HOSPITAL KUALA KUBU BHARU

PHARMACY BULLETIN

1st edition /June 2016

HIGHLIGHTS:

Middle East Respiratory Syndrome - Coronavirus (MERS-CoV) : Page 1— 3

Immunisation Program in Malaysia : Page 4-6

PHARMACY EDUCATION

Oral Contraceptive : Page 7- 9

EDITORIAL BOARD

ADVISOR

Ratna Suny bt Mohamed Esa

CHIEF EDITOR

Noor Haslina bt Zainor Abidin

EDITOR

Ainur Fadlina bt Mohd Nadzir

Nur Shazwani bt Mokhtar

CONTRIBUTORS

Mohamad Shafawie bin

Mohamad Sidik

Murni bt Mohammed Ariffin

For further enquiries, please

contact us at :

PHARMACY RESOURCES

INFORMATION CENTRE

(PRIC)

Pharmacy Unit,

Hospital Kuala Kubu Bharu,

44000 Kuala Kubu Bharu,

Selangor

03-60641333 ext 279

INTRODUCTION

MIDDLE EAST RESPIRATORY SYNDROME -

CORONOVIRUS (MERS– CoV)

Middle East Respiratory Syndrome (MERS) is an

illness caused by a virus (more specifically,

a coronavirus). MERS affects the respiratory system

(lungs and breathing tubes). About 3-4 out of every

10 patients reported with MERS have died. Most of

the people who died had an underlying medical

condition. Some infected people had mild symptoms (such as cold-like symptoms) or no symptoms

at all; they recovered.

HISTORY

Health officials first reported the disease in Saudi Arabia

in September 2012. Through retrospective

investigations, health officials later identified that the

first known MERS cases occurred in Jordan in April

2012. So far, all cases of MERS have been linked

through travel to or residence in countries in and near the

Arabian Peninsula. The largest known outbreak of

MERS outside the Arabian Peninsula occurred in the

Republic of Korea in 2015. The outbreak was associated

with a traveler returning from the Arabian Peninsula.

Prepared by : Noor Haslina binti Zainor Abidin

fever

cough

shortness of breath

gastrointestinal symptoms

(diarrhea, nausea, vomiting)

SYMPTOMS

Pneumonia

Kidney failure

COMPLICATION

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people with pre-existing medical conditions (diabetes; cancer; and chronic lung, heart, and kidney

disease)

Individuals with weakened immune systems

** the incubation period for MERS (time between when a person is exposed to MERS-CoV and when they

start to have symptoms) is usually about 5 or 6 days, but can range from 2-14 days.

PREVENTION

WHO HAS HIGH RISK OF GETTING MERS-COV

Non-human to human transmission Camels are likely to be a major reservoir host for MERS-

CoV and an animal source of infection in humans.

Human-to-human transmission Spread from an infected person’s respiratory secretions and is

droplets. MERS-CoV has spread from ill people to others through close contact, such as caring for or

living with an infected person. Infected people have spread MERS-CoV to others in healthcare settings,

such as hospitals.

TRANSMISSION

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Avoid any unnecessary contact with camels. Travelers should practice good general hygiene

measures.

Risk assessment of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) with soap and

water at all times, but especially before and after visiting farms, barns or market areas.

Avoid raw camel milk and/or camel products from the Middle East. More generally, travelers are

also advised to avoid consumption of any type of raw milk, raw milk products and any food that may

be contaminated with animal secretions unless peeled and cleaned and/or thoroughly cooked.

Travelers returning from the Middle East with severe respiratory symptoms should seek medical

advice and must report their travel history so that appropriate infection control measures and testing

can be undertaken. People who are acutely ill with an infectious disease are advised not to travel.

TRAVEL ADVICE

REMINDER TO ALL HEALTHCARE STAFF

1) https://www.cdc.gov/coronavirus/mers/

2) http://www.who.int/mediacentre/factsheets/mers-cov/en/

REFERENCES

There is no specific antiviral treatment recommended for MERS-CoV

infection. Individuals with MERS can seek medical care to help relieve

symptoms. For severe cases, current treatment includes care to support

vital organ functions.

TREATMENT

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IMMUNISATION PROGRAM IN MALAYSIA

Immunisation is the process of giving vaccine to the person with the intention of

stimulating the body own’s immune system against infectious disease. Immunisation

protects the individual and community from disease outbreaks

HOW DO VACCINE WORKS?

