1

VOL 28: MAC — ARPRIL 2015

ADVERSE DRUG REACTION...

...MEDICATION ERROR

CRYSTAL HEALING...

...ATOSIBAN

2

FOCUS ADVERSE DRUG REACTION: SJS & TENS

TOPIC OF CURRENT INTEREST HOW TO AVOID MEDICATION ERROR

COMPLEMENTARY MEDICINES CRYSTAL HEALING

DRUG COMPARISON AMINOVEN INFANT 10% VS VAMINOLACT 6.5%

DRUG PROFILE ATOSIBAN

COUNSELLING THALASSEMIA

DRUG SAFETY UBI GADONG, HANS BEAUTY & MAAJUN

PHARMACY JOKES

ACTIVITIES KURSUS KOMUNIKASI BERKESAN

3-4

5-6

7-8

9-10

11-12

13-14

15-16

17

18

EDITORIAL BOARD:

PN.HAZLINDA ABU HASSAN

CIK TAY EEK POEI

PN. SYAMSIAH BT. SHARIFF

PN. JULIA BT. SHAMSUDIN

EDITOR:

CIK RAIBAH BT MD

JAZAM

CONTRIBUTORS:

CIK MASTURA BT ABU

BAKAR

CIK NUR SYAFINAZ BT

ASMUNI

ADVISOR:

PN. SAIDATUL RAIHAN

BT. IBRAHIM

3

By: Mastura Abu Bakar

Stevens Johnson Syndrome or Toxic Epidermal Necrolysis is a severe allergic drug reaction.

- Painful blistering of the skin and mucous membrane involve-

ment.

– In many cases preceded with flu like symptoms and high fever.

– As it evolves the skin literally sloughs off.

– Ocular involvement includes severe conjunctivitis, iritis, palpe-

bral edema, conjunctival and corneal blisters and erosions, and cor-

neal perforation.

Almost any DRUG can

cause SJS/TEN,

including over the

counter drugs. SJS &

TEN do not

discriminate against

anyone! Everyone

should be aware of

Stevens Johnson syndrome

A D V E R S E D R U G R E A C T I O N

Adult Female Patient SJS/TEN

12 month old female 26

Days into SJS/TEN

Stevens Johnson Syndrome Foundation

Drugs most commonly associated with SJS and TEN

Approximately 75% of SJS/TEN are caused by medications, and 25% by

infections and 'other' causes.

Allopurinol

Carbamazepine

Sulfonamides:

-Trimethoprim-sulfamethoxazole -Sulfadiazine -Sulfasalazine Antiviral agents: -Nevirapine -Abacavir Anticonvulsants: -Phenobarbital -Phenytoin -Valproic acid -Lamotrigine

4

Treatment:

First and foremost, affected persons must stop taking

the offending drug immediately to prevent complica-

tions. Treatment for SJS is good supportive care. Be-

cause patients literally burn from the inside out, burn,

infectious disease, ophthalmology and dermatology

teams are recommended. IV fluids and high calorie for-

mulas are given to promote healing. Antibiotics are giv-

en when necessary to prevent secondary infections

such as sepsis. Pain medications such as morphine are

administered to make the patient as comfortable as

possible. Most SJS patient can be managed in medical

ICU however, TENS patients should be treated in burn

unit. However, amniotic membrane grafts can help pre-

vent permanent blindness if used in the first 3 to 5 days

of diagnosis. Immunoglobulin (IVIG) treatment has been

beneficial in intravenous immunoglobulin treating

SJS/TEN.

SJS: WHAT IS IT?

Stevens– Johnson Syndrome (SJS) and toxic Epider-

mal Necrolysis Syndrome (TEN) another form of SJS

are severe adverse reactions to medication and in

some instances mycoplasma pneumonia. Adverse

drug reactions account for approximately 770,000

hospitalizations each year that result in injury or

death making it the fourth leading cause of death

in the United States.

SJS/TEN is one of the most debilitating ADR’s recog-

nized. It was first discovered in 1922 by pediatrics

A.M Stevens and F.C. Johnson after diagnosing a

child with severe ocular and oral involvement due

to a drug reaction.

Risks: SJS and TENS are life–

threatening reactions. If left un-

treated, they can result in death.

Complications can include perma-

nent blindness dry-eye syndrome,

photophobia, lung damage, chronic

obstructive, pulmonary disease

(COPD), asthma, permanent loss of

nail beds, hair loss (alopecia) scar-

ring of the esophagus, and other

mucous membranes, arthritis, and

chronic fatigue syndrome. These

are just some of the side effect that

have been reported.

WHO CAN GET SJS OR TENS?

Although SJS afflicts people

of all ages many of its victims

are children. More female

cases have been reported

than male, However it does

not discriminate against any-

one.

