Agents, Resistance & Withdrawal

Antiplatelet agents

1. Acetylsalicylic acid (aspirin)
2. Thienopyridines
3. Glycoprotein IIb/IIIa receptor inhibitors

Resistance to antiplatelet agents/drug interactions

Withdrawal of antiplatelet agents




It looks simple, but it is huge! huh!

Preparing for Retail Pharmacy

Antara undang-undang yang mesti diambil perhatian :
* Akta Racun 1952 dan Peraturannya
* Peraturan-Peraturan Racun (Bahan Psikotropik) 1989
* Akta Dadah Berbahaya 1952 dan Peraturan-Peraturannya
* Peraturan-Peraturan Kawalan Dadah dan Kosmetik 1984
* (Pindaan) 2001
* Akta Jualan Dadah 1952
* Akta Ubat (Iklan dan Penjualan) 1956
* Akta Pendaftaran Ahli Farmasi 1951 dan Peraturannya

Panduan Penanda Aras Farmasi Komuniti (Community Pharmacy Guidelines) oleh MPS - http://www.cornerstone-msc.net/new_mps/cfm/announcement_view.cfm?id=1232

Borang untuk import atau eksport bahan psikotropik - http://www.pharmacy.gov.my/aeimages//File/BPF208-1new.pdf

Garis panduan untuk pemegang lesen A - http://jknkl.moh.gov.my/v2/bahagian-bahagian/farmasi/permohonan-lesen-racun/garis-panduan-untuk-pemegang-lesen-jenis-a/

Lipitor

Referring to the ‘Blue Book MOH’, statin available in Malaysia :

Atorvastatin 20 mg Tablet
Atorvastatin 40 mg Tablet
Atorvastatin 80 mg Tablet
Ezetimibe 10 mg & Simvastatin 20 mg Tablet
Lovastatin 20 mg Tablet
Lovastatin 20 mg Tablet
Rosuvastatin 10 mg Tablet
Rosuvastatin 20 mg Tablet
Simvastatin 10 mg Tablet
Simvastatin 20 mg Tablet
Simvastatin 40 mg Tablet

This group of drug is used to lower LDL-cholestrol

Brand name of atorvastatin = Lipitor. Atorvastatin was first synthesized in 1985 by Bruce Roth while working at Parke-Davis Warner-Lambert Company (now Pfizer). With 2008 sales of US$12.4 billion, Lipitor was the top-selling branded pharmaceutical in the world. US patent protection is scheduled to expire in June 2011. http://www.lipitor.com/

LIPITOR is an inhibitor of HMG-CoA reductase (statin) indicated as an adjunct therapy to diet to:

• Reduce the risk of MI, stroke, revascularization procedures, and angina in patients without CHD, but with multiple risk factors (1.1).
• Reduce the risk of MI and stroke in patients with type 2 diabetes without CHD, but with multiple risk factors (1.1).
• Reduce the risk of non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for CHF, and angina in patients with CHD (1.1).
• Reduce elevated total-C, LDL-C, apo B, and TG levels and increase HDL-C in adult patients with primary hyperlipidemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (1.2).
• Reduce elevated TG in patients with hypertriglyceridemia and primary dysbetalipoproteinemia (1.2).
• Reduce total-C and LDL-C in patients with homozygous familial hypercholesterolemia (HoFH) (1.2).
• Reduce elevated total-C, LDL-C, and apo B levels in boys and postmenarchal girls, 10 to 17 years of age, with heterozygous familial hypercholesterolemia after failing an adequate trial of diet therapy (1.2).

Read the prescribing leaflet - http://www.pfizer.com/files/products/uspi_lipitor.pdf

3 Things

Successful people might be intelligent. Or have had a socially well connected upbringings. Or be naturally energetic and open and positive.

But a lot of the factors that make some people more successful at almost anything in life are very much under their control. And much can be improved in anyone’s life by learning from the people that have gone before us.

They have a positive attitude
A negative attitude can be very damaging and limiting to one´s life. A positive one can open new doors every day. It can open your mind to new ideas and input and create or sustain great relationships. It helps you through the hard times as a successful person often sees an opportunity within what others would merely see as a problem.

