Effect of Adrenergic Drugs on Renal Haemodynamics in Cardiac Failure-Induced and Normal Sprague Dawley and Spontaneously Hypertensive Rats S A Abbas1, A S Munavvar1, A P M Yusof1, N A Abdullah2, E J Johns3

1School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang 2Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 3Department of Physiology, Medical School, Birmingham B 15 2TT, U.K. We have reported earlier the effect of adrenergic drugs on renal haemodynamics in cardiac failure induced and normal Sprague Dawley (SD) rats. The high mortality due to cardiovascular abnormalities is mainly observed in hypertensives, where there is structural as well as functional changes which can alter the compliance characteristics of arterial blood vessels. Therefore, the present study was undertaken to examine the effect of adrenergic drugs on renal blood flow in spontaneously hypertensive rats (SHR) with or without cardiac failure. The experimental cardiac failure was produced by concurrent administration of caffeine (20mg/kg) and isoprenaline (5 mg/kg IP) for seven days. On day eight, the rats were used for the acute study. The animals were anaesthetized with pentobarbitone sodium (60mg/kg IP) and tracheotomy done to facilitate artificial respiration if necessary. The left jugular vein and carotid artery were cannulated to allow the continuous infusion of anaesthesia and to measure the arterial blood pressure respectively. A midline abdominal incision was done and the left kidney exposed and an electromagnetic flow probe placed on its artery. The left iliac artery was cannulated such that the bevelled tip of cannula faced the renal artery. The renal nerves were identified, isolated and placed on bipolar electrodes for electrical stimulations. A mixture of saline and pentobarbitone sodium (12.5mg/kg/hour) was infused (6ml/hour) close renal arterially. Upon completion of the surgery, 2ml of saline was injected IV as primer. After one hour of stabilization period, the renal nerves were stimulated at frequencies of 1,2,4,6,8 and 10 Hz for 15 seconds in ascending and descending order and renal blood flow was recorded. Noradrenaline (25, 50, 100, and 200 ηg) followed by phenylephrine (0.25, 0.50, 1.0 and 2.0 µg) and methoxamine (1, 2, 3 and 4 µg ) were given in closed renal artery system. The results showed that renal vasoconstrictor effects of renal nerve stimulation, noradrenaline, phenylephrine and methoxamine were significantly (P<0.05) lower in cardiac failure induced SHR as compared to SHR without cardiac failure. Furthermore, there was a significant (P<0.05) difference in the vasoconstrictor response of renal nerve stimulation, methoxamine and phenylephrine in cardiac failure induced SHR as compared to normal SD and cardiac failure induced SD rats, which suggested the involvement and the possible downregulation of α adrenoceptors at the level of renal resistance vessels in SHR with cardiac failure. Oral presentation 14

Acyl Glucuronides – An Interesting Mechanism for Their Elimination by the Kidney? R W Milne, H Khalil, R L Nation, A M Evans Centre for Pharmaceutical Research, University of South Australia, Adelaide, Australia Acyl glucuronides are reactive metabolites in vivo. However, there is limited information on the mechanisms for their renal elimination. The study aimed to examine the renal disposition of a model acyl glucuronide, gemfibrozil glucuronide (GG), in the isolated perfused rat kidney (IPK), specifically the influence of concentration and of inhibitors of tubular transport. In study one, two groups of kidneys were perfused with GG in a buffered medium at 1.25 µM and 10 µM. In study two, three groups of kidneys were perfused with GG alone (5 µM) for 10 minutes, and with GG plus p-aminohippuric acid (PAH), N-methylnicotinamide (NMN) or probenecid for two further periods (10 minutes) at two concentrations of inhibitor. Urine and perfusate were collected and GG measured by HPLC. From the first study, the ratios of the renal clearance of unbound GG to GFR were 0.088 ± 0.033 (1.25 µM) and 0.19 ± 0.10 (10 µM). In the

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second study, the ratio was decreased by probenecid at 0.18 mM, and increased by the high concentration. The ratios were unaffected by PAH and NMN. The concentration-dependent ratio for GG suggests saturable reabsorption by the kidney. Probenecid at low concentration inhibited the tubular secretion of GG; at high concentration it inhibited reabsorption. There is a combination of mechanisms for the renal elimination of GG: filtration, and active secretion and reabsorption. Oral presentation 15

Influence of Gingko biloba on Hepatic Drug Metabolism A Hj Hussin, Z Mustaffa School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang Gingko biloba has been reported to have an antioxidant effect and can influence some diseases that are related with the ageing process such as stroke, heart attack and memory deficiency. The objective of this study was to investigate the in-vitro and in-vivo effects of G. biloba on the metabolism of aminopyrine in rat liver hepatocytes. The influence of factors such as diabetic state and sex on the effect of G. biloba on aminopyrine metabolism were also investigated. The study involved the use of normal and streptozotocin (STZ)-induced diabetic male and female Sprague Dawley rats of about 15-25 weeks old. Preparation of hepatocytes involved perfusion of the rat liver with collagenase. Certain volumes of hepatocytes representing 6000 cells were incubated for 18 minutes in an incubation medium in the presence of a series of concentrations of fresh aqueous extract of G. biloba. Determination of aminopyrine N-demethylase activity was done according to the Nash calorimetric method. The aqueous extract of G. biloba was found to significantly decrease the metabolism of aminopyrine in male diabetic rats and also significantly increase aminopyrine metabolism in male normal rats. In the normal male rat group which was orally administered with G. biloba for a period of 2 weeks, significant increases in aminopyrine metabolism was observed. In conclusion, the aqueous extract of G. biloba is able to influence hepatic aminopyrine metabolism. Gender and disease factor (diabetes) are able to influence the effect of the extract on aminopyrine metabolism. Oral presentation 16

