UMP1M

Medicine Through Pos 1Malaysia (Ubat Melalui Pos 1Malaysia) (UMP 1M)

By, Daniel Liew CY

Patients with chronic diseases can now get their regular medicine delivered to them at home. "Medicine Through Pos 1Malaysia", will be offered specifically for patients with chronic diseases, especially those with regular follow-ups after their pharmacists have determined the stability of the drugs treatment.  This new service was an innovative idea by the ministry in partnership with Pos Malaysia Bhd.  This idea came from the Ministry's Pharmacy Services Department as a number of chronic patients missed their scheduled check-ups and medicine because it was inconvenient for them to go to hospital.

Noting the service was available at 26 hospitals nationwide. At the moment, the main load is only at the pharmacy units of state hospitals. Ministry of Health will expand the service by stages in other hospitals and health facilities.  Putrajaya Hospital, Selayang Hospital and Luyang (Sabah) health clinics are the pioneers to start on UMP 1M project.

The pilot project for the service was done in October 2009 at the Putrajaya Hospital.  As of December last year, 1,054 patients have used the service and we expect more patients to benefit.  With this new service, patients with chronic diseases such, including diabetics and heart patients who have trouble getting their follow up drug supplies, do not have to go to hospital.  Instead, the prescribed drugs will be sent to their homes or any address within Malaysia via Pos Laju.

The medicine will be first prepared, counter-check and packed by authorised pharmacists.  The packing will then sealed carefully before posted. The packaging cannot be opened by unauthorised personnel.

The cost of delivery is absolutely affordable and the patients will have to bear the cost of delivery, simply RM3.50 within Putrajaya, RM5 in Peninsular Malaysia and RM8 in Sabah and Sarawak.

By implementing this creative and innovative UMP 1M, MOH provides convenience, safe and less time consuming services to patients from nationwide.

ADR Reporting

An Overview of Adverse Drug Reaction (ADR) Reporting

By, Siti Fauziah bt Abu

Adverse Drug reaction (ADRs) is define as a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function (WHO 2002). It is important in reporting all the cases that related to ADRs especially for new medicines for which the safety profile has not yet been completely established. It is reported that ADRs was found to be the 4th-6th largest cause for mortality in the USA and has accounted for approximately 10% of hospital admissions in European countries (Lazarou et al. 1998; WHO 2002). Thus, this may cause an increment in the length of hospital stay and also medical costs due to the drug complications (White et al. 1999).

In our Department of Health Kuala Lumpur & Putrajaya Federal Territory; starting from year 2008 until March 2011 we have received only 155 ADR reports (Chart 1). The most reported suspected drugs were from Antihypertensives (37%) group, followed by Antiinfectives (16%) and Analgesics and Painkillers (6%) (Chart 2). The trend was found to be similar with the National data by MADRAC 2010.

To increase the number of ADR reported, Pharmaceutical Services Division, Department of Health Kuala Lumpur & Putrajaya Federal Territory have conducted several activities and workshops to raise awareness on the drug safety problem and to convince health professionals that reporting of adverse reactions is their moral and professional obligation. It is hope that the continuous evaluation of their benefit and harm will help to achieve the ultimate goal to make safer and more effective treatment available to patients.

Online Report ADR here

ROP in Smoking Cessation Program

Role of Pharmacist in Smoking Cessation Program

By, CHAN PL

Nicotine is a highly addictive drug and can causes dependence, as evident in tobacco smokers.  Nicotine addiction is a complex disorder that requires treatment directed at both the biological and the behavioral aspects of the disease. Many smokers believe that smoking is simply a bad habit, as a result of weakness in character and an inability to change one’s behavior. However research has shown that nicotine addiction is a chronic brain disease resulting from an alteration in brain chemistry. It is a complex process involving the interplay of many factors (pharmacologic, environmental, and physiologic) that influence an individual’s decision to use tobacco. The pharmacologic and behavioral processes that determine nicotine addiction are similar to those that determine addiction to drugs such as heroin and cocaine. Hence, healthcare professionals, namely pharmacists, must treat nicotine use and dependence as a serious medical condition.

Why Pharmacist? Pharmacists can play an active role because they are easily accessible, approachable, knowledgeable and able to offer advice in smoking cessation. Studies have shown that patients who received a tobacco cessation intervention from a non-physician clinician or physician clinician were 1.7 and 2.2 times likely to quit (at 5 or more months post cessation), respectively, compared with patients who did not received such intervention (Fiore et al., 2008; p.88). Similarly, the number of clinicians that assist with quitting is related to success rates. An analysis of 37 studies determined that patients who received a tobacco cessation intervention from two or more clinicians were more than twice as likely to quit (for 5 or more months) than patients who received no assistance from a clinician (Fiore et al., 2008).

