Pharmacy Bulletin - Hospital Kuala Kubu Bharu

HOSPITAL KUALA KUBU BHARU
Pharmacy Bulletin
2nd edition / Dis 2013
ISSUE OF THE MONTH : TAKING CARE OF YOUR FAMILY
DURING SCHOOL HOLIDAY (PAGE 1 - 5)


Focus on how to avoid your family from danger when visiting places
like highlands, forests, lake, river, beach
Preparations needed to be done before off to vacation with family
A GLANCE OF PHARMACEUTICAL SCIENCE (PAGE 6 - 8)

Pharmacology : The Importance of Taking Your Medications at the
Right Time

NSAIDs, Anticholesterol agents, Diuretics, Antibiotics, Insulin
KNOW YOUR MEDICINE (PAGE 9 - 16)

Antivirals Available in HKKB : Acyclovir & Oseltamivir

Analgesic @ Painkiller : A review’
PHARMACY EDUCATIONS (PAGE 17 - 22)

G6PD Deficiency- What You Should Know

KUB - The Differences with the General X-Ray Procedure
UPDATES FROM PHARMACY (PAGE 23 - 24)
Sistem Temujanji - Easy Way to collect your Medications
EDITORIAL BOARD
ADVISOR : Cik Ratna Suny Mohamed Esa
CHIEF EDITOR : Raden Azwani R.M Puja Seti
EDITOR : Wan Fazlinawati Bt Wan Ismail
CONTRIBUTORS
1)
2)
3)
4)
5)
Aw Hong San
Choo Huan Ting
Syazyanti Izyanti Mohd Ariffin
Wan Fazlinawati Wan Ismail
Nurulain Abdul Razak
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I S S U E O F TH E MO N T H
Taking Care of Your Family During
School Holiday
BY:
AW HONG SAN
Is holiday season again! Holiday is the time for
family getting together. Every year from mid of
November to January is our nation school
break. During this time of the year, many people
will go for vacation be it the beach, camping in
the forest, the highland or even visiting other
country.
The holiday season is filled with happiness and celebration, but it can also be a
time of danger. During the holiday, we are also exposed to various potentially
harmful activities, environment and other small thing that we used to ignore. So,
are we ready to protect ourselves and our family from the potential danger?
Know Your Medical Condition
Regular medical check-up helps to review your health condition. By knowing your
own health condition you can be prepared before the holiday trip. Some people
with known medical condition such as chronic disease must take their medicine
on a daily basis. Therefore, they need to prepare enough medicine before the
holiday trip. For example, people who has diabetes mellitus required to take insulin injection every day, hence it is important to prepare sufficient insulin for the
whole holiday trip.
First-Aid Kit
First aid is the provision of initial care for an illness or injury. A first aid kit is a
collection of supplies and equipment for use in giving first aid.
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First aid kits come in many shapes and sizes.
Trauma injuries, such as bleeding, bone fractures
or burns, are usually the main focus of most first
aid kits, with items such as bandages and dressings being found in the vast majority of all kits.
You can purchase one local drug. Some kits are
designed for specific activities, such as hiking,
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These alternate uses can be
an important consideration
when picking items for a kit
that may be used in wilderness or survival situations. An
alternative could however also
be the use of additional kits
with tools such as Survival
kits and Mini survival kits.
camping or boating. Whether you buy a first aid
kit or put one together, make sure it has all the
items you may need.
Typical contents include adhesive bandag-
Asthma
es, regular strength pain medication, gauze and
Asthma is a condition in
low grade disinfectant. Remember to include any
which your airways narrow
personal items such as medications and emer-
and swell and produce extra
gency phone numbers or other items your health-
mucus. This can make breath-
care provider may suggest. Check expiration
ing difficult and trigger cough-
dates and replace any used or out-of-date con-
ing, wheezing and shortness
tents.
of breath. It can be a major
Besides its regular use in first aid, many
first-aid items can also have improvised uses in a
survival situation. For example, alcohol pads and
petroleum jelly-based ointments can be used as
problem that interferes with
daily activities and may lead to
a life-threatening asthma attack.
a fire-starting aid in an emergency, and the latter
Asthmatic patient usual-
can even be used as an improvised lubricant for
ly prescribed with a quick-
certain mechanical devices, and adhesive tapes
relieve inhaler or other type of
and bandages can be used for repairs.
medicine to prevent or to relieve the asthma attack.
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These medicines must be kept access to at any
time to as asthma attack can be sudden.
A number of outdoor allergens and irritants —
ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid
those triggers. 3 Some inhaler can be taken before you
do some exercise or sport to prevent the attack of asthma.
Camping in the forest
Camping is a fun way to get family and friends together to enjoy the outdoors.
Follow these tips and use the packing checklist to help ensure your camping trip is
safe and healthy.
Vaccinations can help protect against certain diseases and conditions while
camping. Check with your doctor or nurse to see if you've had all of the recommended vaccines. He or she may recommend tetanus, pertussis (whooping cough), meningitis, and/or hepatitis A, depending on your medical history, destination, and other
factors.
To prevent food poisoning, follow these steps to keep your food safe:

Pack foods in tight, waterproof bags or containers.
Wash hands and surfaces often. Use hand sanitizer
if water is not available.

Separate raw foods from cooked foods.
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Camping is a great way to get physical activity. Do things such as walking,
hiking, biking, or swimming to keep you
active during the camping trip. Be sure to
bring protective gear, such as helmets,
sturdy shoes, and life jackets. Avoid poisonous plants. Know your limits, and take
steps to avoid injury during activities. Never hike or swim alone. Some wild animals
carry diseases that are dangerous to people,
including
rabies,
Hanta-
virus, Giardia infection, and more. Avoid
touching, feeding, and getting near wild
animals. Enjoy watching them from a safe
distance in their natural surroundings
Mosquitoes, ticks, and other insects
can cause certain diseases. For example,
mosquitoes can spread dengue and malaria. To help fight the bite, apply insect
repellent. Used mosquitoes net during
sleep to prevent mosquitoes bite. If travelling to places where malaria is prominent,
you can get some medicine from the doctor for prophylaxis.4
The Pool, Beach, River and Lake
Swimming in the ocean, pool
and river takes different skills, so before you get your feet wet, it’s best to
learn how to swim. You should also
swim only at a lifeguard-protected
beach, within the designated swimming area. Obey all instructions and
orders from lifeguards. While you’re
enjoying the water, keep alert and
check the local weather conditions.
Make sure you swim sober and that
you never swim alone. And even if
you’re confident in your swimming
skills, make sure you have enough
energy to swim back to shore.
Have young children or inexperienced swimmers wear life jackets in
and the around water. No one should
use any other type of floatation device unless they are able to swim.
Don’t dive headfirst—protect your
neck. Check for depth and obstructions before diving, and go in feet first
the first time. Pay especially close attention to children and elderly persons when at the beach.
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Even in shallow water, wave action can
cause a loss of footing. Keep a lookout for aquatic
life. Water plants and animals may be dangerous.
Avoid patches of plants.5, 6
When your skin is exposed to the sun for a
period of time, eventually it burns, turning red and
irritated. Cover any exposed areas of skin liberally
with broad-spectrum sunscreen. That means sunscreen that protects against both UVA and UVB
rays. The sunscreen should have a sun protection
factor (SPF) of at least 30.
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KNOW YOUR MEDICINE
ANALGESICS
@ PAINKILLERS
BY : WAN FAZLINAWATI BINTI WAN ISMAIL
Know your pain score
 Measure the pain intensity by
using the pain scale
 It tends to be more accurate
in the acute pain and not as
helpful for chronic pain
 For chronic pain
multidimensional tools are
more useful in evaluating the
function.
Figure 1: Single dimensional pain scale
Business Name
Figure 2: McGill
Pain
Questionnaire;
multidimensional
tools
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ANALGESICS & PAINKILLERS
Know your options of treatment
LIST OF ANALGESICS AND PAINKILLER IN HKKB
Know your
limitation
MAXIMUM DOSE:
Acetaminophen: 4g daily
Aspirin: 4g daily
Mefenemic acid: 1500mg/
day
Diclofenac sodium: 150 mg
daily
Ibuprofen: 2.4g daily
Celecoxib: 200 mg daily
Dihydrocodeine: 360mg/day
Tramadol: 400 mg/day
Pethidine: 400 mg/day
Morphine: 1600mg/day
Reference: Drug formulary
Warning box!!

inform the doctor if
you have any allergies

NSAIDs should be
taken after meal to
avoid any
gastrointestinal tract
disturbance.

