Buletin Farmasi 11/2013

8/13/2019 Buletin Farmasi 11/2013

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In addition to monitoring

patients' compliance withmedicine usage, a number of

Medication Therapy Adherence

Clinics (MTAC) operated by

pharmacists has been established.

The objective of this service is to

improve patient adherence to

medications.

MTAC was started in 2004 and has

grown exponentially. This servicestress on the importance of

p a t i e n t a d h e r e n c e t o

medications and this will lead to

reduction on the complications of

the illness.

This service also involves

c o l l a b o r a t i o n b e t w e e n

pharmacists and medical officers

in providing pharmaceutical careto patients.

MTAC pharmacists carry out the

monitoring of drug therapy andproviding information to patients

to improve their understanding

about treatment pharmacother-

apy and provide motivation so

that patients have a positive

perception about the disease and

treatment received.

This service also includes clinical

consultations, and alteration of

the dose of some drugs such asinsulin and warfarin.

Medication Therapy

Adherence Clinic (MTAC)

Contraception For Special Groups

P H

A R M A

C Y B U

L L E T I

N

P H A R M

A C Y

D E P A R T M

E N T ,

H O S

P I T A L

J E L I

Volume 1, Issue 1

November 2013

MTAC

Medication Therapy Adherence Clinic (MTAC) 2

Contraception For Special Groups 4

Middle East Respiratory Syndrome (MERS-COV) 6

Pharmacy department staff movement 8

Pharmacy humor 9

Inside this issue:

DEFINITION

Contraception: Intentional prevention of conception or impregnation through

the use of various devices, agents, drugs, sexual practices, or surgical

procedures.

Special groups: adolescent, post partum and lactating (breastfeeding) women,

women with medical conditions or risk factors, older women.

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While medication dispensing is the best-

known function of the pharmacist, pharmacists-

through counseling, medication therapym a n a g e m e n t ( M T M ) , d i s e a s e - s t a t e

management , and other means—can play a

pivotal role in patient care.

There are opportunities in every type of

pharmacy practice to improve patients’

adherence and therapeutic outcomes, and

pharmacists must embrace and act on them.

Many factors dictate a patient’s medicationadherence, and each patient is unique. The

pharmacist must approach each patient

individually to determine the level of adherence

and what barriers may exist that are preventing

the patient from taking his or her medication

appropriately.

Education, while helpful, is usually not enough to

persuade the patient to comply with the

physician’s drug orders. Information must bepresented in clear, easy-to-understand language,

and the patient must understand not only the

benefits of adherence, but the repercussions of

non-adherence.

Also, positive reinforcement goes a long way;

patients who feel empowered and cared for are

more apt to play an active role in their

treatment.

Dosing simplification and minimization of

adverse effects are extremely successful

strategies for improving adherence. When filling

a prescription, the pharmacist should do a quick

review to see whether the dosing schedule is assimple as possible. The pharmacist should inquire

frequently about any adverse effects the patient

is experiencing and then consult the physician

regarding suggested alternatives.

Preparing a dosing card containing only the most

essential elements of the patient’s medications

can be highly beneficial. Including the name of

the pill, an image (if possible), the condition it is

for, and time of day taken can be extremelyhelpful for patients who take many medications

or who have cognitive barriers.

Reminder calls, texts, or e-mails are helpful for

many patients, especially those with busy life-

styles. Automatic refills are a useful strategy.

Small details, like splitting a patient’s pills when

necessary and providing easy-off caps, can be

beneficial.

Whatever the barriers to adherence may be, the

only way to assess them is to talk to the patient.

The pharmacist needs to be diligent about

including the patient in the treatment

experience. The more trust the patient has in the

pharmacist, the more he or she will open up and

disclose any apprehensions or difficulties about

taking his or her medication.

Only then can the pharmacist play an integral

role in improving a patient’s adherence.

Page 2

Role of Pharmacist in Medication Adherence

PHARMACY BULLETIN

List of MTAC Clinic Available In Government Health Care

Among the types of MTAC offered are:



V OL UME 1, IS SUE 1

Re-educating patients, further study of the

effects of pharmacist communication, and

updating pharmacy education curriculum arechanges that can facilitate effective pharmacist-

patient communication in the future. Several

organizations emphasize the need to educate the

public about the expanding role of pharmacists.

