6 Must Have Smartphone Application for Malaysia Pharmacist

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As a Pharmacist which compete with the massive amount of new medicines, it is vital to keep us up to date and having all the references in your fingertips to provide the most precise information whenever our client need it. It is very tedious to bring along all the references such as 3000 pages drug references or a thick BNF book walk around the ward and it is very time consuming too whenever you need to check for a drug.

Luckily with the advancement of technology, smartphone application provide us the fingertips reference with immediate search references. Here are 6 smartphone apps which I would like to introduce to the pharmacists in Malaysia:

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1. Lexi-comp drug references:

My main reference during my PRP-ship

Pros:

  • Provide concise up to date references of all the drug listed by FDA, details such as renal dose adjustment, peads & adult dosing and provide studies and article for references.
  • Work offline
  • Side reference such as Harison practice, adult patient counseling point and Lexi-tox
  • Great calculator tools
  • Simple but handy drug interaction checker

Cons:

  • Paid apps and costly
  • Drugs not listed in FDA cant be refer.

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2. Medscape

Pros:

  • Provide offline references of medical procedures and drugs which updated regularly with information similar to
  • It’s Free
  • CME provided which can keep you up to date medical information

Cons:

  1. Don’t provide studies on drug
  2. Long loading time

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3. Stanford Antibiotic Guide

Pros:

  • Provide latest antibiotic spectrum to all the microbes that causes diseases
  • Details information of each antibiotics
  • serve as my second references next to lexi comp for antibiotics

Cons:

  • Paid application
  • Have to update yearly. no automatically update available

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4. Pocket Lab Reference Values

Pros:

  • Provide a range of lab values to reference which sort according to their categories in SI units and US units
  • Description of each value are included
  • Work offline
  • Provide differential for increased/decreased value
  • Provide lab diagnostic technique such as container information

Cons:

  • Too much information on a value, sometimes the differential will make you confuse

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5. Drugs.com

A newly published apps by the famous drugs.com

Pros:

  • Contain all the information as in drugs.com
  • Pill Identifier
  • Interactions checker
  • Free apps

Cons:

  • Required internet connections and accounts

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6. My Blue Book

Pros:

  • The only application that allow you to check prescriber categories
  • Provide offline information for drug in Malaysia KKM Hospital
  • Allow you to check the dosage available in Malaysia KKM Hospital
  • Provide generic / brand conversion easily

Cons:

  • Too few information such as renal dosage adjustment are not available
  • Calculator tools are not available (It’s coming soon)
  • Iphone user are not allowed to view the dosage

There are few more handy applications which is good and handy, but however, with this 6 application installed in your smartphone, basically you can solve any questions by your clients in the hospital, be sure you choose the correct tools to solve the problems/questions.

How to identify a SAFE and REGISTERED Medicine product in Malaysia.

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How to identify a SAFE and REGISTERED Medicine product in Malaysia.

Here are some sharing of knowledge on how to identify a SAFE and REGISTERED Medicine product in Malaysia.

Why Registered Medicine Products?
Almost every Medicinal/Pharmaceutical products in Malaysia are required to register to the National Pharmaceutical Control Bureau (NPCB) to be approve by our Drug Control Authority (DCA) for sale and use in Malaysia in order to provide Malaysian with a Safe, unadulterated, and efficient medicine products.

Beside that, NPCB will check whether the medicinal manufacturer had the proper quality and facilities to be produce your medicine (GMP) and will not allow them to produce it if they doesn’t meet the requirement. It is a good way to ensure that we, as a Malaysian obtain the highest quality of drug.

Comparatively with the so called “medicine” sold in pasar malam without proper registration, you can’t know:
Who are the one who produce it?
Do they add in fake / dangerous active ingredient?
Do the medicine effective?
Do the expiry date is true?

Are you confident to consume it even you don’t know what is it?

So, next time when you want to purchase yourself a medicine product (* Even PANADOL) you should check whether it is registered or not.

To check for MAL number validity, I had made an smartphone application (MediQuest) to ease your life, you can download it on below:

https://play.google.com/store/apps/details?id=air.mypharmacisthouse.mediquest

or you can go to NPCB website to check for it:
http://portal.bpfk.gov.my/search-product.cfm (an easier link)

Thank you very much
Best Regard,
My Pharmacist House

Link

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Denguide: Malaysia CPG Guideline

Dengue is dangerous, especially for the old and babies. It can possibly kill the patient if poorly manage.

