Malaysian Parliment

(Sources: JeffOoi)
Is this the correct way to debate in the Malaysian Parliament? Yang Berhormat= Yang "Bodoh"?

I wonder how much the blood pressure of our Yang Berhormat will rise during Parliament sessions. Maybe pharmacist should do a service to check Yang Berhormat's pressure before and after the parliament sitting.

In pharmalogik, we offer free blood pressure checking using the most advanced Blood Pressure Monitor in the market. Accuracy is clinically proven. Come to pharmalogik to get your blood pressure check, Yang Berhormat!!!

To our highly respected Yang Berhormat, i just can say, "Berani kerana benar, takut kerana salah!" Truth will prevailed. Time will tell.

Fever: To treat or not to treat?

Fever is defined as a body temperature higher than 37C. Many of my patients suffer from what we called "fever phobia", the irrational fear that body temperatures from 37.8-40C will cause severe harm eg brain damage to their children, themselves or loved one and they quickly find solution to their fever.Actually, the decision to treat fever is based on patient because fever is not associated with many harmful effects unless temperature exceeds 39.4-41.1C. In fact, many microbs or bacteria is thermolabile, therefore, their growth is impaired by higher than normal temperatures.

Clinical reports already suggest treating conditions like chicken pox may increase the duration of the symptoms compared with no treatment. Also, treatment of rhinovirus with aspirin may increase viral shedding. This is because fever increases oxygen consumption, production of carbon dioxide, and cardiac output. Specifically, fever increases the release of interferons, neutrophil release and improve chemotaxis, thus boosting up the activity of the immune system, helping patient to combat viral and bacterial infections.

So to treat or not to treat fever, and when to treat? Buy a thermometer and monitor your fever.
How do we choose which type to buy? How many types of thermometer available in the market?
Glass/plastic thermometer
Advantages
1)Low cost
2)Light weight
3)Compact size

Cons
1) Extra care in rectal measurement as it can break
2) Glass or plastic may break
3) Proper storage ie cool location, out of sunlight

Electronic thermometer
Advantages
1) Register reading quickly
2) Not subject to glass breakage and risk of cuts
3) Can used with disposable covers to eliminates the need to disinfection after use
4) Easier to read

Tympanic thermometer
Advantages
1) Most accurate as it measure tympanic membrane(close to the hypothalamus)
2) Measurement takes only 1 second, appropriate for baby and small children

Cons
1)Slightly expensive

Skin thermometer
Advantages
1) Easy to use
2) Relatively cheap

Cons
1) Only measure skin temperature (which can be influenced by environment and skin perfusion
2)Only useful in noting temperature trends but not absolute temperature

Ask the pharmacist!
1)Do you think you know how to measure body temperature correctly?

0-3 months old-Rectal method is preferred because due to the size and shape of infant's ear canal, the tympanic thermometer is not indicated.
3 months to 5 years old- Axillary or tympanic method is preferred. Rectal may cause discomfort.
More than 5 years old- Oral or tympanic method is preferred.

2)When the body temperature exceed 40C, sponge the body with lukewarm water(not cold) water. Usually the person must wait 1 hour after a dose of fever medicine before sponging the body.
3)Wear light clothing, remove blanket, and maintain room temperature about 25-26C.
4)Drink sufficient fluids to replenish body fluid losses.5) But still, remember to seek medical attention if the fever persists after 3 days of treatment or fever continues to increase during treatment (>39.4C, or history of febrile seizures) because you need to treat the underlying cause of the fever.
6) Email me if you want to know more or want to buy a thermometer for your family...

Medication in pregnancy

40 years ago, the thalidomide catastrophe which caused one-third of women taking this agent during the first trimester give birth to infants with limb defects. This tragedy shocked the medical world as thalidomide had been evaluated for safety in several animal species.

Ever wonder your medication is safe to use in pregnancy? Refer to the chart below....