Biopharmaceutic Evaluation of Two Diclofenac Formulations in the Pig M V Lu1, R C H Fishlock1, L N Sansom1, E Kostewicz1, T Kuche12. 1Centre for Pharmaceutical Research, School of Pharmacy and Medical Sciences, University of South Australia S.A.50001 2Institute of Medical and Veterinary Sciences, S.A. 50002 Australia The bioavailability of two commercially available 50mg diclofenac products: Voltaren Rapid50 (a rapid release formulation) and Voltaren 50 (an enteric-coated (EC) slow release formulation) were determined in six female Southern White pigs (mean weight±SD 3l±7.9kg). Using a randomised three way cross over design, diclofenac was administered (on separate occasions, after an overnight fast) either as an IV dose (25mg) or one of two oral preparations. A validated HPLC method and jugular venous blood samples were used to quantify plasma diclofenac concentrations. Total clearance was 0.08±0.03L/h/kg and the terminal half-life was 1.7±0.6h. The mean maximum concentrations and the time of their occurrence for both the rapid and EC formulations were 4.7±l.6 and 7.0±3.1 mg/L and 2.3±l.2 and 3.5±3.7h respectively. The absolute bioavailability and T1ag was 92±25 and 97±38% and 0.04±0.10 and 2.32.6h respectively. There is no significant difference in the pharmacokinetic parameters between the two oral formulations (P>0.05). The bioavailability and inter-pig variability is consistent with human studies (Fabs=90%). Both products are well absorbed in the pig, however, the time to reach peak concentrations is longer than that reported in humans (0.3-1h for the rapid and 2h for the EC formulation). This may be due to differences in gastric emptying. A relevant feature in the study was finding multiple peaks post dosing. In vitro dissolution shows

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that both formulations have a significantly faster release characteristic under basic conditions than acidic conditions. The results of this study may support the use of the pig as a model for oral drug absorption studies. Oral presentation 17

N-Oxidation of Dietary-Derived Trimethylamine in Ethnic Malays and Malaysian Chinese and Indians M S Abdullah1, Ching Y Ng1, Lyaquatali A Damani2 1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur 2Visiting Professor Trimethylaminuria (TMAU) or fish-odour syndrome is an inherited metabolic disorder characterised by the incomplete metabolism of dietary-derived trimethylamine (TMA) to the stable, non-volatile and non-odorous TMA N-oxide (TMAO). This study was conducted to investigate the incidence of TMAU among the three main ethnic groups in Malaysia. Subjects were screened for TMAU by measuring TMA and TMAO levels in early morning-voided urine. A total of 100 volunteers were recruited in this preliminary study (22 Malay female; 18 Malay male; 19 Chinese female; 13 Chinese male; 15 Indian female and 13 Indian male). Mean percentage of total TMA excreted as TMAO for Malay subjects was 77.57 ± 15.19 % [Female=77.05 ± 16.57 %; Male=78.19 ± 13.76 %]; for the Chinese 85.30 ± 9.04 % [Female=84.87 ± 11.07 %; Male=85.93 ± 5.18 %] and for the Indians 85.50 ± 13.49 % [Female=87.20 ± 4.88 %; Male=83.53 ± 19.33 %], all data are means ±.S.D. In terms of percentage of total TMA excreted as TMAO, there was a statistical significant difference when data for Malay subjects were compared to those for Chinese and Indian subjects, but there was no significant difference between the Indian and Chinese subjects. A total of 15 of the 100 subjects were found to excrete <70% of TMA as TMAO. Of these, 12 [or 80%] were Malays; one was a Chinese female and two were Indian males. This preliminary study suggests that the frequency of TMAU may be higher in Malays than in Chinese and Indian Malaysians. Oral presentation 18

Access to Community Pharmacies in Malaysia Y Y Soo, S S Chua, S Y Yip, R Dorall Department of Pharmacy, Faculty of Medicine, University of Malaya This research was conducted to study public access to community pharmacies in Malaysia. The application of a geographic information system (GIS) in the study of public access to community pharmacies was also explored. The study was organized into macro-level and micro-level. Primary data was collected from a nationwide survey of community pharmacies and a customer survey in three selected pharmacies from the Klang district. Information on the location of community pharmacies in Malaysia was assembled from the Pharmaceutical Services Division, Ministry of Health, Malaysia. Other sources of data included the Department of Statistics, Municipal Councils and various international pharmaceutical control bodies and societies. A digital road network was also developed for analysis at the micro-level. From the results of the study, it was found that the density of pharmacies in Malaysia is low, with 23,451 inhabitants per pharmacy, in comparison to the developed countries and some other developing countries. The East Coast of Peninsular Malaysia, Sabah and Sarawak were found to have a low density of pharmacies relative to the West Coast of Peninsular Malaysia. Most of the urban centres have a satisfactory density of pharmacies. Community pharmacies in Malaysia are under-utilised. Most of them are small in terms of manpower, and have limited functions. At the micro-level, areas that lack access to pharmaceutical services and the locations of prospective pharmacies in Klang were identified using computer-generated models. In conclusion, public access to community pharmacies in Malaysia is low in most of the districts except for

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the urban districts. The ratio of 10,000 inhabitants per pharmacy is recommended as the target ratio for Malaysia. However, individualized ratios at the micro -level for each state or district should be planned and studied. GIS is found to be a useful planning and decision making tool for the management of community pharmacies in Malaysia. Oral presentation 19