I had convert our country clinical practice guideline into an easier view apps in order to facilitate your view toward the guideline in anytime and anywhere.

Just hope that this little apps can assist you all in saving patients life

Warfarin

Click here to download Mediscan now!

Click here to download Mediscan now!

Kegunaan Ubat:

Ubat ini digunakan untuk menghalang pembentukan darah beku dan menghalang darah beku sedia ada daripada menjadi semakin besar.

Cara Pengambilan Ubat:

Ambil ubat ini pada masa yang sama setiap hari selepas makan (Biasanya pukul 6 petang). Teruskan mengambil ubat ini sehingga doctor anda memberitahu anda untuk berhenti. Jangan berhenti mengambil ubat ini hanya kerana anda berasa lebih baik.

Langkah Berjaga-jaga:

Anda mungkin berdarah dengan lebih mudah, berhati-hati dan mengelakkan kecederaan. Jangan derma darah semasa mengguna ubat ini. Maklumkan doktor atau ahli farmasi anda jika anda mempunyai: penyakit buah pinggang, penyakit hati, penyakit thyroid, jantung yang lemah, merancang untuk hamil. Maklumkan kepada doktor gigi anda bahawa anda sedang mengguna warfarin.

Jika terlupa ambil ubat:

  • Ambil dos yang tertinggal sebaik sahaja anda teringat, jika ianya dalam tempoh hari yang sama.
  • Teruskan mengambil warfarin anda pada waktu yang sama pada keesokan hari.
  • Jangan gandakan dos. Menggandakan dos mungkin menyebabkan peningkatan pendarahan.
  • Catatkan tarikh dos yang tertinggal dan beritahu doktor anda semasa janji temu anda yang seterusnya.

Penyimpanan

  • Jauhi dari kelembapan (simpan di tempat yang kering) dan kepanasan (elakkan daripada sinaran terus matahari)
  • Simpan ubat di tempat yang selamat dan jauh daripada kanak-kanak

Peringatan

  • Kehamilan: Warfarin boleh menyebabkan kecacatan semasa lahir. Maklumkan doktor atau ahli farmasi anda jika anda hamil atau berhasrat untuk hamil.
  • Pembedahan: Jika anda akan melalui pembedahan (termasuk pembedahan gigi) maklumkan doktor atau doktor gigi berkenaan bahawa anda mengambil warfarin. Doktor mungkin meminta anda berhenti mengambil warfarin selama beberapa hari sebelum prosedur tersebut untuk mengelakkan pendarahan berlebihan.
  • Alkohol: Elakkan pengambilan alkohol berlebihan. Dinasihatkan supaya tidak mengambil lebih daripada 5 tin bir atau lebih daripada 1 botol wain seminggu.
  • Aktiviti Harian: Berhati-hati apabila menggunakan pisau cukur dan objek tajam lain. Elakkan sukan lasak (contohnya, bola sepak, rugbi, seni mempertahankan diri) atau aktiviti yang boleh mencederakan anda .Elakkan penggunaan berus gigi, floss yang keras.
  • Kecederaan: Sekiranya anda mengalami kecederaan ringan, basuh dan berikan tekanan atas kawasan tersebut sehingga pendarahan berhenti (ini mungkin mengambil masa sehingga 10 minit). Dapatkan perhatian perubatan dengan segera jika pendarahan banyak berlaku pada tempat cedera atau jika anda mengalami kecederaan di kepala. Teruskan memberi tekanan pada tempat luka sambil menunggu bantuan.

Semasa anda mengambil warfarin, anda perlu kembali untuk pemeriksaan darah secara berkala. Pada setiap temu janji dengan doktor anda, pemeriksaan darah akan diarahkan untuk memeriksa Nisbah Ternormal Antarabangsa (INR), yang mencerminkan keberkesanan rawatan antikoagulasi. Jadi, penting bagi anda menghadiri setiap temu janji untuk memastikan bahawa warfarin diberikan dengan wajar. Sentiasa buat janji temu lain jika anda gagal menghadiri salah satu. Anda hendaklah pertimbangkan membawa kad pengenalan (Buku Panduan untuk Pesakit Warfarin) untuk menunjukkan yang anda mengambil warfarin. Ini penting terutamanya semasa kecemasan atau apabila anda tidak sedar. Berunding dengan ahli farmasi atau doktor anda mengenai cara mendapatkan kad ini.