Indication	Use may be justified when indicated	Use may be justified in rare circumstances	Use is not justified at all
Acne	Topical benzoyl, Topical erythromycin (B), clindamycin(B), peroxide(C)	Systemic erythromycin(B), Topical Tretinoin(C)	Isotretinoin(X)
Allergy	Diphenhydramine(B), Dimenhydrinate(B), Cetrizine(B)	Fexofenadine(C), Loratadine(B)
Asthma	Salbutamol(C), Salmeterol(C), Terbutaline(C)	Montelukast(B), Zafirlukast(B),
Behavioral Therapy	Amitriptyline(D), Fluoxetine(C), Escitalopram(C), Citalopram(C), Bupropion(B)	Benzodiazepines(D), Lithium(D) Valproic acid(D), Avoid use in 1st trimester
Constipation	Bisacodyl(C'), Lactulose(B), Psyllium(B),Mineral Oil(B)
Cough	Dextromethorphan(C), Guaifenesin(C)
Diabetes	Insulin	Gluburide(B), Metformin(B)	Chlorpropamide(C), Glipizide(C), Tolbutamide(C)
Diarrhea	Diphenoxylate/ Atropine(C), Loperamide(B)
Dyspepsia (Gastric)	Ranitidine(B), Famotidine(B), Cimetidine(B), Omeprazole(B), Antacid(B)	Lansoprazole(C)	Misoprostol(X)
Headache	Paracetamol(A)	All NSAIDs (B),(C)	Sumatriptan(C), Naratriptan(C), Rizatriptan(C)
Hypertension	Labetalol(C), Methyldopa(B),, Acebutolol(B), Hydralazine(C)	Nifedipine(C) 3rd trimester only, Clonidine(C), Hydrochlorothiazide(B), Prazosin(C)	ACE inhibitors(D)eg. Catopril Enalapril, Angiotensin II Antagonist(D) Candesartan, Irbesartan, V alsartan
Immunization	Diptheria(C), Hepatitis A or B (C), Inactivated polio(C), Influenza(C),Tetanus(C)		Live Vaccines MMR Sabin polio, Varicella
Infection	Valacycolvir(B), Acyclovir(C), Zidovudine(C), Azithromycin(B), Erythromycin except esolate(B), Penicillin(B), Metronidazole(B), Terbinafine(B), Clotrimazole(B), Nystatin(B)		Clartihromycin(C), Doxycycline(C) Fluoroquinolones(C), Tetracycline(D)
Nasal congestion	Nasal cromolyn(B), Ipratropium(B), Nasal Beclomethasone or Budesonide(C)	Pseudoephedrine(C)
Nausea	Dimenhydrinate(B), Metoclorpamide(B), Prochlorperazine(C), Promethazine(C)	Ondansetron(B)
Pain management	Paracetamol(A)	Aspirin(D), All NSAIDs (B)(C)
Pruritus	Calamine lotion, moisturizing cream, Diphenhydramine(B), Hydroxyzine(C')
Seizures	Carbamazepine(C), Phenobarbital(D), Phenytoin(D), Oxycarbazepine(C)	Gabapentin(C), Lamotrigine(C), Valproic Acid(D)	Trimethadione
Thrombosis	Heparin(C)	Streptokinase(C), Alteplase(C)	Warfarin(X)
Thyroid	Levothyroxine(A)		PTU(D)

Pregnancy category
Category A-Controlled studies show no risk
Category B- No evidence of risk in human
Category C-Risk cannot be ruled out
Category D-Positive evidence of risk
Category X-Contraindicated in pregnancy

(Sources:American College of Physicians)

Ask the pharmacist!
1)The chart above is only serve as reference, not to replace medical advise from your healthcare provider. Always consult your health care professionals, eg dr or pharmacist.
2)Ask the doctor what medication are you taking and maybe why?
3)Do not self medicate without the consultation with health professionals.
4)Discuss your medication regimen with your doctor.
5)Consider lifestyle modifications which can help alleviate some symptoms, eg. avoidance of allergen in allergic patient, relaxation in headache.
6)Take note that malformations generally occur in the first trimester (first 3 months).
6)It is ultimate important for woman of childbearing age to consider carefully her use of drugs and discuss with her physician. Take up your own responsibility, as you are the one who take the medication, not your doctor or pharmacist.

Antibiotic resistance!!

In 1941, when penicillin was first produced, it was hailed as a wonder drug that could control several serious bacterial infections. Medical experts quickly predicted that infectious diseases would become history. But the bacteria that are under attack don't just take this abuse lying down, they evolve to fight back. Bacteria respond via the natural process of occasional changes to their DNA. It survives and passes down the resistant trait to its offspring.

Therefore within 2 years, penicillin resistant bacteria which resist the effect of penicillin was reported. Almost as soon antibiotics became available, bacteria began developing ways to fight back. Ever since, we have been in a race between the development of new and more powerful antibiotics and the ability of bacteria to adapt itself to defeat those drugs.

For examples,
Staphylococcus aureus is a common bacterium found normally in our noses and our skin. It can cause minor infections, or life threatening diseases like pneumonia. Penicillin used to kill it in 1940s, but in the 1950s Staph aureus had become so resistant to Penicillin that healthy people going to hospitals got sick and died. So drug company developed Methicillin in the 1960s. By 1980s, Stap aureus was resistant to Methicillin.