Pharmacists surveyed for the Boehringer

Ingelheim study noted the need to re-educate

the public about the services pharmacies are

providing, and to change their view of pharmacy

from a pill dispensary to a source of medicationinformation.

And a 2006 policy brief from the Center for

Health Improvement, based on surveys and

studies of California pharmacists, stresses the

need to educate patients about the changing

practice of pharmacy so that patients will learn

to rely on pharmacists for medication and health

information.

More data and documentation, as well as

updating pharmacy curriculum, can also provide

pharmacists with information that will help them

move communication and education efforts

forward.

Many organizations and researchers call for more

studies to document evidence that pharmacist

intervention does decrease rate of errors, and

increase medication adherence.

NCPIE calls on the federal government to begin

collecting information on medication

management and adherence intervention best

practices.

NCPIE also suggests that colleges of pharmacy

and continuing education programs adopt

curriculum on patient adherence management,

train faculty apropriately, and include patient

a d h e r e n c e

management as

a graduation

competency.

Page 3

Future Changes Warranted

Classification Of Contraception

Classification Hormonal Non Hormonal

Oral Combined OCP

Progestrogen only pill (POP) -

Non Oral Progestrogen IM depo

Depo Provera

Progestrogen implant

Implanon

Levonorgestrel IUCD

Copper IUCD

Barrier methods

Spermicide

Lactational amenorrhoea

Sterilisation

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Page 4

Available Oral Contraceptive Agents (OCP) in MOH Facilities

Different Contraception Methods for Different

Groups

PHARMACY BULLETIN

Brand Progestin Estrogen

Loette 100mcg Levonorgestrel 20mcg Ethinyl Estradiol

Nordette 150mcg Levonorgestrel 30mcg Ethinyl Estradiol

Rigevidon 150mcg Levonorgestrel 30mcg Ethinyl Estradiol

Marvelon 150mcg Desogestrel 30mcg Ethinyl Estradiol

Mercilon 150mcg Desogestrel 20mcg Ethinyl Estradiol

Noriday 350mcg Norethisterone -

Escapelle 1.5mg Levonorgestrel -



Reference

1. Combined Oral Contraceptives, http://www.moh.gov.bh/PDF/MCHnewsLetter/English-OCP.pdf

2. Contraception and Lactation, Joyce King , J Midwifery Womens Health. 2007;52(6):614-620.

3. The Efficacy of Intrauterine Devices for Emergency Contraception, Kelly Cleland, Haoping Zhu, Norman

Goldstuck, Linan Cheng, James Trussel Hum Reprod. 2012;27(7):1994-2000.

3. Educate patient on possible side effects, ways to identify and manage to improve compliance.

4.Advise for annual blood pressure monitoring & clinical problems possibly relating to the CHC (e.g.,

breakthrough bleeding, amenorrhea, weight gain, and acne).

1. Make sure patient receive both verbal and written instructions on the chosen method of

contraception.

2.Advice on dosage and administration (missed dose).

Role of Pharmacist

V OL UME 1, IS SUE 1 Page 5

http://www.moh.gov.bh/PDF/MCHnewsLetter/English-OCP.pdf





What is the novel coronavirus (MERS-CoV)?

Coronaviruses are a large family of viruses that cause illness in humans and animals. In people,

coronaviruses can cause illnesses ranging in severity from the common cold to Severe Acute Respiratory

Syndrome (SARS). The novel coronavirus, first detected in April 2012, is a new strain of coronavirus thathas not been seen in humans before. This new coronavirus is now known as Middle East Respiratory

Syndrome Coronavirus (MERS-CoV). It was named by the Coronavirus Study Group of the International

Committee on Taxonomy of Viruses in May 2013.

Where are MERS-CoV infections occurring?

Nine countries have now reported cases of human infection with MERS-CoV. Cases have been reported

in France, Germany, Italy Jordan, Qatar, Saudi Arabia, Tunisia, the United Arab Emirates (UAE) and the

United Kingdom. All cases have had some connection (whether direct or indirect) with the Middle East.

In France, Italy, Tunisia and the United Kingdom, limited local transmission has occurred in people whohad not been to the Middle East but who had been in close contact with laboratory-confirmed or

probable cases.

