PHARMACY BULLETIN

P E J A B A T K E S I H A T A N D A E R A H J O H O R B A H R U

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Advisor:

Pn Siti Fatimah Abu Bakar

Editor:

Pn Raja Norrima Raja Arrif

Members:

Cik Toh Chia Chia

En Tey Keat Ming

Pn Faradia Mohmed

Pn Amalina Nasis

En Amir Harith Ali

Cik Norasikin Md Saman

Pn Syareena Izani Razak

Pn Goh En Mian

Arthritis 2

Guideline on the management of Arthritis 3

Non-pharmacological management for Arthritis 4-5

Brand Changes 6

Transfer in & transfer out pharmacy staff Jun-Nov 2014 7

Perbelanjaan Ubat Arthritis 8-9

Perkhidmatan Tambah Nilai: Kad Temujanji 10-11

Pharmacy Jokes 12

Page 2 PHA RM A CY B ULLE TI N

Introduction: What is arthritis?

Arthritis is an inflammation of joints which causing joints painful and

stiff. There are 2 common types of arthritis.

Osteoarthritis (OA) vs Rheumatoid Arthritis (RA)

Osteoarthritis is caused by damage and loss of cartilage that acts as a

protective cushion between bones. As the cartilage is loss, the bone

form spurs, abnormal hardening and finally form the subchdronal cysts

which will cause pain when the joints are used. When the disease pro-

gressed, inflammation develop, the patient may feel pain even when the

joints are not being used.

Rheumatoid arthritis is an inflammatory arthritis and an autoimmune

disease. The immune system attacks the body’s own tissues, especially

the synovium causing swollen and fluids build up in the joints and sys-

temic inflammation occurs too.

Risk Factors

Advancing age

Obesity

Heredity

Reproductive vari-able: female are most likely to have arthri-tis, postmenopausal

Hypermobility

Major injuries

Occupational eg: knee OA in manual worker, hip OA in farmer

Environmental fac-tors such as exposure to smoking tobacco, silica mineral and chronic periodontal disease increase the risk of RA

Pharmacological Management

Osteoarthritis (OA)

Analgesic: paracetamol, NSAID, opioid

Intra-articular injection: glucocorticoid, hyaluronan

Topical therapy: methylsalicylate liniment (LMS), capsaicin, NSAID containing plas-ter

Glucosamine supplement

Ginkgo extract

Rheumatoid Arthritis (RA)

Analgesic: NSAID

Corticosteroids

Disease modifying antirheumatic drugs (DMARD): methotrexate, salfasalazine, hydroxychloroquine

Immunosuppressants: cyclosporine, azathioprine, cyclophosphamide

Sign and Symptoms

Osteoarthritis (OA) Pain during and after activity

Stiffness

Functional limitation due to painful and re-stricted movement

Tenderness around joint area

Rheumatoid Arthritis (RA)

Warm, tender, swollen joints

Morning stiffness that may last for hours

Restricted movement

Pain

Symmetrical joint deformity

Firm bumps of tissue under the skin of arms (rheumatoid nodules)

Systemic inflammation: fatigue, ane-mic, lose appetite, low grade fever,

Example of Osteoarthritis (OA)

Example of Pheumatoid Arthritis (RA)

TOH CHIA CHIA

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TEY KEAT MING

EULAR recommendations for the management of rheumatoid arthritis with

synthetic and biological disease-modifying antirheumatic drugs: 2013 update

1. Therapy with DMARDs should be started as soon as the diagnosis of RA is made.

2. Treatment should be aimed at reaching a target of remission or low disease activity in every patient.

3. Monitoring should be frequent in active disease (every 1–3 months); if there is no improvement by at most 3 months after

the start of treatment or the target has not been reached by 6 months, therapy should be adjusted.

4. MTX should be part of the first treatment strategy in patients with active RA.

5. In cases of MTX contraindications (or early intolerance), sulfasalazine or leflunomide should be considered as part of the

(first) treatment strategy.

6. In DMARD-naïve patients, irrespective of the addition of glucocorticoids, csDMARD monotherapy or combination ther-

apy of csDMARDs should be used.

7. Low-dose glucocorticoids should be considered as part of the initial treatment strategy (in combination with one or more

csDMARDs) for up to 6 months, but should be tapered as rapidly as clinically feasible.

8. If the treatment target is not achieved with the first DMARD strategy, in the absence of poor prognostic factors, change to

another csDMARD strategy should be considered; when poor prognostic factors are present, addition of a bDMARD

should be considered.

9. In patients responding insufficiently to MTX and/or other csDMARD strategies, with or without glucocorticoids,

bDMARDs (TNF inhibitors*, abatacept or tocilizumab, and, under certain circumstances, rituximab†) should be com-

menced with MTX.

10. If a first bDMARD has failed, patients should be treated with another bDMARD; if a first TNF inhibitor therapy has

failed, patients may receive another TNF inhibitor* or a biological agent with another mode of action.

