OKTOBER 2013 BULETIN FARMASI

Methadone ialah ubat yang tergolong di dalam kumpulan opioid yang digunakan sebagai terapi gantian untuk merawat ketagihan heroin dan lain-lain ketagihan opioid. Opioid dikelaskan sebagai ubat-ubat penekan (depressant drugs) kerana ia memperlahankan sistem saraf. Kesan methadone adalah lebih lama daripada heroin (kesan heroin han-

yalah selama beberapa jam sahaja). Perkhidmatan Rawatan Terapi Gantian Methadone di Klinik Kesihatan Batu Gajah beroperasi sejak Mac 2011. Bermula dengan hanya seorang pesakit, kini (sehingga Jun 2013) seramai 25 orang telah berdaftar untuk menjalani rawatan ini di KK Batu Gajah.

Perkhidmatan ini dibuka pada jam 9.00 pagi hingga 10.00 pagi setiap hari bekerja. Pada hari minggu dan cuti am, para pesakit akan ke Hospital Tanah Merah untuk meneruskan rawatan mereka.

PKD TANAH MERAH

Setiap pesakit yang menjalani rawatan terapi gantian methadone hanya perlu mengambilnya sekali sehari sahaja.

UNIT FARMASI

Pesakit

untuk ke luar negara perlu mengemukakan permohonan kepada Pegawai Farmasi atau Pegawai Perubatan/Pakar, sekurang-kurangnya 1 bulan sebelum tarikh lawatan. Tempoh lawatan 1 minggu Tempoh lawatan > 1 minggu Dalam kepekatan Dos Bawa Balik (dicairkan) Dalam kepekatan asal. Pesakit perlu diberi maklumat pencairan Sirap Methadone secara bertulis

Isi kandungan
Pendispensan methadone Sidang pengarang Statistik methadone KK Batu Gajah History of Methadone Methadone Dispensing Policy Benefits MMT for Clients Myths & Facts About Methadone BCG Does Not Only A Vaccine The Rise in Bed Bugs Taking Your Meds Safely Eczema & Topical Steroids Aktiviti Farmasi Kesihatan Tanah 1 2 2-3 3 4-6 7 8 9 9 10 11 12

Tahukah anda?
Sirap Methadone adalah selamat digunakan untuk ibu hamil dan menyusukan anak.

Sirap Methadone yang telah dicairkan (mengikut garis panduan) adalah stabil selama 7 hari pada suhu bilik.

PN. ZUNAIDAH MAT JUSOH

NABILAH ISMAIL

MD FARHAN AB RAHMAN

DINA AZWIN BAHARUDIN

RABIATUL ADAWIYAH ADNAN

INFO

Bilangan pesakit Methadone KK Batu Gajah

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Bilangan daftar pesakit methadone sehingga Jun 2013 adalah seramai 25 orang tidak termasuk kes transfer in. Semua pesakit methadone di KK Batu Gajah adalah DOT (direct observe therapy) dan tiada DBB (dos bawa balik).

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25 20

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18

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10 5 0 2011 Bil.Daftar 2012 Bil. Pesakit Aktif

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2013 (Jan-Jun)

Methadone - The predominant painkiller used in Germany, and most of the world, in the 1930's for injuries and for wounds. Since it appeared that a war was coming, the German government realized that it would need supplies of painkillers and that their access to raw opium might be interrupted, and thus encouraged the development of alternative painkiller drugs. Methadone was developed in the late 1930's in Germany by the I.G. Farben company. Methadone is almost as effective if taken orally as if injected. Named Amidon, methadone was used during World War

II but not as much as anticipated. The German patents on medical drugs were voided at the end of World War II. In 1947, Dolophine, the trade name for methadone, was released in the United States as a pain reliever. Soon it just became known as methadone. In the 1960's, heroin use was growing.

Initially as a marketing plan to sell it, methadone, a legal drug, was promoted as a replacement for heroin, an illegal drug. Because methadone was taken orally and not intravenously or by snorting, it was not only legal but also less likely to cause other diseases and conditions. In order to regulate the use of methadone as a treatment for heroin, the Drug Enforcement Agency (DEA) issued the Controlled Substances Act in 1970. This act established strict rules for methadone clinics, or Narcotic Treatment Programs (NTPs).

