Contents

Introduction

Clinical practice has no absolutes, but is constantly evolving and heavily driven by current best evidence.

• Moreoever, conflicting advice on certain issues is common.

The pharmacist notes presented here are based on my personal readings and beliefs.

• They are intended to facilitate your learning process and should not substitute professional clinical judgement.
• I do not assume any responsibility for any potential loss resulting from the use of this information.

Feel free to explore beyond textbooks and journals to deepen your understanding.

Front Matter

• Ideation - Dream big, start small
• The Journey - The origins of the blog
• Preface - Something that I want to tell you first at the beginning
  
• Pharmacist as Career - Pursuit if that is your passion
• Provisional Registered Pharmacist Training: Hospital or Community Pharmacy - Advice to fresh pharmacy graduates
• New to Pharmacy - Study the essentials first
• Experience Talks - Confidence in clinical recommendations
• The End - The need for a pause

Tools

• Rx - My personal notes on medicines and supplements
• Drug Album - To quickly identify unknown drugs
• Rx Calc - TDM calculator via Microsoft Excel and Open as App
• Learning Module - Questions bank for PRP training
• Pilleye - Pill counting app

Legislation

Examination

• Qualifying Examination to Practice Pharmacy - Examination Format

Poisons Act and Dangerous Drugs Act

• Poisons Act 1952 and Regulations - Exploring License A, Poison Groups and Prescription Book
• Poisons Board - Members and Roles
• Licensing Officer and Drug Enforcement Officer - Stating the powers
• Poisons (Psychotropic Substances) Regulations 1989 - Refresh on legislation requirements in dispensing
• Dangerous Drugs Act 1952 and Regulations - Refresh on legislation requirements in dispensing
• Labelling of Dispensed Medicine - To learn about legislation requirements
• Cautionary and Advisory Labels - To provide supplementary information
• Bringing Medication into Malaysia - For personal use

Other Relevant Acts and Regulations

• Sale of Drugs Act 1952 and Regulations - Legislation about power and duties
• MAL No. - Drug registration number
• Medicines (Advertisement & Sale) Act 1956 and Regulations - To learn prohibitions of medicine advertisement and Medicine Advertisement Board
• Registration of Pharmacists Act 1951 and Regulations - Pharmacy Board Malaysia and legislation aspects of provisional, full and temporary registration
• Code of Ethics for Pharmacists 2018 - Patient as first priority

Essentials

Drug Basics

• Drug Nomenclature - Discussing some principles
  
• Drug Discovery and Development - An expensive and lengthy process with high failure rate
• Generic Drugs - Discussing on generics drugs, authorized generics and quality concern
• Tablet Excipients - Many can be multifunctional
• Biosimilars - Highly similar but not exactly the same as reference molecule.
• Brand Name Search - Introducing MIMS Malaysia and NPRA Quest 3+ Product Search
• Common Generic Name and Brand Name - A short list
• Drug Dosing - Explaining dosing differences across references.
• Paediatric Drug Dosing - Can paediatric dosing exceed adult dose?
  
• Off-label Use - Learn up some examples of off-label use
• Drug-Drug Interactions - Two or more drugs given at the same time can exert their effects independently or they can interact.
• Drug-Food Interactions - Predominantly the effect of food on absorption
• Drugs and Pregnancy - Discussing FDA Pregnancy and Lactation Final Rule and Australian Categories for Prescribing Medicines in Pregnancy
  
• Drugs and Lactation - Discussing key references
• Dosing in Obese - One dose fits all?
• G6PD Deficiency - Explaining G6PD Deficiency
• Ramadan - Medications during Ramadan fasting

Adverse Drug Reactions

• Adverse Drug Reactions - All adverse reactions are adverse drug event
• Pharmacovigilance - To detect unreported ADRs
  
• Drug Allergy - Management vary based on the signs and symptoms
• Medicine-induced Discolouration - Red? Orange? Yellow? Green? Blue?
• Drug-Induced Photosensitivity - Either phototoxicity or photoallergic
• Medication Induced Ophthalmic Issues - Some common drugs
  

Pharmacology

• Drug Pharmacology - Relating it to daily practice
  
• How Drugs Act? - Discussing the 4 main drug targets
• Functional Groups - Quick refresh on IUPAC nomenclature
• pH and pKa - Discussing Henderson-Hasselbalch Equation
• Drug Potency - Discussing Maximal Effective Concentration (EC₅₀)
• Drug Metabolism - Discussing Phase I and II reactions, as well as CYP450 system
• Pharmacogenomics - Discussing some examples