Interaksi warfarin dengan ubat ubatan lain

Banyak pengubatan mengganggu keberkesanan warfarin. Penting bagi anda memberitahu doktor atau ahli farmasi anda jika anda mengambil pengubatan lain termasuk pengubatan tanpa preskripsi, tradisional dan herba. Ini termasuk:

  • Antasid
  • Batuk atau ubat selesema
  • Ubat ulser gaster
  • Julap
  • Ubat tahan sakit (contohnya, aspirin dan NSAIDS lain)
  • Vitamin tambahan (Vitamin K)

Interaksi warfarin dengan makanan:

Bincang diet anda dengan doktor. Jangan lakukan sebarang perubahan besar terhadap pengambilan makanan yang mengandungi vitamin K, seperti hati, sayuran berdaun hijau dan brokoli, kerana ia mungkin mengubah kesan warfarin.

Interaksi warfarin dengan herbal:

Dinasihatkan supaya tidak mengambil apa-apa Jamu, ubat Cina (Gingko Biloba, Ginseng, Dong Quai) atau Ayurvedik , kerana kesannya terhadap warfarin tidak boleh diramal.

Kesan Terapeutik

  • Mencegah dan merawat darah beku di dalam saluran darah.

Kesan Sampingan

Kesan sampingan warfarin yang paling biasa ialah pendarahan. Sila dapatkan perhatian pengamal perubatan sekiranya anda mengalami simptom berikut:

  • Pendarahan daripada telinga, hidung, gusi (jangan lupa menggunakan berus gigi lembut)
  • Muntah darah (yang mungkin kelihatan seperti serbuk kopi atau darah segar)
  • Sakit perut tanpa sebab
  • Bintik merah pada kulit
  • Kesakitan atau pembengkakan luar biasa (con. Pada sendi)
  • Darah dalam air kencing
  • Darah haid yang banyak
  • Pendarahan rektum
  • Najis hitam, melekit

Lebam-lebam: Anda mungkin mudah menjadi lebam sekiranya jatuh atau terlanggar sesuatu. JANGAN gosok atau urut kawasan tersebut. Sila dapatkan perhatian perubatan jika lebam bertambah besar atau saiznya tidak berkurangan, atau jika anda mendapat lebam-lebam tanpa sebab nyata.

References:

Kaunselling Ubat Hospital USM

Diclofenac (Voltaren)

Click here to download Mediscan now!

Click here to download Mediscan now!

Usage:

This medicine is used to ease pain and swelling. This medicine also used to treat arthritis and gout attacks.

How to use it / Best taken:

Take this medicine with food to prevent an upset stomach. Take with a full glass of water. Many times this medicine is taken on an as needed basis.

Precautions / Warning:

You may bleed more easily, be careful and avoid injury. Talk with your doctor if you have risk for heart disease, kidney disease, liver disease, ulcer / bleeding from your stomach or bowel, pregnant, plan to getting pregnant or breast feeding.

Disclaimer:

The information in this webpage is general information only. This page is not medical advice specific to you or any other person. This page does not contain all information about this drug and does not cover all uses, directions, precautions, warning, drug interactions or side effects. Read the package insert for more information.

Tramadol (Tramal)

Click here to download Mediscan now!

Click here to download Mediscan now!

Usage:

This medicine is used to ease pain

How to use it / Best taken:

Take this medicine with or without food, take with food if it causes an upset stomach. Drink a lot of water unless told to drink less liquid by your doctor. Many times this medicine is taken on an as needed basis.

Precautions / Warning:

This medicine may let you feel lightheaded, sleepy, blurred eyesight, or dizzy. Avoid driving or doing other tasks that call for you to be alert or have clear eyesight. This drug may be habit-forming with long-term use.

Disclaimer:

The information in this webpage is general information only. This page is not medical advice specific to you or any other person. This page does not contain all information about this drug and does not cover all uses, directions, precautions, warning, drug interactions or side effects. Read the package insert for more information.

Metoclopramide (Maxolon)

Click here to download Mediscan now!

Click here to download Mediscan now!

Usage:

This medicine is used to prevent nausea and vomiting. This medicine also used to treat heartburn and gastroesophageal reflux disease (GERD).

How to use it / Best taken:

Take this medicine 30 minutes before meals.