Please take more
fibers and drink a plenty
of water if you are
taking opiod to avoid
constipation
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ANALGESICS & PAINKILLERS
WHO | WHO’s cancer pain ladder for adults. WHO. Retrieved December 1, 2013, from http://
www.who.int/cancer/palliative/painladder/en/
Analgesics & Painkillers are given based on the severity of the pain. Pain ladder was designed as guideline in managing the pain. This three-step approach of administering the
RIGHT DRUG in the RIGHT DOSE at the RIGHT TIME is inexpensive and 80-90% effective.
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ANALGESICS & PAINKILLERS
Q1: I ‘have an aspirin allergy. Is there any alternatives to relieve my pain?
SYMPTOMS OF ASPIRIN ALLERGY

Hives

Itchy skin

Runny nose

Red eyes

Swelling of the lips, tongue or face

Coughing, wheezing or shortness of breath
ALTERNATIVES:
Reactions to aspirin are common. If you have an aspirin allergy
or sensitivity, you may also have a reaction to NSAIDs, including
ibuprofen and naproxen. For the mild pain, acetaminophen
can be used to relieve the pain in this case. However, for
patient with aspirin allergy, they should be caution in taking
over the counter analgesics. Please inform the doctor or
pharmacist before taking any analgesics.
Q2: Previously I took diclofenac to relieve my pain. However doctor find out that
my kidney has problem. Can I continue taking diclofenac?
Severity
Special considerations for CKD
Mild
Acetaminophen at greater intervals recommended
(i.e. 650 mg per oral every 6 h instead of 4 h);
(pain scores 1–3/10)
If NSAIDS required:
ASA 650 mg q 4–6 h
Short-acting NSAIDS
Consider sulindac or salsalate
Moderate
(pain scores  4–6/10)
Severe
(pain scores 7–10/10)
Tramadol may be considered because it is not known to be nephrotoxic. 
Opioids: toxic metabolites accumulation in CKD; Consider dose adjustments
Fentanyl or methadone maybe acceptable, dose and frequency reduction may be
advisable. Fentanyl transdermal system is reserved for opioid-tolerant patients with
severe pain
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Q3: I’m taking warfarin and require analgesic to relieve the pain. Can you
suggest any analgesics to me?
Most of NSAIDs have interaction with warfarin by enhancing the anticoagulant effect of warfarin.
Besides that, tramadol also has increased risk of bleeding when given with warfarin. In addition, acetaminophen also has interaction with warfarin. Patient on warfarin therapy can take dihyrocodeine to
relieve pain as it does not interact with warfarin.
Q4: I’m pregnant and I need an analgesics to relieve my pain. Any suggestion?
Medications used in therapeutic doses for acute and chronic pain appear to be relatively safe in pregnancy. To minimize fetal risk, initiate drug interventions at the lowest effective dose, especially in late
pregnancy, and select analgesics only after careful review of a woman’s medical or medication history. Women should avoid using NSAIDs after 32 weeks’ gestation, owing to the possibility of antiplatelet or prolonged bleeding effects. Opioids should also be used with caution, especially in higher doses
in late pregnancy when the infant should be observed carefully in the neonatal period for any signs of
withdrawal (neonatal abstinence syndrome).
REFERENCES
Pham, P.-C. T., Toscano, E., Pham, P.-M. T., Pham, P.-A. T.,
Pham, S. V., & Pham, P.-T. T. (n.d.). Pain management in patients with chronic kidney disease. Retrieved November 28,
2013, from http://ckj.oxfordjournals.org
BNF March 2011
Drug formulary hkkb
Drug Information Handbook
Babb, M., Koren, G., & Einarson, A. (2010). Treating pain during pregnancy. Canadian Family Physician, 56(1), 25–27.
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Is It COLD Or Is It FLU
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G6PD Deficiency
What you should know?

TREATMENT
Identification and discontinuation of the
precipitating agent is critical in cases of
glucose-6-phosphatase dehydrogenase (G6PD) deficiency.

Affected individuals are treated with oxygen and bed rest, which may afford symptomatic relief.

Medicines to treat an infection, if present.
Table 1: List of drugs and food to avoid in G6PD Deficiency
Antihelmintics
Antibiotics
Antimalarials
Antimethemoglonaemic Agents
Antimycobacterials
Antineoplastic Adjuncts
Genitourinary Analgesics
Others
Food





Β-Naphthol
Niridazole
Stibophen
Nitrofurans (Nitrofurantoin, Nitrofurazone)
Quinolones (Ciprofloxacin, Moxifloxacin, Nalidixic acid, Norfloxacin,
Ofloxacin)
 Chloramphenicol
 Sulphonamides
 Co-trimoxazole (Sulfamethoxazole+trimethoprim)
 Sulfacetamide
 Sulfadiazine
 Sulfadimidine
 Sulfamethoxazole
 Sulphanilamide
 Sulfapyridine
 Sulfasalazine (Salazosulfapyridine)
 Sulfisoxazole (Sulfafurazole)
 Mepacrine, Pamaquine, Pentaquine, Primaquine
 Methylene blue
 Dapsone
 Para-aminosalicylic acid
 Sulfones
 Aldesulfone sodium (Sulfoxone)
 Glucosulfone
 Thiazosulfone
 Doxorubicin
 Rasburicase
 Phenazopyridine (Pyridium)
 Acetylphenylhydrazine
 Phenylhydrazine
 Fava beans – also called broad beans (Kacang parang)
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G6PD Deficiency
What you should know?
REFERENCES