Detection and Assessment of Risk Factors for Coronary Artery Disease in a Malaysian Population Group J Singh, A Lai, H Kaur, S Nair, S Lim Heartscan (M) Sdn. Bhd., Kuala Lumpur

Coronary artery disease (CHD) continues to be the leading cause of death among Malaysians. Many Malaysians are unaware of risk factors for CHD. The objectives of the study were to detect the presence of risk factors in a normal population using a modified risk score chart for risk factor analysis for CHD, highlight these risk factors and give appropriate advice and counselling in risk modifications to these individuals. A total of 104 adults who were 20 years and above agreed to be screened for risk factors for CHD. This was done in two shopping malls within the vicinity of a middle to upper class residential area. The screening included height and weight for Body Mass Index, blood glucose and total cholesterol, blood pressure, smoking and exercise habits, stress level, family history of heart disease and age. Scores were assigned to risk stratify individuals as low, moderate, high and very high risk. From the 104 individuals who were screened, 28 (27%) scored as low risk, 54 (52%) were in the moderate risk group, 21 (20%) were in the high risk group and one (1%) was in the highest risk group. The modified risk score chart for risk factor analysis for CHD can be used to risk stratify individuals. Appropriate advice and counselling can be then directed to such individuals to modify their risk factors including directing them to seek further medical advice. Pharmacists can play this vital role in helping to create the awareness of coronary artery disease towards reducing cardiac events.

Oral presentation 20

Public Usage of Oral Lecithin : To Reduce Plasma Cholesterol?

B K Tan, S S Chua, L K Teh Department of Pharmacy, Faculty of Medicine, University of Malaya

Hypercholesterolaemia is an important risk factor associated with the development of coronary heart diseases. Lecithin is among the many food supplements being extensively researched for the potential to lower blood cholesterol. Despite its escalating popularity, epidemiological data on lecithin usage is not available. The aim of the present study was to evaluate the usage of oral lecithin to reduce plasma cholesterol among the general public in Malaysia. A total of 300 respondents who took lecithin were interviewed in 30 retail pharmacies. Pertinent biochemical data including blood cholesterol levels before and after lecithin intake was recalled and recorded. Lecithin was most commonly used by married, middle aged, Chinese females. Of these respondents, 95% of them used lecithin as sole agent or as add on therapy with prescribed statins to reduce their blood cholesterol. Lecithin alone and in combination with statins caused mean cholesterol reductions of 6.35% and 23.81% respectively. However, it was more effective in reducing plasma cholesterol in the borderline cases (5.2-6.2mmol/L). Some common side effects reported with lecithin intake were nausea and diarrhoea. The extent to which the public consulted the pharmacist regarding lecithin remains low. In conclusion, lecithin appeared effective only in mild forms of hypercholesterolaemia.

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Oral presentation 21

Assessing Factors Contributing to Inconsistent Use of Oral Contraceptive Pills (OCP) among Malays Z M Yusoff, M L Tan, S Othman, M I M Ibrahim. School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang Inconsistent use of OCP has been shown to cause unwanted pregnancies, and various factors have been said to cause this. Inconsistency is defined as missing two or more pills in a three-month period. The objective of this study was to explore factors contributing to inconsistent OCP taking in a community pharmacy setting. A total of 80 Malay OCP users were non-randomly selected over a three-month period. Users were interviewed face-to-face or via telephone using a standard questionnaire. Data collected were used to describe factors that may contribute to inconsistent pill taking. Chi Square test was used to determine factors associated with inconsistent pill taking. Results : users’ mean age was 30.5 years and 83% were below 37 years old; 56% were from a low- income group; 81% of users and 88% of their spouses completed secondary education; 67% had two or more children. 99% of the users had been using OCP for more than 3 months; 6% users were initiated by pharmacists, 43% by nurses and 35% by doctors. Only 48% of the users read the information leaflet and 45% of them claimed to have understood the content. OCP price was important to 61% of the users. 39% of the users did not take the OCP at a fixed time. Inconsistency in pill taking was seen in 19% of the users, in which 66% took the pill at irregular times of the day. No significant association was found between inconsistency in pill taking and all the above factors except for fixing the time daily (P=0.007). This study shows that establishing a regular routine when taking OCP could reduce inconsistency.

Poster presentation 1

Medication Problems among Geriatrics at the Outpatient Pharmacy Setting in Hospital Universiti Sains Malaysia (HUSM), Kelantan A Mat1, D Che Abdullah1, M I M Ibrahim2, Mohamed Azmi H3 1Universiti Sains Malaysia Hospital, Kelantan 2School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang 3Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur Medication problems among the elderly population are reported as very crucial and is a major problem to the health care system. Therefore, the main aim of this study was to explore medication problems among geriatric patients at the outpatient pharmacy setting. A retrospective study was conducted. It involved screening of prescriptions for a one-month period (March 2000). All prescriptions issued to the elderly patients (patients 60 years old and above) were selected and screened. A total of 10,429 prescriptions were screened. Only 15.35% (1601 prescriptions) of the prescriptions were for the geriatrics. Out of 1601 prescriptions, 25.17% (403 prescriptions) of the prescriptions were found to have medication problems. The problems between both genders were found to be almost equal. Medication problems were found to be high for the elderly patients especially at the early age (60-64 years old). Patients who received more than nine drugs had a higher incidence of medication problems (32.61% of cases). Patients with more than three clinical diagnoses also contributed to the higher cases of the medication problems (10.06%). These problems occurred more in the specialist clinic (37.52%) than in the general clin ic (10.59%). The cost estimated for the medication problems identified was approximately RM 8,134.29 and RM 9,327.17 when personnel cost was included. If the percentage of medication problems were assumed to be equal in all the months, the projected cost of medication problems was RM 15,6363.24 per annum. In conclusion, it is very clear that the role of pharmacist is very great in preventing and minimising these problems.