Vaccination Schedule by the Ministry of Health Malaysia

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Prepared by : Mohamad Shafawie bin Mohamad Sidik

Disease Complication of the

disease Vaccine product Route of giving vaccine

Tuberculosis

Serious infections of the lung (pneumonia), the membrane

covering the brain (meningitis) and spread throughout the body

Weakened bacterium (BCG)

Beneath the skin in the arm

Diphtheria Blockage of the airway and

pneumonia Modified bacterial

toxin(D)

DTaP/ Hib/ IPV is giv-en together into the

muscle of the thigh (if less than 1 year old) or

arm (if more than 1 year old)

Tetanus Stiffness of body muscles and

inability to open the jaws (lock jaw) Modified bacterial

toxin(T)

Pertussis Severe cough (whooping cough), reduction of oxygen going to the

brain and pneumonia

Killed bacterium (aP)

Haemophilus influenza type B

Infection of the lungs (pneumonia), airway and covering of the brain

(meningitis)

Bacterial component (Hib)

Poliomyelitis Infection of the brain (encephalitis) and permanent weakness of the leg

muscles Ruled virus

Given as a liquid by mouth

Hepatitis B Acute and chronic liver damage and

predisposes the individual to liver cancer in later life

Viral component (Hep B)

Given as MMR into the muscle of the thigh

Mumps Infection of the brain (encephalitis)

and testis (orchitis) which can lead to infertility

Weakened virus (M)

Measles Infection of the brain (encephalitis)

and testis (orchitis) which can lead to infertility

Weakened virus (M)

Rubella

If the rubella virus circulates in the community, an expectant mother,

especially in the first three months of pregnancy may get the disease result-

ing in a baby with multiple birth defects. The baby may have mental

damage, hearing and visual problems and heart defect (usually a PDA

patent ductus arteriosus)

Weakened virus (R)

Cervical Cancer Reconcurrent virus Into the muscle of the

arm / thigh

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References:

1. http://www.myhealth.gov.my/en/

2. Paeds Protocol 3rd Edition

HERD

IMMUNITY

Occurs when a sufficient proportion of the group is immune. The

decline of disease incidence is greater than the proportion of

individuals immunized because vaccination reduces the spread of an

infectious agent by reducing the amount and/or duration of pathogen

shedding by vaccines, retarding transmission.

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Oral contraceptives or “the pill” are tablets taken once a day

to prevent pregnancy

Since 1960’s, the pill has been available and several changes

have occurred over time

One major change has been the reduction in the dose of the

hormones, estrogen and progestin.

The pill is an oral contraceptive that is 99% effective when taken properly

There are 2 main types of pills :

1. Combined pill - contains 2 female

hormones; estrogen and progestin

2. Mini pill - contains only progestin

The difference between brands is the amount of

estrogens and the type of progestin used.

WHAT ARE ORAL CONTRACEPTIVES?

ABOUT THE PILL

ORAL CONTRACEPTIVES Prepared by: Murni bin Mohamed Ariffin CHILDREN BY CHOICE, NOT BY CHANCE

DRUG INDICATION, DOSE

Norethisterone 350mcg

(NORIDAY)

Oral contraceptive: Progestin-only pill (POP)

1 tab daily starting on the first day of

menstrual bleeding

Can be taken with or without food

Desogestrel 150mcg,

Ethinylestradiol 30mcg

(DESOLON)

Oral contraceptive: Combined oral

contraceptive pill (COC)

1 tab daily starting on the first day of men-

struation without interruption for 21 days,

followed by 7 tab-free days.

Can be taken with or without food.

ORAL CONTRACEPTIVES AVAILABLE IN HKKB

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WHAT DO YOU NEED TO KNOW ABOUT TAKING THE PILL?

HOW DOES THE PILL WORK? One pill is taken every day for 21 days, followed by a 7-day break. When taken correctly

the hormones will cause the following changes in the body :

The ovaries stop releasing eggs. Without eggs, no pregnancy can occur.

The cervical mucus thickens to make the sperm more difficult to penetrate into the

cervix, making it difficult to reach the egg.

The lining of the womb (uterus) does not develop sufficiently for a fertilized egg to

implant

Reduces sperm transport in the upper genital tract.

1) When to start taking each pill

pack ?

Your first pill pack is started on the

first day of your period.

Each new pill pack be started on the

same day of the week, no matter when

your period starts or ends.

2) When to take your pills?

Remember to take your pill at the

same time everyday.

Choose the most convenient time,

when you first start taking the pill,

and then be sure to continue taking at

the same time.

3) Management of pills

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COMBINED ORAL CONTRACEPTIVES PILLS (COC) METHODS

Patient compliance is essential for best

protection

Missed pill period up to 12 hrs

Fertility usually returns quickly

Serious side effects are rare

Can be used by women of any age, whether

or not they have children

Help prevent anemia,menstrual cramps and irregular bleeding

Help to lower down risk of ovarian and endometrial cancers

Skin conditions such as acne can improve - has to be taken daily

In the first few months, some users may experiences side effects such as stomach

upset, bleeding between periods or spotting, mild headache, or moodiness.

Not suitable for women over 35 and smoke.

Mood of action : thickening of cervical mucus

Good choice for nursing mothers who want

pills beginning at 6 weeks after childbirth

Suitable for women who wants to avoid

estrogen

Effective during breastfeeding

Can be used as emergency method after unprotected sex

If used when not breastfeeding, bleeding changes are to be expected— especially

spotting and bleeding between period

Greater incidence of irregular bleeding & amenorrhea

PROGESTIN-ONLY PILLS(POP/MINIPILL) METHODS

REFERENCES:

Lippincott Williams & Wilkins, Koda Kimble and Young’s Applied Therapeutics: The

Clinical Use of Drugs, Tenth Edition.

MIMS Drug Dosage and Information at www.mims.com.

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