hbuk buletin farmasi vol. 1 2018 - ministry of health
TRANSCRIPT
●
•
•
•
•
•
•
•
•
•
•
•
& ( )
A common viral illness that usually affects infants and children younger than 5 years old. It can sometimes occur in older children and adults. It is caused by enterovirus named coxsackievirus a16 & enterovirus 71.
From 1ST Jan until 23rd July 2018 , 35886 cases of Hand,
Foot & Mouth disease HFMD reported nationwide
Enterovirus 71 which causes hand-foot-and-mouth
disease
• Hand Foot & Mouth Disease can be transmitted through:
Saliva Nasal mucus Blister fluid Feces of an infected person Close contact eg. Hugging
or touching surfaces that are contaminated
• Infected persons are most contagious during the first week of the illness, BUT the period of communicability can last for several weeks
• HFMD is not transmitted to or from pets or other animals.
May involve ALL of the following signs and symptoms OR SOME of them. They include:
Most common complication is dehydration. If severe enough, intravenous (IV) fluids may be needed.
It can cause sores in the mouth and throat, making swallowing painful and difficult.
Hand-foot-and-mouth disease (HFMD) is a minor illness causing only a few days of fever and relatively mild signs and symptoms. However, it can also cause complications such as:
Viral meningitis. This is a rare infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord. Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. However, it rarely occurs.
Currently there is NO vaccine to protect against the viruses that cause HFMD & there is NO any specific treatment for this disease. However, precautionary measures can definitely lower the risk of being infected. Some of the things that can be done to relieve symptoms: -Take over the counter medications to relieve pain and fever -Use mouthwashes or sprays that numb mouth pain
Ways To Prevent HFMD
Adopted from:www.mypositiveparenting.org
&
-NST June 7,2017
42.5 32.6
31.8 28.2
27.6
0 10 20 30 40 50
Malaysia
Singapore
Philippines
Prevalence of overweight (BMI≥25) among adults, ages 18+, 2016
Percentage of Overweight (%)
Classification BMI
Underweight < 18.50
Normal range 18.50 – 24.99
Overweight ≥25.00
Obese ≥30.00
Source: WHO 2016 Available at http://apps.who.int/bmi/index.jsp?introPage=intro_3.html
)Height(mx Height(m)
(kg)Weight
BMI is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults.
BMI=
/UNHEALTHY LIFESTYLE HABITS
lack of exercise (sedentary lifestyle), increased intake of fast
food/calorie-rich, nutrient poor food
AGE
high incidence during childhood & for adult, the risk increases with
age until 60-65 years old
FAMILY HISTORY & GENETICS
Obesity risk is 2-8 times higher with family history of obesity
RACE & ETHNICITY
Studies shows in Malaysia, rates were higher in Indian & Malay
women, while for men; Chinese men have higher incidence of obesity
Source: WHO Global Health Observatory (GHO) data Available at http://www.who.int/gho/ncd/risk_factors/overweight/en/
UNHEALTHY ENVIRONMENT
Increased usage of vehicle rather
than walking/cycling
SEX
Greater in female than male.
However, women tends to store less
unhealthy fat in the abdomen than men
SOME MEDICAL CONDITIONS
endocrine disorders :
Hypothyroidism, Cushing syndrome & tumors (eg.
craneopharingioma – tumor that develop
near parts of the brain that control hunger)
MEDICATIONS
Some medications from these category can cause weight gain,
leading to overweight & obesity:
-Antipsychotics: Atypical antipyschotics
-Antidepressants: eg. amitriptyline, imipramine , phenelzine,
paroxetine & mirtazapine
- antiepileptics: sodium valproate, carbamazepine, gabapentin
-Antihyperglycemics: Insulin, meglitinides, sulfonylureas &
thiazolidinediones
&
(increase in BP, causing stroke)
(Fat cells may release hormone that affect cell growth, leading
to cancer eg. breast, colon, rectum, endometrial,
gallbladder & kidney cancer)
(studies shows 87% DM type 2 patients are obese &
overweight)
(Extra fats build up at liver causing liver injury )
(Increased in fat stored around neck,
making airway smaller, causing difficulty in breathing)
(since heart need to pump harder to supply blood to all cells)
(Increase in BP, cholesterol & sugar, increases risk for heart diseases)
(Increase in blood pressure & blood sugar level, causing risk for kidney disease)
(Pain & stiffness of joint, due to extra pressure on joint/cartilage)
Drug therapy is considered along with diet, exercise and behaviour modification after a careful evaluation of risks and benefits. Anti-obesity drugs should be used only under careful medical supervision and should be part of a long-term management strategy. A patient should only be started with drug therapy if they have tried diet and exercise modification for 6 months and have: 1. BMI between 25 and 27.5 kg/m2, and at least two of these
co-morbidities such as type 2 diabetes mellitus, coronary heart disease, cerebrovascular disease, hypertension, hyperlipidemia or waist circumference more than 90 cm for men whereas, more than 80 cm for women.