They do the most productive thing right now
Instead of trapping themselves in doing productive but not so important tasks or projects they realise what’s most important and do that. And after they´re done with that they do what´s most important again. Instead of just doing a lot of things, they think and plan before they act and try to focus as much as possible of their thoughts and actions on those few very important things.

They have found a purpose in life
They are internally driven rather than externally driven. They do what they have a burning desire to do rather than conforming to what others think they should do. Even if what the others think may be positive and successful stuff.

Maxis Broadband

Location : Indera Mahkota 2
Time : 633am
Broadband : Maxis, RM50 per month.

Enema

I was asked by someone about ‘enama’. Then, I verified him is it ‘edema or enema?’ because I had never heard enama. At the same time, I was not familiar about ‘enema’.

I took my netbook, connected to the internet and started the searching. What I found are :

An enema (plural enemata or enemas) is the procedure of introducing liquids into the rectum and colon via the anus.

Available in Malaysia :
1)Sodium Biphosphate 16% & Sodium Phosphate 6% Enema - FLEET READY-TO-USE ENEMA
2)Sodium Biphosphate 16% & Sodium Phosphate 6% Enema - FLEET READY-TO-USE ENEMA FOR CHILDREN
3)Glycerin 25 % & Sodium Chloride 15 % Disposable Enema - BANDI-S15 ENEMA
4)5- aminosalicylic acid (Mesalazine) 6.67 % w/w Enema - SALOFALK ENEMAS

There are 2 types of drugs preparation :
1)LAXATIVES, PURGATIVES (CATHARTICS) = Glycerin 25% and NaCl 15%Disposable Enema

2)ANTINEOPLASTICS = Mesalazine (5-aminosalicylic acid) 6.67% w/w Enema

Warfarin

According to Malaysian Drug Code Listing By Anatomical Group, warfarin is categorized under Antithrombotic Agents. The brand names available are : COUMADIN, APO-WARFARIN & ORFARIN

According to the Blue Book MOH Drug Formulary, warfarin is a Group B Category of Prescriber. It exists in form of :

• 1. Warfarin Sodium 1 mg Tablet
• 2. Warfarin Sodium 2 mg Tablet
• 3. Warfarin Sodium 3 mg Tablet
• 4. Warfarin Sodium 5 mg Tablet

According to British Pharmacopeia, warfarin is a vitamin K epoxide reductase inhibitor. There are 4 types of preparation :

• 1. Warfarin Sodium
• 2. Warfarin Sodium Clathrate
• 3. Warfarin Oral Suspension
• 4. Warfarin Tablets

According to ‘Terapi Warfarin’ by knowyourmedicine - http://www.knowyourmedicine.gov.my/aeimages//File/warfarin_3.pdf

TINDAK BALAS WARFARIN DENGAN UBAT-UBATAN LAIN / MAKANAN
Ubat-ubatan dan makanan yang bertindak balas dengan warfarin akan sama ada meningkatkan / mengurangkan kesan warfarin. Contohnya:

• 1. antibiotik (seperti cloxacillin, clarithromycin, dll)
• 2. ubat anti-epileptik
• 3. ubat tahan sakit jenis anti-inflammatori bukan steroid (seperti aspirin, diclofenac, mefenamic acid, dll)
• 4. herba (ginseng, gingko biloba, Dong Quai)
• 5. sayur-sayuran berdaun hijau (seperti bayam, brokoli, sawi, dll)

According to ‘Katemateegaroon, Dussanee, and Anusornsangiami, Wan Ar At, and Thomudtha, Adisak, and Nasurivong, Pornpimol, (2005) Pharmacist Monitoring Of Warfarin-Related Problems In Outpatient Anticoagulation Clinic. Malaysian Journal of Pharmaceutical Sciences, 3 (2). pp. 58-58. ISSN 16575-7319’, warfarin-related problems in the two groups included bleeding (10.0% vs. 3.1%), thrombo-embolism (0% vs. 0.5%), drug interactions (3.2% vs. 10.9%), and non-compliance (9.3% vs. 9.0%) in the study group versus the control group, respectively.