11. Tofacitinib may be considered after biological treatment has failed.

12. If a patient is in persistent remission after having tapered glucocorticoids, one can consider tapering‡ bDMARDs§, espe-

cially if this treatment is combined with a csDMARD.

Algorithm based on the 2013 EULAR Rheumatism Classification of DMARDs by European

League against Rheumatism (EULAR)

Page 4 PHA RM A CY B ULLE TI N

1. Omega-3 fatty acids. They may sound technical and unappetizing, but it’s worth savoring what omega-3s do for the body — especially the joints. Fatty acids are a family of special fats that the body needs but can’t make for itself, so you have to get them from food. Once in the body, they collect in cells, where they help form hormone-like substances, called leukotrienes, that put the brakes on inflammation — a root cause of rheumatoid and, to a lesser extent, osteoarthritis. More than a dozen reliable studies suggest that increasing your intake of omega-3 fatty acids can help quell symptoms of rheu-matoid arthritis, even if the fats don’t slow progression of the

disease.

The most important food source of omega-3s is cold-water fish such as salmon, tuna, mackerel, and trout. But you’ll also find types of omega-3s in nuts and seeds, beans, soy products,

2. Vitamin C. It’s one of the most familiar of all nutrients, but vitamin C’s role in joint health tends to be underappreciated. Vitamin C not only helps produce collagen, a major component of joints, but sweeps the body of destructive molecular byproducts known as free radicals, which are destructive to joints. Without vitamin C and other so-called antioxidant nutrients, free-radical damage to joints would be much worse. One of the best-known studies looking into vitamin C and arthritis, the Framingham osteoarthritis study, found that people whose diets routinely in-cluded high amounts of vitamin C had significantly less risk of their arthritis progressing.

3. Vitamin D. You can get vitamin D just from standing in the sun. That’s because ultraviolet light converts precursors of the vitamin in the body into a usable form. Many people with arthri-tis are D-deficient. Studies find that getting more vitamin D pro-tects joints from osteoarthritis damage, probably because this nutrient is vital to the health of bones that support and underlie joints. Vitamin D also appears to play a role in production of collagen in joints themselves.

4. Glucosamine .Glucosaminehelps keep the cartilage in joints healthy. But natural glucosamine levels drop as people age. This can lead to gradual

deterioration of the joint.

There's some evidence that glucosamine sulfate supplements help counteract this effect, although experts aren’t sure exactly how they work. Specifically, glucosamine has been shown in some studies to help ease the pain of mild to moderate osteoarthritis of the knee. Glucosamine may also help with other joint pain caused by osteoarthritis. Glucosamine has also been used to try and treat rheumatoid arthritis and other conditions, such as inflammatory bowel disease, asthma, allergies, chronic venous insufficiency, sports injuries, temporomandibular joint problems (TMJ), chronic low back pain, and many

others.

5. Vitamin E. Like vitamin C, this is an antioxidant vitamin that protects the body — including the joints — from the ravages of free radicals. Some of the same research showing that other nutrients protect against arthritis also indicates that vitamin E can help prevent joints from becoming worse, though E’s effects appear more limited than those of vitamins C and D.

6. B vitamins. As cousin chemicals in the B-vitamin family of nutrients, vitamin B6 and folate are also among the nutrients most likely to be lacking in people with arthritis. Part of this is due to deficiencies common population-wide — for example, one study found 90 percent of women don’t get enough B6 in their diet. But there’s also evidence that the inflammation process eats up these B vitamins especially fast in people with rheumatoid arthritis — bad news for a variety of bodily functions, including the manufacturing of protein, the building block for tissues such as cartilage.

7. Calcium. The issue with calcium, as with vitamin D, is bone health. Calcium has obvious importance to bones — more than 90 percent of the body’s stores are contained in the skeleton and teeth. Getting too little calcium raises the risk of osteoporosis, a brittle-bone condition that acceler-ates if you have rheumatoid arthritis. All women (who are especially at risk) should get about 1,200 milligrams a day after age 50 — about twice what’s typical.

faradia Page 5 2ND E DITI ON

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BRAND & PACKAGING CHANGES OF DRUGS

June-Oktober 2014

GENERIC NAME FORMER BRAND &

PACKAGING

CURRENT BRAND &

PACKAGING

TAB. BROMHEXINE 8MG DYSOLVON 8MG BROMHEXINE 8MG

(AXCEL)

TAB. CEPHALEXIN 250MG CEPHALEXINE

(PHARMANIAGA)

UPHALEXIN 250MG

(CCM)

TAB. DIPHENOXYLATE 2.5MG +

ATROPINE SULPHATE 25MCG

BEAMOTIL

(CCM)

DIPHENOXYLATE A

(PHARMANIAGA)

TAB. ERYTHROMYCIN 400MG ERYTHROMYCIN ES

(AXCEL)

