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Pharmacy Unit

PEJABAT KESIHATAN DAERAH ALOR GAJAH (PKDAG)

78000 ALOR GAJAH, MELAKA

Issue 2/2017

Pharmacy Bulletin

Inside this issue:

1. Rabies

2. Leptospirosis

3. What is Scabies?

4. Do you have Depression?

5. Aktiviti Kenali Ubat Anda

PKDAG 2017

6. Staff Contoh Sesi 1/2017

EDITORIAL BOARD

CHAIRMAN:

Dr. Hazlinda Bt Datuk Hj. Hamzah

ADVISER:

Pn. Azliah Bt Sakiman

EDITOR:

En. Chan Wei Jyh

CONTRIBUTORS:

Pn. Anida Bt Daud

En. Fakaruddin Bin Karim

Cik Jenny Shum Kam Hong

Cik Lim Fei Ting

En. Muhamad Lutfi Bin Abdul Samat

Pn. Nur Syafinaz Bt Asmuni

Pn. Nurul Rahimah Mohd Khair

Pn. Saidatul Akmar Bt Borhan

Rabies Contributed by:

Cik Lim Fei Ting

IntroductionRabies is a zoonotic disease (a disease that is transmitted to humans from

animals) that is caused by a virus.

Mode of TransmissionDog is the main transmitter. It can be spread to people through close contact

with infected saliva via bites or scratches.

Clinical ManifestationThe incubation period is typically 1–3 months, but may vary from 1 year.The

initial symptoms of rabies are fever and often pain or an unusual or

unexplained tingling, pricking or burning sensation (paraesthesia) at the

wound site. As the virus spreads through the central nervous system,

progressive, fatal inflammation of the brain and spinal cord develops. 2

forms of disease can be followed:

i. hyperactivity, excited behaviour, hydrophobia and sometimes

aerophobia. After a few days, death occurs by cardio-respiratory arrest.

ii. Paralytic (muscle paralysis) A coma slowly develops, and eventually

death occurs.

Prevention and control of Rabies in Malaysia

3 case definition:

i. Suspected: A case that is compatible with the clinical case

definition and with history of dog bite or scratch.

ii. Probable: A suspected case plus history of contact with a

suspected rabid dog.

iii. Confirmed: A case that is laboratory-confirmed.

REFERENCES:

1. INTERIM Guideline for Human Rabies Prevention & Control in Malaysia.Disease Control Division Ministry of Health Malaysia.

Rabies

Phamacy Bulettin PKD Alor Gajah 2

REFERENCES:

1. INTERIM Guideline for Human Rabies Prevention & Control in Malaysia.Disease Control Division Ministry of Health Malaysia.

Contributed by:

Cik Lim Fei Ting

RISK

CATEGORY

TYPE OF

EXPOSUREACTION TO BE TAKEN

1

Touching/feeding

animal. Licking of

intact skin.

Nil if history is reliable. If history not reliable, treat as category 2.

2

Nibbling of

uncovered skin.

Superficial

scratch, no

bleeding. Licking

of broken skin.

Apply wound treatment. Administer vaccine. Do not administer

anti-rabies immunoglobulin. Stop vaccination if animal is rabies

negative in laboratory tests, or remains healthy after 10 -14 days

observation (dog or cat). Continue vaccination if animal is not

found/captured

3

Bites/scratches

which penetrate

the skin and draw

blood. Licking

mucous

membrane.

Multiple bites. Any

wild animals bites.

Apply wound treatment. Administer vaccine. Administer anti-

rabies immunoglobulin. Administer anti-tetanus and antibiotic

treatment. Stop vaccination if animal is rabies negative in

laboratory tests, or remains healthy after 10 - 14 days

observation (dog or cat). Continue vaccination if animal is not

found/captured.

General Guideline for Dog Bite Management According to Category of Exposure

Post Exposure Management

i. Local treatment of the wound:

• immediate and thorough flushing and washing of the wound for a minimum of 15 minutes

with soap and water, detergent, povidone iodine or other substances that kill the rabies

virus.

ii. Post-exposure vaccine (PEP) and Rabies Immunoglobulin (RIG)

• PEP is given for risk category 2 and 3 accordingly. RIG is given for risk category 3 only.

