HAART-Highly Active Antiretroviral Therapy

Transcription

Vol 2, 2012
Issue 2, Oct 2012
BAHAGIAN PERKHIDMATAN FARMASI, JABATAN KESIHATAN WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Vol 2, 2012
Apa itu Denggi?
Statistik terbaru Denggi JKWPKL&P
Adakah anda
menggunakan inhaler dengan betul?
What is HIV?
IN THIS ISSUE
HUMAN:
This particular virus can only infect humans.
IMMUNODEFICIENCY:
HIV weakens the immune system by destroying important cells that fight
disease and infection.
VIRUS:
A virus can only reproduce itself by taking over a cell in the body of its host. HIV is the virus that causes AIDS
(acquired immunodeficiency syndrome). HIV is similar like other viruses, including those that cause the “flu” or
the common cold. But there is a difference because over time the immune system can clear most viruses out of
the body. However with HIV the immune system is unable to fight.
HOW DOES HIV HARM THE BODY?
HIV is best known for targeting the T cells of the immune system. The immune system is made up of specialized
cells in the bloodstream that fight off invading germs to keep the body healthy. The “T” cells (also referred to as
“T4,” “helper-T,” or “CD4” cells) are the brains of the operation. These white blood cells identify invaders and
give orders to soldier-type cells, which then battle various bacteria, viruses, cancers, fungi, and parasites. Like
all viruses, the HIV is only interested in one thing: reproducing itself. Once it has attacked and moved into a T
cell, it converts that cell into a miniature virus factory. Eventually there are so many new viruses in the cell that
the T cell explodes, scattering the HIV back into the bloodstream. The virus then moves on to fresh T cells and
repeats the process. Over time, the HIV can destroy virtually all of an infected person’s T cells in this mechanism.
HOW DOES SOMEONE GET INFECTED WITH HIV?
1
3
4
5
6
7
HIV& HAART
8
9
QUM-C
RVD MTAC
Respiratory MTAC
Nuclear Pharmacy
TDM Pharmacy
National TB Control
Programme & Strategies
JKWPKL & P Formulary
Update
10 Kajian Penyelidikan 2012
11 Projek Inovasi 2012:
MyPHAStrack
11 Aktiviti-aktiviti Cawangan
12
Penguatkuasa Farmasi
JKWPKL&P
Alternative Birth Centre
Putrajaya
12 Aktiviti-aktiviti Drug
Information Pharmacist
HIV is found in specific human body fluids. If any of those fluids enter your body, you can become infected with HIV.
Human body fluids that contain high levels of HIV are blood, semen, breast milk, vaginal fluids and rectal mucus.
13 Denggi Update
14 Teknik Penggunaan
Inhaler
15 Penggunaan Accuhaler
Goal: to suppress HIV replication and to slow down the cycle of immune activation and CD4+ cell destruction as
effectively and for as long as possible. The aim would be to reduce plasma viral load to below undetectable levels
for a maximum duration and to improve, maintain and prevent the ongoing decline of CD4+ cells.
16 Penggunaan Handihaler
17 Kawalan iklan ubat dan
Compliance with therapy is one of the major determinants of ensuring a durable response. In all situations
the patient must be agreeable and committed to taking what may be a complex and toxic drug regime before
commencing therapy.
Given the number of possible drug combinations, it is not possible to recommend which particular regimens are
best for treatment of HIV disease. Factors that will influence that decision will include: the condition of the patient
(stage of the disease as well as any concomitant illnesses), the potency and adverse effects of the regimen, any
concurrent therapies and finally, the cost of the regimen.
Disediakan oleh KK Kg Pandan
dan Turbohaler
perkhidmatan di bawah
akta ubat
18
18
19
20
Pertukaran internal staff
Sleep and weight
Pertukaran external staff
Update on Alzheimer’s
disease progress
EDITORIAL TEAM
I. Nucleoside reverse
transcriptase inhibitors
(NRTI)
II. Protease inhibitors (PI)
III. Non-nucleoside reverse
transcriptase inhibitors
(NNRTI)
ADVISORS
Pn. Rosnaini Bt. Kamaruddin
Zidovudine (AZT/ Retrovir ) *
Didanosine ( ddI / Videx ) *
Zalcitabine ( ddC / Hivid )
Lamivudine ( 3TC / Epivir ) *
Stavudine ( d4T / Zerit ) *
Combivir ( AZT+ )3TC
Indinavir ( Crixivan ) *
Ritonavir ( Norvir ) *
Saquinavir - hard gel capsules ( Invirase )
Saquinavir - soft gel capsules ( Fortovase )
Nelfinavir ( Viracept )
Efavirenz ( Stocrin )*
Nevirapine ( Viramune )
EDITOR
Nurul Syahidah Bt Md Dauad
Chua Sin Wee
* Antiretroviral drugs currently listed in Ministry of Health drug formulary (August 2001)
MEMBERS
Daniel Ho Yu kun
Nor Haizan Ibrahim
Chee Joon Min
Teoh Boon Ching
Vol 2, 2012
Commencing Antiretroviral Therapy - What to start with?
When initiating therapy in the patient naive to antiretroviral therapy, one should begin with a regimen that is expected to achieve sustained
suppression of plasma HIV RNA (ie. HAART), a sustained increase in CD4+ T cell count, and a favorable clinical outcome (i.e., delayed progression to
AIDS and death). Additional consideration should be given to the regimen’s pill burden, dosing frequency, food requirements, convenience, toxicity,
and drug interaction profile compared with other regimens.
Antiretroviral therapy comprises of one choice each from Column A and B
( drugs are listed in alphabetical, not priority order )
COLUMN A
COLUMN B
Strongly Recommended
Efavirenz
Indinavir
Nelfinavir
Ritonavir + Indinavir
Ritonavir + Saquinavir
Stavudine + Didanosine
Stavudine + Lamivudine
Zidovudine + Didanosine
Zidovudine + Lamivudine
Recommended as Alternative
Nevirapine
Ritonavir
Saquinavir
Didanosine + Lamivudine
Zidovudine + Zalcitabine
No recommendation due to insufficient data
Hydroxyurea in combination with any antiretroviral drugs
Ritonavir + Nelfinavir
Examples of some possible combinations (not in any order of preference or efficacy)
•
•
•
•
Stavudine
Stavudine
Zidovudine
Zidovudine
+
+
+
+
Didanosine
Didanosine
Lamivudine
Lamivudine
+
+
+
+
Efavirenz
Indinavir + Ritonavir
Efavirenz
Indinavir + Ritonavir
Monitoring Antiretroviral Therapy
1. Clinical aspects-effective therapy, clinical signs and symptoms should gradually improve
or disappear.
2. CD4+ / CD8+ cell counts should be regularly monitored i.e. 3 – 6 monthly.
3. Viral load (VL) monitoring is necessary in patients who are on optimal antiretroviral therapy
4. Others: full blood counts, liver and renal profile, erythrocyte sedimentation rate, creatinine
kinase (if on zidovudine), serum amylase (if using didanosine, zalcitabine).
5. If patients are on protease inhibitors, 6-monthly serum lipid and 3-monthly blood sugar
assays should be performed.
6. Hyperglycemia is treated according to standard diabetic protocols.
7. Raised serum lipids should be approached with dietary advice and counseling, failing which
lipid - lowering therapy may need to be commenced especially if other risk factors for
ischaemic heart disease are present.
References
1.
HAART HIV/AIDS Alliance for Region Two; Website: http://www.zinc.org
2.
HIV and its Treatment ; Website: www.aidsinfo.nih.gov/.../HIVandItsTreatment_cbrochure_en.pdf
3.