Pharmacist’s Role  Tobacco dependence requires two-prong approaches for maximal treatment effectiveness. (a) Physiological dependence (addiction to nicotine) can be treated with approved medication for smoking cessation, and (b) Behavioral habit can be treated through behavioral change programs, such as individualized counseling and group or online cessation programs. Pharmacist is there to provide a combination of pharmacotherapy and behavioral counseling in treating patients who smoke.

“Do you smoke or use tobacco?” Pharmacist should start screening for tobacco use by asking each client or customer. Evidence shows that screening for tobacco use significantly increases clinician intervention. Smoker should be strongly urged to quit at every encounter. Advice should be clear, personalized, supportive and non-judgmental.

Identify Potential Benefits:  If a smoker is willing to quit, pharmacist will assist patient to indicate why quitting is personally relevant. Patient will be asked to identify potential negative consequences to smoking and potential benefits to quitting.

Identify Potential Barriers:  For smokers who have tried to make a quit attempt and have failed previous attempts, pharmacist should advice them not to give up.  The reason is simply because most people repeatedly failed in their attempts before they can succeed. Pharmacist should continuously motivated patients to quit, help patient to identify barriers to quitting and address the barriers. If a smoker is unmotivated to quit, pharmacist will repeatedly giving motivation at every visit. A motivational counseling will be more successful if the pharmacist is empathetic, promotes patient autonomy, supports the patient’s self efficacy and avoids arguments.

Smoking Cessation Aid:  Patient on action stage, where they wish to quit within the next 30 days should be assisted in quitting. Smokers can talk to their pharmacists about the medications available for smoking cessation e.g. Nicotine Replacement Therapy (NRT) and Varenicline. Smokers who are given pharmacotherapy intervention will be advised on administration, dosage, nicotine withdrawal symptoms and possible adverse reaction.  Pharmacist is also available to give further counseling on tobacco-related illnesses and Drug Interactions with Smoking. Combined counseling and medication is more effective than when either intervention is used alone. Person-to-person treatment delivered at least 4 or more sessions appear especially effective in increasing abstinence rates.

Follow Up:  It does not stop there as patient on pharmacotherapy intervention will soon be arranged a follow-up after the quit date. Patient should be congratulated if they succeed and strongly encouraged to remain abstinent. If patient smoked, pharmacists will review circumstances and encourage recommitment to complete abstinence. Patients will be encouraged to discuss on the problems encountered and challenges that may occur in the future. On the follow-up visits, pharmacist will assess pharmacotherapy use and problems. If required, pharmacist can consider use or referral for more intensive treatment.  In patients who have recently quit smoking, the pharmacist should reinforce the patient’s decision to quit, review the benefits of quitting and help the patient with any residual problems arising from quitting. Smoking relapse usually occurs within the first 3 months of quitting and can occur months or years after the quit date. Therefore pharmacist need to continuously be involved in relapse prevention interventions.

In summary, nicotine addiction is a form a chronic brain disease. Tobacco use is a complex disorder involving the interplay of the nicotine pharmacology, environmental factors and physiologic factors. Treatment of tobacco use and dependence requires a two-prong approach for maximal treatment effectiveness. Pharmacists are effective providers of smoking cessation program. Greater utilization of pharmacist in tobacco cessation efforts will have significant impact on smoking rates, prevention of tobacco-related illnesses and overall improvement in public health.

 

Veloxin

New Drug Update: Veloxin® Tablet meclozine HCl 25mg + pyridoxine HCl 50mg
by Maggie Tan MK

Introducing Veloxin®, a once daily dosing antihistamine listed in the Malaysia Ministry of Health Drug Formulary (Blue Book) as a category B medicine.  It is indicated for the prevention and treatment of nausea, vomiting or vertigo associated with motion sickness and other vestibular disorders.

Veloxin® contains Meclozine 25mg is a first generation antihistamine of the piperazine class. It is classified by FDA as category B for use in pregnancy. There are no adequate and well controlled studies in pregnant women or animals’ studies which have shown an adverse effect. This means that it is not expected to harm an unborn baby.

Veloxin Tablet also contains Pyridoxine (vitamin B6) which is classified by FDA as category A. Therefore, it is considered to be safe for use during pregnancy. In fact, Pyridoxine requirements increase during pregnancy. It has been found to be effective in significantly reducing severe vomiting.

Common dosage of Veloxin® is 1 - 2 tablet(s) daily. The onset of action is about 1 hour and the drug has prolonged duration of action, with effects persisting 8 to 24 hours following administration of a single oral dose. Some common side effects such as drowsiness, dry mouth, tiredness may occur. Caution should be used to avoid over dosage when concomitantly administer with drug such as antidepressants, alcohol, antihistamines, sedative, pain relievers, anxiety medicine, and muscle relaxants.

Meclozine may be distributed into breast milk. However problems in human have not been documented. It may inhibit lactation due to is anti cholinergic effect therefore is not recommended for lactating women.  

Comparison of Meclozine to other antiemetic is shown as below:-