Previously

unvaccinated people

•4 doses at day 0, 3,7, and 14 and a doseof RIG at the sametime as the first doseof the vaccine toprovide rapidprotection thatpersists until thevaccine works

Previously vaccinated

people

•2 doses at day 0 & 3

and RIG is unnecessary

and should not be

given.

Immunocompromised

patient

•5 doses at day 0, 3, 7,

14 and 28 and a dose

of RIG at the same time

as the first dose of the

vaccine to provide rapid

protection that persists

until the vaccine works.

Nicorette & Zincofer Drug Talk

Bilik Seminar KKIA, Alor Gajah

13 July 2017


Contributed by:

Cik Nurul Rahimah

Seretide Accuhaler Drug Talk

Bilik Seminar KKIA, Alor Gajah

29 July 2017

“Leptospirosis is

an infectious

disease caused by

pathogenic

bacteria called

leptospires,”

Leptospirosis


REFERENCES:

1. Medscape- Feb 22, 2016, Leptospirosis, Sandra G Gompf, MD, FACP, FIDSA; Michael Stuart

Bronze, MD MPH, FACP, FACOEM

2. World Health Organization. Human leptospirosis : guidance for diagnosis, surveillance and control

3. Paul N. Levett, Leptospirosis, 2001 Apr; 14(2): 296–326.

4. Sarawak Handbook of Medical Emergencies 3rd Edition

Contributed by:

Pn Nur Syafinaz

Treatment of Leptospirosis

Treatment of leptospirosis differs depending on the severity and duration of

symptoms at the 6me of presentation. Treatment with effective antibiotics should be

initiated as soon as the diagnosis of leptospirosis is suspected. Mild cases can be treated

with oral antibiotics such as amoxycillin, ampicillin, or doxycycline. Severe cases of

leptospirosis should be treated with high doses of intravenous penicillin. Third-generation

cephalosporins, such as ceftriaxone and cefotaxime, and quinolone antibiotics also

appear to be effective.

Patients with severe cases of leptospirosis also require supportive therapy and

careful management of renal, hepatic, hematologic, and central nervous system

complica6ons. If renal failure ensues, early initiation of hemodialysis or peritoneal dialysis

may reduce mortality by nearly two-thirds. Additional supportive care may include inotropic

agents, diuretics, or ophthalmic drops.

“Scabies is a

contagious skin

condition caused

by tiny mites

Sarcoptes scabiei

that burrow into

the skin. ”

What is Scabies?


REFERENCES:

• GUIDELINE FOR MANAGEMENT OF SCABIES IN ADULTS AND CHILDREN 2015, Ministry of Health Malaysia

• Formulari Ubat Hospital Canselor Tuanku Muhriz

Contributed by:

En. Fakarrudin

The main symptoms of scabies are intense itching and skin rash on areas

where the mites have burrowed. The intense itching associated with

scabies is thought to be caused by immune system reacting to the mites

and their saliva, eggs and faeces. Without effective treatment, the life

cycle of the scabies mite can continue indefinitely. Scabies mites are

resistant to soap and hot water and cannot be scrubbed out of the skin.

Treatment Options For ScabiesClinical

condition

Recommended therapy Alternative therapy Additional measures Comments

Classical

scabies

i. Infants < 2

months

6% Sulphur in Calamine

Lotion. Rinse off after 24

hours and then reapply every

24 hours for the next 3 days

- Treat whole body

including the face

(avoid eyes and

mouth)

Treat all family

members/close

contacts

simultaneously

ii. Children <

2 years

2 applications of Permethrin

5% lotion for 8-12 hours at

one week apart

6% Sulphur in Calamine

Lotion. Rinse off after 24

hours and then reapply

every 24 hours for 3 days

Treat whole body

including the face

(avoid eyes and

mouth)

Crotamiton 10%

cream TDS for 5-

7days for nodular

scabies.

iii. Children <

12 years



one week apart

Benzyl Benzoate 12.5%

lotion* Whole body neck

and below. Rinse off after

24 hours then reapply for

3 consecutive days.