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P K D T A NA H M E R A H

1 PREMISE Methadone dispensing to patients shall be carried out by pharmacists in a designated room away from other patients. Control of methadone dispensing for treatment purpose ...no person unless he is a licensed pharmacist or a pharmacist in the public service Regulation 17 of P(PS)R 1989 Dispensing via counter is not allowed as patients need to be supervised and counselled during drug taking.

Methadone shall be kept safely in a Dangerous Drug Cabinet under lock, and key movements shall be recorded for purposes of trace. Pharmacies carrying out dispensing of Methadone shall adhere to guidelines as stipulated in Garis Panduan Pendispensan dan Pemantauan Rawatan Terapi Gantian Methadone, Bahagian Perkhidmatan Farmasi, KKM. Panduan Kaunseling Methadone bagi Rawatan Terapi Gantian oleh Bahagian Perkhidmatan Farmasi, KKM 2 DISPENSING SERVICE Operating hours: Working days: eg: 8.00 - 4.30 pm Saturdays, Sundays dan Public Holidays: As stipulated by treatment centre.

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P K D T A NA H M E R A H

3 RECORDS Patient Records All Methadone prescription and dispensing records are confidential and must be kept for a minimum of 2 years. Prescription and dispensing records by private dispensing doctors shall be kept by supplying hospital Supply Records All records of Methadone dispensing and supply shall be in accordance to Poisons Act 1952 and Poison Regulations (Psychotropic Substances) 1989

Patients Folder

Methadone Prescription

Daily Dispensing Records

DD Stock Record Book

VOLUME 1, ISSUE 1

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4 DISPENSING TO CLIENTS Dispensing of Methadone shall be done daily by Direct Observe Therapy (DOT) in low concentration liquid form. Must be consumed under the direct supervision of a health professional Approval for take-aways will be subjected to terms and conditions.

Daily Dosing

Take-Away

Must be clear and readible Auxillary label to be affixed as follows:

5 LABELING

6 ADDITIONAL INFORMATION All pharmacists involved in the dispensing methadone shall be knowledgeable/ trained in aspects of MMT.

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P K D T A NA H M E R A H

Maintaining opioid dependent individuals on methadone has many benefits:

Reduced illicit drug use Improved health status as a result of access to treatment Decreased transmission of HIV, HCV, HBV Decreased illegal activity Increased employment

Without (subtitution) therapy, the only things waiting for drug users are overdose, prison, HIV, other diseases, homelessness and the grave!!!

KERATAN AKHBAR

VOLUME 1, ISSUE 1

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MYTH: Methadone gets into your bones and weakens them. FACT: Methadone does not "get into the bones" or in any other way cause harm to the skeletal system. Although some FACT: Methadone patients report having aches in their arms and legs, the discomfort is probably a mild withdrawal symptom and may be eased by adjusting the dose of methadone. MYTH: It's harder to kick methadone than it is to kick a dope habit. FACT: Stopping methadone

use is different from kicking a heroin habit. Some people find it harder because the withdrawal lasts longer. Others say that although it lasts longer, it is milder than heroin withdrawal.

FACT: People have been taking methadone for more than 30 years, and there has been no evidence that longterm use causes any physical damage. Some people do suffer some side effects from methadone-such as constipation, increased sweating, and dry mouth-but these usually go away over time or with dose adjustments. MYTH: Methadone is worse for your body than heroin FACT: Methadone is not worse for your body than heroin. Both heroin and

MYTH: Taking methadone damages your body.

methadone are non toxic, yet both can be dangerous if taken in excess- but this is true of everything, from aspirin to food. Methadone is safer than street heroin because it is a legally prescribed medication and it is taken orally.