ERYMIN-400MG

(ROYCE)

ISOSORBIDE MONONITRATE

50MG

ELANTAN LONG 50MG

(GSK GLAXOSMITHKLINE)

IMDEX 60MG CR

(CCM)

TAB. METFORMIN 500MG METFORMIN HCL 500MG

(SUNWARD)

GLUMET D.C

(PHARMANIAGA)

TAB. METOCLOPRAMIDE 10MG MALON

(CCM)

ANPRO METOCLOPRA-

MIDE 10G

(MPI)

PERINDOPRIL 8MG COVAPRIL 8MG

(CCM)

PERINACE 8MG

(CCM)

TRIPROLIDINE HCL 2.5MG

+PSEUDOEPHEDRINE HCL

60MG

TRIDINE

(AXCEL)

FEDAC TABLET

(DHA)

Amir harith

Transfer In & Transfer Out

Pharmacy Staff Jun— Nov 2014

No. Name Position Transfer in from Transfer out to Resign/New

1 Ho Ern Huey Pegawai Farmasi U41

Selangor

2 Muhammad Ali Bin Suradi

Penolong Pega-wai Farmasi U29

PKD Kota Tinggi

3 Nur Aiman Bin Mohd Amin

Penolong Pega-wai Farmasi U29

Hospital Sara-wak

4 Samsidah Binti Latif

Pegawai Farmasi U44

PKD Kulai

5 Anu Priya A/P Mukunan

Pegawai Farmasi U41

PKD Kota Tinggi

2ND E DITI ON Page 7

NORAHSIKIN

PERBELANJAAN UBAT ARTHRITIS

2013-2014

NAMA ITEM SKU PERBELANJAAN

2013 (RM)

PERBELANJAAN SE-

HINGGA OKTOBER

2014 (RM)

PARACETAMOL 500MG TABLET 1000'S 52,836.84 41,057.59

TRAMADOL 50MG CAP 100'S 1,594.32 799.00

ACETYL SALIC AC SOL 300MG TABLET

(ASPIRIN) 30'S 124,833.00 89,193.00

DICLOFENAC SODIUM 50MG TABLET 1000'S 10,864.20 13,035.60

MEFENAMIC ACID 250MG CAP 1000'S 128,300.04 70,611.36

INDOMETHACIN 25MG CAP 500'S 765.60 262.16

KETOPROFEN 30MG PATCH PCS 3,084.48 1,237.58

CELECOXIB 200MG TABLET 100'S 2,360.12 6,865.09

MELOXICAM 7.5MG TABLET 100'S 390.00 658.50

METHYLSALICYLATE 25% OINTMENT 500G 21,103.94 10,345.14

METHYLSALICYLATE 25% OINTMENT 30G 103,807.10 92,733.19

Jadual menunujukkan perbelanjaasn ubat-ubatan untuk Arthitis dari tahun 2013 sehingga Oktober 2014.

Page 8 PHA RM A CY B ULLE TI N

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-20,000.00 40,000.00 60,000.00 80,000.00

100,000.00 120,000.00 140,000.00

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NAMA ITEM

PERBELANJAAN UBAT-UBATAN ARTHRITIS

PERBELANJAAN 2013 (RM)

PERBELANJAAN SEHINGGA OKTOBER 2014 (RM)

Graf menunujukkan perbandingan perbelanjaasn ubat-ubatan untuk Arthitis dari tahun 2013 sehingga

Oktober 2014.

PERBELANJAAN UBAT ARTHRITIS

2013-2014

2ND E DITI ON

AMALINA

PHARMACY BULLETIN

Kad Temujanji : Kad temujanji yang diberikan kepada pesakit yang mempunyai bekalan ubat

susulan di mana ubat pesakit disediakan sebelum tarikh pesakit datang mengambil ubat. Preskripsi

yang mempunyai tempoh melebihi 1 bulan yang memerlukan bekalan ubat susulan sahaja boleh

dipilih.

PROSEDUR KERJA

KK Mahmoodiah

KK Tebrau

KK Majidee

KLINIK-KLINIK YANG

MENAWARKAN

PERKHIDMATAN KAD

TEMUJANJI

KK Kempas

KKPasir Gudang

KK Taman Sri Orkid

Syareena Page 10 PHA RM A CY B ULLE TI N

2ND E DITI ON Page 11

A patient comes into her local pharmacy to collect her regular arthritis medication. The phar-macist hands over her prescrip-tion and says, "take one of these tablets every four hours. Or as often as you can get the cap off."

I was in the bookstore the other day and came across a book ti-tled "Living with Parkinson's Disease and Arthritis". I looked at the back to see what the critics had to say about it. "After an initial shakey start, I " just couldn't put this book down."

My wife suffers from terrible rheuma-tism and it's incredibly painful for her to walk. That's why I sold her car

Goh En Mian Page 12 PHA RM A CY B ULLE TI N