Miscellaneous

• Pharmaceutical Calculation - Essential skills
• Continuous Professional Development - Needed for renewal of annual retention
• Teaching - A selfless effort driven by passion
• Immunization - The association of autism with MMR vaccination has not been proven.
• Drug Adherence - Discussing compliance, concordance and adherence
• Dealing with Aggressive or Violent Patients - Remember these do's and don'ts
  
• Dealing with Mistakes - Forgive yourself ultimately
• The Placebo Effect - Modulate treatment outcomes
• Illness Behaviour - Illness is the patient's subjective experience of ill health
• Confidentiality - Should be maintained
• Deaf Awareness - Listing common medication instructions in sign languages
• Global Trends in Pharmacy - The evolving roles of pharmacists
• Drug Pricing and Affordability - A complex issue
• Telepharmacy - Good concept but challenging to implement
• Biomedical Ethics - Respect for autonomy, non-maleficence, beneficence, justice and veracity

Drug Administration

Overview

• Drug Administration - An overview of various drug administration routes
• Timing of Medication - Morning? Afternoon? Night?
• Cold-Chain Items - A tabulated list
• In-use Shelf-life - Shelf-life post opening?
• Missed Dose Management - What to do?

Oral Route

• Oral Administration - Exploring oral formulations and bioavailability
• Administration of Medicines to Children - Some recommendations and precautions
• Measuring Oral Liquid - Not to use household teaspoon or tablespoon
• Reconstituting Oral Suspension - Learn how to do it right!
• Oral Medications with Special Administration Method - Discussing some examples
• Before, With or After Food? - Include a short list of medications that should be taken before or with food
  
• Before, With or After Food: Case Studies - Discussing on gliclazide, rivaroxaban and lenalidomide. Also discuss on co-administration of alendronate and levothyroxine.
• Split Medication in Half - Is it safe to split all medication?
• Dysphagia - Practical considerations
• Enteral Administration - Discussing administration through feeding tube
  
• Ghost-Pill - Discussing tablet-like looking structures in stool

Pulmonary Route

• Inhalers - Correct inhaler technique is important
• Metered-Dose Inhalers (MDIs) - Discussing MDI inspiratory force and dose checking, priming of inhalers and spacers.
• Dry-Powder Inhalers (DPIs) - Not suitable for children ≤5 years and some elderly

Parenteral Route

• Parenteral Route - IV is preferred when rapid absorption is essential
• Insulins Injections - Discussing pen needles, pinching of the skin, insulin injection sites, insulin stability and Somogyi effect
• Protect From Light - Some examples
  

Other Routes

• Eye Preparations - Discussing eye drops and eye ointments administration method, 1 ml = 20 eye drops, storage and expiry date.
• Nasal Preparations - Risk of rebound congestion with nasal decongestants
• Otic Drug Delivery - More commonly used for outer ear and some middle ear diseases.
• Topical Preparations - Discussing lotion, cream and ointment
• Transdermal Patches - Discussing transdermal patch application
• Rectal Route - Drug absorption is often irregular and difficult to predict
• Vaginal Route - Is sex-specific in nature
  

Reference

Overview

• Information Search Strategies
  
• Recommended Medical Reference
• Medical Mobile Applications
• Online Medical Resources
• Dilution Protocol
• Enteral Administration Reference
• Renal Drug Dosing References
• The Future of Pharmacy References
  

Selected Reference

• UpToDate, DynaMed and BMJ Best Practice
• Therapeutic Guidelines, Australian Medicines Handbook and APF
• British National Formulary and BNF for Children
• Lexicomp Drug Information Handbook
• AHFS Drug Information
• IBM Micromedex
• Medscape
• Martindale The Complete Drug Reference
• Clinical Pharmacology by ClinicalKey
  
• Epocrates
• Frank Shann Drug Doses
• Sanford Guide
• NCBI Bookshelf
• Critical Care Pharmacy Handbook
• Calculate by QxMD and MDCalc Medical Calculator
• Drug-Induced Diseases
• Sarawak Handbook of Medical Emergencies
• MIMS Malaysia
• Drugs and Drugs

Hospital Pharmacy - Government

Overview

• Hospital Pharmacy FAQ - Advice to first day in hospital pharmacy
• Decision Making in Hospital Pharmacy - Seek help if needed
  
• Useful Pharmacy Books - Especially if you just embarked on the journey as a pharmacist
• PRP Assessment - What should be the indicator?
• J for Junior - Can I always be?