Therefore, we use Vancomycin, often known as a last resort antibiotics to finish off the bacteria. But in 1997, cases of vancomycin-resistant Staph aures showed up.

Therefore in the year 2000, linezolid was approved to fight it. It took less than a year for the first cases of linezolid resistant Staph aureus to show up. So patients who are actually infected by Linezolid and Vancomycin Resistant Staph aureus (VRSA) can basically call their day. It is actually more dangerous than AIDS. At least with AIDS, you may have another 10-20 years to live.

Can you imagine yourself going to visit a friend in hospital, you touch some chairs with VRSA, then you forget to wash your hands when you get back home, and worse you accidentally cut yourself or somehow the VRSA manage to get into your blood stream eg..you touch your eyes, noses, or you have a cut? Pls remember these type of infectious wound and diseases do not heal!!

Ask the pharmacist!
1) Ask your Dr. why are you taking the antibiotics? Is it necessary? It is ok if you don't take them?

Do you know how misuse of antibiotics cause antibiotics resistance bacteria to develop?
When a microbial population of various organisms is exposed to an antibiotic, the bacteria susceptible to the antibiotic will be killed. Bacterias that have some resistance survive. Without other species around to compete for food, it is easier for the resistant bacteria to proliferate. The result is that antibiotics kill off the weak bacteria, and they also increase the stronger one and made them become MORE AND MORE!!
2)Take full course of antibiotics.
As i said before, the weakest germs are killed within the first few days and symptoms often disappear, so usually the patient will stop taking the antibiotics thinking that they have recovered fully. This is where it goes wrong because the stronger bacteria, which can resist the first few days of medication, will survive, evolve and spread. They will be back, prepared for the battle with their armor on!! And the same weapons that we have i.e. our antibiotics won't work anymore. It is important for us to kill every single one of their bacteriakind at the first round of attack itself by finishing the whole course of antibiotics (usually for 7 to 10 days, NOT 3 DAYS)

3) Always maintain a good hygiene. Wash your hands.

4)If you don't know what medicine you are taking.. don't take it!! Ask for more information.

What say u? Bacteria winning or human winning the fight? Ask yourself...Are you contributing to the proliferation of these bacteria?

Smoking!! TAK NAK!!

TAK NAK SMOKING!!
Is it successfully implemented in Malaysia? Lets analyze...

First we have to understand the symptoms when a smoker try to quit smoking:Craving, difficult concentrating,irritability, anger, frequently sleep disturbance, GI distress, and increased appetite. Can smokers tolerate the symptoms?

The addiction of smoking
Study has shown that the addiction risk is greater than that for any addictive drug including crack cocaine, heroin and methamphetamine. So, that is why even after quiting, most people are highly vulnerable to relapse for many years.

Lets analyze the pharmacokinetics:
Smoke delivered nicotine is absorbed primarily via the lung where it is almost instantaneously absorbed in the alveoli, thus producing arterial spikes that are many time higher than peak levels observed in venous blood, and considerably higher than levels produced by nicotine medications. There is little difference in peak nictotine level or dependence across cigaratte brands because cigarette smokers typically obtain about 1-3mg nicotine from virtually all widely used brands whether "light" or "regular".

Ask the pharmacist!!
Medications deliver their therapeutic nicotine much more slowly, helping to explain why they are not only substantially less addictive than cigarettes but also do not fully replace the rapid relief of craving and production of pleasure produced by tobacco use.

The half life of nicotine averages about 90-120minutes, thus overnight sleep leaves the person at low levels of plasma nicotine and with withdrawal symptoms emerging upon waking, the time to the first cigarette of the day is one of the most reliable signs of dependence with shorter times (within 30 minutes)

Cigarette can be viewed as a portable chemical factory containing hundreds of substances and emitting more than four thousand chemicals when burned. This cocktail includes substances that acy synergistically with nicotine to enhance its addicting effects (acetaldehyde), substances that increase the fraction of unprotonated or "free base" nicotine thus increasing the "kick" (ammonia and urea) substances that ease deep inhalation of large quantities of smoke(menthol and glycerol) as well as flavourings such as chocolate and licorice that make the products more palatable and easily inhalable. No wonder it is so hard to quit smoking....

Brain imaging research suggests cigarette smoke may inhibit monoamine oxidase that might contribute to its mood altering effects such as relief of feelings of depression and possibly contributing to the higher risk of smoking in people with histories of depression. But dont think smoking can heal your depression, it will worsen it over long time. Do consult your healthcare provider for help.

