Topic of current

interest:

MERS-COV

Drug comparison:

PEGASYS vs

PEGINTRON

Focus:

Vaccine Immunization

PHARMACY

NEWSLETTER 2015

Jabatan Farmasi dan Bekalan,

Hospital Melaka

Complementary

medicine:

AYURVEDA

VOL 29:

MAY-JUNE 2015

EDITORIAL BOARD:

PN.HAZLINDA ABU HASSAN

CIK TAY EEK POEI

PN. SYAMSIAH BT. SHARIFF

PN. JULIA BT. SHAMSUDIN

EDITOR:

MUHAMMAD

AZIZE

CONTRIBUTORS:

MELISSA JOAN

IZYAN

ADVISOR:

PN. SAIDATUL

RAIHAN BT.

IBRAHIM

FOCUS

VACCINE IMMUNIZATION

TOPIC OF CURRENT INTEREST

MIDDLE–EASTERN RESPIRATORY

SYNDROME CORONAVIRUS

(MERS-COV)

THE USE OF ANTIBIOTIC IN POST

SPLENECTOMY

DRUG COMPARISON

PEGASYS VS PEGINTERFERON

DRUG SAFETY

JINGZHI YINQIAO & DERMACEUTIC

SPOT CREAM

COMPLEMENTARY MEDICINE

AYURVEDA

PHARMACY JOKES

ACTIVITY

KURSUS THERAPEUTIC DRUG MONITORING

3-4 5-6

7-8

9

10-11

12-13

14

15

Vaccination

What is pertussis?

REFERENCES

http://infomed.com.my/vaccination-in-malaysia.

http://emedicine.medscape.com/article/967268-overview

http://www.vaccines.gov/diseases/pertussis/#

Early symptoms

can last for one to

two weeks and

usually include:

Runny nose

Low-grade fever

Mild, occasional cough

Apnea – a pause in breathing (in infants)

Whooping Cough

Symptoms Pertussis most commonly affects infants and

young children and can be fatal, especially in

babies less than 1 year of age.

Prevention through

immunization remains the

best defense in the fight

against pertussis.

Ministry of health of

Malaysia

recommendations for

vaccination are as

follows:

DTaP vaccine:

Recommended at

the ages of 2, 3, 5,

and at 18 months.

Bordetella pertussis

Pertussis

By: Izyan

Global Pertussis Initiative Stresses Vaccination in Pregnancy Troy Brown, RN

May 12, 2015

Medscape Medical News

"A high priority should be given to achieving a complete

cocoon, defined as full immunization of the family, since the

robustness of protection against pertussis is a function of the

number of infant contacts vaccinated," the authors write. "If

a complete cocoon is not possible, then the next priority is

vaccination of both parents, followed by the mother only."

"It is reasonable to assume that pertussis

immunization during pregnancy, which

has been steadily increasing since its

emphasis in California beginning in 2010,

has contributed to the reduction in infant

deaths."

As whooping cough grows, study finds vaccine wanes

Originally published May 3, 2015 at 9:44 pm Updated May 4, 2015 at 1:13 pm

“Despite the waning protection, Acosta and other health

officials said pertussis immunization remains important.

It reduces the severity of illness when people do get sick

and, when given to pregnant women, can induce

immunity in newborns who are most likely to develop

serious complications.”

MIDDLE-EASTERN RESPIRATORY

SYNDROME CORONAVIRUS

(MERS-COV)

MERS-CoV belongs to the coronavirus family. Human

coronaviruses were first classified in the mid 1960s. There are

currently six coronaviruses that can affect humans including

Alpha coronaviruses which are Human coronavirus 229E and

Human coronavirus NL63 (HCoV-NL63, New Haven

coronavirus). Beta coronaviruses would include Human

coronavirus OC43, Human coronavirus HKU1, SARS-CoV and

Middle East respiratory syndrome coronavirus (MERS-CoV).

CAUSES OF MERS-COV

The cause of MERS-CoV is not yet fully understood. Although

not confirmed, the infection could be primarily zoonotic in

nature, with limited human-to-human transmission. It is thought

that mammals play a role in the transmission of the virus - bats

and camels remaining a high contender.

Camels are a probable source of infection transfer to humans,

while bats may be the ultimate reservoir of the virus. The high

infectious dose would require very close contact between an

infected camel and humans for instigation of human MERS-CoV

infection by camels. It has been suggested that the virus could

infect humans by air, via camel milk or meat.

Centre for Disease control and

Prevention (CDC),US reported that the

1st case was in Saudi Arabia on

September 2012

Through retrospective investigations it

was identified,that the first known case

of MERS occurred in Jordan in April

2012.