MIMS Annual Malaysia 2006 (MIMS Annual Summary Table, B27)

Herndon, J. (2012). G6PD Deficiency. Accessed online 7 November 2013 at: http://www.healthline.com/health/
glucose-6-phosphate-dehydrogenase-deficiency

Diagnosis and treatment of glucose-6-phosphate dehydrogenase deficiency. Accessed online 7 November 2013
at:http://www.uptodate.com/contents/diagnosis-and-treatment-of-glucose-6-phosphate-dehydrogenasedeficiency#H1

British National Formulary (BNF). (March 2011)
,
Hospital Kuala Kubu Bharu
By: Syazyanti Izyanti Bt Mohd Ariffin
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By : Raden Azwani
PHARMACY EDUCATIONS
KUB (KIDNEY, URETERS & BLADDER X-RAY) :
THE DIFFERENCES WITH THE GENERAL X-RAY
What is KUB?
In medicine, KUB refers to a diagnostic medical imaging technique of
the
abdomen
and
stands
for Kidneys, Ureters, and Bladder.
KUB X-ray may be performed to assess
the abdominal area for causes of abdominal pain, or to
assess the organs and structures of the
urinary and/or
gastrointestinal (GI)
system. A KUB X-ray may be the first
diagnostic procedure used to assess the
urinary system.
X-rays use invisible electromagnetic
energy beams to produce images of
internal tissues, bones, and organs on
film. X-rays are made by using external
radiation to produce images of the body,
its organs, and other internal structures
for diagnostic purposes. X-rays pass
through body tissues onto specially treated plates (similar to camera film) and a
"negative" type picture is made (the more
solid a structure is, the whiter it appears
on the film).
biopsy, prostate ultrasound, retrograde cystography, retrograde pyelogram, uroflowmetry, and renal venogram.
Other related procedures that may be
used to diagnose problems of the urinary
organs of the abdomen include computed
tomography (CT scan) of the kidney, kidney ultrasound, kidney scan, cystography,
cystometry, cystoscopy, intravenous pyelogram, kidney biopsy, prostate ultrasound, retrograde cystography, retro-
Reasons for the procedure
A KUB X-ray may be performed to diagnose the
cause of abdominal pain,
such as masses, perforations, or obstruction. A KUB
X-ray may be taken to evaluate the urinary tract before other diagnostic procedures are performed. Basic
information regarding the
size, shape, and position
of the kidneys, ureters,
and bladder may be obtained with a KUB X-ray.
The presence of calcifications (kidney stones) in
the kidneys or ureters
may be noted.
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Before the procedure
The preparations should be made 2 days prior the date of the
procedure:

Day 1 : 8.00 pm

Eat 2 tabs of Bisacodyl (Dulcolax) 5 mg, and

Insert 1 Bisacodyl suppository into the rectum

- Day 2 : 12.00 pm

Mix 1 pack of Magnesium Sulphate Crystal (20gm) into
240ml of water and drink. Drink plenty of water afterwards
- 8.00 pm
PRECAUTIONS

Eat 2 tabs of Bisacodyl (Dulcolax) 5 mg, and

Insert 1 Bisacodyl suppository into the rectum

DO NOT EAT OR DRINK ANYTHING EXCEPT FOR PLAIN
WATER AFTER 12AM.


Day 3
Undergo the procedure
During the procedure
A KUB X-ray may be performed on an outpatient basis or as part of your stay in a
hospital. Procedures may vary depending
on your condition and your doctor's practices.
Generally, a KUB X-ray follows this process:
 You will be asked to remove any
clothing, jewelry, or other objects that
might interfere with the procedure.
 If you are asked to remove clothing,
you will be given a gown to wear.
 You will be positioned in a manner
that carefully places the part of the
abdomen that is to be X-rayed between the X-ray machine and a cassette containing the X-ray film or digital media. You may be asked to stand

Because of the risks of radiation exposure to
the fetus, pregnant women are advised to
avoid this x-ray procedure.