How about "light" cigarette?
Myth: "Light" cigarette do no harm!
Fact: Light cigarettes offer no health benefit compared to regular cigarettes.
Why? Light cigarettes generally have near the tip of the filter which dilute the smoke to the testing machines used to rate tar and nicotine levels but these are easily occluded by smoker's fingers and lips, enable cigarette smokers to easily obtain several times higher levels of tar and nicotine than implied by advertised "FTC method" rating.(Sources: Epocrates CME)

Conclusion: DO NOT SMOKE AT ALL. But how many people actually quit successfully? Is TAK NAK campaign successfully deliver its messages?

For help, contact

Farmasi Pharma Logik 05-6226639

Quitline
National Poison Centre, Penang
04-657 2924

Quit smoking clinics
03-2694 0701 (Federal Territory) For complete list, go to www.infosihat.gov.my

MyHealth portal
Health Ministry
03-8883 1450/1446/1437
Email: contact.myhealth@gmail.com
Website: www.myhealth.gov.my

Spot the sign of stroke

Now doctors say a bystander can recognize a stroke by asking three simple questions:

S * Ask the individual to SMILE.

T * Ask the person to TALK to SPEAK A SIMPLE SENTENCE(Coherently) (i.e. It is sunny out today)

R * Ask him or her to RAISE BOTH ARMS.

NOTE: Another ’sign’ of a stroke is this: Ask the person to ’stick’ out their tongue. If the tongue is ‘crooked’, if it goes to one side or the other that is also an indication of a stroke. If he or she has trouble with ANY ONE of these tasks, call 999 immediately !! and describe the symptoms to the dispatcher.

A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved.

Sources above: Mr. Lim Kit Siang's blog

Ask the pharmacist!
Usually a stroke patient will experience

1) Weakness: paresthesia(numbness, prickly, stinging, or burning feeling); loss of sensation in face, arm, or leg.
2) Loss of speech
3) Loss of vision in one eye or in one visual field
4) Vertigo, with dysarthria(impairment or clumsiness in the uttering of words), diplopia (2 images of an object seen at the same time or double vision), imbalance.

Want to know your 10 year risk of stroke?
Let me know your age, your systolic blood pressure, also your systolic BP if you are on medication, smoking or not, any history of atrial fibrillation, any diagnosis of left ventricular hypertrophy, and history of heart attack and are you a diabetic?
Then i can calculate your risk of stroke based on Am Heart J 1991;83:356-362 Statement for health professional!!

Diarrhea

How does your stools looks like?
According to Wikipedia, Type 1 and Type 2 indicates constipation, 3 and 4 are the easiest to pass and types 5-6 are the more symptomatic of diarrhea, while type 7 may be a sign of cholera, food poisoning, etc.

If you are having type 7 stools?
Sign and symptoms
Loose liquid stools +/- blood or mucus, fever, abdominal pain and distension, headache, anorexia, malaise, vomiting, myalgia, cramping.

Treatment
Oral Rehydration Salt: The main treatment.
Loperamide: 4mg followed by 2mg capsule after each unformed stool
Diphenoxylate/Atropine: 2.5mg/25ug every 4 hours until symptoms resolved.

If the pathogens identified (after consulting your doctor or pharmacist)
Giardia: Metronidazole 250mg tds for 5 days.
E.histolytica: Metronidazole 750mg tds for 10 days.
Shigella: Trimethoprim-sulfamethoxazole 160mg and 800mg 2bd for 5 days, or Ciprofloxacin 500mg bid for 3 days.
C.difficile (associated with antibiotic uses): Metronidazole 500mg tds for 10-14days.
Travellers diarrhea: Ciprofloxacin 750mg one dose or, if severe 500mg bid for 3 days.

Ask the pharmacist!
1)If you are given antibiotic by your doctor, make sure you ask for what type of antibiotic you are taking.
2)If you are given antibiotics others than above, maybe you can ask what is your actual diagnosis.
3)Photosensitivity is the common side effect when taking above antibiotics, so you may need to reduce your sun exposure during treatment.
4)Let the pharmacist know what other medication you are taking, eg. Ciprofloxacin increase theophylline levels and cost toxicity.
5)There is no evidence that bowel rest speeds recovery, and food may enhance the efficacy of oral rehydration therapy. I would encourage you to follow your normal diet or this (dry toast or bread, baked potato, chicken soup with rice or noodles, poultry, bananas) but you still need to avoid coffee, alcohol, diary products, most fruits, vegetables, red meats, and heavily seasoned foods.
6) Taking probiotics can reduce the duration of acute infectious diarrhea (Systemic review of 23 randomized trials of probiotics in 1,917 patients with acute diarrhea; probiotics reduced risk of diarrhea at 3 days(15 trials) and mean duration of diarrhea by 30.5 hours (12 trials)
7) Taking zinc supplementation at 3x RDA reduce duration of diarrhea (Pediatrics 2002 May;109(5):898), reduced diarrheal duration and volume (J Paediatr Gastroenteral Nutr), and reduce morbidity and mortality(BMJ 2002 Nov 9;325(7372):1059)

Blood Glucose Monitor : AccuCheck Advantage III vs OneTouch Ultra

Comparing 2 of the best selling and most well known blood glucose monitoring system available in Malaysia.