Drug Information and Formulary

• Drug Information Services - The current roles
• Ministry of Health Medicines Formulary - Explaining MOHMF, Category of Prescribers, KPK application, Dossier
• Drug Formulary - Exploring the concept of drug formulary
• Drug Formulary App - Listing mobile application options available.
• Category of Prescribers in Malaysia MOH Setting - Ensures quality of patient care while controlling cost

Inpatient

• Medication Distribution System - Explaining the floor stock and patient prescription system
• The Silent War in Inpatient Pharmacy - The unseen battle
  

Outpatient

• Focus in Outpatient Pharmacy - Quality > Quantity
• Behind the Pharmacy Counters - The hardship that we face
• A Heartless Pharmacist - Some self reflections
• First Time Dispensing - Practice makes perfect
• Learning in Outpatient Pharmacy - Tips to active learning
• Learn and Apply - Some life experience sharing
• Return Your Medicines Program - To safeguard environment

Logistics

• Inventory Systems - Aims to maximize inventory turnover while minimise inventory carrying costs (or holding costs)
• Inventory Control - Experience Sharing
• Stock Handling - Discussing stock receiving, distribution and disposal
  
• Drug Storage - Cold chain breach?
• Product Complaint - Actions to be taken
• Drug Recall - A brief overview

Sterile and Nonsterile Manufacturing & Prepacking

• Extemporaneous Formulation - Discussing on references, vehicle in extemporaneous formulations and alcohol in compounding
• Extemporaneous Preparation with Unknown Stability - Some recommendations
• Extemporaneous Compounding - Discussing on method of preparation, choice of container and safe handling
• Aseptic Technique - A brief introduction
• Syringes and Needles - Discussing glass filter needles
• Cleanroom - Controlled environment
• Medications Repackaging - Important elements in department policy

Clinical

• Clinical Pharmacy - History and clinical pharmacist roles
• Patient Care Process - endorsed by JCPP in 2014
• Medication Counselling - "Garis Panduan Kaunseling Ubat-ubatan" and Topical Preparations Counselling Guide for Pharmacist
• Motivational Interviewing - Behavoiur change cannot occur without the individual themselves recognizing the need to do so
• Medication History Taking and Medication Reconciliation - Explaining the purpose of CP1
• MyMAAT - Replacing 8-items Modified Morisky Medication Adherence Scale (MMMAS-8)
• Pharmaceutical Care Issues - Cheat sheet for PCIs in CP2 form
• Clinical Inertia - Barrier to improving patient care and clinical outcomes
• Medical Note Entry - In SOAP format
  
• Laboratory Data - Reminders on few interpretation key points
• Medical Terms - Some common medical terms
  
• Medical Abbreviations - Some common medical abbreviations
• Antimicrobial Choice - To use National Antimicrobial Guideline, 2019
• Antimicrobial Stewardship - To slow down and prevent antimicrobial resistance
• Intravenous Antibiotics-Oral Switch Therapy (IVOST) - Common oral antimicrobial options
• Acute Kidney Injury - A general management
• Chronic Kidney Disease - Discussing staging and general management
• Renal Replacement Therapy - Dialysis and renal transplant
  
• Geriatric Patients - Introducing AGS Beers Criteria for Older Adults 2019
• Prescribing in Hepatic Impairment - Drug prescribing should be kept to a minimum in all patients with severe liver disease
• Child-Pugh Score - Classification of hepatic impairment
• Definitions in NICU - Explaining some common terminologies
• Physical Examination - Inspection, palpation, percussion and auscultation
• Vital Signs - Temperature, pulse rate, respiratory rate and blood pressure
• Glasgow Coma Scale - Determine impaired consciousness
• Bristol Stool Chart - 7 types of faeces
• Sepsis - Life-threatening organ dysfunction caused by dysregulated host response to infection
• Arterial Blood Gases - Learn how to interpret
• Schwartz Formula - Learning why we do not use Cockcroft-Gault equation for children CrCl
• Discharge Letter - Discussing things to write
• Drug Overdose and Poisoning - Discussing the general management and antidotes available
  