Antiretroviral Therapy for HIV Infection , Author: R Chris Rathbun, PharmD, BCPS, AQ-ID, AAHIVE; Chief Editor:
Ronald A Greenfield, MD more... http://emedicine.medscape.com/article/1533218-overview
4.
Consensus on Anti Viral Treatment, 2nd Edition (2001), 2nd National Guidelines on Antiretroviral Therapy by Malaysian
Society of Infectious Diseases & Chemotherapy (MSIDC).
2
Structure of HIV
Vol 2, 2012
Retroviral Disease Medication Therapy Adherence Clinic (RVD MTAC)
The concept of Medication Therapy Adherence Clinic (MTAC) was first introduced in 2004 as part
of the clinical pharmacy services in Ambulatory Care that emphasizes on medication management
to improve the quality, safety and cost-effectiveness aspects of patient care. MTAC is operated by
pharmacists through which drug therapy monitoring and patient education is provided to improve
patients’ ability to successfully manage their disease condition, prevent debilitating symptoms and
reduce the likelihood of medication errors. It also includes clinical pharmacokinetic consultations;
laboratory monitoring and dosage adjustment for relevant medications. The MTAC covers various
type of disease amongst other diabetes, respiratory, retroviral etc.
As for the retroviral disease, pharmacists play an important role in providing pharmaceutical care
to Human Immunodeficiency Virus (HIV) patients. By adopting the pharmaceutical care concept,
pharmacist needs to cooperate with the patient and other professionals in designing, implementing
and monitoring a therapeutic plan that will provide specific therapeutic outcomes for the patient.
The Retroviral Disease (RVD) MTAC is the way forward to achieve the abovementioned purpose.
The objectives of RVD MTAC are mainly to optimize the benefits of Highly Active Retroviral Therapy
(HAART) and other therapies related to HIV patients as well as to assist patient to recognize and
manage adverse drug effects due to HAART and other therapy.
In RVD MTAC, the pharmacist will educate and counsel the followings:
New patient prior to starting HAART (pre HAART)
New patient on HAART (HAART)
Patient requiring changes in HAART
Patient with long standing adherence problems
An average of 10 to 15 minutes per case will be spent for counseling; however, longer time (around 30 minutes) will be needed for newly referred cases.
The workflow of RVD MTAC is based on the RVD Protocol, 1st Edition 2010, as published by the Pharmaceutical Services Division, Ministry of Health, Malaysia.
Disediakan oleh KK Tanglin
Workflow of MTAC RVD
1. PRE HAART
2. HAART
3. POST HAART
HAART Initiated
Review patient’s case notes
accordingly
HAART Naive / Regimen
Select patient to be counseled
Assess patient’s
data & medication history
After
2-4
weeks
Assess patient’s readiness
for HAART
Assess patient’s
Counsel patient
Assess patient’s
Assess patient’s
compliance & adherence
Communicate assessment to doctor,
document assessment & plan in:
- Case notes
- Counselling form
Counsel patient
Counsel patient
Document assessment & plan in:
- Case notes
- Counselling form
Document assessment & plan in:
- Case notes
- Counselling form
Reassess patient’s beliefs,
perceptions & compliance
End
Patient reviewed by doctor
End
End
3
Vol 2, 2012
Respiratory Medication Adherence Clinic (RMTAC)
As the name implies, RMTAC is a service provided by the pharmacist to take a step forward in helping
and improving the quality of life of respiratory patients, especially the asthmatic patients and patients with
Chronic Obstructive Pulmonary Disease (COPD).
RMTAC had been established in KK Jinjang since January 2012. The current enrollment of patients were all
asthmatic patients. Follow-up appointments were made for RMTAC participants with the pharmacist, usually
once every month or every two months until their appointment with doctors. Below are the comparison of
patients Asthma Control Score, ACT and Mean Peak Expiratory Flow Rate (PEFR) before and after enrolment into
RMTAC. (Data is updated as of May 2012).
Disediakan oleh KK Jinjang
Objectives of RMTAC
AIMs
1.
1.
Optimization of respiratory medications’ Therapies
50% of RMTAC patients attended at least 3 follow up sessions in 12
months duration.
2.
Improve respiratory inhalers’ handling technique
2.
50% of RMTAC patients who attended 3 followed up sessions achieve
at least 20-24(on target) score of Asthma Control Test (ACT).
75% of the RMTAC patients achieve good inhalers handling technique.
Mean PEFR(L/min)
Asthma Control
>20
AsthmaScore
Control
Test Score
25
21.5
20
17.6
100.00%
71.40%
15
10 35.70%
0.00%5
0
P
stM o..
.
TA
C
Asthma
Control
Test
Score
Po
stM
TA
C
17.6
21.5
3.
Po
Asthma Control Test Score
Pr
eM
TA
C
25
20
15
10
5
0
Improve compliance of respiratory medication
Pr Pr
eM . ..
TA
C
3.
Chart Title
400
Asthma
300
Control
200
Test
100
Score
337.65
184
0
PreMTAC
PostMTAC
Common pharmacist’s intervention done in RMTAC
Educate patients in identifying their asthma trigger factor.
Just for Laughs!
A pharmacist looks out the front of the
store and sees a woman holding a bottle
jumping up and down in the parking lot. The
pharmacist walks out to the parking lot and
asks the woman what’s the matter. She replies
“I saw it said ‘Shake Well’ after I took it”.
Educate the importance of compliance on controller inhalers.
Educate patients on identifying asthma symptoms and action to be
taken. (asthma care plan)
Educate maximum dose and side effects of medication as well as
method to reduce side effects.
Suggest to doctor regarding asthma medication step up or step down
management.
Inform doctor if patients had other co-morbidity which worsens their
asthma condition.
Identify drug-drug interaction.
4
Vol 2, 2012
The Nuclear Pharmacy Unit of Hospital Putrajaya
OVERVIEW
SERVICES
Nuclear Pharmacy seeks to improve and promote the public health through
safe & effective use of radioactive drugs for diagnosis and therapy. A nuclear
pharmacist specializes in the procurement, compounding, quality control
testing, dispensing, distribution, and monitoring of radiopharmaceuticals. In
addition, the nuclear pharmacist provides consultation regarding health and
safety issues, as well as the use of non-radioactive drugs and patient care.
The Nuclear Pharmacy Unit provides radiopharmaceutical services not
only to Hospital Putrajaya, but also Hospital Pulau Pinang as well as private
health institution within Klang Valley.
The Nuclear Pharmacy Unit of Hospital Putrajaya has evolved into a modern,
state-of-the-art, computerized facility with up-to-date equipment and a full
complement of Nuclear Pharmacy staff.
The unit also serves as a valuable information resource for other healthcare
practitioners regarding new radiolabeled drugs and ligands and their proper
use in patient care.
CT Scan
PET Scan
PET/CT Scan*
Organs and bones
Cell activity
Exact location of high cell activity
These services include the daily production of FDG Putra Injection ([18F]
FDG), synthesis of Ga-DOTATATE (currently for internal usage), dispensing
of over 150 patient doses per month and ensuring the safe and effective use
of these radiopharmaceuticals.
WHAT IS FDG PUTRA INJECTION?
Chemical name: 2-deoxy-2-[18F] fluoro-D-glucose, abbreviated [18F] FDG.
Description:
It is a radio labeled analog of glucose which is used for diagnostic purposes in conjunction with Positron Emission Tomography (PET). It is administered
by intravenous route and rapidly distributed to all organs in the body.
