final pharmacy bulletin 2014
TRANSCRIPT
CONTRIBUTORS : - Anida Hamzah - Nur Nadiah Marzuki - Ng Sin Yee - Erwany Md Dewa - Amreet Kaur Gill - Teh Wan Yuan - Loh Tze Min - Tan Siong Guan - Mohd Solleh Rahim - Noridarabiaton Ali Akbar - Ku Yee Kun
Edition 01/2014
PEJABAT KESIHATAN DAERAH JASIN, MELAKA
Pharmacy Bulletin
EVENTS 2 MEDICATION ERROR REPORTING
4
NITROGLYCERIN PRODUCT
6
NEW DRUG IN PKDJ 8
INSUMAN 10
STAFF UPDATES 13
POSITIVE THINKING 14
SUPPLEMENTS 12
MTAC Medication Therapy Adherence Clinic (MTAC) is an ambulatory care service by certified pharmacists in collaboration with physicians with the aim of empowering patients in disease control. It was introduced in 2004 as part of the Clinical Pharmacy Services of the Ambulatory Clinic System, emphasizing on medication management to improve quality, safety and cost-effectiveness of patient care. This year, Klinik Kesihatan (KK)Selandar, KK Jasin and KK Merlimau have started conducting diabetes MTAC (DMTAC). KK Umbai will begin in October 2014. DMTAC’s aim is to help diabetic patients improve their medication adherence level and glycemic control. The patients enrolled in this clinic will be followed up for a minimum of eight (8) visits where they will receive a number of services including medication adherence assessment, medication counseling, and diabetes education by pharmacists. Apart from that, pharmacists will also assess patients and address their needs as well as scheduling appointments for them. Any pharmaceutical related issues and changes will be noted in both the MTAC review and the patient’s case notes. Patients will be discharged provided he completed all the necessary education modules and showed excellent diabetes control.
EDITORIAL BOARD ADVISOR : Chan Bee Leng EDITOR: Lio Ee Lee
Inside this issue:
On 29th April 2014, a methadone programme was organized by Klinik Kesihatan Selandar. The event was held in Dewan Parameswara from 8.00 am to 1.00pm.
The objectives of the programe include: • To strengthen the bond between patients and staffs • To reinforce the inclusion and exclusion criteria and to highlight the
essential rules • To give vivid explanation to the methadone clients regarding the order
to stop supplying takeamway doses • To introduce the Methadone 1 Malaysia (M1M) service to all the
clients as an approach to encourage DOT. At the end of the session, several prizes were given away to those who
won the lucky draw and a special reward was presented to the best methadone client in Klinik Kesihatan Selandar for Year 2014. Before adjournment, a Q&A session was dedicated for the clients to share related issues and clarify their doubts regarding the MMT programme. The programme ended successfully with co-operation from the medical officers, pharmacists, medical assistants, staff nurses as well as the methadone clients.
Page 2 Events KK SELANDAR - METHADONE PROGRAMME
Inside Story Headline
BIL TARIKH MASA TEMPAT
1 13/1/2014 8.30-12.30 KK Merlimau
2 13/1/2014 2.30-4.30 KK Umbai 3
23/4/2014 8.00-12.00 SMK Dato Abd
Rahman Yaakub
4 29/4/2014 8.00-12.00
KK Selandar
5
24/5/2014 8.00-5.00
MINI Stadium Jasin
6
25/5/2014 8.00-1.00
Japerun Serkam
7 20/6/2014 8.00-12.00
KK Umbai
8
21/6/2014 8.00-1.00
Sek Keb Tehel
9 22/6/2014 8.00-12.00
Balai raya Kg. Alai
AKTIVITI
Pameran QUMC
Pameran QUMC
Pameran QUMC
Ceramah & Pameran QUMC
Pameran QUMC Sempena Karnival Pendidikan & Kerjaya Pameran QUMC Sempena Program Kesihatan Cegah Kanser Servik &Payudara Pameran&Ceramah Sempena Program Nafas Baru Bermula Ramadhan Pameran & Ceramah QUMC sempena Program Doktor Muda
Pameran & Ceramah QUMC
BIL PESERTA
55
40 60
40
43
100
35
200
77
Events Quality Use of Medicine-Consumer (QUM-C ) Jan - June 2014
Page 3
What is a medication error? A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient or consumer. Such an event may be related to professional practices, healthcare products, procedures and systems including prescribing, order communication, product labelling, packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use. Although many medication errors may not cause grave harm to patients, some medications are known to carry a higher risk of harm than other medications. Errors in the administration of these medications can have catastrophic clinical outcomes.