In HUKM, warfarin clinic is also known as INR clinic - http://pharmacy.hukm.ukm.my/services/inr.htm. The main aim of pharmacists' participation in INR clinic is therefore to provide integrated care to our warfarin patients. In return, this initiative is hoped to improve patient understanding and compliance to the therapy hence reducing complications, as well as to reduce our doctors' workload during the clinic.

Roles of Pharmacists in INR Clinic:

• • Warfarin therapy, compliance and adverse effects monitoring
• • INR interpretations
• • Dosage adjustment according to treatment protocols
• • Patient education

According to PSD website - http://www.pharmacy.gov.my/index.cfm?menuid=29&parentid=107, Ambulatory Care Pharmacy Service > Medication Therapy Adherence Clinic (MTAC) > MTAC Warfarin.

Medicines Advertisements

Let’s us be familiar with the law sentences. Today I quote some interesting sentences from Medicine (Advertisement and Sale) Act 1956 (Incorporating all amendments up to 1 January 2006)

No person shall take any part in the publication of any advertisement referring to any article, or articles of any description, in terms which are calculated to lead to the use of that article of that description as a medicine, an appliance or a remedy for the purpose of treatment or prevention of diseases or conditions of human beings other than the diseases and conditions specified in subsection 3(1), unless such advertisement has been approved by the Medicine Advertisements Board.

Any advertisement proposed to be published may be submitted to the Medicine Advertisements Board (MAB) for approval in the manner provided for by regulations made under section 7.

The policy & decision MAB http://www.pharmacy.gov.my/aeimages//File/MAB_POLICY_AND_DECISION%281%29.pdf

The Web Site Advertisement of Hospital Services - Hospital advertisement content in web sites is allowed to include the following:
a. Full name of the registered medical practitioner
b. Qualifications of the registered medical practitioner
c. Photograph of the registered medical practitioner
d. The address of the registered medical practitioner (as in the APC)
e. The specialist curriculum vitae (CV) (provided that the specialist has registered with National Specialist
Register. A copy of the registration certificate or letter must be provided with application).
f. A video demonstration of the services provided (do not expose patients’ picture and identity)
g. List of services and price offered (only standard and accepted practice and services are permitted)
h. All contents are subject to MAB’s approval.

MAB in its meeting on 24th November 2006 decided:
i. Advertisement of product by retail pharmacy
- Retail pharmacy is allowed to do advertisement of products. Applications must be done by the product registration holder. Advertisement must be approved by MAB.

O °C = 32 °F & 100 °C = 212 °F

O °C = 32 °F

100 °C = 212 °F

Our normal body temperature is 37 °C. Then, use your mathematical knowledge and you will get 98.6 °F. (updated)

*Where the difference of 1 °C is equivalent to 1.8 °F

IIUM Speed

Testing the internet speed of a computer available at IIUM Library, LAN networking.

See the differences with the previous entry, cable connection is faster than wireless network.

Hypertension

I used 3 sources : Merck,The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) & National Health Morbidity Survey Third (NHMS III)


Causes :
1)High blood pressure with no known cause is called primary (formerly called essential) hypertension.
2)High blood pressure with a known cause is called secondary hypertension. In many of these people, high blood pressure results from a kidney disorder. Then, hormonal disorder (such as Cushing's syndrome, hyperthyroidism, hyperaldosteronism, pheochromocytoma) > use of certain drugs (such as Oral contraceptives)

One of the risk factor of cardiovascular disease (CVD) is microalbuminuria, estimated glomerular filtration rate <60>Blood pressure is written as systolic pressure/diastolic pressure—for example, 120/80 mm Hg (millimeters of mercury). This reading is referred to as "120 over 80."

A hypertensive urgency is blood pressure that is more than 180/120 mm Hg but has not yet produced any organ damage that is apparent to people or their doctors. A hypertensive urgency usually does not produce symptoms.

A hypertensive emergency is a particularly severe form of high blood pressure. Blood pressure is at least 180/120 mm Hg, and there is evidence of progressive damage in one or more vital organs, often accompanied by a variety of symptoms.