Precautions / Warning:

This medicine may cause lasting muscle movements that you cannot control, talk to your doctor if it happened. Use with precaution if you have mental illness, Parkinson’s disease, kidney disease or heart disease.

Disclaimer:

The information in this webpage is general information only. This page is not medical advice specific to you or any other person. This page does not contain all information about this drug and does not cover all uses, directions, precautions, warning, drug interactions or side effects. Read the package insert for more information.

Glyceryl Trinitrate (GTN)

Click here to download Mediscan now!

Click here to download Mediscan now!

Usage:

This medicine is used in emergency for chest pain (heart attack)

How to use it / Best taken:

Put 1 tablet under the tongue during chest pain for every 5 minute until the chest pain resolve or when there are side effects associated with the drug.

Precautions / Warning:

Most chest pain will resolve in 1-5 minutes, if you still experienced chest pain after 3 tablets (15minutes), get emergency medical help immediately. Don’t swallow this medicine

Disclaimer:

The information in this webpage is general information only. This page is not medical advice specific to you or any other person. This page does not contain all information about this drug and does not cover all uses, directions, precautions, warning, drug interactions or side effects. Read the package insert for more information.

Vioxx Story- A story that worth sharing

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This is one of the subtopic of my presentation titled “How drug company misled healthcare professionals and harm patients” during my DPIS attachment. One of the famous event happened in drug history. The story is quiet lengthy sorry i tried to summarized it already 

Vioxx (rofecoxib), a selective NSAID that made a annual sales of 2.5 billion in 2003 and estimated 80 millions people were prescribed with vioxx at some time and the second famous cox 2 inhibitor next to Celebrex. (celecoxib). On the other hand, this drug also accounted to approximately 90 thousand American’s heart attacks and 38 thousand of death.

Well, although it is very scientific (I dislike to be scientific xD), I would try to explain the story in a more easy way.

The story begin in 1999 when the FDA approve vioxx, in the same year, Merck (Company of vioxx) conducted a study call vioxx gastrointestinal research study (VIGOR), this study involve 8 thousand patient to compare the safety of vioxx to naproxen in gastrointestinal.

Few months later the safety panel review that vioxx have serious heart problems and death among vioxx patients is twice as high as the naproxen group, the safety board votes to continue the trial as the effect might be because of the cardio protective effect of naproxen.

In year 2000, merck get the result of the VIGOR trial and publish it to the New England Journal of Medicine (NJEM), however, they only submitted 17 of the 20 heart attack without acknowledge NEJM the 3 extra death.

7 month later, Merck submitted the result to FDA but still didn’t submit to NEJM, so the study published in NEJM doesn’t mention the another 3 death and leave out alots of data on cardiovascular effects.

(*Note: The data were published by NEJM in 2005 after the withdrawal of vioxx, the relative risk cardiovascular event increase from 4.25 to 5%.)

Then in 2001, some researcher manage to get the data from FDA and made a meta analysis on it, the result cast a serious doubt on the hypothesis that naproxen protects the heart.

The story continue until 2004, there are several epidemiological studies shown vioxx increased cardiovascular problems, but this doesn’t affect the sales of vioxx, and it continue to rise until 2003 for its peak sales.

In 2004, merck voluntary withdraws vioxx after a study called “Approve” which shown that the drug rises the risk of heart attack after 18 months.

By the time it withdraw, it is estimated there are 20 million Americans have taken the drug, research later published in lancet which estimate that approximately 90 thousand American had heart attacks from taking vioxx, and 38 thousand of them died!

So, the next question is, how about other cox 2 inhibitor? Bextra which is marketed by Pfizer were removed from market due to the concern of possible increased risk of heart attack and strokes, which is after vioxx events. Arcoxia, which is the next generation of merck cox 2 inhibitor are not approved by FDA due to insufficient safety data provided.

Next is celecoxib, the celecoxib long term arthritis safety study (CLASS) did not present an increase in events, but however, some researcher cast a doubt on the safety of Celebrex as the CLASS trial is only range from 6 month to 13 month (Note: Vioxx rise the risk of heart attack after 18 month), so Pfizer promise to do a big, large trials for Celebrex named PRECISION trial, which begin in 2006 and completed in may 2014 which is after the Celebrex patent end. 