Cancerous cells are generally characterized by enhanced glucose metabolism partially due to an increase in activity of glucose transporters, an
increased rate of phosphorylation activity, a reduction of phosphatase activity or a dynamic alteration in the balance among all these processes. Thus,
FDG is indicated for assessment of abnormal glucose metabolism to assist in the evaluation of malignancy, identification of left ventricular myocardium
with residual glucose metabolism and reversible loss of systolic function or abnormal glucose metabolism associated with foci of epileptic seizure.
Before the procedure, patients’ blood glucose levels should be stabilized. PET imaging can be initiated within 40 minutes of administration of FDG Putra
Injection and will be clear from most tissues within 24 hours, and eliminated from the body unchanged in the urine.
WHAT IS Ga-68 DOTATATE?
Ga-68 DOTATATE is a generator produced PET Radio-Pharmaceutical which allows clinical studies
without an on-site cyclotron. It has a physical half-life of 68 min which is compatible with the
pharmacokinetics of most radiopharmaceuticals of low molecular weight such as antibody,
fragments, peptides, aptamers, oligonucleotides and others.
Among other peptides, DOTATATE or (DOTA-D-phe-cys-tyr-Dtrp-lys-thr-cys-thr) is used to be labeled
with Ga-68 for neuroendocrine tumour imaging such as insulinoma and malignant phaechromocytoma.
DOTATATE is a somatostatin analogue with high affinity for somatostatin receptors expressed in
cancer of neuroendocrine origin.
CH2OH
H
OH
H
OH
H
O
H
18
H
OH
F
References
1.
FDG Putra Injection product leaflet
2.
Balter et al. Radiolabelled DOTA-TATE: Its evaluation for Targeted Radiotherapy, World Journal of Nuclear Medicine,
Volume 5, Number 3, July 2006
Contact Us
The Nuclear Medicine Department Hospital Putrajaya, Nuclear Pharmacy, Presint 7, 62200 Putrajaya
Phone: (+603) 8314 5501 Fax: (+603) 8314 5555
5
Vol 2, 2012
Therapeutic Drug Monitoring – A Vital Pharmacist’s Role
Clinicians routinely monitor drug pharmacodynamics response by directly measuring physiological
indices of clinical endpoint. However, for many drugs there is either no readily available measure of
effect or it is insufficiently sensitive. In other cases it is difficult to distinguish between the progress
of the disease and the pharmacological effects of a drug. It is in these situations that therapeutic drug
monitoring (TDM) is an essential part of clinical management.
TDM is the process of applying pharmacokinetic principles to determine the dosage regimens of
specific drug products for specific patients to maximize pharmacotherapeutic effects and minimize
toxic effects.
Pharmacists have a vital role to play in TDM, offering advice to medical and nursing staff about the use
of TDM, dose calculations and interpretation of the results obtained. This could involve recommending
an appropriate drug regimen to maximize the efficacy and avoid drug toxicity. It usually takes into
account dose, dosage interval and route, based on a number of patient-specific factors such as age,
weight, and renal function. Pharmacists can also use their expertise to examine possible causes of
unusual TDM results, which may arise from problems with bioavailability, drug interactions, noncompliance, sub therapeutic dose or medication errors.
Application of these principles requires an understanding of the absorption, distribution, metabolism,
and excretion characteristics of specific drug products in specific diseases and patient populations.
The influence of factors such as age, sex, diet, pathophysiologic conditions, and concomitant use of
other drug products must also be understood.
Benefits of TDM
Used for treating diseases of which their clinical end points can hardly be monitored, e.g. blood pressure, heart rate, cardiac
rhythm, blood sugar, blood cholesterol and triglycerides, urine volume, body temperature, inflammation, pain, and headache.
For drugs with a poor relationship between dose and serum drug concentrations (SDC)
For drugs with a good relationship between serum SDC and therapeutic/toxic effects
For drugs with complicated/non-linear pharmacokinetics.
When clinical signs of toxicity of drug difficult to recognized.
For patients that have other co-morbidities which can alter pharmacokinetic parameters (e.g. congestive heart failure)
Example of drugs in which TDM is useful
•
Antibiotics e.g. gentamicin, amikacin and vancomycin
•
Immunosuppressant e.g. cyclosporine
•
Cardiac drugs e.g. digoxin, lidocaine
•
Bronchodilator e.g. theophylline
•
Anticancer e.g. methotrexate
•
Psychoactive drugs e.g. lithium
•
Antiepileptic e.g. phenytoin, carbamazepine, valproic acid and phenobarbitone
Proper drug monitoring will decrease duration of hospital stay, increase productivity of hospital staff and improve quality of life for patients.
Therefore, input from pharmacists is very important in TDM, hence the need for a TDM pharmacist to undergo comprehensive training and
continuing education in order to satisfy minimum standards of competency. They are also encouraged to participate in professional societies with
an interest in TDM such as the International Association for Therapeutic Drug Monitoring and Clinical Toxicology.
by Yeoh Suang Meng (formerly from KK Dato’ Keramat)
6
Vol 2, 2012
National Tuberculosis (TB) Control Program & Strategies The National TB Control Program was set up in 1961 to control and
reduce the prevalence of TB throughout the country. The program, now
under the Section of Communicable Diseases, Disease Control Division
of the Department of Public Health, MOH, was decentralized in 1995
so that states are responsible for their own TB control and prevention
measures.
The objectives of the Malaysian TB Control Program, consistent with
WHO objectives, are
(i)
to reduce the prevalence rate by half by 2010;
(ii) to ensure an 85% cure rate among newly detected smear positive
cases;
(iii) to ensure that 100% of smear-positive cases are on Directly
Observed Therapies (DOTS) by 2005
(iv) to detect at least 70% of estimated smear-positive cases.
Strategies towards attaining the objectives of the TB Control Program
include:
(i)
BCG vaccination for all newborn babies;
(ii) Screening of symptomatic cases and high-risk groups (mandatory
screening of foreign workers and HIV patients in prisons and drug
rehabilitation centers)
(iii) Raising awareness of the disease through the mass media
(iv) Training health staff about the disease
(v) Conducting research related to TB epidemiology and treatment
outcomes.
ALL IN A DAY’S WORK!
However, TB still remains the most serious infectious disease in
Malaysia, in terms of incidence and deaths. The key challenges that
remain in combating TB in Malaysia include:
(i) Increasing awareness of the disease among clinicians, medical
personnel and the public.
(i) Reducing poverty and optimizing access to medical facilities,
especially in rural and remote areas.
(ii) Ensuring 100 per cent of identified cases are incorporated into the
DOTS program
(iii) Achieving more effective follow-up of patients who are defaulting
on their treatment regime;
(iv) improving the screening and routine monitoring of infected
migrant workers to increase treatment and reduce infection;
(v) Curbing the accelerating occurrence of co-infection with HIV
(vi) Pre-empting and/or dealing with the rise of multi-drug resistant TB
Disediakan oleh KK Setapak
7
Vol 2, 2012
Quality Use of Medicine – Consumer (QUM-C)
Irrational drug usage has been identified as one of the global issues during 2nd “International Conference on Improving the Use of Medicine”
held on April 2004. From a research carried out by WHO in 2002, 50% from overall prescribed, dispensed or sold medication are irrational and it
was reported that 50% of the patient failed to use medication the right way. Thus, this leads to the implementation of Quality Use of Medicine –
Consumer (QUM-C) by Ministry of Health to deal with this important issue.
Below are the specific objectives of QUM-C:
1. To increase consumer awareness on rational use of medicine and their right to get information on medication.
2. To provide knowledge on issues related to medicine and health.
3. To provide educational program to improve the consumer’s knowledge Adverse Drug Reaction.
A total of 69 activities were carried out from January – June of 2012 in all health clinics, hospital and headquarters of Pharmaceutical Services
Division; Federal Territory of Kuala Lumpur and Putrajaya.