There is one reported case in Malaysia

in March 2014

References

http://www.medicalnewstoday.com

/articles/262538.php?page=2

http://www.cdc.gov/coronavirus/m

ers/risk.html

http://www.medscape.com/viewarti

cle/838947

•WHO's MERS-CoV Summary and

Literature Update, June 11, 2014

By: Melissa

Image of MERS-CoV

TREATMENT & PREVENTION

According to the US Centers for Disease Control and Prevention (CDC) and WHO (World Health

Organization), there are no specific treatments for patients who become ill with MERS-CoV infection.

Recommended suggestion includes supportive medical care to help relieve the symptoms.

Supportive care means providing treatment to prevent, control or relieve complications and side

effects, as well as attempting to improve the patient's comfort and quality of life.

Travel advice has been provided to reduce the risk of MERS-CoV infection among travelers, which

includes information such as:

There is an increased chance of illness for those travelers with pre-existing chronic conditions

Frequent hand-washing is advised with soap and water

Avoid undercooked meat or food prepared under unhygienic conditions

Ensure fruit and vegetables are properly washed before consumption

If a traveller develops acute respiratory illness with fever, they should minimize close contact with

others, wear a medical mask, sneeze into a sleeve, flexed elbow or tissue (making sure it is

disposed of properly after use)

If during 14 days after returning from travel acute respiratory illness with fever develops; medical

attention should be sought immediately

SIGN AND SYMPTOMS

Fever 100 degrees F or higher,

Cough, Breathing difficulties,

Chills, Sore throat, Malaise

(a general feeling of being

unwell), Headache, Diarrhea,

Nausea/Vomiting, Runny nose

WHO IS MOST AT RISK?

Patients with chronic diseases:

diabetes

chronic lung disease and

heart conditions

The elderly

Organ transplant recipients

who are on

immunosuppressive

medications

Other patients whose

immune systems are weak,

such as cancer patients

undergoing treatment.

Antibiotic Prophylaxis

It is stated that the use of life-long prophylactic

antibiotics disease directed against pneumococcal disease has been the policy for more than 20 years

“But clearly, failures of both vaccination and

antibiotic prophylaxis are well documented…”

The use of Antibiotic in Post Splenectomy

Following splenectomy there

is a small but significant

lifelong susceptibility to

sepsis, particularly involving

Streptococcus pneumoniae.

The majority of infections are due to S.

pneumoniae (50-60% in most series)

followed by Haemophilus influenzae

(particularly in children).

General Info Risk of infection is

related to age, the

underlying reason for

splenectomy and elapsed

time since splenectomy

prevention through vaccination and

antibiotic prophylaxis is the basis of

the management of patients who have

had splenectomy or have

hyposplenism.

Images of S. pneumoniae

References:

1. Davies JM, Lewis MP, Wimperis J, Rafi I, Ladhani S, and Bolton-Maggs PH. 2011. Review of guidelines for the prevention and treatment

of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology

by a working party of the Haemato-Oncology task force. Br J Haematol ;155(3) :308-17.

2. Read RC and Finch RG. 1994. Prophylaxis after splenectomy. J Antimicrob Chemother ; 33: 4–6.

3. Keenan R.D., Boswell T., and Milligan D.W. 1999. Do post-splenectomy patients take prophylactic penicillin?. British Journal of Haema-

tology, 105 (2); 509-510.

4. Gaston M.H., Verter, J.I., Woods,G., Pegelow, C, Kelleher, J.Presbury, G. et al. 1986. Prophylaxis with oral penicillin in children with

sickle cell anaemia. New England Journal of Medicine, 314; 1593-9.

5. Waghorn D J. 2001. Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J

Clin Pathol, 54 :214–218.

By: Izyan

In hyposplenic

patient up to aged

16 years and

those over 50

years

Patient who have

inadequate

responses to

pneumococcal

vaccination

Patient who have had a previous

episode of invasive pneumococcal

disease

Finally, it is suggested that we should emphasize on patient education

regarding the prevention measures and infectious risk to optimize

patient's compliance.