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Poster presentation 2

A Comparative Study between Direct Supply and Constituted Supply of Medicine at Intravenous Admixture Unit, Pharmacy Department, Hospital Universiti Sains Malaysia (HUSM) D Che Abdullah Hospital Universiti Sains Malaysia, Kelantan

This was a retrospective study comparing two methods of medicines (antibiotics) supply by aseptic dispensing. The Intravenous Admixture Unit of the Pharmacy Department, Hospital Universiti Sains Malaysia (HUSM), has demonstrated that ‘constituted supply’ is more cost effective than ‘direct supply’ of the medicines. The cost reduction of the medicines was about RM 23,619.98 (up to 7.23% for five months). The average cost reduction was RM 4724.00 per month and up to RM 56,688.00 per annum. So, the study clearly showed that ‘constituted supply’ of the medicines can reduce the cost of the medicines. With that amount of money saved, we could improve our quality of services and also the quality of the medicines supplied. Poster presentation 3

Awareness of Hepatitis Infections among Residents in Kuala Lumpur and Selangor H C Lim, H Rashwan Department of Pharmacy, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur. Hepatitis A and B continue to be major health problems among Malaysians and also worldwide. Although hepatitis B and A vaccines were approved in late 1981 and in 1992 respectively, hepatitis A and B continue to be the most frequently reported vaccine-preventable diseases. A survey was carried out to assess the level of knowledge and vaccination coverage of hepatitis A and B among 753 subjects (>12 years of age) from rural areas, town areas, undergraduate-healthcare providers and healthcare workers. The main objective of the study was to assess the relationship between the level of hepatitis A and B knowledge and vaccination status of the participants. A questionnaire was completed by the subjects. The results showed that the overall level of knowledge among the public was low compared to healthcare workers and undergraduate-healthcare providers. The hepatitis A vaccination coverage was very low among all the groups (<8%). The hepatitis B vaccination coverage was generally low among the groups of non-healthcare workers (<35%) and higher among healthcare workers (65.6%). There was a strong association between the level of knowledge of hepatitis A and B and the status of vaccination among the participants (p<0.01). The study concluded that health education on hepatitis A and B should be provided and vaccination programmes should be held more frequently among the public, especially in rural areas. Poster Presentation 4

Patients’ Knowledge of Warfarin Winston T K Tay, S Alwi, L K Teh Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur

Warfarin is the most widely used oral anticoagulant in the outpatient department. In order to ensure appropriate drug taking behaviour, it is important that patients are knowledgeable about the medications

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that they take. The study aimed to assess the respondents’ knowledge about warfarin and sources of further information on warfarin therapy. Patients who were dispensed with warfarin in the outpatient pharmacy of University Hospital were interviewed using a pre-tested questionnaire from October to December 2000. One hundred and sixty two patients participated in this study. Ninety-four respondents (58.0%) had satisfactory knowledge of warfarin therapy (arbitrarily defined as ≥ 7 questions answered correctly). The average number of questions correctly answered was 6.75 ± 1.53 with a mode value of 7. Patients’ knowledge of warfarin was not associated with sex, race and indications of therapy but was associated with educational level. There was a significant but weak negative correlation between age and number of questions correctly answered (r = -0.23, p<0.01). The respondents lacked knowledge on drugs, food and conditions that interfere with warfarin therapy and warfarin’s mode of action. 81.5% of the respondents would opt for doctors for further information on warfarin while only 6.2% would choose pharmacists. This study showed that knowledge about warfarin among patients dispensed with warfarin in the outpatient pharmacy was generally satisfactory but not perfect. There was also a need to improve the image of the pharmacist as a principal drug advisor to the public. Poster presentation 5

Granulocyte Colony Stimulating Factor in Paediatric Neutropenia Secondary to Acute Lymphoblastic Leukaemia M A Adliah1, M B Bahari2, R Jamal3

1Department of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur 2School of Pharmacy, Universiti Sains Malaysia, Pulau Pinang 3Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur Recombinant human granulocyte colony stimulating factor (G-CSF) is used to shorten the recovery from neutropenia after intensive chemotherapy. Its role in the management of childhood leukaemia however is still unclear. The objective of the study is to evaluate G-CSF usage and the clinical outcome in paediatric acute lymphoblastic leukaemia (ALL) in Hospital Universiti Kebangsaan Malaysia (HUKM). All children (age less than 15 years old) diagnosed with ALL and treated with G-CSF between January 1999 and December 2000 at the Paediatric Department, HUKM, Cheras, Kuala Lumpur were included in this descriptive retrospective study. A total of 46 patients were included in the study. Results showed that there was a significant and moderate relationship between days on G-CSF and days of hospitalisation with r value +0.631 (p= 0.00). The median duration of neutropenia was 7 days and there was a significant and strong relationship between days on G-CSF and duration of neutropenia with r value +0.824 (p=0.00). Thirty-five percent of cases had severe infection (grade 3 and 4) where septicaemia was the highest (24%) followed by pneumonia (11%). Forty percent of cases developed mild to moderate infection (grade 1 and 2) such as phlebitis, oral thrush, mucositis, pharyngitis and upper respiratory tract infection. The study showed that the use of G-CSF shortened the days of hospitalisation and duration of neutropenia. However, the rate of infection among paediatric neutropenia patients was still high. Prospective studies utilizing larger numbers of subjects are recommended to further evaluate the impact of these agents on the outcome of paediatric neutropenia secondary to ALL. Poster presentation 6