By Maisara Abdul Rahman
Campaign merchandises for QUM-C activities from Pharmaceutical Services Division, Ministry Of Health.
Clockwise from right: money box, plastic fan, pouch, posters and key chain.
8
Vol 2, 2012
How does a drug get listed in the Ministry of Health (MOH)?
WHAT?
The formulary consists of drugs approved for use in all hospitals/Institutions in the Ministry of Health.
WHY?
The Formulary is to promote rational, cost-effective use of drugs whereby newer and effective drugs were introduced in a controlled manner so as to
minimize wastages and funds set aside for the purchase of drugs are optimally used.
HOW?
1. Specialist/ Medical Officer/ FMS/ Pharmacist would first fill a proforma with clinical references/ papers which would then be reviewed by the
hospital/ health Drug Committees.
2. If approved, the proposal would then be reviewed by State Drug Committees.
3. If approved by the State Drug Committees, it would then be reviewed by Pharmaceutical Services Division, MOH, which would receive
feedbacks from Technical Drug Working Committees.
4. And finally, if the proposal is approved by the MOH Drug List Review Panel, the result would then be informed to all state/MOH institutions via
drug circular and the drug would be listed in the formulary.
Appplication of Proforma and Approval Status 2011
1
2
3
4
5
6
7
8
Proforma appplication
Approval Status (state level)
Approval Status (national level)
Proforma B – Somatropin 10mg/1.5ml
Proforma - Nicotine Gum 2mg & 4 mg
Proforma - Novomix 30
Proforma D – SAXAGLIPTIN 2.5mg & 5mg
Proforma D - TOCILIZUM 80mg/200mg/400mg
Proforma B – ETANERCEPT 50mg Inj
Proforma B - Metformin/Glibenclamide 500mg/2.5mg & 500mg/5mg tablets
Proforma B - Amlodipine/Valsartan: 5/160mg & 10/160mg
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
No
Yes
No
Yes
In Progress
In Progress
Application of new drugs to be listed in Formulary (Kesihatan) JKWKL 2011
1
2
3
4
5
6
Listed in Klinik Kesihatan
Listed in Klinik 1 Malaysia
Listed in KKIA
Listed in Emergency trolley
Amoxicillin Trihydrate 125 mg/5 ml Syrup
Nicotine patch 5mg, 10mg, 15mg/16 hour
Levonorgestrel & ethinyloestrodil 100mcg/20mcg (Loette)
Aqueous Cream
Heparin Sodium 50unit in NaCL Injection
Paracetamol 125mg Supp
Paracetamol 250mg Supp
Diazepam Rectal Slution 5mg
NaCl 0.9% Irrigation
Nil
Nil
9
Vol 2, 2012
Kajian penyelidikan 2012 :
A randomised controlled trial to determine the impact of the medication adherence aid
(Websterpak®) among geriatric patients in government health clinics of Kuala Lumpur
•
Kajian luar menunjukkan kepatuhan (adherence) kepada ubat-ubatan adalah sukar bagi
semua pesakit terutamanya pada warga tua dan mereka yang mempunyai penyakit kronik.
•
Kajian ini telah dilakukan oleh Bahagian Perkhidmatan Farmasi, JKWPKL&P untuk melihat
keberkesanan Websterspak ® sebagai alat bantuan kepatuhan ubat-ubatan di kalangan
pesakit geriatrik (warga tua > 60 tahun).
•
Sebanyak 420 pesakit kencing manis dan / atau hipertensi dari 6 buah klinik kesihatan
di JKWPKL&P dari November 2010 hingga Julai 2011 telah dipilih menggunakan kaedah
systematic sampling.
•
Daripada jumlah ini, hanya pesakit berkepatuhan rendah dan sederhana dipilih dan
dibahagikan kepada 2 kumpulan iaitu kawalan atau intervensi (Websterspak ®).
•
Keberkesanan kajian telah diukur dengan menggunakan kaedah kiraan baki pil dan penilaian
klinikal (tekanan darah & HbA1c) untuk lebih 3 lawatan susulan.
•
Keputusan menunjukkan halangan utama kepada pematuhan ubat adalah terlupa iaitu
sebanyak 43.3%.
•
Terdapat pengurangan signifikan dalam tekanan darah sistolik purata dalam ketiga-tiga
lawatan (p <0.001) bagi kumpulan Websterspak ®.
•
Kumpulan Websterpak juga telah menunjukkan pengurangan HbA1c yang signifikan (Min
Perbezaan = 0,286; 95% CI 0,089, 0,481, p = 0.005) berbanding dengan Kumpulan Kawalan.
•
Secara ringkas, Websterspak ® adalah alat yang berguna dalam meningkatkan pematuhan
ubat dan keputusan klinikal di kalangan warga tua yang mengambil ubat-ubatan oral kronik.
Disediakan oleh Tham Su Ann
Aktiviti-Aktiviti yang telah dilaksanakan oleh Cawangan Penguatkuasa Farmasi
Kuala Lumpur dari bulan Januari hingga September 2012
AKTIVITI
TARIKH
Kursus
Bengkel Asas Pembangunan Laman Web dengan Drupal
Kursus Pengurusan Bahan Kimia
Team Building
Kursus Pengumpulan Keterangan Kes-kes Pemilikan dan Kaunterfeit
Kursus Komunikasi dan Integriti
13 Februari 2012–14 Februari 2012
19 Mac 2012–20 Mac 2012
11 Mei 2012–13 Mei 2012
29 Mei 2012–31 Mei 2012
13 Jun 2012–15 Jun 2012
CME
Meningkatkan kecekapan serbuan dan pendakwaan
Faktor memberatkan hukuman
Pemeriksaan Premis
17 Februari 2012
16 Mac 2012
09 April 2012
Dialog
Dialog bersama NST
Dialog dengan pemborong ubat terkawal di Chow Kit, Kuala Lumpur
Dialog dengan pemborong Lesen B
Dialog dengan pemborong ubat terkawal di Chow Kit, Kuala Lumpur
23 Mac 2012
24 Mei 2012
10 September 2012
24 Mei 2012
Ceramah dan pameran
•
•
Sepanjang Tahun
•
•
•
•
•
Sekolah-sekolah menengah
Badan Kerajaan seperti Pusat Latihan Polis, Pejabat Perdagangan
dalam Negeri, Koperasi dan Kepenggunaan
Universiti
Kelab-kelab Rukun Tetangga
Klinik Kesihatan
Dewan orang ramai
Tempat-tempat awam seperti sambutan Hari Belia.
10
Jumlah Ceramah: 24
Jumlah Pameran: 30
Perkhidmatan Kerajaan
di Telefon Bimbit Anda
Vol 2, 2012
Projek Inovasi 2012
- MyPHAStrack
Kesinambungan daripada perkhidmatan Pharmacy Appointment System
(Phas), Bahagian Perkhidmatan Farmasi JKWPKL&P pada tahun ini telah
mengambil inisiatif untuk mewujudkan satu projek Inovasi yang diberi
nama MyPHAStrack. Ia telah mula digunakan di Unit Farmasi, Klinik
Kesihatan Jinjang sejak September 2011 dan melepasi tempoh enam
bulan penggunaannya.