If you goto the clinicaltrials.gov check for the PERCISION study at here http://clinicaltrials.gov/ct/show/NCT00346216?order=13 and see the progress.

References:
1. “PRECISION : Prospective Randomized Evaluation of Celecoxib Integrated Safety vs Ibuprofen Or Naproxen”. ClinicalTrials.gov. National Library of Medicine. 2006-12-07.
2. Expression of Concern: Bombardier et al., “Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis,” N Engl J Med 2000;343:1520-8. Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., and Jeffrey M. Drazen, M.D
3. Drugs.com: Arcoxia FDA Drug Approval Status
4. http://www.npr.org/templates/story/story.php?storyId=5470430
5. http://www.naturalnews.com/011401_Dr_David_Graham_the_FDA.html

Question to ask Your Pharmacist on New medicine

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Question to ask Your Pharmacist on New medicine

Every medicine is unique and has different function to our body, it is essential that whenever you receive a new medicine prescript by doctors, you should know your medicine well. Below are questions that you can ask your pharmacist:

1. Why Should I take this medicine?
You wont receive the medicine without any purpose. Understanding how this medicine help your illness and how important is the medicine will make you understand your body better. Besides that, if you dont want to take it, tell us your concern, it might be other alternative and ways to help your condition.

2. Is the medicine safe for me?
Different people have different reaction toward the medicine, make sure you tell your pharmacist
-> All your current medicines which included over the counter drug, vitamin and minerals, herbs and supplments
-> Any Drug allergies you encountered before
-> Any illness or condition you have such as asthma
-> If you are nursing, pregnant, or planing to be pregnant

3. How should I take my medicine?
In order to optimized the therapy of each medicine, the medicine should be consume in their specified time, dose, frequency and methods. Some medicine will be greatly affected by the food you consuming or other drug you are taking together. Make sure you ask your pharmacist regarding:
-> How often do you need to take the drug (e.g one times per day, two times per day)
-> Before meal, after meal, or with meal
-> How much do you need to take it
-> Is there food/drug you need to stop
-> is there anything you should not do (e.g Driving)

4. How long should I take the medicine?
Some medicine should be stop after the symptoms gone but some should be continue after the symptoms gone to prevent relapse of the disease. Some medicine will be consume even there is no symptom. So make sure you have a clear mind on when to stop your medicine and not stopping your medicine yourself.

5. What are the side effects?
We know all medicines have side effects, but there are solutions to prevent or stop some of the common side effects, for example, some gastric irritated medicine side effect will be reduce if you consume the medicine after meal.

Besides that, if you know the common side effects that might be happened on you, you wont be frighten off when it appear on you. Ask your pharmacist when should you go to hospital on the side effects.

Lastly, Make sure you know your medicine well before you leaving the pharmacy, dont hesitate to ask us as your health and wellness is our major concern.

Resource: Consumerreport.org: Drug Safety: Starting a New Drug 6 Questions to Ask Your Pharmacist

Click to access 6questionstoaskyourpharmacist.pdf

Pollutant Standard Index (PSI)

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Pollutant Standard Index (PSI)

Pollutant Standard Index (PSI) @ My Pharmacist House

Recently the haze topic already spam my whole facebook wall, this term – PSI keep appear in the article, it is an important air quality indicator used by Singapore to tell the public the conditions of the air around them whereas in Malaysia, we use Air Pollutant Index (API) or so called “Index Pencemar Udara” (IPU). These 2 index were similar but not identical in calculations.

These index were calculated based on the 5 major air pollutant which are CO, NO2, SO2, particulate material and ozone in the air which count on 24 hour basis (Singapore’s is based on 3 hour basis which have more reflection on real time air condition)

When inhaled these air pollutant, it will cause serious harm to our body, especially for elderly, pregnant women, children and peoples with chronic lung & heart medical conditions, you can see the impact of these air pollutant on health by visiting WHO website:

http://www.doe.gov.my/webportal/wp-content/uploads/2013/01/WHO-Air-quality-guidelines-for-particulate-matter-ozone-nitrogen-dioxide-and-sulfur-dioxide-summary-of-risk-assessment.-WHO-2005.pdf.

This poster were cite based on singapore NEA websites, hope that this will make you all more understand about the PSI reading

For Malaysia part, we can check the API on depart of environment website: http://www.doe.gov.my/apims/index.php

and for singapore we can check it on National Environmental agency website:
http://app2.nea.gov.sg/