2. BMI ≥ 27.5 kg/m2. 3. Symptomatic complications of obesity such as severe
osteoarthritis, obstructive sleep apnea, reflux oesophagitis, and the compartment syndrome.
Anti-obesity drugs can be divided into two groups which are those acting on the gastrointestinal system to reduce fat absorption such as orlistat and those acting on the central nervous system (CNS) to suppress appetite such as phentermine and sibutramine.
Achieve more than 5% weight
loss by 3 to 6 months without
any weight regain
Orlistat Available brands in Malaysia : Xenical, Cuvarlix Both are available in capsule form
Sibutramine Registration of products
containing sibutramine has BEEN SUSPENDED Drug Control Authority (DCA) on October 2010 due to safety concern.
Sibutramine Cardiovascular
Outcomes (SCOUT) study conducted by Abbott Laboratories on their product Reductil®, confirmed an increase in cardiovascular risk in obese and overweight patients taking sibutramine .
Phentermine Available brands: Adipex Retard, Duromine Phentermine is a group B poison & it is strictly
controlled by doctor’s prescription
Surgery is indicated in patients with severe obesity (BMI ≥ 40 kg/m2 or between 35 and 40, with major weight related comorbidities), when other measures have failed, and who are suffering from serious complications of obesity. Surgical therapy can result in sustained weight loss from 50 kg to as much as 100 kg over a period of 6 months to 1 year. The aim of surgery is to alter the gastrointestinal tract to reduce net food intake. It may cause nutrient deficiencies and gastrointestinal symptoms such as “dumping syndrome” or gallstones. Surgical interventions commonly used in Malaysia include gastric partitioning (Vertical gastric banding) and gastric bypass (Roux-en-Y).
Vertical gastric
banding
Gastric bypass
Counselling for lifestyle
changes
Contingency management
Cognitive & behavioural
strategies
Weight loss support
groups
Stress management
Stimulus control (eg. avoid
snacking when watching
TV)
Portion control Self-monitoring
Physical activity
should be an
INTEGRAL part
of weight loss
therapy and
weight
maintenance
because it
contributes to
weight loss,
decreases
abdominal fat
and increases
cardio-respiratory
fitness.
45–60 min/day
Low Calorie
Diet
Lower-Fat Diet
Very Low-Calorie Diet
Provides a calorie deficit of 500 to 1000 kcal/d from maintenance requirement & is important for weight loss and prevention of weight regain
Lowering fatty food intake produce weight loss primarily by decreasing caloric intake
Intake of 200 to 800 kcal/day indicated for moderately to severely obese patients & results in most rapid weight loss
Dietary education
Limit fats and oils during cooking
Evaluate energy value & nutrition labels
Reduce of portion sizes
Reduce intake of both high-fat & high-carbohydrate food
Maintain adequate water intake
Limit alcohol consumption
GOAL
NAMA GENERIK JENAMA LAMA JENAMA BARU
AMLODIPINE 5MG Tablet AMCARDIA
(Unique Pharmaceutical Laboratories, India)
NULOP 5 (Sai Mirra Innopharm Pvt. Ltd,
india)
JENAMA LAMA JENAMA BARU
JENAMA LAMA JENAMA BARU
NAMA GENERIK JENAMA LAMA JENAMA BARU
METFORMIN 500mg tablet GLUMET DC
(Pharmaniaga Manufacturing Berhad)
CCM METFORMIN (Duopharma (M) Sdn. Bhd)
JENAMA BARU
NAMA GENERIK JENAMA LAMA JENAMA BARU
DONEPEZIL 10MG tablet DEMEALRAN
(Sun Pharmaceuticals Ind. Ltd)
TORPEZIL (Torrent Pharma)
Sila isi borang aduan produk (BORANG BPFK 418.4)
sekiranya terdapat sebarang masalah selepas ubat
ditukar dari jenama lama ke jenama yang baru
Sila hubungi Seksyen
Farmasi Maklumat Ubat (DIS) untuk maklumat lanjut
di talian sambungan 6083 atau 5609.