STEVENS–JOHNSON SYNDROME

References: 1) http://www.skinassn.org/what-is-stevens-johnson-syndrome.html

2)http://emedicine.medscape.com/article/1197450-overview

5

The goal of drug therapy is the achievement of defined thera-peutic outcomes that improve a patient’s quality of life while minimizing patient risk. There are inherent risks, both known and unknown, associated with the therapeutic use of drugs (prescription and non-prescription) and drug administration de-vices. The incidents or hazards that result from such risk have been defined as drug misadventuring, which includes both ad-verse drug reactions (ADRs) and medication errors. Episodes in drug misadventuring that should be preventable through effec-tive systems controls involving pharmacists, physicians and other prescribers, nurses, risk management personnel, legal counsel, administrators, patients, and others in the organiza-tional setting, as well as regulatory agencies and the pharma-ceutical industry. Through a systems-oriented approach, the pharmacist should lead collaborative, multidisciplinary efforts to prevent, detect, and resolve drug-related problems that can result in patient harm. AHSP Guideline (Medication Misadven-

tures Guidelines)

By: Nur Syafinaz Asmuni

T o p i c o f C u r r e n t I n t e r e s t

6

Avoid

Abbreviation

Always check pa-tient allergies be-fore administering medication. Clarify with pharmacist or

physicians for

Pay close attention to

medications that

‘LOOK ALIKE,

Always double

check

‘HIGH ALERT’

medi- cation

7

CRYSTAL HEALING

C o m p l e m e n t a r y M e d i c i n e s

HOW DO CRYSTALS WORK?

Each variety of crystal has a unique

internal structure, which causes it to

resonate at a certain frequency. It is

this resonance that is said to give

crystals their healing abilities. Apply-

ing this resonance in a coherent way

can help to restore stability and bal-

ance to the bodies energy systems,

stimulating the body's natural heal-

ing mechanisms.

CRYSTALS FOR HEALING

Crystals can be placed on specif-

ic points of the body to bring re-

lief or can be swept over the body

using, for example, a crystal pen-

dulum healing technique or

a crystal wand healing technique.

Carrying or wearing a crystal that

resonates with a physical condi-

tion can also gently ameliorate

the condition. Specific colour

crystals can be used for chakra

healing. They can be placed on

the body using the Seven Colour

Chakra Layout.

TREATS

HEADACHES

DIFFICULTY

SLEEPING

LACK OF

ENERGY

LACK OF LIBIDO

DIFFICULTY

STUDYING CONCENTRATION

PROMOTE PEACE

OF THE MIND

By: Raibah Md Jazam

BENEFITS OF EACH METHOD?

Pendulums are primarily used for dowsing. Dows-

ing's primary function is to find an an-

swer/solution to a question/problem.

Massage is beneficial to us in a variety of ways. It

can improve blood circulation, calm the nervous

system, improve muscle tone, stimulate skin func-

tion, ease muscular and joint aches and pains

and most of all it 'feels' wonderful!

8

CR

YSTA

L

PE

ND

ULU

MS

METHODS.. To remove energy imbalances from the body's finer energy systems.

A clear quartz or amethyst pendulum will work as an all-purpose healer. Other crystal pendu-

lums will have focused balancing actions. Have the patient lie down and position yourself comfort-

ably by the side of them. Hold the pendulum lightly and firmly between the thumb and forefinger.

Allow the wrist to relax and hold the arm and body in a comfortable position.

Suspend the pendulum a few centimetres above the body just below the feet in line with the cen-

tral axis of the body. Start the pendulum swinging in a line to and fro. This is known as the neu-

tral swing. Move the swinging pendulum slowly up the body along the centre line of the body, to-

wards the head.

Wherever the pendulum moves away from neutral simply stay at that point until the neutral swing

returns. When you reach a point above the head move back to the feet and repeat along each side

of the body.

The rounded base of a crystal wand allows it to be used directly on the skin without scratching

making crystal wands a good tool for massage.

Lightly and gently moving the wand in small circles over a tense area, particularly on the head,

hands and feet can release tension in that area.Wands can also be used to massage the subtle

body energies and release unwanted tensions.

To do this have the patient lie down and sit comfortably by their side. Begin at the feet with the

wand held point outwards and make small anticlockwise circling movements. Slowly work up the

body. You will probably be aware of areas that feel different where you instinctively feel the need

for the wand to move in a different way or where the wand feels heavy and 'sticky'. If you do feel

this need to change the wand's movement, do so and then return to the normal movement.

