Rx Note

Introduction Much of the public's perception of a pharmacist's role is shaped by their interactions in the ward and at outpatient or community pharmacies. However, a significant number of dedicated pharmacists work diligently in inpatient settings, ensuring accurate medication dispensing to hospitalized patients. Daily tasks often involve managing medication stock (through floor stock supply and filling medication trolleys ) and providing patient counselling, especially in wards without dedicated clinical pharmacists. Transition From Outpatient Pharmacy Having transitioned from outpatient to inpatient pharmacy, I personally prefer the latter due to reduced patient-related stress, such as dealing with aggressive patients and dispensing at crowded, noisy counters. Unlike outpatient settings with strict waiting time policies and crowded waiting areas, inpatient pharmacy work seems more flexible, but remains demanding. When staff are absent or in meetings, we still need to comple...

Introduction Each insulin injection device has its own advantages and drawbacks. Insulin Syringes To be used with insulin vials. Reusable insulin pens Not all insulin cartridges can be used in all insulin pens, but they are brand specific. e.g. NovoPen, INSUPen. Pre-filled insulin pens Disposable once finished, but more costly.    Insulin Syringes Insulin syringes are available by prescription in 3 sizes: 0.3 ml, 0.5 ml and 1 ml. Choose a syringe based on the dose (units) of insulin you require. A 6 mm and 8 mm needle is recommended over a 12.7 mm needle due to a higher risk of intramuscular injection.       NovoPen 3, NovoPen 4, NovoPen 5 and NovoPen 6 Although NovoPen 4 has been phased out and replaced by NovoPen 5 in the UK, NovoPen 4 is still marketed in Malaysia.    NovoPen 5 offers an additional feature of a digital display that shows the dose memory. Time elapsed: Each segment represents an hour since the last injection. Last dose volume: Reco...

Introduction Dry-powder inhalers are portable, inspiratory-flow-driven inhalers that administer dry-powder formulations to the lungs. DPIs do not contain propellant and are breath-actuated, hence eliminating the need of hand-held coordination of conventional MDIs . Nonetheless, the patient's inspiratory flow should be adequate enough to draw the drug from the device. NOTE: DPIs are not suitable for children ≤5 years and some elderly. Capsule devices are difficult for patients with tremor. Turbuhaler Turbuhaler contains a large number of doses (up to 200) of undiluted, loosely aggregated micronized drug, which is stored in a reservoir from which it flows on to a rotating disc in the dosing unit. As the rotating disc is turned, by moving a turning grip back and forth ( a "click" sound is heard in one of the turning direction), one metered dose is presented to the inhalation channel. Perform this procedure twice for priming. If the Turbuhaler is accidentally dropped, a new ...

Introduction Prefabricated transdermal patches are designed to deliver a constant and controlled dosage over extended periods for systemic therapy. They offer advantages over conventional oral dosage forms in that Drug administration through the skin avoids the pH variations seen with gastrointestinal transit. The drug reaches the systemic circulation whilst avoiding first-pass hepatic metabolism (though the skin has some metabolic activity). Patches can be removed easily and quickly in cases where adverse drug reactions occur. Patient adherence is high. Designs of Transdermal Patches The simplest transdermal systems contain the drug in an adhesive, with more complexity introduced in matrix-type patches and reservoir systems. Simple drug-in-adhesive patch These patches are formed by dissolving or dispersing drug within an adhesive, which is then coated onto a backing layer before a release liner is applied. Different daily dosages can easily be delivered by increasing the surface are...

Introduction Warfarin is an oral anticoagulant - a medicine that increases the time it takes for your blood to clot. It helps to stop unwanted clots from forming inside blood vessels. However, it does not dissolve clots, but prevents them from growing larger, allowing the body's natural system to break down the clot over time. A thrombosis can cause a stroke, a heart attack, a deep vein thrombosis or a pulmonary embolism. However, warfarin use can be challenging in clinical settings due to Its narrow therapeutic range The influence of various factors on dosing such as genetic variation, drug interactions and diet. The time spent outside the therapeutic range increases the risk of bleeding and/or thromboembolic complications that warfarin is intended to prevent. Baseline Testing Before initiating warfarin therapy, certain baseline tests should be obtained Baseline prothrombin time (PT) with international normalized ratio (INR) and baseline activated partial thromboplastin time (aPT...

Introduction The acronym, MIMS , was derived from the original publication which was called Monthly Index of Medical Specialties . As early as 1968, the first edition of Drug Index for Malaysia & Singapore (DIMS) was published. Core Features Apart from being a source of product leaflet , MIMS also provides some very useful resources. Patient Medicine Information under generic medicine info Useful in medication counselling Latest medical news and special reports Product Highlights and Drug Updates where you can learn some newly registered drugs at Malaysia Pill Identifier Continuing Medical Education Mobile Application In 2013, MIMS recognized the need for convenient access to their information and developed a mobile application companion to MIMS.com. The app was released on both the Google Play Store and Apple App Store for public download. Resources Some of the very useful clinical tables prepared by MIMS are Antidotes in Opioid Toxicity and Substance Dependence Antidotes in ...

Introduction In August 2018, I started a self-initiated drug database project, called "Rx" . My motivation stemmed from not finding a database that met my needs at work and desiring a more organized way to record my reading material. Additionally, the existing unofficial MOH Formulary mobile applications are often infrequently updated and require users to pay a fee to remove advertisements. About the Project In my role as a full-time pharmacist at a government hospital in Malaysia, the Malaysia Ministry of Health Medicines Formulary (MOHMF) has served as the foundation for my self-initiated drug database. At work, we frequently consult MOHMF for information such as prescriber categories , approved indications and purchase methods. To improve the comprehensiveness of the database, Brand name search has been prioritized to include both original brand and local generic brands for oral medications. The prescription of medications by doctors frequently involves the use of prop...