High-risk groups need careful counselling and follow up to ensure

adherence to antibiotic prophylaxis

Preventative strategies continue to be based on education of staff and

patients, appropriate immunization schedules and chemoprophylaxis

The Positive

For children with sickle cell disease

which are rendered functionally asplenic

but are not absolutely comparable,

penicillin prophylaxis can reduce

risk of pneumococcal septicaemia by

more than 80%

The Negative

Postoperative antibiotic prophylaxis

(eg; Phenoxymethyl-penicillin

(Penicillin –V) is prescribed for two

years minimum and lifelong

prophylaxis should be offered to high

risk of pneumococcal infection patient

For WHO?

lack of good clinical data

demonstrating its efficacy in

asplenic patients

Increasing antimicrobial

resistance has provoked

concerns over continuous

antibiotic prescription

patient compliance

difficulties

S.pneumoniae insensitivity to

antibiotic

Conclusion

“We should emphasize

on patient education

regarding the

prevention measures

and infectious risk to

optimize patient's

compliance …”

Pegasys

(Peginterferon Alpha-2a)

PegIntron

(Pegylated interferon Alfa-2b)

Indication (a) Chronic Hepatitis B: Pegasys is indicated

for the treatment of both HBeAg-positive

and HBeAg-negative chronic hepatitis B in

non-cirrhotic patient with compensated liver

disease.

(h) Chronic Hepatitis C: Pegasys alone or in

combination with copegus (ribavirin) in

non- cirrhotic and cirrhotic patient with

decompensated liver disease.

Chronic hepatitis B

Chronic hepatitis C

Dosage (a) 180 mcg weekly SC for 48 weeks

(b) 180mcg weekly SC with ribavirin

800mg daily for 24 weeks ( depending

on genotype)

(a) 1.15mcg/kg once weekly for at least 24 weeks up

to 52 weeks

(b) monotherapy: SC at a dose of 0.5 or 1 mcg/kg

once weekly for at least 6 months.

Combination: 1.5mcg/kg for at least 24 weeks and

up to 52 weeks

Blood Test Support blood test (genosys) viral load Do not support any blood test viral load

Mechanism of

Action

They possesses the in vitro antiviral and antiproliferative activities of alpha interferon. interferons

will bind to specific receptors on the cells surface initiating a complex intracellular signaling

pathway and rapid activation of gene transcription. Interferon-stimulated genes modulate infected

cells, inhibition of cell proliferation and immunomodulation.

Pharmacokinet-

ics/

dynamics

Half life elimination: Terminal- 50-150 hours;

increased with renal dysfunction.

Half life elimination: ~40 hours

Excretion: ~30%

Storage Store in refrigerator at 2C – 8 C.

Do not freeze or shake.

Prior to reconstitution, store at 2C to 8C.

Price RM533.86 RM569.90 (120mcg); RM544.00(80mcg)

Administration 180mcg Prefilled syringe (PFS). Allow PFS to

come to room temperature for a few minutes

before injection.

Ready to be used, no reconstitution and dial

adjustment needed.

50mcg, 100mcg, 150mcg and 120mcg Redipen

(single use prefilled pen)

Reconstitution: to mix the prefilled pen, keep the

prefilled pen upright, press top half of pen

downward toward hard, flat surface until “click”

sound is heard.

Dial the dose. Hold pen firmly, then pull dosing

button out as far as it will go. Then turn the dosing

button until prescribed dose is lined up with the

dosing tab.

10% -

Central nervous system: Headache (54%), Fatigue (56%),

fever (37%).

Dermatologic: Alopecia (23%), pruritus (12%)

Gastrointestinal: (nausea and vomiting (24%), diarrhea (16%)

Hematologic: Neutropenia (21%), lymphopenia (14%), anemia (11%)

Hepatic: ALT increase 5-10 x ULN during treatment (25%)

Neuromuscular: Weakness (56%), myalgia (37%)

Adverse reactions

References

MOH Medicines Formulary 2014

Drug Information Handbook (21st Edition)

By: Azize

The National Adverse Drug Reaction Monitoring

Centre, National Pharmaceutical Bureau (NPCB) is

alerting and advising the public against buying and

using product labeled as “ Jingzhi Yinqiao Jiedu

Tablet 260 Mg ”

Jingzhi Yinqiao Jiedu Tablet 260

Mg is registered as tradisional

medicine for fever, headache, sore

throat, cough and runny nose.

Reference

http://portal.bpfk.gov.my/newsmaster.cfm?&menuid=52&action=view&retrieveid=369

Products contain paracetamol which is

controlled under the Poison Act 1952.

Continuous use without any health

professional supervision is dangerous as

may lead to liver toxicity.

Some of the signs for liver

toxicity includes nausea and

vomiting, tea coloured urine,

yellowish eye and skin and

lethargy.

By: Azize

The Health Ministry of Malaysia has advised consumers in

the country against buying two specific cosmetic products,

Dermaceutic Spot Cream and Dermaceutic Spot Cream

claiming they both contain potentially toxic ingredients.

Dermaceutic is an Ireland-based brand that is generally

distributed by dermatology professionals worldwide.