When you reach the top of the head reverse the wand so that the point faces inwards. Move down

the body from the head to the feet, once again moving the wand in small circles but this time

clockwise. This recharges the body's energy fields. Once again you may feel the need to change

the wand's movement over certain areas, do so and then return to moving the wand in small

To help balance the whole chakra system, a stone of the appropriate colour is placed on each area for a few minutes. This will give each chakra a boost of its own vibration without altering the overall harmony of the system.

Violet crystal or clear quartz crystal here will integrate and balance all as-pects of self - physical, mental, emotional and spiritual.

Indigo or dark blue crystal here will promote intuitive skills and memory.

Light blue crystal here will bring peacefulness, ease communication difficul-ties and to promote self-expression.

Green crystal here will promote a sense of calm, create a sense of direction in life and to balance your relationship with others.

Yellow crystal here will reduce anxiety, clear your thoughts and improve con-fidence.

Orange coloured crystal here will balance creativity and release stress.

Red or black crystal on the top of each leg will balance physical energy, moti-vation and practicality and promote a sense of reality.

Reference: 1) http://www.crystalwellbeing.co.uk/introcrystalhealing.php

9

Glycine, L-Alanine; L-Arginine; L-Cysteine, L-Histidine, L-Isoleucine, L-Leucine, L-Lysine, L-Lysine Monoacetate, L-Malic Acid, L-Methionine, L-Phenylalanine, L-Proline, L-Serine, L-Threonine, L-Tryptophan, L-Tyrosine, L-Valine, N-Acetyl-L-Cysteine, Taurine.

Studies with this product have not been carried out on pregnant women. However, the clinical experience with similar parenteral amino acid solutions has not shown evi-dence of risk in pregnant and breastfeeding women.

COMPOSITION OF AMINO ACID

Alanine, Arginine, Aspar-tic acid, Cysteine, Glu-tamic acid, Glycine, Histi-dine, Isoleucine, Leucine, Lysine, Methionine, Phenyalanine, Proline, Serine, Taurine, Threo-nine, Tryptophan, Tyro-sine, Valine.

In extremely sick, prema-ture and small babies requiring neonatal inten-sive care, liver function is likely to be immature and/or disturbed. Amino acids which, to a large extent, are metabolised by the liver may there-fore accumulate in plas-ma. In this clinical condi-tion, monitoring of ami-no acid concentration during therapy is advisa-ble.

D r u g C o m p a r i s o n

For supply of amino acids as part of parenteral nutrition regimen.

INDICATION It provides nourishment

into your child’s blood stream when they cannot eat normally. It provides amino acids, which the body will use to make pro-teins (to build and repair muscles, organs, and other body structures)

By: Nur Syafinaz Asmuni

Journal of Pediatric Gastroenterology and Nutrition, November 2005 ESPGHAN.

10

I N D I C A T I O N

Atosiban is indicated to delay imminent pre-term birth in

pregnant adult women with:

regular uterine contractions of at least 30 seconds

duration at a rate of ≥ 4 per 30 minutes

a cervical dilation of 1 to 3 cm (0-3 for nulliparas)

and effacement of ≥ 50%

a gestational age from 24 until 33 completed weeks

a normal foetal heart rate

D O S E

Tractocile is administered intravenously in three succes-

sive stages: an initial bolus dose (6.75 mg), performed

with Tractocile 6.75 mg/0.9 ml solution for injection,

immediately followed by a continuous high dose infusion

(loading infusion 300 micrograms/min) of Tractocile

37.5 mg/5 ml concentrate for solution for infusion during

three hours, followed by a lower dose of Tractocile 37.5

mg/5 ml concentrate for solution for infusion(subsequent

infusion 100 micrograms/min) up to 45 hours. The dura-

tion of the treatment should not exceed 48 hours.

M E C H A N I S M

O F

A C T I O N

Atosiban is a nonapeptide, desamino-OT analogue, and a

competitive vasopressin/oxytocin receptor antagonist

(VOTra). Atosiban inhibits the OT-mediated release of

IP3 from the myometrial cell membrane. As a result, there

is reduced release of intracellular, stored calcium from the

sacroplasmic reticulum of myometrial cells, and reduced

influx of Ca2+ from the extracellular space through volt-

age gated channels.

