Assignment 1 PHC528

1. Describe cardiac markers and their role in evaluating the heart function. (10M)
One of the cardiac markers is creatine kinase which catalyzes the transfer of high energy
phosphate groups in tissues that consume large amount of energy such as skeletal muscle,
myocardium and brain. High level of creatine kinase-MB (CKMB), which mainly found
in cardiac muscle cell indicates acute myocardial infection (AMI). Its level begins to
increase three to six hours after an AMI and peaks around 12 to 24 hours.

Another cardiac marker is troponin, proteins that regulate the Ca2+-mediated interaction of
actin and myosin within muscles. It is more specific and sensitive for myocardial damage
indicator compared to CKMB. There are teo types found in cardiac muscles which are
cardiac troponin I (CTnI) and cardiac troponin T (CTnT). The level of CTnI rises within
two to four hours of AMI and remains elevated for about 10 days.

Next is myoglobin, a protein in heart and skeletal muscle cells which providing oxygen to
working muscles. It is less specific than CKMB. When muscle is damaged, myoglobin is
released and increasing within three hours of insult, peak at eight to twelve hours and
then return to normal in about a day.

Lactate dehydrogenase is an enzyme involved in energy production that is found in the

heart, kidney, liver and skeletal muscle, erythrocytes and lung tissue. Although diagnostic
usefulness is limited, its isoenzymes (LDH1 and LDH2) predominated in the heart.
Therefore, increase in both isoenzymes may indicate heart damage.

Brain natriuretic peptide (BNP) released from the heart when there are increase in
demands placed on the myocardial tissue. In an effort to reduce workload on the heart,
BNP counteracts the renin–angiotensin–aldosterone system (RAAS) and causes
vasodilatory effects and natriuresis (high excretion of Na +) in order to reduce blood
volume. Thus, increase in BNP may indicate congestive heart failure.

2. Describe the roles of Pharmacy Services Division, Ministry of Health (MOH) in

ensuring the quality of drug usage in Malaysia. (5M)
Some of the roles of Pharmacy Services Division are formulating policies and guidelines
related to pharmacy practice and monitor their implementation at the MOH facilities,
coordinating the development and implementation of Clinic Pharmacy System (CPS) in
all MOH pharmacy facilities and ensuring the quality of drug procurement and usage
through effective pharmacy practice in order to improve pharmacy services in Malaysia.
They also responsible to plan, coordinate and monitor pharmacy services provided in
MOH hospitals and health clinics to ensure the preparation, supply and dispensing of
medications are accurate and safe for patients. Lastly, they must plan, develop and
coordinate pharmaceutical care services in MOH facilities.
3. Describe the role of pharmacist in the drug management at the hospital. (5M)
The roles of hospital pharmacist are to dispense pharmaceutical products to in-patients
and outpatients, counsel patients on the correct use of drugs, monitoring drug usage
among patients, perform compounding of sterile and non-sterile preparations and manage
the procurement and distribution of drugs and other medical supplies.

4. From the drug classes below, provide an example of drug that is contraindicated in
pregnancy and recommend an alternative treatment. (5M)
i) Anti-epilepsy
- Example of antiepileptic drug that is contraindicated in pregnancy is phenytoin. The
alternative drug is lamotrigine.

ii) Antihypertensive
- Example of antihypertensive drug that is contraindicated in pregnancy is captopril as
ACE inhibitor drug is associated with fetal anomaly. The antihypertensive drug of
choice for pregnant woman is methyldopa.

5. Discuss the general use of drugs in pregnancy. (5M)

There are many drugs that can result in teratogenicity, therefore the use of drugs during
pregnancy is not encouraged unless it is essential for the health of the mother and the
fetus. To be a proven teratogen, a drug must produce deformities in more than 2 to 3% of
mothers exposed, produce a consistent pattern of deformities and drug must not only be
given in sufficient dosage in order to observe dose-related effect. Fetus/ placenta/
amniotic fluid can be considered to be in dynamic equilibrium with the maternal
circulation, thus all drugs the mother takes will pass to the fetus to some extent. Before
the pregnant mother make any decision to take any drugs, they must consult the doctor or
any health care practitioner about the benefits and risks of taking the drugs. The doctor
usually consider the drug for treatment when the potential benefit outweighs known risks.
Some dietary supplements containing vitamin and minerals required for the development
of fetus such as folic acid and iron are usually recommended to be taken.