MYTH: Methadone harms MYTH: The lower HIV-positive patients who are your liver. the dose of methaFACT: The liver taking methadone are healthier done, the better. metabolizes and live longer than those drug FACT: low doses (breaks down users who are not on methadone. will reduce withand processes) drawal symptoms, methadone, but but higher doses methadone does not "harm" are needed to block the efthe liver. Methadone is actufect of heroin and-most imally much easier for the liver portant-to cut the craving for to metabolize than many heroin. Most patients will other types of medications. need between 60 and 120 People with hepatitis or with milligrams of methadone a severe liver disease can day to stop using heroin. A take methadone safely. few patients, however, will feel well with 5 to 10 milliO K T O B E R 20 1 3

MYTH: Methadone is harmful to your immune system. FACT: Methadone does not damage the immune system. In fact, several studies suggest that HIV-positive patients who are taking methadone are healthier and live longer than those drug users who are not on methadone.

grams; others will need hundreds of milligrams a day in order to feel comfortable. Ideally, patients should decide on their dose with the help of their physician, and without outside interference or limits. MYTH: Methadone causes drowsiness and sedation. FACT: All people sometimes feel drowsy or tired. Patients on a stabilized dose of methadone will not feel any more drowsy or sedated than is normal.(1)
(1) Catania, Holly JD, About Methadone, Herlin Press, INC. 2000 (drugpolicy.org)

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Bacillus Calmatte-Guerin (or BacilleCalmatte-Guerin, BCG), a vaccine against tuberculosis, prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis2, can also be used to treat bladder cancer4. It is the only agent approved by the US Food and Drug Administration as the primary therapy of carcinoma in situ (CIS) in the mid 1980s1. When instilled into the bladder, BCG eradicates existing tumors, reduces the frequency of tumor recur-

(intravesically) into the baldder4.

Reference: 1.http://emedicine.medscape.com/artic le/1950803-overview 2.http://en.wikipedia.org/wiki/BacillusGu%C3%A9rin

rences, delays stage progression to invasion and improves survival compared to other local treatments3. It is most often used after the cancer has been removed from the bladder using transurethral resection surgery. When it is used to treat bladder cancer, BCG is given through a urinary catheter

3.http://pdn.sciencedirect.comscenceo b=MiamiImageURL& cid=273470& pii=S0022534707022884& check=y& origin=search& origin=search% zone=rslt list item& coverDate=200801-31&wchp=dGLzVISzSkzk&md5=c224eted17111b052ca76 db601321a1b/1-s2.0S0022534707022884-main.pdf

Bed bugs have been a known human pest for thousands of years. They are small, wingless insects with a flat body that is ideal for hiding in cracks and crevices in headboards, mattresses, and box springs. They feed exclusively on the blood of humans or warm blooded animals. Their bites can elicit various cutaneous and systemic reactions in humans and are generally treated symptomatically. Bed bugs can be very difficult to eradicate since they have developed resistance to many chemical treatments. Not only can bed bugs create an emotional effect, but they have a significant impact on public health.
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Role of the Pharmacist Due to the rapid resurgence of bed bug infestations, it is likely that pharmacists will encounter patients with questions and concerns about bed bugs. It is important for pharmacists to appropriately educate their patients about bed bugs and offer strategies for their identification, eradication, and prevention. Patient counseling for itching due to bed bug bites includes bathing in cool or lukewarm water rather than hot water, using a humidifier, and using mild and low pH cleansers and moisturizers. It is important for pharmacists to understand and recom-

mend appropriate symptomatic treatment and counseling for cutaneous and systemic reactions to bed bug bites Conclusion Bed bugs are small, elusive insects that can be very difficult to detect and eliminate. A combination of physical and chemical means is generally needed to eradicate bed bugs. Infestations are becoming increasingly more common in the U.S. The clinical responses to bed bug bites vary and are generally treated symptomatically. Eradication of the bed bugs, thereby preventing future bites, is the primary goal of therapy.
[Adapted from Medscape News

P K D T A NA H M E R A H

Most of us have probably been nagged by our mothers not to take medicines with coffee, tea or juices. Most of the time, we just follow them without questioning the reason. But our mothers are right! It is not advisable to take medicines with caffeinated drinks and citrus and grapefruit juices. Here are the reasons; Grapefruit juice or fresh grapefruit

Increases the blood concentration of certain drugs.