• Dexamethasone Suppression Test - To rule out Cushing Syndrome

Therapeutic Drug Monitoring

• Clinical Pharmacokinetics Pharmacy Handbook
• Therapeutic Drug Monitoring (TDM) - Introducing key TDM concepts
• Basic Pharmacokinetics - Exploring bioavailability, volume of distribution, elimination rate constant and half-life
• TDM for Specific Drugs - Discussing aminoglycosides, carbamazepine, digoxin, paracetamol, phenytoin, valproic acid and vancomycin

Oncology

• Chemotherapy - Introduction to chemotherapy and Carboplatin Calvert formula
• Carcinogen - Discussing reviewing agencies
• Safe Handling of Hazardous Drugs - Occupational safety hazard
• Cytotoxic Spill Management - Learn the clean-up procedure
• Chemotherapy Side Effects - Advice to patients
  
• Chemotherapy Safety at Home - Learn to protect your family members
• Extravasation Management - Stop the infusion at the first suspicion
• Tumour Lysis Syndrome - Prevention with allopurinol
  

Parenteral Nutrition

• Parenteral Nutrition - Introducing parenteral nutrition references
• Refeeding Syndrome - Learn the management
  

Research

• Research - At a glance at designing
• Good Clinical Practice - Highlighting the key points
• Sample Size Calculations - Critical in study design
• Read a Paper - Introduction to evidence based medicine
• Critical Appraisal in Aetiology Research - Exploring the key thereotical considerations
• Graphic Appraisal Tool for Epidemiological Studies - To critically appraise epidemiological studies

Miscellaneous

• Medical Documentation - The legal material used to protect both patient and health care professionals
• Medication Safety - The 5 Rs of medication administration
• Medication Error Case Examples - Learn from others' mistakes
• Mercury Spillage - Learn how to manage
• Back to Fundamental - We are one team!
• Healthcare Systems - Discussing the Bismarck Model, the Beveridge Model and the Out-of-Pocket Model

Community Pharmacy

Overview

• Community Pharmacy FAQ - Advice to first day in community pharmacy
• Business Nature of Community Pharmacy - To survive in today's market
  
• Community Pharmacy Books - Community Pharmacy: Symptoms, Diagnosis and Treatment, 2020 and Symptoms in the Pharmacy, 2018
• Analytical Thinking in Community Pharmacy - A crucial aspect
  
• Responding to Symptoms - Mnemonics are rigid, inflexible and often inappropriate.
• Dermatological Complaints - Visual examination is important
• Specific Product Requests - Exploring the situation
• The Ever Changing Community Pharmacy - Numerous supplements have surfaced in the market
  
• Into the Animal World - Listing useful reference in veterinary pharmacy
• Human OTC Products for Veterinary Patients - Some are potentially toxic
• Herbs and Supplements - Use with caution
• OTC Medication Use in Pregnancy - Covering few common ailments
• OTC Medication Use in Breastfeeding - Covering few common ailments
• Homeopathy - Not better than placebo
• Dispensing Separation - Complex and debated issue

Services

• Blood Pressure Monitoring - Does body posture affect BP measured?
• Blood Glucose Measurement - Fasting blood glucose and HbA1c
• Blood Lancet - For capillary blood sampling
• Glycemic Index (GI) - A measure of the relative impact of carbohydrate-containing foods on serum glucose
• Pulse Oximetry - Uses spectrophotometry to measure peripheral arterial oxygen saturation
• Incentive Spirometer - Learn how to use
• Wound Care - Learn about interactive wound dressing

Respiratory

• Cough - Referral to doctor if duration longer than 3 weeks
• Common Cold - Antihistamines are not so effective in reducing nasal congestion
• Seasonal Influenza - Vaccination is the key to prevention.
• Sore Throat - Not to use honey for children <1 year old
• Smoking Cessation - Drug treatment and behavioural support

Gastrointestinal

• Constipation - Avoid drinks with caffeine
• Diarrhoea - Rehydration as the main treatment
• Heartburn - Antacids or H2 antagonists for mild symptoms
• Intestinal Gas and Bloating - Belching, flatulence, abdominal bloating and distension
• Steatosis - Fatty liver
• Haemorrhoids - Also called piles
• Gallstones - Asymptomatic gallstones can be managed expectantly
• Nausea and Vomiting - The site of action determines the circumstances in which an antiemetic is effective.
• Threadworm - Night-time perianal itching is the classic presentation
• Oral Thrush - Unusual in healthy adults
  
