Rx Note

Introduction The World Health Organization (WHO) classifies low bone mineral density (BMD) according to T-score as either osteoporosis or osteopenia ; these definitions only apply to BMD measurements taken at the lumbar spine, total hip or femoral neck. Normal = -1 or higher Osteopenia = Between -1 and -2.5 Osteoporosis = -2.5 or lower Osteoporosis occurs most commonly in postmenopausal women, men over 50 years, and in patients taking long-term oral corticosteroids (glucocorticoids). Definitions: The T-Score is the number of standard deviations by which a patient's BMD varies from the young adult mean for their sex , as measured by dual energy X-ray absorptiometry (DXA). The Z-Score is the number of standard deviations a person's BMD varies from the age- and sex-matched mean BMD . Z-scores are recommended for reporting BMD in premenopausal women, men younger than 50 years and children. Management Conservative management (i.e. lifestyle changes) Address inadequate calcium i...

Introduction In a dream, my lecturer was showing a long list of medications. He asked, do you know what is the most prominent drug interaction that you can identify. I tried my best but I could not recognize the drug name. He answered, it would be interaction with MONEY. Yes, it is bit off topic here. Drug Interactions Two or more drugs given at the same time can exert their effects independently or they can interact. Interactions may be beneficial or may cause you to experience an unexpected side effect or reduced efficacy. Drug-drug interactions can be broadly classified as being either pharmacokinetic or pharmacodynamic. Pharmacokinetic - occur when one drug alters the absorption, distribution, metabolism or excretion of another. Pharmacodynamic - might be due to competition at receptor sites or occur between drugs acting on the same physiological system. Potentially harmful drug interactions may occur in only a small number of patients, but the true incidence is often hard to es...

Introduction Statins are widely recognized as the first-line lipid-modifying therapy for reducing cardiovascular risk due to consistent results of numerous randomized primary and secondary prevention clinical trials. They achieve this by inhibiting the hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase), which catalyses the first committed step of cholesterol synthesis in the liver. Statins are hepatoselective with extensive first-pass metabolism , which is advantageous because the liver is the main site of cholesterol synthesis, with extrahepatic sites synthesising essential cholesterol. NOTE: There is growing interest in their potential pleiotropic effects , which are actions unrelated or indirectly related to their effect on plasma LDL levels, such as anti-infammatory and antioxidant effects. Administration Time When advising patients on statin use, it is commonly recommended to take statins at night. However, this statement may not apply universally to all statins av...

Introduction For hypertension management in patients without comorbidities , recommended options in most guidelines include: ACE inhibitors - especially for nonblack patients and may reduce mortality ARBs - especially for nonblack patients but they may not reduce mortality and have limited data on comparative efficacy Calcium channel blockers - have limited data on mortality reduction Thiazide-type diuretics - shown to reduce mortality The drug of choice for hypertension in pregnancy is still methyldopa (first line) and labetalol (alternative first line) with nifedipine as second line. Methyldopa, oral 250 mg TDS, doubling every 48 hours (up to 1 g TDS) until BP well controlled. Labetalol, oral 100 mg BD, doubling every 48 hours (up to 400 mg BD) until BP well controlled. Nifedipine, oral 10 mg TDS, up to 20 mg TDS, when BP poorly controlled despite maximum doses of methyldopa ± labetalol. Beta Adrenoreceptor Antagonists Beta-blockers are a class of drugs that slow down the heart rat...

Introduction According to the statistics from the Department of Statistics of Malaysia , the years that babies in Malaysia in 2020 are expected to live has increased further to 74.9 years or almost 75 years. Hence, our population is actually ageing. This could be due to Decreased fertility Lower infant mortality Better healthcare & public health, e.g. vaccination, hygiene and nutrition As we age, there is Physiological changes , for example Cognitive impairment, e.g. forgetful Reduced muscle mass and total body water Decreased GFR Deteriorating sight and hearing Inability to swallow solid dose form Loss of manual dexterity; muscle weakness Increased susceptibility to medical problems and complications Functional ability, dependence and quality of life issues are of increasing concern NOTE: Some of the physiological changes listed above contribute to medication noncompliance . Serum creatinine concentration is an unreliable indicator of renal function in elderly since it may remai...

Introduction Medication error is any preventable event that may harm patient. In outpatient pharmacy setting, centralized quality dispensing control (CQDC) is ideally in place to minimize medication errors. Most medications errors can be attributed to carelessness or fatigue, such as Picking up the wrong medications or medications with wrong strength Labelling error on dose and frequency Labelling error on patient name Since all humans make mistakes , focusing on improving weaknesses in the medication-use system is the cornerstone of sustainable medication safety. Sharing mediation errors serves as a valuable source of data and insights, allowing us to identify vulnerabilities and implement targeted interventions. Today, we are going to have a few case examples, focusing primarily on prescribing errors. Carbamazepine and Carbimazole A prescription of CBZ 10 mg reached a junior pharmacist at the outpatient counter. He glanced at the low dose, wondering if it was because the patient is ...

Introduction Case clerking using CP2 (Pharmacotherapy Review) form and medication review are often done concurrently. If the pharmaceutical case issue is significant to the patient's current medical plan, the issue should be highlighted to other healthcare providers during ward rounds or whenever necessary. Prior Starting First, we should make a comprehensive medication management review . Summary of all relevant past and current medical conditions Chief complaint - The reason patient is seeking medical care, documented in patient's own words. History of presenting illness - Description on progression of patient's current problem. Past medical history Reason for use of each medicine. All current medicines (including prescription, non-prescription and complementary medicines), compliance aids, therapeutic devices and appliances Medication history, including immunisations Dose, strength, dose form, directions, route of administration, duration of therapy and indication for...