Angiotensin II causes the muscular walls of small arteries (arterioles) to constrict, increasing blood pressure. Angiotensin II also triggers the release of the hormone aldosterone from the adrenal glands and antidiuretic hormone from the pituitary gland.

Aldosterone causes the kidneys to retain salt (sodium) and excrete potassium. The sodium causes water to be retained, thus increasing blood volume and blood pressure.

Treatment :
Primary hypertension cannot be cured, but it can be controlled to prevent complications. (Merck)

Usually, potassium-sparing diuretics are not used alone because they do not control blood pressure as well as thiazide diuretics do; however, the potassium-sparing diuretic spironolactone is sometimes used alone. (Merck)

Majority of patients will require two medications to reach goal. (JNC-7)

http://www.acrpm.com.my/documents/nccr_09/handouts/day1/11_PharmacoEpid.pdf


Facts on NHMS III 2006 : Adults aged 30 and above - Diabetic 14.9% & Hypertensive 42.6%

Digoxin

It’s effective! I am practicing the combination of different field of knowledge in order to come out with the good outcome.

Let’s hightlight some information about digoxin.

1. From http://www.mdconsult.com,

A large, randomized, controlled trial has shown that the use of digoxin reduces the rate of hospitalization for heart failure, but does not reduce mortality. - Digitalis Investigation Group: The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997; 336:525-533.

Digoxin is excreted by the kidneys, so dose adjustment is necessary in cases of renal failure.
A low dose of digoxin (0.125 mg daily) should be prescribed to most patients, especially women, and serum digoxin levels maintained at lower than 1 ng/mL. Digoxin may be prescribed for patients with left ventricular systolic dysfunction who remain symptomatic while receiving standard medical therapy, particularly if they are in atrial fibrillation.

Agent : Digoxin
Initial Dose : 0.125 mg qd (A low dose of digoxin (0.125 mg daily) should be prescribed to most patients, especially women)
Maximal Dose : 0.25 mg qd

q.d. (qd or QD) is once a day; q.d. stands for "quaque die" (which means, in Latin, once a day).


2. From http://www.mims.com.my/

Loading dose: 0.75-1.5 mg in the 1st 24 hr. Slow digitilisation: 250 mcg 1-2 times/day. Uusal maintenance: 0.125-0.250 mg/day.

IV Emergency heart failure - For patients who have not received cardiac glycosides in the previous 2 wk: 0.5-1 mg via infusion as a single dose or in divided doses

Poison schedule : B

3. From Blue Book MOH Drug Formulary - http://www.pharmacy.gov.my/aeimages//File/Blue_Book_1-2010.pdf

Digoxin 0.25 mg Tablet – Group B
Digoxin 50 mcg/ml Elixir – Group B
Digoxin 500 mcg/2 ml Injection – Group A
Digoxin 62.5 mcg Tablet – Group B

Brand Name : Lanoxin

*1mg = 1000mcg @ 1000µg

4. From freepatentsonline,

http://www.freepatentsonline.com/result.html?query_txt=digoxin&sort=relevance&srch=top&search=
contains all documents related to digixon.

5. From BP,

Action & Use - Na /K-ATPase inhibitor; cardiac glycoside.
Storage (for both tablet & solution) - Protected from light.
Identification - Infrared absorption spectrophotometry

Tests for tablet : Dissolution, Uniformity of Content,

For digoxin injection solution (adult preparation),
Digoxin - 25 mg
Ethanol (80 per cent) - 12.5 ml
Propylene Glycol - 40 ml
Citric Acid Monohydrate - 75 mg
Disodium Hydrogen Phosphate Dodecahydrate - 0.45 g
Water for Injections - Sufficient to produce 100 ml

Relaxing Time

I'm at 'Masjid IIUM' KOM currently while waiting for my customer to give me back my car.


Wow! See the speed.

Reconnected

It is a celcom broadband student package RM50, no contract & no activation fee. I am still waiting for the approval from Mahallah Office to install our own streamyx at the hostel.