Medication Error Reporting Online
Page 4
Below are strategies that can be implemented by the facility in order to reduce the medication errors.
• Allergy card • Streptokinase card • Splenectomy card • General vaccination card • High Alert Medication Labeling • Unit Dose • Medication Therapy Adherence Cilinic (MTAC) • Medication Reconciliation / Pharmacist Discharge Planning • Medication Counselling • Medication History Taking • Tallman Lettering • Standard Medication Abbreviation • Medication Generic Name
Example of prescription with non-standard abbreviation:
The ‘MTF’ abbreviation is non-standard and cannot be used to prescribe a Metformin. The prescription can be mistakenly filled with MTX, which is the standard abbreviation of Methotrexate. In Malaysia, medication error reporting is at the moment on a voluntary basis.All the error detected can be reported online via http://mers.moh.gov.my/MERS. The main objective of medication reporting is to minimise the reoccurrence of errors and ultimately to improve patient safety.
Medication Error Reporting Online
Page 5
Reference:
Guideline on Medication Error Reporting. MoH. 1st ed. July 2009.
Nitroglycerin is a vasodilator,
a medicine that opens
blood vessels to improve
blood flow. It is used to
treat angina, a type of chest
pain or discomfort
that happens when there is
not enough blood flowing
to the heart. To improve
blood flow to the heart,
nitroglycerin opens up (dilates)
the arteries in the heart
(coronary arteries), which
improves symptoms and
reduces how hard the heart
has to work. Quick-acting
forms of nitroglycerin are used
to relieve angina or used just
before activities that typically
cause angina. Long-acting
forms of nitroglycerin are used
to prevent angina from happen-
ing. They are not used to stop
sudden symptoms of angina.
Type of Nitroglycerin Products
Nitroglycerin comes in quick-acting forms and long-acting forms.
1) Quick-acting forms:
• · The tablets are placed under the tongue (sublingual) or between the cheek and gum (buccal).
• · The spray is used on or under the tongue
• 2) Long-acting forms:
• · Extended-release tablet
• · Skin patches
Quick-acting Nitroglycerin A) Tablet The different types of nitroglycerin tablets
include sublingual and buccal tablets. Be-
fore using any type of nitroglycerin, pa-
tients should sit down, because it may
cause fainting or dizziness. The doctor may
instruct the patient to take a dose before
any physical activity that may cause angina
or as soon as the patient first notices symp-
toms. Some people may be instructed to
take a second dose after five minutes if the
first dose does not alleviate chest pain. A
third dose may be taken five minutes after
the second if needed. In the event that three
nitroglycerin tablets are ineffective at re-
lieving symptoms, patients will need to call
for an ambulancefive minutes following
the third dose. Buccal nitroglycerin tablets
should be placed in the mouth between the
gum and the cheek and allowed to dissolve
completely. Patients must avoid chewing
or swallowing these tablets.
Page 6
Fig. 1 GTN Spray. Fig. 2 GTN patch
B) Spray Those who have difficulty with nitroglyc-
erin tablets may take the drug in a spray.
Patients should avoid shaking the con-
tainer. After removing the cap, it should be
held upright and placed very close to the
patient’s open mouth. He may then press
the button once to release one dose. The
medicine should not be inhaled and pa-
tients must avoid spitting or drinking for
five to 10 minutes. To treat an angina at-
tack, use 1 to 2 sprays on or under the
tongue as directed by your doctor. Sit qui-
etly after using a dose. A spray may be re-
peated every 3 to 5 minutes as directed by
your doctor.
Do not use more than 3 sprays in 15 min-
utes unless your doctor tells you otherwise.
If chest pain continues after a total of 3
sprays, seek medical attention at once,
unless your doctor gives you different in-
structions. If you use nitroglycerin spray to
prevent angina caused by physical activity,
use it 5 to 10 minutes before activity.
Long-acting Nitroglycerin A) Extended-release Tablet Extended-release tablet of glyceryl trinitrate are used to prevent
the chest pain caused by angina pectoris. Angina occurs when
there is an inadequate supply of oxygen for the work the heart is
performing. The tablets will reduce the heart's work and will
release the medicine slowly giving protection over several
hours. Extended-release tablets are not suitable for treating an
attack that has already star ted as the tablets will take too long to
start working. One example of extended-release tablets available
in market is Sustac® Tablet.