Untuk makluman warga JKWPKL&P, hampir semua Unit Farmasi di
Tercetusnya idea untuk memulakan sistem ini disebabkan oleh terdapat
kesukaran dan kerumitan dalam proses perekodan data, semakan
data, pencarian lokasi ubat dan penyediaan laporan bagi 3 jenis sistem
temujanji pesakit sediada . Projek ini dikelaskan dalam kategori Inovasi
Teknologi dan merupakan ciptaan asli yang menggunakan perisian
Microsoft Access yang sedia ada di Unit Farmasi Klinik Kesihatan Jinjang
fasiliti JKWP&P telah melaksanakan Pharmacy Appointment System
– ada di semua 14 fasiliti
Hasilnya membolehkan proses pendispensan ubat adalah lebih
lancar, tersusun dan pantas kerana data-data penting pesakit dan
ubat-ubatan telahpun tersimpan di dalam sistem komputer. Program
ini tidak menggunakan sebarang kos kerana ia hanya menggunakan
perisian Microsoft Access yang sedia ada di dalam komputer di fasiliti
masing-masing.
Satu kemudahan flexible kepada pesakit untuk mendapatkan
Ahli kumpulan projek MyPHAStrack ini merangkumi:
(PhAS) iaitu perkhidmatan tambah nilai dengan membolehkan
pesakit mengambil ubat susulan dengan lebih mudah dan fleksibel:
1. Sistem Pendispensan Ubat Bersepadu (SPUB)
bekalan ubat susulan dari mana-mana fasiliti Farmasi di
bawah KKM(tidak termasuk KKIA & K1M) yang berdekatan
dengan tempat kediaman pesakit melalui sistem rujukan
yang seragam.
1. Tuan Syed Fadzli bin Syed Sailuddin, Ketua Penolong Pengarah
Kanan (Amalan & Perkembangan), Bahagian Perkhidmatan Farmasi,
JKWPKL&P.
2. Nor Haizan binti Ibrahim@Ghazali, Pegawai Farmasi U44, Klinik
Kesihatan Jinjang.
2. SMS dan Ambil (MySMS Ubat)
– ada di semua 14 fasiliti
Pesakit tidak lagi perlu beratur atau menunggu lama, hanya
dengan cara menghantar pesanan ringkas (SMS) tentang
butiran nama & no pendaftaran (MRN/IC) beserta tarikh dan
masa yang diingini sebelum datang mengambil ubat ke satu
nombor 15888. Ia juga merupakan projek kerjasama antara
3. Anthony Sandur, Penolong Pegawai Farmasi U36, Klinik Kesihatan
Jinjang.
4. Grace Tan Poh Lian, Penolong Pengarah Kanan Farmasi, Cawangan
Amalan & Perkembangan, Bahagian Perkhidmatan Farmasi, JKWPKL&P.
5. Maisara binti Abdul Rahman, Penolong Pengarah Farmasi, Cawangan
Pengurusan Farmasi, Bahagian Perkhidmatan Farmasi, JKWPKL&P.
JKWPKL&P dengan pihak MAMPU dengan menyediakan
gerbang kerajaan iaitu portal MySMS 15888 untuk tujuan ini.
3. Perkhidmatan Ubat melalui Pos 1Malaysia (UMP 1M)
– ada di 50% 14 fasiliti
Perkhidmatan pembekalan ubat susulan terus ke lokasi pilihan
pesakit melalui pos dengan caj kiriman yang telah ditetapkan.
Pesakit akan membayar kos penghantaran kepada posmen
semasa ubat diterima.
11
Vol 2, 2012
Alternative Birth Centre
(MAIWP-Majlis Agama Islam Wilayah Persekutuan)
Alternative Birth Center (ABC) 1 Malaysia (Majlis Agama), Presint 8 adalah satu projek kerjasama di antara Majlis Agama Islam Wilayah Persekutuan
(MAIWP) dan Kementerian Kesihatan Malaysia (KKM). Projek ini dilaksanakan bertujuan untuk mengurangkan kesesakan di Bilik Bersalin dan juga
di wad Obstetrik dan Ginekologi di Hospital Putrajaya yang semakin hari menerima kehadiran pesakit yang semakin meningkat. Pusat ini telah
beroperasi pada 25hb Januari 2012 dan telah dirasmikan oleh Perdana Menteri Malaysia, Dato’ Sri Mohd Najib bin Tun Haji Abdul Razak pada
19hb April 2012. Unit Farmasi di dalam ABC memainkan peranan penting dengan menyediakan perkhidmatan Farmasi Pesakit Luar dan Farmasi
Pesakit Dalam.
Farmasi Pesakit Luar membekal ubat-ubatan yang dipreskrib oleh Pegawai Perubatan dari Atenatal klinik, Post Acute Care (PAC), Klinik Obstetrik/
Ginekologi dan juga dari Klinik Kesuburan. Selain itu, Unit Farmasi juga menyediakan sebarang informasi mahupun perkhidmatan kaunseling
dalam meningkatkan kefahaman pesakit semasa menerima ubat-ubatan dari Farmasi Pesakit Luar. Selain itu, Unit Farmasi Pesakit Dalam juga
berperanan membekalkan ubat-ubatan dan melakukan pendispensan di wad bagi pesakit yang akan discaj. Pesakit yang akan discaj akan
diberikan penerangan mengenai ubat-ubatan yang diberikan agar penggunaan ubat adalah secara berkualiti. Dengan kewujudan pusat seperti
ABC ini, kesesakan di Bilik Bersalin dan wad O&G boleh dikurangkan dan pada masa yang sama seiring dengan peningkatan kualiti perkhidmatan
yang disediakan oleh Kementerian Kesihatan Malaysia khususnya Unit Farmasi.
Disediakan : Mohd Syafiq (Klinik Kesihatan Persint 3 Putrajaya)
Aktiviti-Aktiviti Perkhidmatan Maklumat Ubat (DIS)
Perkhidmatan Maklumat Ubat( DIS) merupakan satu jawatankuasa Jabatan Kesihatan Wilayah
Persekutuan Kuala Lumpur & Putrajaya (JKWPKL&P). Bagi tahun 2012, pelbagai aktiviti telah
dijalankan oleh ahli jawatankuasa Perkhidmatan Maklumat Ubat( DIS) iaitu, Majalah Ulang Tahun
Farmasi, Buletin Farmasi, Program Medication Error Reporting System (MERS) dan Adverse Drug
Reaction (ADR).
Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur & Putrajaya (JKWPKL&P) telah ditubuhkan
selama 10 tahun. Bersempena dengan ulang tahun yang ke-10, ahli jawatankuasa DIS telah
merancang untuk menerbitkan sebuah majalah ulang tahun untuk Bahagian Farmasi. Majalah
ulang tahun JKWPKL&P ini bertajuk “Memoirs of Decade” dan penerbitannya di jangka akan siap
pada akhir tahun 2012. Majalah ulang tahun ini mengandungi sejarah dan pencapaian semua
fasiliti di JKWPKL&P termasuk Hospital Putrajaya, Klinik Kesihatan, Stor Farmasi Kesihatan Awam
dan Bahagian Penguatkuasa Farmasi. Selain itu, majalah ulang tahun ini turut memaparkan aktiviti
dan program yang telah dijalankan di JKWPKL&P seperti program Quality Use of Medicine (QUM)
dan aktiviti 5s.
Selain daripada Majalah ulang tahun dan Buletin Farmasi, DIS juga bertanggungjawab dalam usaha
menjayakan Program Medication Error Reporting System (MERS) dan Adverse Drug Reaction (ADR).
Satu Kursus MERS dan ADR telah diadakan oleh DIS pada 29 Mei 2012 di Hospital Putrajaya selama
sehari untuk semua warga JKWPKL&P termasuk pegawai perubatan, pegawai farmasi, penolong
pegawai perubatan dan jururawat. Kursus ini bertujuan untuk memberi kesedaran kepada warga
JKWPKL&P mengenai MERS dan ADR supaya semua medication error dapat dilaporkan dan pesakit
dapat menerima rawatan yang berkualiti.