My Kulliyyah Building was already equipped with Wi-Fi. I am very happy for that. Thanks IT Department.

Again, I have to manage my time properly. No mid sem. exam starting in this semester will see a variation in final result. Let’s us struggle our best in order to achieve the great level of performance.

Like A Sword

It is all about time.

Time management is a common topic, but it is the most difficult task to manage it. Many successful people always talk about ‘time management’ when they were asked on how do they achieve to that great level of the respected field.

Let us try to manage our time properly. Teenager’s time should not be wasted with the bad things. Some said that time is like gold. Time is like a sword. If you don’t cut it then, it will cut you.

Advertisement

It comes back!

Continue JPA Scholarship

The scholarships were focused on critical fields such as medicine, dentistry, pharmacy, veterinary, engineering, science and technology and social sciences.

PHARMACY.....

This is because manpower in these fields is much required by the public service sector and the country.

JPA received 18,844 applications for the PILN 2010, of which 10,956 candidates surpassed the minimum requirement of the field of study.

Aurothiomalate & Auranofin

Many people want to have gold as their property

It has served as a symbol of wealth and a store of value throughout history. Gold may symbolize power, strength, wealth, warmth, happiness, love, hope, optimism, intelligence, justice, balance, perfection, summer, harvest and the sun.

In modern times, injectable gold has been proven to help to reduce the pain and swelling of rheumatoid arthritis and tuberculosis.

Referring to British National Formulary (BNF), gold can be given by intramuscular injection as sodium aurothiomalate or by mouth as auranofin.

Gold therapy should be discontinued in the presence of blood disorders, gastro-intestinal bleeding (associated with ulcerative enterocolitis), or unexplained proteinuria (associated with immune complex nephritis) which is repeatedly above 300 mg/litre. Urine tests and full blood counts (including total and differential white cell and platelet counts) must therefore be performed before starting treatment with gold and before each intramuscular injection; in the case of oral treatment the urine and blood tests should be carried out monthly. Rashes with pruritus often occur after 2 to 6 months of intramuscular treatment and may necessitate discontinuation of treatment; the most common side-effect of oral therapy, diarrhoea with or without nausea or abdominal pain, may respond to bulking agents (such as bran) or temporary reduction in dosage.

Not all people believed that gold can be used as a treatment.

Thinking of Business

According to Wikipedia, business is a legally recognized organization designed to provide goods or services, or both, to consumers, businesses and governmental entities.

There are 4 forms of ownership :
1) Sole proprietorship
2) Partnership
3) Corporation - either a limited or unlimited liability entity, owned by multiple shareholders (involve in decision-making authority) and is overseen by a board of directors, which hires the business's managerial staff.
4) Cooperative - limited liability entity, differs from a corporation in that it has members, as opposed to shareholders, who share decision-making authority.

Transportation businesses deliver goods and individuals from location to location, generating a profit on the transportation costs.

I’m thinking to start again my small business in transportation service. Students need transportation and I have an extra vehicle. Why don’t I help them? At least, I contribute something to the ummah and of course I make certain profit to cover the maintenance cost.

Manufacturing Perspective

Before I started my industrial attachment, I looked at the medicine on its clinical aspect only..

Now, when I see any medicine, I see how the production is going on. Well, the attachment really broadens my thought. Thank you very much Ain Medicare.






I’m currently in industrial report mood. Please pray with me so that I’m able to complete it. Huh!

I'm Reporting

I'm currently trying to complete the Industrial Report which brings 70% of the assessment. Another 30% is from the Verbal Assessment. By the way, credit hour is 4.

3 things about this report :
1) Wasting of time
2) Theory is not 100% accurate
3) Knowledge is more important than written report.


My dearest friends, have a look at this document.

Do not read word by word.
Read by searching the keyword (Ctrl + F).
Why don't you try to search 'sterile'?

Countdown

1)Still have time starting from 12/7/2010 ---> 16/4/2011.
2)Will start working on July 2011 as previous batch (or earlier, who knows?)

We learn together,
We grow up together,
We laugh toghether,
We will graduate together Insyaallah.

Thanks amal for this pic. *amik tak mintak. Hehe...