Rx Note

#MarchProject2025#Preview Introduction Unlike outpatient pharmacies, inpatient pharmacies also handle injectable medications. Ampoules are typically single-use containers; once opened, they cannot be resealed, and any remaining medication must be discarded. In contrast, reconstituted powdered drugs can sometimes be stored for a limited time, depending on their chemical and physical stability, which varies between brands. To reduce costs, a reconstituted vial is ideally used for multiple doses. For example, a 1 g vial could provide three 300 mg doses. The stability data for some common reconstituted IV preparations are shown below. For simplicity, this discussion excludes ampoule injections and the stability of reconstituted injections after dilution in various diluents (e.g., normal saline or 5% dextrose). Summary

Introduction The advice presented in this post are solely based on my four-year experience in inventory management at my hospital. Hopefully, these will serve as some tips when you are new to inventory management. As the rule of thumb, we should practice FEFO principle (i.e. First Expiry First Out). When receiving new stocks, remember to compare the expiry date of new and existing stocks. Storing medications with different expiry date at different location to avoid confusion is a handy measure. This is because humans are forgetful . NOTE: For the details in inventory management in logistics pharmacy at government facilities, you may refer to Garis Panduan Pengurusan Farmasi Logistik Kementerian Kesihatan Malaysia, 2020 and Modul Latihan Farmasi Logistik, 2024 . Monthly Usage As the rule of thumb, when comes to inventory management, the decision should not be based on one's intuition. The important parameter that we should always refer to will be monthly usage. However, monthly u...

Introduction Despite the evolving role of pharmacists in clinical management of patients (such as medication reconciliation and drug therapy optimization), medication dispensing will remain a vital responsibility. Currently, Ministry of Health hospitals employ 3 drug distribution systems: Floor stock (traditional system) Patient prescription system (i.e. unit-of-use) Unit dose system NOTE: Both unit-of-use (UoU) and unit-dose (UoD) medication dispensing systems typically utilize a cart-fill system. This involves preparing and filling medication carts for individual patients. Floor Stock System The floor stock system is a decentralized system where a limited quantity of medication is stored in designated storage area on each nursing unit. This system is often used for medications that are frequently used or needed immediately in emergency cases. The pharmacy and the ward/unit collaboratively determine the floor stock medication list, which should be reviewed periodically. While the li...

Introduction Every year, tens of millions of ringgit worth of medicines dispensed by government health facilities remain unused by patients. Meanwhile, an unnecessary health risk is created in the home whereby the patient or family members may accidentally consume expired medicines or wrong drug (due to unclear or damaged labels). Failure to discard medications properly may also contaminate the environment through poor disposal either via trash or sewer system. In 2010, the Pharmaceutical Services Division, Ministry of Health Malaysia (MOH) has implemented the Return Your Medicines Program. Through this program, patients can return their unused or excess medicines kept at home to pharmacy counter or medicine return box provided at all pharmacy facility in MOH hospitals and health clinics for safe disposal. Launched in 2024 by the Ministry of Health (MOH) and supported by various public and private organizations, MyMediSAFE is a Malaysian initiative promoting the safe disposal of med...

Introduction Pharmaceutical care has been defined as medication-related care provided through direct patient contact and intended to improve quality of life. One of the fundamental components will be patient education and counselling. In United States, concerns regarding improper medication use led to mandates requiring pharmacists to provide patient counselling and education (e.g. The Joint Commission), professional association standards of practice (e.g. ASHP), and federal regulations (e.g. The Omnibus Budget Reconciliation Act of 1990 [OBRA-90] ). Ideally, medication counselling should extend to all patients and their caregivers regardless of the patient care setting. Collaboration with other healthcare professionals may help to individualize counselling. However, barriers do exist , such as excessive workload, lack of financial compensation and patient's attitudes. At Malaysia, due to high patient load at government facilities, we tend to counsel only the essentials. Hopefully...

Introduction Drug expiration dates reflect the time period during which the product is known to remain stable when it is stored according to its labelled storage conditions. Nonetheless, at work, many patients may ask you, how long more you can keep using a solution or cream once opened. Or sometimes, is it still fine to keep using an expired medication? The old adage that "all good things come to an end" applies this situation very well. Medications last longer (up to expiry date) when they are stored unopened. Using expired medications may cause harm or it has lost its effectiveness over time. Antibiotic Suspension Please refer to products leaflet since the recommendation is brand specific. Amoxicillin 200 mg and Clavulanate 28 mg per 5 ml Syrup Augmentin - The dry powder should be stored in unopened containers in a dry place at below 25°C. Reconstituted suspension should be stored in a refrigerator (2-8°C) and used within 7 days. Clamovid BID - Refrigerate and use withi...

Introduction Rather than writing on personal life stories, this blog focuses on summarising essential facts within the ever-changing medical field. While medical practices evolve gradually, they can differ significantly 5 years down the line. Hence, this prompts me to ponder each time I access the blog - where should I begin to revise and enhance? As time passes, I might lack the time and determination to sustain this effort . The Evolving Pharmacy Landscape Faced with competitive pressures, community pharmacies have adopted various strategies, including the provision of dietitian consultations, wound care services, Webster packing for medication adherence, telehealth platforms for e-prescription and e-commerce websites with delivery, as well as specialization in extemporaneous compounding and veterinary medicine . Panduan Pembelian Ubat "Online", 2023 Guidelines for Pharmacists on the Application for Permission to Sell Compounded Preparations at Community Pharmacy Premise...