Disediakan : E Cheang Khor (KK Sg Besi)
12
Vol 2, 2012
Denggi
Agen Penyebab Penyakit Denggi
Penyakit denggi disebabkan oleh sejenis kuman virus yang dipanggil
virus denggi. Virus ini tergolong di dalam keluarga Togaviridae. Ia
merupakan virus yang berkembang biak dalam serangga. Terdapat
empat jenis ‘serotype’ virus yang telah dikenalpasti iaitu Den 1,
Den 2, Den 3 dan den 4. Semua jenis serotype ini boleh meransang
meransang pembentukan antibodi yang berbeza-beza. Namun begitu
kekebalan yang dihasilkan oleh pertahanan badan tidak menyeluruh
terhadap semua jenis virus denggi. Ia akan hanya melindungi individu
untuk jenis virus tersebut sahaja. Virus ini masuk ke dalam peredaran
darah manusia melalui gigitan nyamuk aedes dan boleh didapati
dalam tempoh yang singkat sahaja iaitu 4 hingga 5 hari pada tahap
awal penyakit.
Statistik Denggi
Bagi tempoh 1 Januari hingga 30 Jun 2012, sebanyak 11 794 kes
denggi telah dilaporkan manakala 24 kematian denggi telah dicatatkan
di Malaysia. Kebanyakan kes dilaporkan di kawasan urban, di mana
46% (5 422) daripada kes tersebut dilaporkan di negeri Selangor
manakala 10% (1129) dilaporkan di WPKL & Putrajaya. Bagi WPKL
dan Putrajaya, ini merupakan peningkatan sebanyak 21% berbanding
tempoh yang sama pada tahun 2011. Zon Titiwangsa merakamkan
36% (407) daripada jumlah kes WPKL dan Putrajaya.
Tanda-tanda serangan penyakit Denggi
Demam kuat secara mengejut dan berterusan
Ruam pada kulit
Sakit tulang, otot, sendi, biji mata dan kepala
Hilang selera makan
Muntah-muntah
Apa itu Denggi?
Sakit perut
Penyakit denggi adalah suatu penyakit berjangkit merbahaya yang
boleh membawa maut. Denggi biasa terjadi di kalangan orang dewasa
dan kanak-kanak akibat dari gigitan nyamuk Aedes. Penyakit ini
biasanya berlarutan selama 10 hari dan kadang-kadang memerlukan
masa yang lama untuk sembuh sepenuhnya.
Perdarahan pada badan , hidung dan mulut
Langkah Kawalan Denggi
Sistem pemantauan
Semburan asap
Jenis-jenis penyakit Denggi
Pemeriksaan premis untuk mencari dan memusnahkan jentik-jentik
•
Demam denggi klasikal
Menggalakkan penggunaan abate
Pesakit menunjukkan gejala demam, ruam, sakit badan, sakit
sendi dan sakit otot. Gejala penyakit ini biasanya tidak teruk dan
jarang menyebabkan kematian. Demam jenis ini juga pernah
dinamakan ‘demam patah tulang’ atau ‘breakbone fever’
Mengedarkan risalah dan pemberitahuan mengenai langkah
pengawalan pembiakan nyamuk aedes
•
Meminta kerjasama pengetua dan guru besar bagi menggerakkan
pelajar bersama memeriksa halaman dan dalam rumah
Demam denggi berdarah
Biasanya terjadi di kalangan kanak-kanak terutama dalam
lingkungan umur 2 hingga 13 tahun. Pada tahap awal (selama
2 hingga 4 hari) gejala yang dihidapi adalah sama seperti
demam denggi klasikal dan diikuti oleh tahap yang lebih teruk
dengan gejala seperti tekanan darah rendah, ruam dan bintikbintik merah di badan, perdarahan gusi, berak berdarah (najis
berwarna hitam) disertai dengan sawan dan tidak sedar diri.
Ia sering menyebabkan kematian jika rawatan tidak diberikan
dengan segera.
Di sediakan : Carolyn Marie Peter (KK Pantai)
13
Vol 2, 2012
Teknik Penggunaan Inhaler
4. Masukkan corong ke dalam mulut dan rapatkan
bibir. JANGAN menggigit corong.
Inhaler merupakan alat yang digunakan untuk memberi ubat secara
sedutan. Penggunaan inhaler dapat membantu memulihkan sistem
pernafasan pesakit untuk kembali bernafas secara normal. Terdapat
pelbagai jenis inhaler dalam pasaran. Antaranya adalah Meter dosed
inhaler (MDI). Ubat adalah dalam bentuk aerosol. Contohnya seperti
salbutamol dan terbutaline. Teknik penggunaan inhaler yang betul sangat
penting untuk memastikan keberkesanan rawatan. Inhaler terbahagi
kepada 2 komponen penting, iaitu ‘canister’ dan ‘actuator’.
Disediakan oleh KK Sentul
1. Buka penutup inhaler dan pegang inhaler pada
posisi menegak seperti yang ditunjukkan oleh
diagram.
5. Tekan canister dan serentak itu, tarik nafas (melalui
mulut) sedalam yang mungkin. Tahan nafas anda
sekurang-kurangnya selama 8 hingga 10 saat.
2. Goncang inhaler 3 hingga 5 kali secara menegak
untuk mencampurkan kandungan ‘canister’.
6. Keluarkan inhaler dari mulut dan kemudian hembus
nafas secara perlahan.
3. Hembus nafas keluar secara perlahan melalui mulut.
JANGAN hembus ke dalam corong actuator.
7.
Tutup semula inhaler dengan penutup. Sekiranya memerlukan lebih
daripada satu sedutan, ulangi langkah ke-2 hingga ke-6 untuk sedutan
seterusnya selepas 30 saat hingga 1 minit.
Sekiranya anda menggunakan inhaler
corticosteroid seperti budesonide,
beclomethasone atau flixotide, anda
disarankan supaya kumur mulut anda
dengan air dan buang air kumuran
tersebut.
14
Vol 2, 2012
Cara-cara penggunaan alat pernafasan yang betul
ACCUHALER
5
1
Pegang bahagian luar Accuhaler dengan satu tangan sambil meletakkan ibu jari tangan sebelah di bahagian pegangan ibu jari.
Tolak bahagian pegangan ibu jari sehingga kedengaran bunyi klik.
2
Gelongsorkan penyungkat sehingga kedengaran bunyi klik.
(Nombor di kaunter dos akan menunjukkan kiraan satu dos).
3
Hembus nafas keluar untuk mengosongkan rongga pernafasan tetapi jangan menghembus ke dalam Accuhaler.
4
Letakkan bahagian penyedut pada bibir anda, sedut dengan perlahan dan mendalam melaluinya.
Keluarkan Accuhaler dari mulut anda.
Tahan nafas selama lebih kurang 10 saat atau selama yang boleh.
Hembus nafas dengan perlahan melalui hidung.
Tarik balik pegangan ibu jari Accuhaler hingga tutup.
Penyungkat akan kembali ke posisi asalnya.
Accuhaler anda kini sedia digunakan sekali lagi.
5
TURBOHALER
1
Tanggalkan penutup dengan memusingkannya.
2
Pegang Turbuhaler secara menegak.
Putarkan pemegang ke kanan dan kemudian
ke kiri sehingga kedengaran bunyi klik.
3
Hembus nafas keluar untuk mengosongkan
rongga pernafasan.