Crotamiton 10%

cream TDS for 7- 14

days for nodular

scabies.

iv. Adults 2 applications of Permethrin


one week apart

Benzyl Benzoate 25%

lotion* whole body; neck

and below. Rinse off after

24 hours then reapply for

3 consecutive days.

People in close

physical contact, even

without symptoms,

should receive

treatment at the

same time.

v. Pregnancy/

lactating

women



one week apart.

-

Crusted

scabies

Apply Permethrin 5% lotion

every 2-3 days for 1-2weeks

PLUS

Ivermectin*(200ug/kg/dose)

should be taken with food.

Depending on the infection

severity, ivermectin should

be taken in 3 doses (days

1,2,8), 5 doses (days

1,2,8,9,15) or 7

doses(days1,2,8,9,15,22,29)

Oral

Ivermectin*(200ug/kg

single dose and repeat

after 2 weeks) alone or in

combination with

permethrin OR several

applications of Benzyl

Benzoate 25%.

Apply keratolytic

agents (salicylic acid

in vaseline) to

hyperkeratotic areas

to help reduce

crusting of the skin

and aid in the

absorption of the

topical permethrin or

benzyl benzoate.

Keep nails short and

apply medication to

subungual areas.

Patients may need

admission. Strict

control to prevent

spread of infection.

Do You Have Depression?

“According to the

latest (fifth) edition

of The Diagnostic

and Statistical

Manual of Mental

Disorders, someone

is diagnosed as

depression if he or

she has at least five

of the following

symptoms for nearly

every day.


REFERENCES:

• Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5

Contributed by:

Cik Jenny Shum

1. Depressed Mood

Feel irritable most of the day, nearly every day for more than

two weeks. He or she may appear sad, empty or tearful to the

people around him or her.

2. Lack of Interest

The person shows decreased interest or pleasure in most

activities, including activities that he or she previously enjoyed,

most of each day.

3. Significant Weight or Appetite Change

Medically, a weight change of 5% (gain or loss) may be an

indication of depression.

4. Change in Sleeping Habit

Some people may have problems falling asleep (insomnia),

while others may sleep more excessively than usual

(hypersomnia).

5. Fatigue

The affected person seems listless and lacking in energy most

of the time, often showing little inclination to snap out of the

mood.

6. Guilt

The person feels an excessive or inappropriate amount of guilt

over a past incident. He or she may also feel helpless to

change a situation, or that he or she is worthless to people

around him or her.

7. Lack of Focus

He or she has a reduced ability to concentrate or think, and is

also indecisive.

8. Suicidal Thoughts

The person frequently entertains the thought of death or

suicide, perhaps even has a plan in mind on how to carry out

the suicide

Aktiviti Kenali Ubat Anda PKDAG 2017


Contributed by:

Pn Anida Daud

Program Jelajah Masjid Di Masjid Kg Sungai Jernih Sempena Ramadhan 1438

Masjid Kg Sungai Jernih

17 Mei 2017

Pameran Kenali Ubat Anda Masjid Padang Sebang

Masjid Padang Sebang

2 Jun 2017

Program Sembang Kopi

Gadek

28 Februari 2017

Program Sembang Kopi & Lawatan ke Rumah

Alor Gajah

20 April 2017


Jalan Hospital,

78000 Alor Gajah

Melaka .

Phone : 06-5566235/

06-5566237

Fax : 06-5566236/

06-5566249

Aktiviti Kenali Ubat Anda PKDAG 2017 Contributed by:

Pn Anida Daud

Ceramah oleh Pegawai Farmasi PKDAG

Sekolah Kebangsaan Sungai Jernih

17 April 2017

Pameran bersama Duta Farmasi

Restoran Astana

8 Jun 2017

Staff Contoh Sesi 1/2017 (Januari – Jun 2017)

Pameran QUMC di Klinik Kesihatan Tebong

KK Tebong, Alor Gajah

5 Ogos 2017

Puan Nur Atikah Binti Yaakub

Pegawai Farmasi UF 52

Klinik Kesihatan Masjid Tanah

Contributed by:

Pn Saidatul

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