P H A R M A C 0 -

K I N E T I C

Cpss: mean 442 ± 73ng/ml, range 298 to 533ng/ml

Time to Cpss: 1 hour

Half-life: 0.21 ± 0.01 hour

Terminal half-life: 1.7 ± 0.3 hour

Clearance: 41.8 ± 8.2 L/h

Volume of distribution: 18.3 ± 6.8 L

D r u g P r o f i l e

B y : R a i b a h M d J a z a m

11

P H A R M A C O—

D Y N A M I C

In rats and guinea pigs, atosiban was shown to bind to

oxytocin receptors, to decrease the frequency of con-

tractions and the tone of the uterine musculature, re-

sulting in a suppression of uterine contractions. Atosi-

ban was also shown to bind to the vasopressin receptor,

thus inhibiting the effect of vasopressin. In human pre-

term labour, atosiban at the recommended dosage an-

tagonises uterine contractions and induces uterine qui-

escence. The onset of uterus relaxation following atosi-

ban is rapid, uterine contractions being significantly

reduced within 10 minutes to achieve stable uterine

C O S T

TRACTOCILE 7.5MG/ML SOLUTION FOR

INJECTION

RM: 14.79/vial of 0.9ml

TRACTOCILE 7.5MG/ML CONCENTRATE FOR

SOLUTION FOR INFUSION

RM: 59.16/vial of 5ml

A L T E R N A T I V E

Beta-sympatomimetics:

Fenoterol

Hexoprenalin

References:

1. Electronic Medicines Compendium. England. Jun 2013 https://www.medicines.org.uk/emc/medicine/4297

2. Sanu O, Lamont RF (2010). "Critical appraisal and clinical utility of atosiban in the management of preterm labor". Ther Clin Risk Manag. 6: 191–199. doi:10.2147/tcrm.s9378. PMID 20463780.

12

HALASSEMIA T By: Nur Syafinaz Asmuni

C O U N S E L L I N G

The thalassemias are a group of autosomal recessive disorders caused by reduction or absent production of one or more of the glo-

bin chains that make up the hemoglobin (Hb) tetramers. According to the type of globin chain involved, two main types, i.e., the α- and β-thalassemias can be distinguished. In addition, complex thalassemi-as resulting from defective production of two to four different globin

chains (δβ-, γδβ-, and εγδβ-thalassemia) are recognized (Weatherall and Clegg 2001).

WHAT IS THALASSEMIA?

The information provided is aimed at giving an in-formation basis on which to make a decision about

reproduction.

Explained on risk for thalassemia based on

genetic family history.

Medical problems may give risk factors in-

clude (family history of other haemoglobin

traits or diseases, hereditary hemochromato-

sis, G6PD deficiency, inherited thrombophil-

ia, cardiovascular disease or its risk factors,

cardiac conduction defects, diabetes, renal

disease, ophthalmologic disorders, hearing

loss, allergies etc.)

Reliable source of emotional or social sup-

port.

Help to convey information about genetic

risk to other patient’s family member.

“Genetic testing” may help to check wheth-

er the sibling could be the suitable bone mar-

row donor and useful for deciding interrup-

tion of pregnancy in case of affected foetus.

13

national pharmaceutical bureau

iss

ue

tod

ay

Illegal Drugs

Side Effects (hydroquinone): -Skin redness - Discomfort

-Skin discoloration -Hypersensitivity

-Blue– black darkening skin -Skin cancer

Side Effects (mercury) -Damage kidney & nervous system

-Skin rashes & irritation

-Interfere with brain development in unborn

children & very young children (through breath-

ing & ingest)

Consumers Cautioned Against Using

Cosmetic Product Containing

Scheduled Poison. Hans Beauty

& Health

14

Iss

ue

Tod

ay

Ubi Gadong

( DIOSCOREA HISPIDA)

ILLEGAL DRUG

MAAJUN TOLAK ANGIN

Warning to public against usage of unregistered product Maajun Tolak Angin

The National Adverse Drug Reaction

Monitoring Centre, National

Pharmaceutical Bureau (NPCB) is

alerting and advising the public

against buying and using unregistered

product labeled as “ Maajun Tolak

Angin”, which is sold as Malay

traditional medicine”.

Adverse Drug Reaction

headache

severe Curshing’s

Syndrome

Ubi gadong also known as Gadong,

Gadog, Gadong Lilin, Gadong

Mabok, Ubi Arak, Ubi Akas, Taring

Pelanduk, Susur Gadang, Gadongan,

Kedut and Ubi Bekoi.

If not processed properly, the rest of the

alkaloid in the Ubi Gadong can cause harm to

humans, such as burning sensation in the

throat, dizziness, difficulty breathing and

can be fatal.

Ubi Gadong contain poison alkaloid;

Dioscorinine

Products contain dexamethasone which is corticosteroid controlled under the Poison Act 1952. This product claims to treat joint pain, bones pain, nerve pain, back pain, aches, heel numbness, cramps,tense nerve and muscle, tiredness, neck fatigue and headache.

15

PHARMACY JOKES

16

KURSUS KOMUNIKASI BERKESAN

ACTIVITIES...

COME &

LEARN!

14 Mac 2015 Auditorium Sri Baiduri, Hospital Melaka