• Hiccups - Most commonly are self-limited (<48 hours)
• Faecal Incontinence - Unintentional passage of stool
• Pouching Systems - Available as one-piece or two-piece systems

Eye

• Watery Eye - Treatment depends on the underlying cause
  
• Dry Eye - Evidence of superior efficacy among any of the ophthalmic lubricants is lacking
• Soft Contact Lenses - A basic overview
• Red Eye - Discussion on few possible conditions
• Styes - Warm compresses are the mainstay of treatment
• Eye Floaters - It is not often treated, except in severe cases.

Dermatology

• Ingredients in Skin Care - Prioritize your skin specific needs
• Benign Skin Lesions - Learn the ABCDE criteria
• Fungal Skin Infections - Athlete's foot, ringworm, pityriasis versicolor, cutaneous candidiasis
• Onychomycosis - Fungal nail infection
• Acne - First-line treatment should be benzoyl peroxide
• Itch Without Rash - Dry skin is the most common cause
  
• Dermatitis - Sore, red itchy skin
• Urticaria - Avoid identified triggers
• Dandruff - Greyish-white flakes or scales on the scalp
• Eczematous Cheilitis - Lip dermatitis
  
• Soap-Free Cleanser - Milder nature and pH-balanced
• Sunscreen - Learn about sunscreen SPF and 5S to minimize solar damage
• Sunburn - Acute cutaneous inflammatory reaction to UV radiation
• Burns - Treated to a full 20 minutes under cool running water
  
• Antiseptics - Suitable for cleaning contaminated or traumatic acute wounds and bites
• Topical Antibacterial - Frequently, their use is not necessary
• Subungual Hematoma - Blood under the nail
  
• Acute Paronychia - Inflammation of nail folds
• Ridges in Fingernails - Vertical are fairly common and nothing to worry
  
• Alopecia - Hair loss
• Cold Sore - Caused by herpes simplex virus type 1
• Bedsores - Generally affect patients with limited mobility
• Corns and Calluses - Result from incorrect distribution of pressure
• Warts and Verrucae - Spontaneous resolution is seen
• Vitiligo - Can have a marked psychological impact
• Hair Removal - Plucking, waxing, shaving and laser
• Scabies - Intensely itchy skin especially at night
• Head Lice - Mostly transmitted by head-to-head contact
• Chickenpox - Self-limiting in otherwise healthy children ≤12 years old.
• Shingles - Reactivation of the varicella zoster virus
• Ingrown Toenails - For surgical correction
  
• Prickly Heat - Avoid conditions that may cause sweating
• Hyperhidrosis - Excessive sweating
• Acanthosis Nigricans - Darkening and thickening of skin folds
• Scars - Not every scar requires treatment
• Rhytides - Wrinkles
• Melasma - Patches of discolouration

Ear, Nose, Throat

• Allergic Rhinitis - Intranasal corticosteroids are most effective medication class for controlling symptoms of allergic rhinitis
• Earwax (Cerumen) Impaction - No apparent difference in cerumenolytic agents
• Otitis Externa - Generally caused by bacterial infection
  
• Acute Otitis Media - Self-limiting infection that mainly affects children.
• Vertigo - Spinning sensation
• Tinnitus - Ringing in the Ears
• Motion Sickness - Options include hyoscine hydrobromide and sedating antihistamines
• Hearing Loss - Can be sensorineural, conductive or mixed
• Perforated Eardrum - Most heal without treatment within a few weeks.
  

Women's Health

• Primary Dysmenorrhoea - Period pain
• Menorrhagia - Heavy menstrual blood loss
  
• Cystitis in Women - Characterized by pain when passing urine.
• Uncomplicated Vulvovaginal Candidiasis - Discussion on clotrimazole pessary
• Urine Pregnancy Test - Waiting a week or two after a missed period before performing a urine pregnancy test
• Contraception - A basic overview
• Plan B Pills - "Morning after pills"
• Delaying A Period - Norethisterone 5 mg TDS, to be started 3 days before expected onset.
• Stretch Marks - Develops when our skin stretches or shrinks quickly.
• Nutritional Supplementation in Pregnancy - Folic acid is recommended in all women of childbearing age