JENAMA LAMA
NO NAMA UBAT CATATAN
1. Dothiepin HCl 25 mg Capsule/Tablet Product discontinued (Mesy JKUT 1/2018)
2. Ketoconazole 200 mg Tablet
Product discontinued. Alternative Griseofulvin 125mg Tab (ultramicrosize) (Mesy JKUT 1/2018)
3. Glibenclamide 5 mg Tablet Removed from FUKKM list (Pindaan
FUKKM Bil 1/2018)
NO NAMA UBAT CATATAN
1. Methylphenidate HCl 18 mg & 36 mg Extended-release Tablet (Concerta®)
Refer to 16.04.02 (Mesy JKUT Bil 1/2018)
2. Atomoxetine HCl 40mg Capsule (Strattera®)
Refer to 12.05.04 (Mesy JKUT Bil 1/2018)
3. Permethrin 1% w/v Lotion Refer to 06.07.07 (Mesy JKUT Bil 1/2018)
Formulari Ubat HBUK boleh dimuat turun dari laman web rasmi hospital
http://hbuk.moh.gov.my
NO NAMA UBAT CATATAN
1. Bromhexine HCl 8mg Tablet Change from B to C (Pindaan FUKKM Bil 1/2018)
2. Hyoscine N-Butylbromide 10 mg Tablet
3. Mefenamic Acid 250 mg Capsule
4. Miconazole 2% Cream
Kad Informasi Ubat Allopurinol boleh didapati di HBUK untuk
pesakit yang telah diberikan ubat Allopurinol. Kad ini mengandungi informasi tentang indikasi, risiko kesan sampingan ubat Allopurinol
& tindakan yang perlu diambil sekiranya berlaku kesan sampingan seperti yang disenaraikan dalam kad
Allopurinol tersebut. Kad Allopurinol ini diberikan kepada pesakit di bawah Jabatan Pesakit Luar yang pertama kali dipreskrib
dengan ubat Allopurinol.
Kad Informasi ‘Valproate & Pregnancy’ boleh didapati di HBUK. Kad ini diberikan khas kepada pesakit wanita yang telah diberikan ubat sodium
valproate (Epilim). Kad ini mengandungi indikasi Epilim,
kesan sampingan Epilim kepada wanita yang mengandung &
berpotensi mengandung. Kad ini juga mengandungi nasihat
umum kepada wanita yang sedang menggunakan ubat
Epilim. Kad ini diberikan kepada wanita yang berpotensi
mengandung & dipreskrib dengan ubat Epilim buat
pertama kali.
Valproate is an effective medicine to treat generalized or partial epilepsy and bipolar disorder. It is know that valproate is associated with the risk of abnormal pregnancy outcomes.
DEVELOPMENT DISORDER Exposure to valproate in utero can have adverse effects on mental and physical development of the exposed children. The risk seems to be dose dependent but the threshold dose below which no risk exists. Studies in preschool children exposed in utero to valproate show 20-30% experience delays in their early development such as talking, walking later, low intellectual abilities, poor language skill and memory problems.
CONGENITAL MALFORMATIONS Data derived from a meta-analysis has shown that 10.73% of children od epileptic women exposed to valproate monotherapy during pregnancy suffer from congenital malformations (95%, Cl: 8.16-13.29), which represents a greater risk of major malformations than for the general population whom the risk is equal to 2-3%. The risk is greater at higher dose above 1g daily.
Valproate can be harmful to unborn
children when taken by women
during pregnancy.
Valproate can cause serious birth defects,
which effects the child develops as
grow.
Birth defects include spina
bifida; facial & skull
malformation; heart; kidney;
limbs.
30-40% of preschool (3yrs-5yrs) children
whose mothers took valproate during
pregnancy may have problems with early
childhood development.
Sodium valproate should not be used in female children, female adolescents, woman of childbearing potential and pregnant women.
Sodium valproate should not be used in female children, female adolescents, woman of childbearing potential and pregnant women.
Sodium valproate should be prescribed as monotherapy and at lowest effective dose. Prolonged release formulation is preferred to avoid high plasma concentrations. The daily
dose should be divided into at least 2 single dose.
Women of childbearing potential must use effective contraception during treatment and be informed of the risk associated with the use of sodium valproate during pregnancy.
Patient is advise to contact healthcare professional immediately if they become pregnant or think they might be pregnant.