A Review of Management of Diabetes Mellitus on the Elderly in a Teaching Hospital S Balan1, S Alwi1, S Hj. Hussain1, R Pendek2 1Department of Pharmacy 2Department of Medicine Faculty of Medicine, University of Malaya, Kuala Lumpur

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Diabetes mellitus is a growing health problem for the elderly population. Managing elderly diabetic patients is very important because poor control of their condition will lead to a greater risk of complications and associated disability. With the increasing number of elderly and prevalence of the disease, diabetes in the elderly will be a major health problem in the 21st century. The aims and objectives of this study were to review the management of elderly diabetic patients in a teaching hospital and to identify the most common treatment modality used to treat this group of patients. The medical records of 120 Type II diabetic patients who were 60 years old and above were reviewed retrospectively. In this study it was found that the use of oral hypoglycaemic agents (OHA) was the most common type of treatment modality, accounting for 45% of the patients. 26.7% of patients were treated with a combination of OHA and insulin. Insulin treatment was given to 14.2% of the patients and 11.7% of the patients were managed with diet. Thirty-six patients (30%) had at least one hypoglycaemic attack. 39% of the patients received monotherapy which comprises of OHA or insulin alone. 27% of the patients received combination therapy. The highest range of change in blood glucose level was 1.5 mmol/L to 7.5 mmol/L, and this was recorded for patients who were on combination therapy. The general approach to the management of diabetes mellitus in the elderly should be relatively conservative to avoid occurrence of hypoglycaemia and other complications. Poster presentation 7

Comparison of Once Versus Multiple Daily Dosing of Gentamicin in Paediatric Patients W C Ong, S Alwi, M S Abdullah Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur A retrospective study was undertaken in 128 paediatric patients prescribed with gentamicin from 1st January 1999 to December 2000. Sixty-three of the paediatric patients were started on once daily dosing (ODD) of gentamicin and 65 were on multiple daily dosing (MDD). Throughout the hospitalisation, switches of dosage regimen occurred and each of the dosage regimen was studied individually. The aim of the study was to evaluate the pharmacokinetic and pharmacodynamic profiles of gentamicin in paediatric patients on ODD and MDD. The study also aimed at establishing pharmacokinetic parameters of gentamicin that enable effective Therapeutic Drug Monitoring (TDM) in the paediatric population. Patients were grouped into various age groups in the study due to the large variation of pharmacokinetic profile in paediatric patients, especially the newborns. The mean serum peak concentration of gentamicin was significantly higher in ODD patients compared to MDD patients. However, levels of both regimens did not vary significantly except in term neonates. Mean volume of distribution of gentamicin was highest in term neonates (0.688L/kg) and lowest in children age 1 to 12 years old (0.426 L/kg). The elimination constant increased as the age of the patients increased. A favourable clinical response was observed in 49/76 (64.5%) patients of the ODD group and in 60/101 (59.4%) patients in the MDD group. Mean length of therapy in the ODD group was 3.87 days and 5.14 days in the MDD group. Nephrotoxicity was observed in three patients who underwent MDD of gentamicin and no sign of toxicity was observed from the ODD of gentamicin. It was concluded that MDD of gentamicin was as effective as ODD but more nephrotoxic. Poster presentation 8

A Review on the Management of Hypertension in a Teaching Hospital N A Bakar, S Alwi, M S Abdullah Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur Drugs available for the treatment of hypertension include diuretics, beta blockers, angiotensin converting enzyme inhib itors (ACE I), angiotensin II antagonists, calcium channel blockers, alpha blockers, centrally acting drugs and vasodilators. The decision to initiate pharmacological treatment requires consideration of several factors such as blood pressure, presence of concomitant conditions, risk factors and age, as

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documented in the Malaysian Hypertension Consensus Guidelines 1998 (MHCG). Thus, this study assessed the extent of use of the MHCG by physicians. This study aimed to review the drug therapy in hypertension and to assess physician compliance to the MHCG. This retrospective study was conducted in a teaching hospital. The medication records of 150 hypertensive patients in 1998 were randomly selected and examined. Hypertension was most prevalent in the elderly (57.4%), women (52.7%) and the Chinese population (42.7%). Old age (57.3%) and diabetes mellitus (37.3%) were the most common risk factors. Antihypertensive medications that were commonly used in the ward were beta blockers (51.3%) and calcium channel blockers (50.0%). The combination of drugs was seen in 54.0% of cases. Drugs used in the presence of other concomitant conditions were in agreement with recommended guidelines. It can be concluded that the reduction of high blood pressure can be achieved with appropriate drug treatment based on the patient’s condition. Physician compliance was also in accordance to the MHCG. Poster presentation 9

A Review on the Management of Hyperlipidaemia in a Teaching Hospital J Tamotharan, S Alwi, S S Chua Department of Pharmacy, University of Malaya, Kuala Lumpur

Consensus Statement on the Management of Hyperlipidaemia has been developed by the Ministry of Health of Malaysia to provide guidelines and current recommendations for the treatment of hyperlipidaemia. However, guidelines are of no value if it is not utilized but information on the extent of such practice in Malaysia is still scarce. Therefore, the study was conducted to review and compare the management of hyperlipidaemia in a teaching hospital with the recommended treatment in the Malaysian Consensus Statement on the Management of Hyperlipidaemia. The study involved a retrospective review of data from the medication records of patients whom were diagnosed as hyperlipidaemic from the year 1994 until 2000. The Malaysian Consensus Statement on the Management of Hyperlipidaemia for 1994 and 1997 were used as references for reviewing the data. Of the 250 medication records screened, only 53.6% of the treatments complied with the overall guideline and 54% of this achieved the recommended total cholesterol goal. The results also showed that 10.4% of the subjects were undertreated and this may not be favourable, especially in patients with high risk for developing cardiovascular diseases. The Malaysian guideline on the management of hyperlipidaemia appeared not to be widely followed in the present study. Therefore, further investigations on the reasons for such noncompliance to the guideline should be conducted to improve the practicability of treatment approaches in such guidelines. Poster presentation 10