Musculoskeletal

• Muscle Spasm - Generally resolves by itself
• Low Back Pain - Usually acute
• Bunions - Valgus malformation of the great toe
• Trigger Finger - Also called stenosing flexor tenosynovitis
• Plantar Fasciitis - One of the most common causes of heel pain in adults
• Crepitus - Joint noises

Nutrition

• Vitamin Supplementation - A healthy and balanced diet remains the best source
• Vitamin D Deficiency - Occurs even in developed countries
• Probiotics - Most studies have been small and use highly variable probiotic preparations
• Organic Foods - Consumer demand has grown steadily
• Infant Formula - To closely mimic human milk

Neurology

• Sleep - Learn the health benefits
• Insomnia - Learn about sleep hygiene
• Restless Legs Sydnrome - Urge to move the legs when rest

Cardiovascular and Hematopoietic

• Anaemia - Mild or early-stage anaemia are often asymptomatic
• Bruise - Heals on their own in 2 weeks
• Salt - Excessive sodium intake is associated with elevated BP

Dental

• Mouth Ulcers - Minor aphthous ulcers are self-limiting
• Angina Bullosa Haemorrhagica - Oral blood blister
  
• Bad breath - Treatment depends on the underlying cause
• Toothpaste - Dental caries vs fluorosis
• Toothbrushing - Toothbrush should be replaced every 3-4 months.
• Dental Flossing - Is recommended once daily
• Mouthwash - Not a replacement for daily brushing and flossing
• Denture Care - Dentures are custom-made prosthetic devices used to replace missing teeth.
• Dry Mouth - May consider artificial saliva

Paediatric

• Infantile Colic - May occur in up to 20% of infants
• Teething - Start as early as 3 months and continue up to 3 years.
• Nappy Rash - Irritant nappy rash is the most common cause
• Nocturnal Enuresis - Bed-wetting

Endocrine

• Non-nutritive Sweeteners - No evidence that use of any NNS increase the risk of cancer
• Hypoglycaemia - Abnormally low blood glucose
• Obesity - Lifestyle measure +/- pharmacologic therapy

Miscellaneous

• Set Up A Retail Pharmacy - Things to consider
  
• CMEd Program - Complementary Medicine Education
• Self-Test COVID-19 Test Kit - Learn how to use it
• Travel Medical Kits - List of items that you could consider
• Altitude Sickness - To ascend slowly
  
• Insect Bites and Stings - Reactions are generally mild
• Insect Repellents - DEET is the gold standard
• Alcohol Intolerance - Most often found in Asians
  
• Lactose Intolerance - Usually due to lactase deficiency
• Varicose Veins - Swollen and enlarged veins
• Compression Stockings - Anti-embolic stockings (TED) and gradient pressure stockings
• Kidney Stones - Consider hydration and pain control first
• Fatigue - A common, nonspecific symptom.
  

Clinical Management

Cardiovascular

• Hypertension - Learn the BP target
• Hypertensive Disorders in Pregnancy - Differentiating chronic hypertension, gestational hypertension, preeclampsia and eclampsia
• Acute Coronary Syndrome - Discussing the initial and chronic management
  
• Stable Ischaemic Heart Disease - Chest pain (angina) from exertion
• Atrial Fibrillation - Anticoagulation, rate +/- rhythm control
• Heart Failure - treat all patients with ACE-I, beta blocker, MRA, SGLT2 inhibitor
• Dyslipidemia - Statins are first-line lipid-modifying therapy for the reduction of CVD risk
• Venous Thromboembolism - Discussing DVT and PE

Endocrine

• Addison Disease - Primary adrenal insufficiency
• Diabetes Mellitus - Type 1 vs Type 2
• Gestational Diabetes Mellitus - Metformin and insulin as treatment options
• Ramadan and Diabetes - Discussing risk stratification and lifestyle/medication change
• Osteoporosis - Pharmacologic therapy should be considered in people with presence or history of minimal-trauma fracture or when BMD is low
• Thyroid Disorders - Discussing hypothyroidism and hyperthyroidism
• Cushing Syndrome - Results from excess cortisol

Respiratory

• Asthma - Inhaled corticosteroid use in mild asthma?
• Chronic Obstructive Pulmonary Disease - LAMA +/- LABA in COPD
• Tuberculosis - 2EHRZ followed by 4HR

