PHARMACY BULLETIN VOLUME 1

PHARMACY UNIT, HOSPITAL BAHAGIA ULU KINTA JAN - JUN

[ This newsletter also available online at http://hbuk.moh.gov.my ] 2015
INSIDE THIS ISSUE
 Asthma
ASTHMA
(Page 1) By Liew Ming Yan (PF U41)
 How To Use MDI
(Page 2)  Asthma medications play a vital role
 How To Use An
in keeping you well and helping you
Accuhaler
(Page 3) to achieve good control of your
asthma symptoms. Asthma
DID YOU
 How To Use
Turbuhaler
(Page 4)
medications work very well when
taken properly.
KNOW!
 Beta Blockers
(Page 5)
 However, up to 90% of people on
asthma medications don’t use them
UP TO 90% OF
PEOPLE ON
 Legacy Effect Of
Earlier Glucose properly. This means many people
Control put up with asthma symptoms when
(Page 7)
 Wounds (Page 10)
they don’t need to and their
everyday life is affected.
ASTHMA
EDITORIAL BOARD  Making your medicine work for you is
an important step in living well with
MEDICATIONS
Advisor :
• Puan Shamini a/p
asthma. Using asthma medications
incorrectly can also increase the risk
DO NOT USE
THEM
Rama (U52)
Chief Editor : of side effects.
• Cik Leong Pei Loo  Even if you think you are using your
(U48)
Editorial Members: medication correctly, it is important
to have your technique checked
PROPERLY
• Puan Wong Vi Vian
(U44) regularly. Ask any health care
• Cik Chia Sue Anne
(U44)
professional to review your
• Cik Nicole Liew Ker medications and check your
Xing (U44) technique at your next visit.
• En. Zulhilmi bin
Aladdin (U44)
• Cik Liew Ming Yan
(U41)

For enquiries kindly contact:

Drug Information Service,

Pharmacy Unit,
Hospital Bahagia Ulu Kinta,
31250, Tg. Rambutan, PERAK
Tel : 05-5332333 (Ext : 5609)
 PHARMACY BULETIN Vol.1, 2015 // PAGE 2

HOW TO USE METERED DOSE

INHALER
 PHARMACY BULETIN Vol.1, 2015 // PAGE 3

HOW TO USE AN ACCUHALER

 PHARMACY BULETIN Vol.1, 2015 // PAGE 4

HOW TO USE TURBUHALER

Reference: Australian Asthma Handbook

 PHARMACY BULETIN Vol.1, 2015 // PAGE 5

BETA BLOCKERS
By Wong Vi Vian (PF U44)

 β-blockers are effective for reducing blood pressure but other antihypertensives are
normally more effective for decreasing the incidence of stroke, myocardial infarction,
and cardiovascular mortality. Hence, other antihypertensives are the first choice for
routine initial treatment of uncomplicated hypertension.
 In general, the dose of a β-blocker for hypertension does not have to be high; for
example, atenolol is given in 25–50mg daily and it is seldom required to increase to
100 mg.
 Sudden withdrawal may cause an exacerbation of angina or rebound worsening of
myocardial ischaemia. Reduce dose gradually when β-blockers are to be stopped.
 There is a risk of precipitating heart failure when β-blockers and verapamil are used
simultaneously in established ischaemic heart disease.

T.Bisoprolol is now
available in HBUK
Formulary

 Bisoprolol and carvedilol reduce mortality in any grade of stable heart failure.
Treatment should be started by those experienced in the management of heart failure,
at a very low dose and titrated very slowly over a period of weeks or months.
Symptoms may worsen initially, requiring adjustment of concomitant therapy.
 Common adverse effects: Fatigue, coldness of the extremities, sleep disturbances with
nightmares.
 Atenolol is water-soluble; they are less likely to enter the brain, and may therefore
cause less sleep disturbance and nightmares.
 Water-soluble beta-blockers are excreted by the kidneys and dosage reduction is often
necessary in renal impairment.
 β-blockers can affect carbohydrate metabolism, causing hypoglycaemia or
hyperglycaemia in patients with or without diabetes, and can also mask certain
hypoglycaemia symptoms.
 Nevertheless,β-blockers are not contra-indicated in diabetes, although cardioselective
β-blockers may be preferred. Avoid β-blockers in frequent episodes of hypoglycaemia.
 β-blockers, particularly when combined with a thiazide diuretic, should be avoided for
the routine treatment of uncomplicated hypertension in patients with diabetes or in
those at high risk of developing diabetes.
 Contraindications: second- or third-degree heart block, worsening unstable heart
failure, history of asthma (usecardioselectiveβ-blocker if really necessary & closely
monitor).
 PHARMACY BULETIN Vol.1, 2015 // PAGE 6