4
Letakkan muncung saluran mulut di antara dua
bibir anda.
Tarik nafas sedalam mungkin melalui mulut
anda.
5
Disediakan oleh KK Petaling Bahagia
15
Vol 2, 2012
Handihaler (Spiriva®)
1
2
3
4
5
6
7
8
9
10
11
12
1. Tekan butang warna hijau untuk membuka Handihaler.
2. Buka penutup dengan menariknya ke atas.
3. Kemudian buka penekup mulut.
4. Pisahkan jalur blister dengan mengoyakkan pada garisan keratan.
5. Kopek belakangnya (hanya sejurus sebelum digunakan) menggunakan tangan sehingga
satu kapsul penuh boleh dilihat. Keluarkan kapsul.
6. Dengan penekap mulut dibuka, masukkan sebiji kapsul ke dalam ruang tengah Handihaler.
7. Tutup penekup mulut dengan ketat sehingga anda mendengar bunyi klik, sambil membiarkan penutup terbuka.
8. Pegang alat Handihaler dengan penekup mulut ke atas dan tekan butang penekup sekali supaya masuk sepenuhnya, dan kemudian lepaskan. Ini
akan menebuk lubang pada kapsul dan membenarkan ubat dikeluarkan apabila anda menarik nafas.
9. Hembuskan nafas keluar sepenuhnya.
10. Letakkan alat Handihaler ke mulut anda dan lekapkan bibir anda pada keliling penekup mulut.
11. Angkat kepala anda supaya selari dengan Handihaler dan tarik nafas panjang secara perlahan-lahan tetapi pada kadar yang cukup untuk
mendengar kapsul berdetar. Tariks nafas sehingga paru-paru anda penuh; kemudian tahan nafas sepanjang yang mungkin dan pada masa yang
sama tarik alat Handihaler keluar daripada mulut. Teruskan bernafas seperti biasa.
12. Buka penekup mulut sekali lagi. Keluarkan kapsul yang telah digunakan dan buang.
Tutup penekup mulut dan penutup untuk menyimpan alat Handihaler anda.
Disediakan oleh KK Petaling Bahagia
Ruangan ketawa!
16
Vol 2, 2012
Kawalan iklan ubat dan perkhidmatan di bawah Akta Ubat
(Iklan & Penjualan 1956)
Apakah iklan?
Apakah iklan-iklan yang dilarang?
Iklan termasuklah sebarang notis , laporan, risalah , label , ulasan, pembalut
atau dokumen lain dan sebarang pengumuman yang dibuat secara lisan
atau dengan sebarang cara bagi mewujudkan atau memancarkan cahaya
atau bunyi. (Seksyen 2 Akta Ubat Iklan dan Penjualan 1956).
Adalah menjadi satu kesalahan mengiklankan tentang:
1. 20 penyakit iaitu:
- Penyakit/kerosakan buah pinggang
- Penyakit/kerosakan jantung
- Kencing manis
-Sawan
-Lumpuh
- Batuk kering
-Asma/lelah
-Kusta
-Kanser
-Pekak
- Ketagihan dadah
-Hernia
- Penyakit mata
- Tekanan darah tinggi
-Kemandulan
-Frigiditi
- Lemah fungsi seks
- Penyakit Vunerus
- Kelemahan urat saraf atau kelemahan lain timbul daripada
atau berhubung dengan perhubungan seks
Contoh iklan:
Iklan di television, radio, majalah, akhbar, risalah, internet, bunting, slot
program tv, talk show, iklan di kenderaan awam, testimoni atau advertorial.
Mengapa iklan ubat, produk kesihatan dan perkhidmatan perubatan
dikawal?
Iklan mengenai ubat, produk kesihatan dan perkhidmatan dikawal oleh
Kementerian Kesihatan Malaysia kerana terdapat banyak iklan-iklan yang
mengelirukan pengguna. Terdapat penjual ubat atau produk kesihatan
yang menggunakan tuntutan (claim) perubatan yang berlebih-lebihan
serta menggunakan indikasi yang tidak diluluskan bagi tujuan menarik
minat pembeli untuk mendapatkan produk mereka. Terdapat juga kes di
mana produk yang diiklan tidak berdaftar dengan Kementerian Kesihatan
Malaysia di mana kualiti, keberkesanan dan keselamatannya diragui. Halhal ini tentunya akan membahayakan keselamatan pengguna.
Bagaimana iklan ubat, produk kesihatan dan perkhidmatan perubatan
dikawal?
Semua iklan berkenaan ubat, produk kesihatan dan perkhidmatan perlu
mendapat mendapat kelulusan dari Lembaga Iklan Ubat, Kementerian
Kesihatan Malaysia.
Iklan yang telah diluluskan akan diberikan nombor pendaftaran. Contoh:
KKLIU/2012/ABC.
Contoh iklan yang dilarang
2. Amalan Pencegahan Kehamilan
3. Memperbaiki fungsi / keupayaan seksual manusia
4. Pengguguran anak
5. Pengiklanan tanpa Kelulusan Lembaga Iklan Ubat
Tanggungjawab Siapa??
Adalah menjadi tanggungjawab semua yang terlibat dalam pembuatan
dan penyiaran iklan untuk memastikan iklan tersebut mendapat
kelulusan dari Lembaga Iklan Ubat dan menggunakan format iklan
yang sama seperti format yang telah telah diluluskan oleh Lembaga
Iklan Ubat.
Sesiapa yang melakukan kesalahan boleh didenda sehingga
maksimum RM 3000 atau 1 tahun penjara atau kedua-duanya sekali
(Seksyen 5(1) Akta Ubat (Iklan & Penjualan 1956).
Contoh iklan produk kesihatan yang dilarang
17
Vol 2, 2012
Intrastate Staff Movement
No. Date
Name
From
To
1
13/12/11
Lim Li San
Cawangan Penguatkuasa Farmasi
Klinik Kesihatan Putrajaya Presint 9
2
15/12/11
Abdul Halim b. Mohamad Yasin
Stor Farmasi, JKWPKL&P
Klinik Kesihatan Tanglin
3
3/1/12
Nur Sohaila Bt Abd Jalil (PPF)
Klinik Kesihatan Jinjang
Klinik Kesihatan Jinjang (naik pangkat)
4
3/1/12
Phang Swee Kiow (PPF)
Klinik Kesihatan Jinjang
Klinik Kesihatan Bandar Tun Razak
5
16/1/12
Norjamiah binti Taufik
Cawangan Amalan dan Perkembangan Farmasi
6
17/1/12
Mastura binti Mat Rudin
Cawangan Pengurusan Farmasi
7
30/1/12
Syarifah Mariam Adlina bt Syed Mohd Gawi
Klinik Kesihatan Batu
Klinik Kesihatan Putrajaya Presint 14
8
2/2/12
Law Phuay Fhren
Klinik Kesihatan Cheras Baru
9
13/2/12
Nurul Husna Binti Hassim
Klinik Kesihatan Kg Pandan
Hosp Putrajaya
10
20/2/12
Ho Ai Wui
Klinik Kesihatan Sg Besi
11
22/2/12
Ng Jia Xing
Klinik Kesihatan Sg Besi
12
27/4/12
Saranjeevi a/l Nalayah
13
15/5/12
Ong Ser Via
Cure & Care Sg Besi
14
16/7/12
Yeoh Suang Meng
Klinik Kesihatan Dato' Keramat
Sleep Keeps the Kilos at Bay
Growing evidence suggests a good sleep routine plays an important part in weight control- with a
study from the Mayo Clinic showing sufficient sleep is needed to keep our calorie intake on track.