Dermatology

• Atopic Dermatitis (Eczema) - Skin hydration is the key
• Psoriasis - Topical treatment options include emollients, topical corticosteroids, coal tar preparations, and topical vitamin D or vitamin D analogues.
• Ichthyosis Vulgaris - Fish scale disease
• Infantile Haemangioma - Most small nonfacial hemangiomas do not need treatment
  

Infectious Disease

• HIV Infection - Discussing first line ART and post exposure prophylaxis
• H. Pylori Infection - "Test and treat" strategy
• Dengue Fever - Take plenty of fluids
• Hand, Foot and Mouth Disease - A highly contagious enteroviral infection
• Mpox - Supportive care is mainstay of treatment

Pain

• Pain - Optimizing pain management
• Migraine - Recurrent primary headache
• Gout - Big toe joint is most commonly affected.
• Osteoarthritis - Chronic musculoskeletal condition that affects the joint and peri-articular structures
• Rheumatoid Arthritis - DMARDs are recommended as first-line therapy

Paediatric

• Apnoea of Prematurity - Consequence of immature respiratory control.
  
• Nephrotic Syndrome - Pharmacotherapy with oral penicillin V and corticosteroid therapy.
• Kawasaki Disease - IVIG 2 g/kg single dose and aspirin.
• Umbilical Granuloma - Common salt as first line therapy

Neurology

• Epilepsy - Recurrent seizure
• Pregnancy in Patients with Epilepsy - Lamotrigine and levetiracetam are the safer antiepileptic drugs during pregnancy
• Status Epilepticus - Continuous seizure activity or repeated seizures without full recovery of consciousness
• Dementia - 50 to 75% of cases is Alzheimer disease
• Parkinson Disease - Treatment is based on symptoms
• Myasthenia Gravis - Pyridostigmine for ocular or mild generalized disease

Male & Female Health

• Benign Prostatic Hyperplasia - Associated with LUTS
• Erectile Dysfunction - May be an indicator for unrecognised disease
• Polycystic Ovary Syndrome - Most common endocrine disorder in women of reproductive age
• Morning Sickness - Expected to improve around the end of the first trimester
• Menopause - Occurs at median age of 51 years
• Endometriosis - Growth of endometrial tissue outside the uterus

Psychiatry

• Attention Deficit Hyperactivity Disorder (ADHD) - Stimulant medications as first-line
• Schizophrenia - First- and Second-generation antipsychotics
• Anxiety Spectrum Disorders - Benzodiazepines should be used at the lowest effective dose for the shortest period of time.
• Depression - Psychological therapies +/- antidepressants
• Bipolar Disorder - Consider mood stabilizers, such as lithium or valproate, and second-generation antipsychotics

Eye

• Glaucoma - Irreversible, progressive visual field loss
• Cataract - Clouding in the lens of the eye
• Age-related Macular Degeneration (AMD) - Smoking cessation is very important
  

Blood Disorders

• Iron Deficiency Anaemia - Oral iron can adequately treat most patients
• Haemophilia - Bleeding disorder due to a lack of factor VIII or factor IX
• Thalassemia - Hematopoietic cell transplantation is the only curative strategy

Nephrology

• Drug Induced Kidney Disease (DIKD) - Avoid nephrotoxic medications if possible
• Anaemia in Chronic Kidney Disease - Discusses the use of ESA.
• Chronic Kidney Disease - Mineral Bone Disorder (CKD-MBD) - To monitor parathyroid hormone (PTH), phosphorus, calcium and vitamin D levels.

Miscellaneous

• Bell Palsy - Offer corticosteroids to patients with new-onset disease
• Systemic Lupus Erythematosus - Primarily affects young women
• Raynaud Phenomenon - Avoid cold exposure
  
• Ascites - Most often caused by cirrhosis
  

Drugs

• Activated Charcoal - As decontaminant for majority of poisoning.
• Alfacalcidol and Calcitriol - Are they interchangeable?
• Allergy to Contrast Media - Discussing corticosteroid premedication
  
• Antacids - Best to separate taking antacids and other medications by at least 2 hours.
• Antihistamines - Similar efficacy across first- and second-generation antihistamines
• Antihypertensive Drugs - Discussing beta blockers, calcium channel blockers, diuretics and renin-angiotensin system.
• Antiplatelets - Discussing aspirin and P2Y₁₂ receptor inhibitor
• Antiretroviral Therapy - Discussing NRTI, NNRTI, Integrase Inhibitor and Protease Inhibitor
  