	One Touch Ultra	AccuCheck Advantage III
Accuracy	Proven 99.2%	Accurate
Alternate site	Yes (Fingertip or forearm)	Yes( Capillary, venous,arterial and neonate)
Blood volume	1uL	4uL
Result test time	5seconds	30 seconds
Measurement range	1.1-33.3mmol/L	0.6-33.3 mmol/L
Variability	<3.2%	<3.5%
Memory	150 readings (14,30 days averages)	480 readings (7,14,30 days averages)
Battery life	1000 tests. Auto off after 2minutes	Not stated. Auto off after 90sec
Strips shelf life	3 months from the date of opening	Not stated.
Operating Ranges	Temp: 6-44C,10-90% humidity	Temp: 14-40C, <85%humidity
Quality control	Control solution supplied	Not supplied.
Reference Manual	English +Chinese manual	English only
Lancets	Needle (cheaper generic available)	Original needle.
Result affected	Hematocrit level	Hematocrit levels
Can do test in high altitude?	up to 3048 meters	up to 3093.72 meters
Interference?	Acetaminophen, salicylates, uric acid, ascorbic acid (high conc will cause inaccurately high results	Galactose or Maltose (via IV)present in blood, peritoneal dialysis using solutions containing Icodextrin
	Oxygen therapy yield falsely low result
	Severe dehydrated, in shock, in hyperosmolar state	Severe dehydrated, in shock, in hyperosmolar state, hypotension, severe congestive heart failure, or peripheral vascular disease
Warranty	Life time. One to one replacement	Life time. Transferable to next of kin.
Meter Storage	2 to 32 C	-25 to 70 C
Awards?	No 1 meter recommended by Diabetes Specialist in US	Best Selling Brand in Malaysia
Toll Free Line	1800-801497 (Mon-Fri: 8.30am-5pm)	1800-88-1313
Member rewards	None	8 boxes of 25 strips free 2 boxes of 10 strips (2007)
Machine cost	RM 375 (before discount)	RM 380 (before discount)
Strips cost	RM 1.85-2.00	RM 1.75-1.90
Lancets cost	RM 0.375 (Generic=RM 0.15)	RM 0.40 (No generic)

Ask the pharmacist!
Operation cost is almost comparable. So, there is no clear winner here. But if u want to save cost, AccuCheck Advantage III may prove to be cheaper option (because of the members reward offers) and wide availability in everywhere.
If you are afraid of pain, then One Touch Ultra maybe better choice since it use smaller blood sample, thus less pain when pricking and also you can even choose to prick your forearm.

Want to get one Blood Glucose Monitoring System?
Pharmalogik also having a one to one exchange with a brand new life time warranty blood glucose machine. Tired with your old machine? Feels u want to have a change? Trade it in!!!
Email me. pharmalogik@gmail.com

My car accident in 2005

Would you buy a Proton Iswara? What happens when they meet head to back?
This actually happened to me some where in 2005, months before pharmalogik opens. Out of nowhere, suddenly the car banged my car from behind. It also turn out the car driver work as an ambulance driver in my district hospital.
Right after the accident, the Kurnia Insurance towing car arrived within minutes.
There he goes...
The result: How about my car?
Would you buy a Proton Iswara/ Saga? Yes and No. Proton Saga/ Iswara is soft in front and super hard at the back. Still i have changed a new bumper. It cost me RM 400 as the guy does not have insurance cover.

Ask the pharmacist!
So next time accident...it is better to get hit from the back than the front when you are driving malaysian car and it is much better to be hit by a better car (as usually imported car has insurance to cover)

I am getting married!!!

7/07/07
Registration of marriage in Tadika Cher Fong Khor, Teluk Intan.

8/07/07
8.30am
"Heng Tai" gather in my father's shop

9.00am
Going to the bride house to "steal" the bride

6.00pm
Dinner at Restaurant Tai Chong, Teluk Intan
(For those with GPS: N 04 00.950', E101 01.798')

Me and my wife!!!