Study participants who slept for 80 minutes less than a control group consumed on average
an extra 550 calories each day. “Research shows that when people are sleep deprived there
are changes inside the brain and this could be driving them to eat even more,” says study coinvestigator Dr Andrew Calvin. The hormones linked to hunger may be upset, too. “Even though
they (sleep deprived study participants) produced the signal telling them they were full, they still
consumed extra calories.”
18
Vol 2, 2012
Staff Transfer
No. Date
Name
From
To
1
16/12/2011
Mursyidah bt Mohd Merzuki
HKL
Klinik Kesihatan Kg Pandan
2
27/12/2011
Rajeswaran a/l Ramalingam
PRP, Hospital Sultanah Nur Zahirah,
Hospital Putrajaya
3
27/12/2011
Nur Khairrunnisa bt Abdul manaf
PRP, Hospital Seremban
4
27/12/2011
Lee Sau Fong
HKL
5
2/1/2012
Kamarulzaman bin Yusof
BPF, KKM
6
9/1/2012
Mohammad Harian Bin Ahmad (PPF)
BPF, KKM
7
16/1/2012
Geetha a/p Gopi Nathan
Klinik Kesihatan Jelebu N. 9
Hospital Putrajaya
8
16/1/2012
Mohd Zayyid Shafie
Cawangan Amalan & Perkembangan, BPF, JKNSelangor
9
16/1/2012
Parvathy a/p Sukumaniam
Hosp. Tapah
10
18/1/2012
Tham Su Ann
Hosp Tuanku Ja'afar
Penguatkuasa Farmasi
11
30/1/2012
Daphne Gima
Hospital Miri
Hospital Putrajaya
12
2/2/2012
Nurul Ain bt Mohd Arop
Bhg. Kawalan dan Peralatan Perubatan,IPKKM
Hospital Rehabilitasi Cheras
13
2/2/2012
Norumizah Bt Sidek
KK Peramu Jaya
Hospital Putrajaya
14
8/2/2012
Pn Salmiah bt Sharudin
Hosp. Changkat melintang
Klinik Kesihatan Cheras
15
13/2/2012
Goh Siew Ying
CPF, Sarawak
16
17/2/2012
S. Sevanthinathan a/l C. Sundram
TCM, KKM
17
20/2/2012
Khoo Yin Ing
PRP, HUKM
18
1/3/2012
Mithra Thuraisingam
PRP, HKL
Klinik Kesihatan Sentul
19
5/3/2012
Yap Ying Hui
PRP, Hospital Pakar Sultanah Fatimah
20
16/3/2012
Nur Amalina binti Mohd Azam
PRP, HUKM
21
16/3/2012
Pn Rohana binti Hassan
22
2/4/2012
Fety Rozina binti Mat Ridzuan
PRP, Hospital Sultan Haji Ahmad Shah
23
2/4/2012
Kamarul Azhar bin Kamaruddin
Bahagian Kawalan Peralatan Perubatan, KKM
24
16/4/2012
Ong See Wan
Bahagian Perkhidmatan Farmasi Negeri Sembilan
Hospital Rehabilitasi Cheras
25
16/4/2012
Nadia Nurazleena binti Azman
Hospital Tengku Ampuan Afzan
26
16/4/2012
Nek Nur Ashikin binti Nek Zahiruddin
Hospital Port Dickson
27
17/4/2012
Nor Baizura binti Noh
PRP, Hospital Selayang
28
17/4/2012
Winnie Shekila a/p Surendran
PRP, HUKM
Klinik Kesihatan Cheras
29
2/5/2012
Wong Chui Shin
PRP, PPUKM
Klinik Kesihatan Petaling Bahagia
32
25/6/2012
Nuruz Zakiah binti Md Zin
PRP, Hospital Putrajaya
Klinik Kesihatan Presint 14
33
25/6/2012
Chua Pei Tiang @ Jeanne Arianna Abdullah
PRP, Hospital Tengku Ampuan Rahimah
Klinik Kesihatan Presint 9
Hospital Putrajaya
19
Vol 2, 2012
Discovered :
How Alzheimer Spreads?
On February 1, 2012, scientists at the University of Columbia, New York,
In nature, mice can’t produce human tau any more than they can
and the Norwegian University of Science and Technology in Trondheim,
produce human arms and legs. If human tau was growing in any region
reported findings that could change the course of how we treat
of the mouse brain other than where scientists had first generated it,
Alzheimer’s Disease (AD). They proved that it spreads through the brain
the only way it could have gotten there is if it had spread from the cells
from the first cell affected, to the one next to it, to the one next to that.
introduced by the scientists.
It damages each connected cell along a predictable path, eventually
destroying a person’s ability to think and remember. Researchers have
Researchers still don’t know the relationship between the plaques and
long known that the worse the symptoms, the more brain area affected.
tangles, but they have theories. “Many researchers think that the plaque
But most of the research centred on the amyloid beta protein plaques
that form between brain cells. Scientists believed they interfered
with signals from one cell to the next, and in doing so caused cells to
part is like the trigger that sets off the disease, and the tangle part is the
executioner that kills the cell,” says Dr Karen Duff, senior author of one
of the mouse studies.
malfunction and possibly die. These plaques seemed to appear decades
What makes these findings important is that if scientists understand
before symptoms occurred.
how the disease progresses, they’ll know what kinds of drugs might
However another abnormal protein, called tau, tangles up inside cells
stop it in its tracks. Thanks to the just announced findings on how
and seems to kill them relatively quickly. But they seemed to show up at
Alzheimer’s spreads, more pharmaceutical companies are turning their
about the same time that Alzheimer’s symptoms begin.
attention to drugs that target the development of tau tangles. However,
In the brains of people who died in the very first stages of the disease,
these tau tangles were always found in one small region called the
it will take several years for a drug to enter the market, assuming if it
proves safe and effective.
entorhinal cortex. People in later stages also had tangles in the in that
One such drug that is being developed is Epothilone D, which is much like
small region-but also in regions directly touching it. Those who died
the chemotherapy agent paclitaxel. Unlike paclitaxel, Epothilone D can
in the last stages had tangles in virtually every cell in the thinking and
enter the brain, and in tests on mice, it is found to “improve the memory
memory regions-areas that were all connected back to the first small
loss”. According to unconfirmed reports, the US biopharmaceutical
region in some way.
company Bristol-Myers Squibb is planning to test Epothilone D on small
Still, scientists couldn’t prove that AD was actually spreading. Maybe,
numbers of Alzheimer’s patients.
some said, all brain cells developed AD at once, but some brain cells
resisted death longer while others succumbed earlier.
Noscira, a Spanish bio-pharma company, is currently testing its tau
tangle-targeting drug Tideglusib on 308 Alzheimer’s patients at 55
Then the scientists implanted abnormal human tau in just the entorhinal
hospitals in 5 European countries. And Canadian company Allon’s drug
cortex region of the brain of genetically engineered mice. They watched
Davunetide has shown promise in small studies of people with mild
as human tau passed from the first brain region to the next, cell by cell.
cognitive impairment.
Disediakan oleh Chua Sin Wee
JAWATANKUASA PERKHIDMATAN MAKLUMAT UBAT DAN RACUN, BAHAGIAN PERKHIDMATAN FARMASI
JKWPKL & PUTRAJAYA, JALAN CENDERASARI, 50590 KUALA LUMPUR
FOR ANY ENQUIRY OR FEEDBACK PERTAINING TO DRUGS, YOU MAY CALL: NATIONAL PHARMACY CALL CENTRE: 1800-88-6722

HAART-Highly Active Antiretroviral Therapy

Transcription

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