• Augmentin 228/5 ml Syrup - Learning the paediatric dosing of Augmentin syrup
• Benzyl Benzoate 10-25% Lotion - Effective yet inexpensive medication in scabies management
• Benzodiazepines - Stopping these medications is often difficult
  
• Benzoyl Peroxide and Topical Tretinoin - Discussing why topical tretinoin and benzoyl peroxide cannot be applied at the same time
• Bowel Preparation Before Colonoscopy - Discussing dietary preparation and other key consideration
• Chlorhexidine - Bisbiguanide antiseptic and disinfectant
  
• Clozapine - Offered for treatment resistant schizophrenia
• Combined Oral Contraceptives - contain an oestrogen and progestogen.
• Co-trimoxazole in Pneumocystis Jiroveci Pneumonia - Used for treatment and prevention
  
• Emollients (Moisturizers) - Key counselling points
• Entresto - Novel therapy for heart failure to reduce morbidity and mortality
• Exjade (Deferasirox) - From dispersible to film coated tablet
• Fibrinolytic Therapy - Learn the indications and contraindications
  
• Ferric Ammonium Citrate 400 mg/5 ml Mixture - 86 mg/5 ml of elemental iron.
• Fluids - Discussing crystalloids and colloids
• Galactagogues - Attempts nonpharmacologic treatment first
• Gamma Benzene Hexachloride 1% lotion (Lindane) - Not for children <50 kg.
• GLP-1 Receptor Agonists - Should not be combined with DPP-4 inhibitors.
  
• GTN Tablet - For acute angina or angina prophylaxis
• Insulins - Discussing insulin initiation and titration
• Levothyroxine - Dosing based on TSH and free T4 concentration
• Lipid-Lowering Drugs - Discussing PCSK9 inhibitors, fibrates and inhibitors of cholesterol absorption
• Low-dose Methotrexate - Folic acid supplementation to reduce gastrointestinal adverse effects
• Lugol's Solution - For thyroid storm
• NSAIDs - Refresher on NSAIDs
• Oral Anticoagulants - Discussing warfarin and DOACs
• Oral Bisphosphonates - Learn the correct administration method
• Oral Glucose Lowering Drugs - Discussing metformin, sulfonylureas, meglitinides, acarbose, glitazones and DPP-4 inhibitors
• Paracetamol - All you should know about paracetamol
  
• Parenteral Iron - Learn about Ganzoni equation for anaemia
  
• Potassium Permanganate 1:10,000 - soak, bath, wash, dab - Discussing how and when to use this preparation
• Proton Pump Inhibitors - Learn the stepping down approach.
• Statins - Not all statins need to be taken at night.
• SGLT-2 Inhibitors - Promote the glucose excretion into the urine
• Terazosin - Off-label use in ureteral stone(s) expulsion
• Topical Corticosteroids - Apply thinly on the skin using fingertip unit.
• Tranexamic Acid - To treat or prevent excessive blood loss

NPRA Drug Safety Updates

• Metformin: Risk of Vitamin B12 Deficiency - September 2022
  
• Domperidone: Not for Under 12 Years - June 2020
• Loperamide: Risk of Acute Pancreatitis - June 2022
• Pholcodine: Risk of Anaphylaxis to NMBAs - March 2023
• Esmya (Ulipristal Acetate 5 mg): Risk of Serious Liver Injury - December 2020
  
• Febuxostat: Increased Risk of Mortality - November 2019
• Ondansetron: Risk of Birth Defects - Jan 2021
• Smecta: Not for Children Below 2 Years - October 2019
• Olmesartan: Risk of Autoimmune Hepatitis - June 2022

Miscellaneous

• Traditional Chinese Medicine - Some basic theories
• COVID-19 - Updates on COVID-19
• Gloves - An important component of PPE
• Face Masking - Discussing how to wear it correctly
• Basic Life Support - To maximize the chance of survival
• Breastfeeding - Human milk is the optimum source of nutrition
• Child-Resistant Packaging - How does it work?
• Figures - Elemental iron and calcium content?
  
• Taxonomy - Classification system and naming of organisms
• Patent Search for Medicines - Learn how to conduct
  
• Global Public Health Days To raise awareness
• The Breakfasteur - Playdough Surgery - This is an interesting yet educating YouTube Channel