The presence of severe obesity, gas or feces in
the intestine or residual barium in the abdomen from a recent contrast x-ray study may
interfere with clear visualization of the urinary
system
 You may be asked to stand erect, to lie
flat on a table, or to lie on your side on
a table, depending on the X-ray view
your doctor has requested. You may
have X-rays taken from more than one
position.
 The X-ray beam will be focused on
the area to be photographed.
 The radiologic technologist will
step behind a protective window
while the image is taken.
 Body parts not being imaged may be
covered with a lead apron (shield) to
avoid exposure to the X-rays.
 Once you are positioned, the radiologic technologist will ask you to hold still
for a few moments while the X-ray
exposure is made.
 It is extremely important to remain
completely still while the exposure is
made, as any movement may distort
the image and even require another Xray to be done to obtain a clear image
of the body part in question.
While the X-ray procedure itself causes no pain, the manipulation of the
body part being examined may cause
some discomfort or pain, particularly
in the case of a recent injury or invasive procedure, such as surgery. The
radiologic technologist will use all possible comfort measures and complete
the procedure as quickly as possible to
minimize any discomfort or pain.
erect, to lie flat on a table, or to lie on
your side on a table, depending on the X-
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After the procedure
Generally, there is no special type of care following a KUB X-ray. However, your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
Results of KUB Radiography

X-ray films are usually ready shortly after the test is completed. A radiologist will examine the images for abnormalities.

A definitive diagnosis can rarely be made based on a KUB study alone. In most cases, additional tests—such as ultrasound or
intravenous pyelography—are required in order to establish a diagnosis and determine the extent of the problem.

Normal KUB x-ray films show two kidneys of a similar size and shape, no renal calculi (stones), and a normal bowel gas
pattern.

Abnormal KUB films may show calculi (kidney stones). If both kidneys are visible, it may be possible to diagnose renal size
discrepancies. The film may also demonstrate an increase in bowel gas, indicating a possible bowel obstruction. In this case an
additional film of the abdomen should be done either upright or in a lateral decubitus position. Soft tissue masses may also be
visualized on a KUB.
REFERENCES :

http://www.healthcommunities.com/urinary-system-tests/kidney-ureter-bladder-x-ray-kub.shtml

http://health.yahoo.net/galecontent/kidney-ureter-and-bladder-x-ray-study-1

http://www.hopkinsmedicine.org/healthlibrary/test_procedures/urology/kidney_ureter_and_bladder_xray_92,P07719/

Drug Formulary Hospital Kuala Kubu Bharu First Edition 2012
22
UPDATES FROM PHARMACY
Sistem Temujanji Ubat (STJ)
PENDAFTARAN
PESAKIT UNTUK STJ
Apa itu STJ?

Satu kaedah terbaru pengambilan ubat secara temujanji

Ubat-ubatan disediakn sebelum tarikh temujanji

Menjimatkan masa menuggu pesakit
Kebaikan STJ?

Masa pengambilan ubat lebih fleksibel (Waktu rehat &
selepas waktu pejabat)

Ubat dibekalkan dengan cepat

Menjimatkan masa menunggu pesakit

Tiada pembaziran ubat
Syarat-syaratnya

Ubat melebihi 2 bulan

Hadir tepat pada tarikh dan masa yang ditetapkan untuk
mengambil ubat
By
Syazyanti Izyanti Mohd Ariffin
Hospital Kuala Kubu Bharu
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UPDATES FROM PHARMACY
Sistem Temujanji Ubat (STJ)
BAGI YANG
BERMINAT
Kesan akibat ketidakhadiran dan kehilangan kad

Kegagalan untuk hadir menyebabkan nama dikeluarkan daripada program dan perlu melalui prosedur biasa untuk pengambilan ubat ulangan.

Sekiranyan kad temujanji hilang, unit farmasi akan
mengantikan kad baru hanya untuk SEKALI sahaja
dan jika berulang lagi, nama pesakit turut akan
dikeluarkan daripada program dan perlu mengambil
ubat ulangan melalui prosedur biasa
WAKTU PENGAMBILAN UBAT ULANGAN
By
Syazyanti Izyanti Mohd Ariffin
Hospital Kuala Kubu Bharu
Hari
Waktu
Isnin—Jumaat
830 pagi—630 petang
Sebarang pertanyaan sila hubungi:
Unit Farmasi Pesakit Luar
Hospital Kuala Kubu Bharu
44000 Kuala Kubu Bharu
Selangor Darul Ehsan
Tel: 03-60641333 (sambungan: 254)
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