BETA BLOCKERS AVAILABLE

IN KKM FORMULARY
No
Name Category Indication (Formulary KKM) Dose (Formulary KKM)
.
Hypertension, angina, MI, Initially 80mg bd, increased as
1. T. Propranolol B arrhythmia, portal hypertension, required to usual range of 160-
migraine, thyrotoxicosis 320mg daily
(Hypertension & arrhythmia) 50-
Hypertension, angina, MI, 100mg OD
2. T. Atenolol B
arrhythmia (Angina) 100mg OD
(MI) Individualised
Treatment of stable moderate
to severe congestive cardiac
3. T. Bisoprolol B 1.25mg OD to 5-10mg OD
failure in addition to ACEI &
diuretics
3.125mg bd for 2 weeks, then
Treatment of stable moderate 6.25mg bd for 2 weeks, then
to severe congestive cardiac 12.5mg bd for 2 weeks then 25mg
4. T. Carvedilol ** A/KK
failure in addition to ACEI & bd (titrated up to the highest
diuretics tolerated level) Max: <85kg 25mg
bd, >85kg 50mg bd
Tachycardia & hypertension in By IV infusion usually within range
5. Inj. Esmolol ** A*
perioperative period of 50-200mcg/kg/min
100mg (50mg in elderly) daily with
food, increased at intervals of 14
Hypertension (including in
6. T. Labetalol ** B days to usual dose of 200mg bd, up
pregnancy)
to 800mg bd. (3-4 divided doses if
higher dose). Max 2.4g daily
Hypertension: Initially 100mg to
max 400mg daily. Angina: 50-
Hypertension, angina, MI, 100mg in 2-3 times daily. MI:
7. T. Metoprolol B
arrhythmias 200mg daily in divided doses.
Arrythmias: 50-300mg in 2-3 times
daily
Supraventricular & ventricular
arrythmias. Adult: Initially
80mg/day as single or in 2 divided
8. T. Sotalol** A* Ventricular tachyarrythmias
doses, increased gradually every 2-
3 days. Usual dose: 160-
320mg/day in 2 divided doses
References
** Not available in HBUK Formulary
• British National Formulary 68
• Formulary KKM
• Oxford Handbook of Practical drug
therapy, 1st edition
 PHARMACY BULETIN Vol.1, 2015 // PAGE 7

LEGACY EFFECT
OF EARLIER
GLUCOSE CONTROL
By Chia Sue Anne (PF U44)

From UKPDS, Prof Dr Rury Holma said ‘Early intensive glucose control leads to increased
benefit over time, and waiting and treating later leads to disappointing results.’

HOW QUICKLY SHOULD

PATIENTS BE REACHING
HbA1c TARGETS?
Intensively so as to achieve
target HbA1c<6.5% within 6
months of diagnosis, shown
reduces the risk of diabetic
complications, greatest effect
on microvascular
RRR: Relative Risk Reduction, P: Log Rank
complications. [1]

VS
1. Paromita King, Ian Peacock and Richard Donnelly. United Kingdom
Prospective Diabetes Study (UKPDS). Br J Clin Pharmacol. 1999 Nov;
48(5):643-648
 PHARMACY BULETIN Vol.1, 2015 // PAGE 8

TREATMENT ALGORITHM FOR

THE MANAGEMENT OF TYPE 2
DIABETES MELLITUS
 PHARMACY BULETIN Vol.1, 2015 // PAGE 9

ORAL HYPOGLYCEMIC AGENTS

AVAILABLE IN HBUK

T. METFORMIN 500MG T. GLIBENCLAMIDE 5MG T. ACARBOSE 50MG

T. GLICLAZIDE 80MG
T. GLICLAZIDE MR 30MG

• Increase insulin secretion

• Problem: lead to beta-cell
dysfunction!
• GLICLAZIDE
- Works faster, shorter half-life,
thus safer for geriatrics.
- More selective, only binds to
the pancreatic ATP channels
• GLIBENCLAMIDE
- Works slower, acts longer,
thus frequent hunger
pangs/hypoglycemia
- Less selective, may also bind
to cardiac ATP channels
• Metformin increase insulin
sensitivity
• Metformin lowered fasting
plasma glucose and HbA1c
in dose-related manner.
Maximal benefits were
observed at the 2000mg.
• Reduce the rate of digestion
of polysaccharides.
• Lower postprandial glucose
without causing
hypoglycemia.
• Often “misuse” when
uncontrolled diabetes patient
on maximum OHA who does
not want to initiate insulin
injection.
• Monnier Study: Useful to
control lower HbA1c, where
post prandial sugars play a
role.

WOUNDS
By Nicole Liew Ker Xing (PF U44)
Red Wounds:
‘simple’,non- complex
Pale pink to beefy red
Granulation tissue is visible
Treatment goal: continue
the proliferation of healthy
tissue while preventing the
start of an infection with
pathogenic micro-organisms.
Yellow Wounds:
Mostly infected
Pale ivory, yellowish green, or
brownish
Large amount of exudates
For microbial culture& analysis
Focus on: aggressive
debridement, treatment of the
microbial infection and the
reduction of exudate.
PHARMACY BULETIN Vol.1, 2015 // PAGE 10
Black Wounds:
With necrotic tissues
Necrotic tissue itself is often
dry; and the tissue below the
necrotic tissue is generally not
healthy.
Surgical/Sharp debridement
to remove the non-viable tissue
is required.
Green Wounds:
Infected & specific type of
bacteria growing in the wound
Identifiable by their
distinctive malodor.
Cleaned and treated in
comprehensive treatment plan
similar to Yellow wounds.
 PHARMACY BULETIN Vol.1, 2015 // PAGE 11

Dermacyn Wound Care is available in Hospital Bahagia Ulu

Kinta. It is a super-oxidized disinfectant solution for treating
ulcers, wounds, cuts and burns which is produced based on the
patented Microcyn technology: a sterile super-oxidized, pH
neutral, purified water-based solution. The solution disinfects
the affected area while maintaining the health of the
surrounding tissue and can therefore also be used in the
debridement, irrigation and moistening of acute and chronic
wounds, ulcers, cuts, abrasions and burns. By reducing the
microbial load and assisting in creating a moist environment,
Dermacyn wound care enables the body to perform its own
healing process

Extracted from: Oculus Innovative Sciences Product Catalogue