PHARMACY

INSIDE THIS ISSUE

Iron Deficiency Pg. 1-2 Anaemia Unveiling Ketum Pg. 3-4

IRON DEFICIENCY ANAEMIA

PREPARED BY AFIQ AIZUDDIN

HOSPITAL KUALA KUBU BHARU

Volume 1 June 2018

EDITORIAL BOARD Advisor :

Ratna Suny Bt Mohamed Esa

Editors :

Surayya Bt Harun

Tan Cai Ting

Writers :

Afiq Aizuddin Bin Abu Johan

Sadhaswaren A/L Subramaniam

CONTACT US

Pharmacy Resources

Information Center,

Hospital Kuala Kubu Bharu

03-60641333 Ext:279

Iron is an important component of haemoglobin,

which is an oxygen carrier in our blood.

Iron deficiency anaemia (IDA) is a condition in which

concentration of haemoglobin is below the

recommended threshold due to negative iron

balance.

Symptoms of IDA include fatigue, rapid heartbeat,

headaches, having trouble concentrating and

unusual eating habits (eg. craving for ice).

IDA could be caused by:

Inadequate dietary iron intake

Malabsorption of dietary iron in autoimmune

gastritis and H. pylori infection

Higher requirement for iron in pregnancy and

growth

Increased iron losses through menstruation or

blood loss

BULLETIN

WHAT TO EAT?

Eat more

IRON-RICH FOOD

to prevent IDA! EAT WITH

Vitamin C

Haem iron source (meat, chicken)

Fermented vegetable (kimchi, fermented soy sauce)

Increase iron absorption

AVOID EATING WITH

Bran products, cereals, oat and rice

Tea, coffee, cocoa and red wine

Calcium supplements, milk and cheese

Decrease iron absorption

HAEM IRON is more efficiently

absorbed than NON-HAEM IRON.

Chicken

Meat

Fish

HAEM IRON

(Animal source) NON-HAEM IRON

(Plant source)

Vegetables

Legume

Cereals

IRON SUPPLEMENTATION Oral iron supplements such as ferrous fumarate, ferrous sulphate, ferrous

gluconate and ferrous citrate can be taken if supplementation from food alone is

not sufficient.

Parenteral supplementation such as iron dextran, iron sucrose and iron polymaltose

are also available for hemodialysis patient and failure of iron oral therapy.

REFERENCES 1. Ng PY. Overview of iron deficiency anaemia, MIMS Pharmacy, 2017(6) 2. Important Facts About Iron-Deficiency Anemia | Healthgrade. Available from: http://www.healthgrades.com/conditions/

important-facts-about-iron-deficiency-anemia

Pg.2

UNVEILING KETUM

Ketum which is also known as kratom internationally is a tropical tree that grows

to a height of 4-16 meter which is indigenous to South East Asia region including

Malaysia. The scientific name of ketum is Mitragyna speciosa.

The issues with use of ketum is widely debated due to it’s opioid receptor activity

where locally people consume ketum for a variety of purposes and it is known to lead

to dependence.

TRADITIONAL USES Rural folk ingest ketum leaves to self

-treat (pain, fever, diabetes and other

illnesses)

Used by manual labourer to reduce

fatigue and improve work

productivity.

Used as opium substitute during

opium scarcity in Malaya.

METHOD OF INTAKE In Thailand, ketum are consumed by

chewing on dried leaf.

In Malaysia, the more common method of

use is by drinking the water after boiling the

leaf. Consumer will gulp it in one shot due

to the bitterness.

More than 20 chemical compounds have been isolated from

ketum, including many alkaloids which contribute to its

pharmacological effects.

Mitragynine and 7-hydroxymitragynine are the compounds that

give ketum its analgesics and opioid-like effects used to alleviate pain

in illnesses.

The effects of ketum in humans are dose-dependent: small doses produce ‘cocaine

-like’ stimulation while larger dosages cause ‘morphine-like’ sedative-narcotic

effects.

KETUM EFFECTS ON PAIN

Pg.3

PREPARED BY SADHASWAREN

ADVERSE EFFECTS OF KETUM In the past years, the cases of reported adverse

effects of ketum by its user have increased. The

adverse effects are widely attributed to its opioid-

like effects (sedation, nausea, constipation, itching)

and stimulant effects (anxiety, irritability, increased

aggression).

High dose (more than 15g) uses have been seen to

produce hyperpigmentation of the cheeks, tremor,

anorexia, weight loss, and psychosis effects.

There have also been reports of seizure in patient

taking ketum alone or with drugs such as modafinil.

Anecdotal reports have suggested that ketum is less addictive than classical

opioids. However, many reports suggest that ketum might be highly addictive in

certain individual compared to others.

In South East Asia, individual seeks use of ketum for euphoric and mind-altering

effects. Chronic user have been seen to be physically dependant and addicted

to ketum.

In Europe, the reports of addiction and dependence to ketum among compulsive

ketum user have increased. Opioid-like withdrawal was reported in these cases

when ketum was stopped.

ABUSE & DEPENDENCE

REFERENCES: 1. Cinosi E, Martinotti G, Simonato P, Singh D, Demetrovics Z, et. al. Following “the Roots” of Kratom (Mitragyna speciosa): The

Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries. 2018

2. Fluyau D, Revadigar N. Biochemical Benefits, Diagnosis, and Clinical Risks Evaluation of Kratom. 2018 3. Prozialeck W, Jivan J, Andurkar S. Pharmacology of Kratom: An Emerging Botanical Agent With Stimulant, Analgesic and

Opioid-Like Effects. 2018 4. Vicknasingam B, Narayanan S, Beng G, Mansor S. The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the

northern states of peninsular Malaysia and implications for drug substitution therapy. 2018

Reports suggest that ketum may potentially be

used in pain management, opioid withdrawal

syndrome or other clinical problems. However,

issues regarding ketum abuse and toxic effect still

remain mainly due to lack of regulation regarding

use of ketum.

With proper interventions to handle the issue,

ketum may be an option for medical use in the

future but further research is needed.

POTENTIAL FOR MEDICINAL USE?

Pg.4