B) Skin Patches Apply one patch every 24 hours. It is usual to apply the patches
to your chest or upper arm, but this may vary depending upon
which brand of patches you have been given. Use a different
area of skin each time you apply a patch. When you use GTN all
the time, your body becomes used to it and then it has much less
of an effect. To overcome this tolerance, you may remove the
patch before you go to bed, to leave your blood free of nitrate in
the early hours when you are asleep.
Page 7
References:
1) Glyceryl Trinitrate for Angina. Available online: http://www.patient.co.uk/medicine/glyceryl-trinitrate-for-angina
2) Nitroglycerin. MedlinePlus, National Institute of Health. Available online : http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601086.html
3) Nitroglycerin Spray. Available online: http://www.drugs.com/cdi/nitroglycerin-spray.html
New Drugs in PKDJ 1. GLICLAZIDE 60MG MODIFIED RELEASE TABLET
INDICATION As monotherapy or in combination with other oral anti-diabetic agents in type 2 diabetes when • Dietary measure • Physical exercise • Weight Loss
2. BENZOYL PEROXIDE GEL BP 5%
INDICATION • Mild to moderate acne vulgaris
Page 8
3. INSUMAN COMB (biphasic) INSUMAN BASAL (intermediate acting) INSUMAN RAPID (short acting)
INDICATION Same indication as insulin from Novo Nodisk
4. INSULIN GLARGINE 300IU/3ML INJECTION
INDICATION Diabete mellitus type 1 in adult and child over 6 years Diabetes mellitus type 2 in adult
New Drugs in PKDJ Page 9
COMPARISON BETWEEN INSUMAN AND NOVO NORDISK INSULIN
Product Novo Nordisk Insulin
Recombinant human in-sulin
√ √
Type of insulin
NPH Intermediate Insulin
Insulatard
Insuman® Basal
Regular Insulin
Actrapid
Insuman ® Rapid
NPH Premixed Insulin
Mixtard
Insuman ® Comb 30
Page 10
Time of admini-stration
NPH In-termediate Insulin
1 hour before bedtime 45-60 min before meal; can be once (evening or bedtime) or twice-daily (plus in the morning)
Regular Insulin
30 min before meal 15-20min before meal
NPH Pre-mixed In-sulin
30 min before meal (twice daily)
30-45 min before meal (twice daily)
Method of admini-stration
Subcutaneously.
Subcutaneously.
Insulin Pen Novopen 4 ALLSTAR™
Re-suspension Insulatard and Mixtard need to be resuspended before injection.
Insuman® Basal and Insuman® Comb 30 need to be resuspended before injection. Insuman® Basal and Insuman® Comb 30 Cartridges have three metal bullets that allow an efficient mixing procedure
Product Novo Nordisk Insulin
Page 11
A dietary supplement is intended to provide nutrients that may otherwise not be consumed in sufficient quantities. Supplements as generally understood include vitamins , minerals , fiber, fatty acids, or amino acids , among other substances. They are marketed in dose form as pills, tablets, capsules, or liquid in measured doses.
Page 12
No. Products Supported goal 1. Amino acids powder / capsules
Increase energy
2. Fish oils soft gels with omega 3 essential fatty acid
Health & Wellness Support healthy heart function , joint
flexibility, cell production
3. Garlic tablet Improve immune system , fight germs of all sort , and reduce the risk for
heart disease
4. Gingko Biloba An Herb Improve blood circulation, which
might help in brain , eyes, ears, and legs function better
5. Alfafa Complex High in protein , calcium, and miner-
als. Also use in herbal medicine to stimu-late appetite and improve digestion
problems
6. Lecithin Capsules Lecithin is a source of choline, an essential nutrient
Benefit in acne , in improving liver function , and in lowering cholesterol
7. Vitamin B Complex Health & Wellness Help to metabolize protein, fats, and
carbohydrates into energy
8. Vitamin C Tablet Health & Wellness Improve immune system ,
Supporting the body natural antioxi-dant
Supplements
Page 13
Noridarabiaton Ali Akbar (PF U41, KK Kemendor)
Tham Ngan Yin Nor Haniza Bt Khairudin
Nor Liza Bt Rabbu
New staff in PKDJ
Pharmacist
Teoh Sook Yee (PF U44, KK Selandar)
Pharmacy Assistant
Qurratu' Aini Bt Kaber ( PPF U29, KK Kemendor)
( PPF U29, KK Umbai) ( PPF U36, KK Jasin)
( PPF U29, KK Umbai)
Page 14