How widespread is MERS-CoV?

How widespread this virus may be is still unknown. WHO encourages Member States to continue to

closely monitor for severe acute respiratory infections (SARI) and to carefully review any unusual

patterns of SARI or pneumonia. WHO will continue to share information as it becomes available.

How do people become infected with this virus?

We do not yet know how people become infected with this virus. Investigations are underway to

determine the source of the virus, the types of exposure that lead to infection, the mode of transmission

and the clinical pattern and course of disease.

Can the virus be transmitted from person to person?

Yes. We have now seen multiple clusters of cases in which human-to-human transmission is either

strongly suspected or confirmed. These have all occurred either in a health care facility or among close

family members. However, the mechanism by which transmission occurred in all of these cases,

whether respiratory (e.g. coughing, sneezing) or direct physical contact or contamination of the

environment by the patient, is unknown. Thus far, no

sustained community transmission has been observed.

Is there a vaccine for MERS-CoV?

No vaccine is currently available.

Does treatment exist for MERS-CoV?

There is no specific treatment for disease caused by MERS-

CoV. Treatment should be based on the patient’s symptoms.

Page 6

Middle East Respiratory Syndrome Coronavirus (MERS-COV)

PHARMACY BULLETIN



Are health workers at risk from MERS-CoV?

Yes. Transmission has occurred in health care facilities, including spread from patients to health care

providers. WHO recommends that health care workers consistently apply appropriate infection

prevention and control measures.

Infection control measures & how to implementStandard precautions

hand hygiene and use of personal protective equipment (PPE) to avoid direct contact with

patients’ blood, body fluids, secretions (including respiratory secretions) and non-intact skin

when providing care in close contact with a patient with respiratory symptoms (e.g. coughing or

sneezing), use eye protection, because sprays of secretions may occur

prevention of needle-stick or sharps injury

safe waste management

cleaning and disinfection of equipment

Apply routinely in all health-care settings for allpatients.

Droplet precautions

Use a medical mask if working within 1 m of

the patient

Place patients in single rooms, or group

together those with the same etiological

diagnosis. If an etiological diagnosis is not

possible, group patients with similar clinical diagnosis and based on epidemiological risk factors,

with a spatial separation of at least 1 m. Limit patient movement and ensure that patients wear medical masks when outside their

rooms.

Airborne precautions

Ensure that healthcare workers performing aerosol generating procedures use PPE, including gloves,

long-sleeved gowns, eye protection and particulate respirators (N95 or equivalent). Whenever

possible, use adequately ventilated single rooms when performing aerosol-generating procedures.

Is MERS-CoV like SARS?

SARS is a coronavirus that was identified in 2003 and is distantly related to MERS-CoV. However, al-

though both viruses are capable of causing severe disease, current information indicates that they

have key differences. Most importantly, MERS-CoV does not appear to transmit easily between people

whereas the SARS virus was much more transmissible.

Are there any travel or trade restrictions related to this new virus?

No. WHO does not recommend any travel or trade restrictions with respect to MERS-CoV. WHO will

continue to review all recommendations as more information becomes available.

Reference:

Source: http://www.who.int/csr/disease/coronavirus_infections/en/index.html (as of 17 July 2013).Information will be updated from time to time

based on the WHO website.




Page 8

Pharmacy Department Staff Movement

PHARMACY BULLETIN




Humor of the Day

A doctor is to give a speech at the local AMA

dinner. He jots down notes for his speech.

Unfortunately, when he stands in front of his

colleagues later that night, he finds that he can't

read his notes. So he asks, "Is there a pharmacist

in the house?"

A customer gets a topical cream.

Pharmacist : Apply locally two times a day.

Customer : I can't apply locally, I'm going

overseas."



uthors

PHARMACY DEPARTMENT, JELI

HOSPITAL

Nur Shuhada Shamsuri

Siti Najlaa Izzatie Mohammed

Marzhuki

Normala Harom

Muhammad Azwann bin Ambak

CONTACT US

Address:

Pharmacy Department

Hospital Jeli, 17600 Jeli, Kelantan.

Tel: 09-9443300

Fax:09-9440014

Outpatient/Inpatient Ext: 3335/3336/3338

Store Ext: 3313/3316

Documents

Buletin Farmasi 11/2013