Bleomycin-Technetium-99m for Tumour Imaging A Hakim, A Zakaria School of Medical Sciences, Universiti Sains Malaysia, Kelantan

Bleomycin is a chemotherapeutic drug which is widely used as an anti-tumour antibiotic to treat various neoplasms. The ability to visualize the tumour during chemotherapy will help the oncologist in the management of cancer patients. The aim of this study was to label bleomycin with Technetium-99m and to investigate the basic properties of the radiolabelled compound with the intention to use this compound for tumour imaging. The labelling process was done using stannous(II) as a reducing agent in acidic condition. The data revealed that 2 milligrams of bleomycin, 20 milliCuries of Technetium-99m and 2 micrograms of stannous produced 90% labelling efficiency at room temperature after the products were purified using Sephadex G-25. The 90% labelling efficiency was stable in-vitro for up to 4 hours after preparation. After 24 hours, the efficiency decreased to 80%. A biodistribution study was done by injecting the radiolabelled compound into the tail of normal mice. The mice were sacrificed at 1 hour, 4 hours and 24 hours after

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injection. The activity in lung, stomach, liver, intestine, spleen, heart, blood, kidneys, muscle and skin was measured using a gamma well counter. The % activity per gram in the kidney 1 - 4 hours after injection was in agreement with previous work. Uptake of about 20% was measured in cancer cell lines. Based on the data obtained the study has shown that Bleo-Tc-99m has great potential for tumour imaging. Poster presentation 11

Prospective Study: Aminoglycoside Utilization Review S Shamsuddin1, N Abd Aziz1, Y Hassan1, R Yahaya2

1School of Pharmaceutical Sciences,, Universiti Sains Malaysia 2Department of Pharmacy, Hospital Pulau Pinang Pulau Pinang The objectives of this study were to evaluate the indications, dosing regimen, monitoring and outcome of aminoglycoside therapy. This study was carried out prospectively in a teaching hospital, involving 91 adult patients who received at least three days of aminoglycoside therapy. A specific data collection form was used to record patient characteristics and clinical information. Most of the aminoglycosides were indicated for appropriate organisms (80.0%). The daily dosing regimen for gentamicin ranged from 160mg to 750mg and for amikacin, 500mg to 1250mg. However, majority of patients were on 160 mg gentamicin daily (61.0%) and 750mg amikacin daily (54.0%). Seventeen patients (18.7% ) required dose adjustment. Results of culture and sensitivity tests were available in 58 patients (63.7%). Serum creatinine concentration was determined in 69.2% of patients before initiation of therapy. Aminoglycoside serum concentrations were monitored in 92.3% of patients. Adverse effects experienced by the patients included nephrotoxicity (16.0%), ototoxicity (12.1%), cutaneous reactions (2.2% ) and fever (2.2% ). The outcome of the aminoglycoside therapy showed that the percentage of patients who became afebrile, had organisms eradicated and had WBC return to normal level were 76.9%, 8.8% and 26.4% respectively. In conclusion, the indications for the aminoglycoside and initial dosing regimens were appropriate. Patient monitoring was incomplete. The most common adverse effect experienced by patients was nephrotoxicity. However, majority of patients achieved therapeutic outcome (based on body temperature). Poster presentation 11A

Prospective Study: Vancomycin Utilization Review S A Mohd Hidzir1, N Abd Aziz1, Y Hassan1, R Yahaya2

1School of Pharmaceutical Sciences, Universiti Sains Malaysia 2Department of Pharmacy, Hospital Pulau Pinang Pulau Pinang The objective of this study was to evaluate the indication, dosing regimen , monitoring and outcome of vancomycin therapy. This study was carried out prospectively in a teaching hospital. The study involved 66 adults who received at least 3 days of vancomycin therapy. A specific data collection form was used to record patient data i.e. demographics, characteristics and clinical information. The results showed that most of indications (84.4%) were for methicillin resistant S. aureus (MRSA) or methicillin resistant coagulase negative S. aureus infections. Majority of patients were on 500mg tds or 500mg qid. Twenty-nine patients (43.9%) had to have their dosing regimen adjusted. Culture and sensitivity tests, and serum creatinine concentrations before initiation of vancomycin therapy were available for majority of the patients (86% and 81.8% respectively). Vancomycin serum concentrations were monitored in 90.0% of the patients. Vancomycin adverse effects experienced by the patients include ototoxicity (12.1%), cutaneous reactions (7.6%), red man’s syndrome (6.1%) and fever (3.0%.). About a quarter of the patients were afebrile (28.8 %), had the documented organism eradicated (24.2%) and had WBC return to normal (22.7%) as the

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outcomes of vancomycin therapy. In conclusion, vancomycin was appropriately used but incompletely monitored. Three to 12% of patients experienced adverse effects. The initial dosing regimen of vancomycin needs to be improved in order to minimize the number of subsequent dosage adjustments. Outcome of vancomycin therapy based on body temperature was low. Poster presentation 12