The products have been marketed in the country as

multifunctional skin care creams, targeting both skin

lightening, as well as for the treatment of skin lightening.

The ministry cited the reason for ceasing sales of these

products is being that both products contain hydroguinone

and tretinoin, which are both said to be potentially toxic,

even for topical use.

Cancellation of cosmetic product— Dermaceutic spot cream

Reference:

1.http://portal.bpfk.gov.my/newsmaster.cfm?&menuid=52&action=view&retrieveid=473

2. http://www.cosmeticsdesign-asia.com/Regulation-Safety/Malaysia-Health-Ministry-advises-consumers-against-two-

cosmetic-products

INTRODUCTION

Ayurveda, also known as Ayurvedic Medicine, is the traditional

medicine of India, which originated there over 5,000 years ago.

Ayurveda emphasizes re-establishing balance in the body through

diet, lifestyle, exercise, and body cleansing, and on the health of the

mind, body, and spirit .

HOW DOES IT WORK? Just as everyone has a unique fingerprint, according to Ayurvedic

beliefs, each person has a distinct pattern of energy whereby it is a

specific combination of physical, mental, and emotional

characteristics. There are three basic energy types called doshas,

present in every person:

A) Vata : energy that controls bodily functions associated with

motion, including blood circulation, breathing, blinking, and

heartbeat. When vata energy is balanced, there is creativity and

vitality. Out of balance, vata produces fear and anxiety.

B) Pitta :energy that controls the body's metabolic systems,

including digestion, absorption, nutrition, and temperature. In

balance, pitta leads to contentment and intelligence.

C) Kapha : energy that controls growth in the body. It supplies

water to all body parts, moisturizes the skin, and maintains the

immune system. In balance, kapha is expressed as love and

forgiveness. Out of balance, kapha leads to insecurity and envy.

References

http://altmedicine.about.com/cs/2/a/AyurvedaDef.htm

http://umm.edu/health/medical/altmed/treatment/ayurveda

By: Melissa

Ayurveda is a holistic health system which aims at bringing about

harmony in the body, and harmony of humans with nature. It looks

at not just body, but health of mind and soul as well.

The most important advantage of course, is that it uses only

natural substances derived from plants, fruits, vegetables and

natural minerals. Alternatively, it uses the plant extracts in

combination to produce required medicines. The side effects are

minimal when compared to other forms of medicine, as natural

substances can't really do your body much harm.

A look at the disadvantages would show that the popularity of the system of medicine declined because

of the fear of adulteration and toxic substances mixed with the Ayurvedic formulae available in the

market today. Also, reliability of the medicines and the physicians practising it has been questioned. One

must not forget that Ayurveda was used ages ago, and today the numbers and kinds of diseases and

illnesses have increased multifold, and newer methods of medicine are being relied on for treatment

and therapy.

AYURVEDA– THE SCIENCE OF LIFE

ADVANTAGES & DISADVANTAGES

On your first visit, the practitioner will

take a detailed medical history, check

your pulse, feel your abdomen,

examine your tongue, eyes, nails, and

skin, and listen to the tone of your

voice. The practitioner will also ask

you questions about your general

health, paying special attention to

your lifestyle, diet, habits, and

surroundings. Practitioners draw from

more than 20 types of treatment, but

the most commonly prescribed

include:

1. Pranayama -- breathing exercises.

Practicing pranayama helps you feel

calm.

2. Abhyanga -- rubbing the skin with

herbal oil to increase blood circulation

and draw toxins out of the body

through the skin.

3. Rasayana -- using mantras

(repeated words or phrases) during

meditation combined with certain

herbs to rejuvenate a person.

4. Yoga -- combining pranayama,

movement, and meditation. Yoga has

been shown to improve circulation

and digestion, and to reduce blood

pressure, cholesterol levels, anxiety,

and chronic pain.

5. Pancha karma -- cleansing the body

to purify it and reduce cholesterol.

Practitioners use methods that cause

sweat, bowel movements, and even

vomit to cleanse the body of toxins.

6. Herbal medicines -- prescribing

herbs to restore a balance.

METHODS

By: Izyan

On 6th of June 2015, Pharmacy Department of Hospital Melaka had organized

Therapeutic Drug Monitoring, 2015 course at the Auditorium Sri Baiduri,

Hospital Melaka .The ultimate objectives of the course are to strengthen the

knowledge of TDM and to promote TDM services at the Melaka Hospital. A

total of 72 participants attended this course . This course managed to instil

interest in TDM and helped to improve knowledge at the same time.. Over-

all, it was a successful event.

ACTIVITIES...