Consuming certain medications, such as some cholesterol lowering statins, with grapefruit juice or fresh grapefruit may result in too much of the medication staying in the body. This increases the risk of liver damage and kidney failure caused by muscle breakdown.

Reduces the absorption of certain drugs.

For certain drugs like fexofenadine (an allergy medication), when taken with grapefruit juice, only half of the dose is absorbed into the bloodstream as compared when it is taken with water. It has also been reported that apple and orange juices may also block the effects of some drugs.

Milk or dairy products If you are taking an antibiotic such as tetracycline, it is recommended that you avoid milk or dairy products for 2-3 hours before or after taking the medicine.

Caffeinated drinks Tea and coffee contain tannic acid, which can react chemically with a range of medications. It can either make the medication less effective or make it quite dangerous. For example, if you take levothyroxine (the synthetic medication) for thyroid hormone replacement with coffee, the absorption of the drug may be reduced by 25-27%. It is recommended waiting 60 minutes after taking levothyroxine before drinking coffee.

Alcohol If you are taking any medications, it is recommended that you avoid alcohol as it can either increases or decreases the effect of many drugs.

O K T O B E R 20 1 3

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Dry, itchy, inflamed skin the hallmark symptoms of a flare-up that every eczema sufferer dreads. While a cure for this disorder remains elusive, current management strategies can control symptoms effectively. This typically involves the use of topical steroids, but the misconceptions shrouding these medications have unfairly generated a lot of flak for a very effective management tool. How steroids help To treat eczema, dermatologists often prescribe steroid creams to reduce inflammation and to relieve dryness and itching. By controlling flare-ups, skin is given a chance to recover. However, the use of steroid preparations does come with the risk of side effects and the one that is of most concern is the thinning of skin. This may scare off those whose doctors have prescribed a topical steroid to help manage eczema. Experts agree that this fear is unwarranted because steroid applications are very effective in relieving eczema flare-ups when used correctly. This means you should benefit from steroid treatment as long as you follow your doctors instructions with regards to the following: Using a steroid preparation with the appropriate strength. There are many types of topical steroids and they vary in terms of strength. Your doctor will prescribe the one that best matches the severity of your symptoms. Using it on the appropriate area of the body. Skin thickness varies across the body: for instance, facial skin is thinner than that of the limbs. If your eczema affects multiple parts of your body, your doctor may prescribe topical steroids of varying strengths. Use them according to the appropriate site. Using the recommended amount of topical steroids. Your doctor will show you how much cream or ointment to apply to a specific site of skin. If you use too much, you may incur side effects, while using too little may not be effective. Using topical steroids for an appropriate time. Steroids are typically prescribed for a specific length of time. If you continue to use them for longer than intended, you may be exposing yourself to the risk of side effects.

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Selamat datang kepada kakitangan yang baru bertugas di unit Farmasi PKD Tanah Merah. Semoga dapat berkhidmat dengan jayanya. 1. 2. 3. 3. 4. 5. Rabiatul Adawiyah Adnan-U41 (Dari HUSM(PRP)) Mohd Syahmy Mohd Arifin-U29 (Dari KK Pusa, Betung, Sarawak) Nor Zarodi Ismail-U29 (Dari KK Ayer Lanas, Jeli) Siti Mardhiah Ramli U29 (Dari KK Bakri, Muar) Ahmad Faizul Muhammad-U29 (Dari KK Chiku 3, Gua Musang) Ho Lee Siang U29 (Dari Hosp. Jerantut)

Jutaan terima kasih diucapkan kepada kakitangan yang telah berkhidmat di unit Farmasi PKD Tanah Merah. Semoga anda semua dapat meneruskan tugas dengan cemerlang. 1. Wan Safura Wan Ibrahim-U32 (Berpindah ke Hosp. Tanah Merah) Zubaidah Yusoff@Daud-U29 (Berpindah ke Hosp. Pasir Mas)

2.

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