A Prospective Study to Evaluate the Rational Use of Antiseptics in Wound Management and the Factors that Can Affect Wound Healing M Syukri S1, Rosnani H1, Satiapoorany S2, Intan Nureslyn S3

1Pharmacy Department, Faculty of Allied Health Sciences, 2School of Nursing, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 3Department of Pharmacy, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur A prospective study was conducted at the surgical and orthopaedic clinics and wards in Hospital Universiti Kebangsaan Malaysia (HUKM) to evaluate the rational use of antiseptics in wound management and the factors that can affect the healing process. This study was carried out over a period of four months. A total of 106 patients were recruited; 52 orthopaedic cases and 54 surgical cases. Patients were randomly selected during their dressing sessions. Two evaluation forms were used, one to assess the type of wounds and antiseptics used, and the other one for obtaining patient information, diagnosis and factors that affect the healing process. Vital information was gathered through observation, interview and through the patient’s ticket. The types of wounds investigated were surgical wounds, leg ulcers, pressure sores and others. Results of the study showed that Povidone Iodine 10% was the most commonly used antiseptic in both surgical and orthopaedic cases (62% and 53% respectively) followed by Eusol, Acriflavine 0.1% and Hydrogen Peroxide. The factors that affect wound healing in the patients under study were smoking, diet, other infections and underlying diseases. Diabetes mellitus was found to be the major factor that influenced wound healing among the study patients. It was observed that the choice of antiseptic was based on nursing experience and not on evidence-based practice. The use of antiseptics in wound management did not follow any guidelines or protocols. In wound management, essential aspects that should be taken into account are proper assessment of the patient, appropriate treatment and consideration of all the factors that can affect the healing process. Patient education is another important aspect that should be addressed to enhance compliance and a wound management policy should be introduced to help provide guidelines to increase quality care and effectiveness of therapy. Poster presentation 13

Factors Affecting Mother’s Choice of Infant Supplementation in Children Aged Five Years and Below Noraiza Maria M H1, Faizah Safina B1, Adlina S2, S Hj. Hussain1

1Department of Pharmacy, 2Department of Social and Practice Medicine, University Malaya Medical Centre, Kuala Lumpur Infant supplementation means giving something in addition to the diet an infant should normally consume. An ideal diet for infants is mother’s breast milk. Giving formula milk means that the mother is supplementing the child with other milk when the natural source is available. Health supplements include vitamins, minerals, tonics and other products that are not considered as drugs. Children aged five years and below were included in this study because during this period, development of body tissues, organs and physiological systems occur most rapidly. This study was designed to investigate factors influencing mothers when choosing supplements, including infant formula milk, and the extent of health supplement

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utilization among children. This study collected data on the socio-economic status of the mother, infant supplementation (intake of infant formula milk, intake of health supplements) and others, through a questionnaire-type survey. This study showed that almost all mothers knew that breastfeeding is the best milk for infants but under certain circumstances, mothers opt for formula milk. Almost all mothers who gave health supplements to their children believed that health supplements provide energy. This concept is misleading. Pharmacists should play an active role in advising mothers for the rational use of health supplements in children. Poster presentation 14

Oral Contraceptives: How Much Do the Users Know? A L Lay , S S Chua , J Amir Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur Oral contraceptives (OCs) are considered highly effective in preventing pregnancy but unplanned pregnancies may still occur. This could be partly due to the users’ failure to follow the instructions correctly or due to ineffective counselling by health care providers. Therefore, this study was conducted to assess OC users’ knowledge and problems associated with the usage of OCs. The survey was conducted in 12 shopping malls around the Klang Valley. Data was collected through personal interview using a structured questionnaire. Among the 504 respondents in the study, 80% of them asserted that they were using some form of contraception. The most common method used was the natural method (44%) while only 15% were using OCs. Majority of the OC users did not have adequate knowledge about their OCs. Problems associated with the usage of OCs included poor knowledge on appropriate measures to be taken when the respondent missed her pills and the appropriate time to start the next cycle of OCs. Most of the respondents obtained their OCs from doctors or pharmacists. Only 10.8% of those who had purchased their OCs from pharmacists received adequate advice from the pharmacists. The results of the present study indicate that better patient education and counselling are required for OC users and that pharmacists should play a more active role in providing such services. Poster presentation 15

Flora Used by Local Chinese and Indian Traditional Medicine Practitioners in Treating Heart Diseases S M Long, S F Yew Pharmacy Department, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur Traditional medicine practitioners are vital sources in aiding the discovery of drugs derived from plants. Therefore, interviews were conducted with four Chinese and Indian traditional medicine practitioners with the aim of identifying the local flora used traditionally in treating heart diseases. This study also involved a literature search for scientific evidence supporting the rationale for their use. Questions asked in the interview included the practitioners’ definitions of various heart diseases, name of plant, part used, source, dosage, rationale of use and preparation method. The results revealed 10 types of local flora used in treating heart diseases. An additional 20 foreign species were also identified. The local species included Allium cepa, Allium sativum, Cassia tora, Datura metel, Eclipta prostrata, Myristica fragans, Ocimum sanctum, Terminalia chebula, Tinospora cordifolia and Zingiber officinale. However, only seven out of ten species above had some scientific basis supporting their use in heart disease. They were A. cepa, A. sativum, M. fragans, O. sanctum, T. chebula, T. cordifolia and Z. officinale. Among these species, M. fragans, O. sanctum, T. chebula and T. cordifolia may be potentially useful in treating congestive heart failure. In addition, there are possible beneficial effects for the use of A. cepa, A. sativum, M. fragans, O. sanctum, T. cordifolia and Z. officinale in angina. Besides angina, A. sativum and T. cordifolia may also play a

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therapeutic role in treating arrhythmia. In conclusion, some of the local species identified above may have a scientific basis in the treatment of heart diseases. Poster presentation 16

Effects of Terminalia chebula on the Isolated Perfused Rat Heart S M Long, S F Yew Pharmacy Department, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur Terminalia chebula (‘manja lawai’) is traditionally used for treating heart failure. Since evidence for its efficacy is lacking, we tested the T. chebula water extract for effects on rat hearts. The water extract was prepared by boiling the powdered husk (1.97g) of the fruit with 20ml distilled water for 5 minutes and obtaining the filtrate. Hearts from 270-320g male Sprague-Dawley rats (n=4) were perfused with Krebs-Henseleit solution, 10ml/min, 37°C, by the Langendorff method. Bolus doses of between 0.01 to 0.5ml extract, saline (negative control) and noradrenaline 100nmol (positive control) were injected into the coronary perfusate and effects on coronary perfusion pressure (CPP, measure of coronary tone), developed tension (measure of cardiac contractility) and heart rate observed. The results revealed that the T. chebula extract decreased CPP by up to 16.3±4.4mmHg (mean±S.E.M) from 91.3±21.8mmHg. However, higher doses (>0.1ml) increased CPP. The extract also dose-dependently reduced heart rate by up to 56±6 beats/min from 254±17 beats/min. Developed tension decreased by up to 57.7±8.1% in the first phase while it increased by up to 23±9.5% in the second phase. The cardiac contractility increase was more pronounced because the duration of the second phase was longer than that of the first phase. All effects, especially at the higher doses, were significantly different from the negative control (p<0.05, paired T-test). In conclusion, the water extract of T. chebula caused coronary vasodilation, reduced heart rate and increased cardiac contractility. These effects may be beneficial in the treatment of heart failure. Poster presentation 17

The Influence of Micellar Solubilisation on the Phototoxic Action of Bergamot Oil on Guinea Pig Skin H Marchaban Faculty of Pharmacy, Gadjah Mada University, Jogjakarta, Indonesia Bergamote oil contains bergaptene (8-metoxypsoralene). This oil is frequently used as raw material to formulate some cosmetic dosage forms. It is already well known that bergaptene can promote berloc dermatitis (pigmentation of the skin due to the phototoxic action) after being used topically and after being exposed to light. The aim of the study was to reduce the phototoxic action of bergamote oil by formulating it in different dosage forms. The influence of the micellar solubilisation to the phototoxic action of the bergamote oil on guinea pig skin was studied. The bergaptene content of bergamote oil was analysed by the HPLC method using Lichrosorb SI 60, diameter of 5 µm as stationary phase and hexane-ethyl acetate (9:1 v/v) as mobile phase. The bergamote oil was then used to formulate the different dosage forms: alcoholic solution, emulsion and micellar solubilisation. All formulas consist of 2 percent bergamote oil (38 ppm of bergaptene). The phototoxic action of the three different dosage forms were observed by applying them onto the skin of the back-part of Hartley guinea pigs and then irradiating them with UV-B light of different doses: 0.5, 1 and 1.5 MED (minimal erytheme dose). The erytheme intensities were observed after 24 and 48 hours. The results indicated that the lowest erytheme intensity was shown by the micellar solubilisation form and this was followed by the alcoholic solution and the emulsion forms. The conclusion of the study is that the solubilised form of bergamot oil shows reduced phototoxic action.

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Poster presentation 18

Hematoporphyrin (HP) as an Alternative Photosensitizer in Photodynamic Therapy (PDT) of Malignancies : The Study of Distribution of HP in Mice Low K S1, Chan H K2, Jayalakshimi P3, Yip C H, Sinniah A3

1University of Malaya 2University of Malaya/Sedaya College 3University of Malaya Medical Centre Kuala Lumpur This study is part of an assessment of Hp as an alternative photosensitiser for the more effective PDT of malignancies with negligible side effects of skin photosensitivity. Quantitative information on the uptake, distribution and retention properties of Hp as well as its derivatives (HpD) were extracted using a five-compartmental model. The various rate constants between the compartments were obtained. The work described the serum, tumour and various normal tissue distribution of Hp and HpD in mice bearing EMT-6 tumours. It was shown that Hp had a four times shorter half-life in serum than HpD. With the rapid clearance of Hp, it is postulated that an effective tumour response to PDT with negligible side effect can be obtained using Hp in conjunction with the alternative protocol of light irradiation immediately after the administration of Hp. Poster presentation 19

Teaching Pharmacy by Using the Internet Instead of the White Board S W Yeong, D Quah, Brian J Chapman Sedaya College, Kuala Lumpur We are involved in a programme to introduce (almost) paperless teaching of Pharmacy. Lecturers are assisted in putting their lecture notes (and assignments, tutorials, laboratory notes) onto a local area network and website, and students download the notes into their own computers. As the topic is discussed in the classroom, a student can type personal notes into his/her computer. At present, however, few pharmacy students own computers, but have computer/internet access, so they bring printed copies to annotate during the lecture. They can later add their notes into their copy of the computer file. Students like this method of delivery. This system can be emulated on a free-standing computer, so conference delegates will be able to test the student experience; check whether/how the content and presentation of pharmacy teaching has changed, and evaluate computer assisted teaching. The “Student Forum”: lecturers propose a discussion topic or problem for students to comment on. The students add their views onto the Forum notice board but cannot alter existing information. The lecturer(s) update and summarize the topic. The aim is to encourage students to talk and write about science/pharmacy. Examples will be shown at the meeting.