Tuesday, January 29, 2008

Is there a difference?

Many types of panadol in the market
1) Panadol 500mg- Acetaminophen 500mg RM 2.00 for 10 tablets
2) Panadol Extend- Acetaminophen 665mg RM 3.30 for 6 tablets
3) Panadol Actifast- Acetaminophen 500mg RM 3.50 for 8 tablets
4) Panadol 650mg- Acetaminophen 650mg RM 1.00 for 10 tablets
5) Panadol Soluble- Acetaminophen 500mg RM 3.00 for 8 tablets

Are they the same?

Ask the pharmacist
1) Wat is the difference between Panadol 500mg, Panadol Actifast and Panadol Soluble? No difference, just the solubility rate or how fast the tablet soluble in the stomach for absorption purposes. In order for our body to absorb the medicine, the tablet need to be soluble first. The faster the tablet dissolves, the faster we can see the effect ie. body feels less pain and fever reduced.

2) So, why r we paying more for the same thing? Becoz the packing is nice? See the Panadol Actifast packing ... Don't u think it stand out the most? See the light? Wah...so bright.....
i like the packing also...

But for those who cannot afford Panadol Actifast...just buy normal Panadol 500mg and chew it before u swallow. i bet the effect is the same. Hehe.....

3) How about Panadol Extend? It contains 665mg of Acetaminophen. Actually i dont think there is much difference between Panadol Extend 665mg and Panadol 650mg. Difference of 15mg is negligible. This time i like the design, the picture....Hehe....

Monday, January 28, 2008

Be mindful of over-prescription and high charges

The News Strait Times 04/11/2007
Hospital apology: Be mindful of over-prescription and high charges

I HAD a bad experience in a private hospital in the Klang Valley when I went to seek medical attention for a slight cough and sore throat on the night of Aug 21.
I was led to a cubicle and sat on a chair for 25 minutes before a medical officer examined me. I had to wait another 28 minutes before my medicine was given to me by a nurse. I noticed a stack of tablets and asked what were they for. She told me that they were for my fever.

I had no fever. My temperature was not taken by the doctor or nurse, so why was the doctor prescribing 30 Panadol tablets? The cashier told me I had a bill of RM215.63 (medical officer’s fees being RM20 and medicine RM184.63).

On checking the billing, I found that I was charged RM1 for the use of the thermometer sheath and RM4.20 for a clinical roll. My temperature was not taken, neither did I lie on the bed which was lined with the clinical roll. I protested but I was ignored.

On returning home, I found that all that was prescribed was in excess, hence the high bill. The Augmentin antibiotic of 625mg each was presribed three times daily for five days and the Phensedyl dry cough Linctus Codeine cough mixture thrice daily at 15ml for five days. According to the leaflet in the Augmentin packaging, the dosage of 625mg should not be taken more than twice daily. The dosage stated on the Phensedyl packaging was between 5ml and 10ml for adults.

I called the hospital and spoke to another medical officer, who agreed that the prescription was in excess.

I decided not to take any of the medicine and saw a physician who does my annual medical check-up at the same hospital the next morning.

He told me that my sore throat was mild and prescribed Klacid antibiotic and Sedilix cough mixture.

I lodged a complaint with the chief executive officer of the hospital on Aug 22.

The hospital said the doctor worked part time at the hospital and worked at a government hospital during the day.

Finally, the hospital gave me an apology in writing and a refund when I returned the medicine.

I am highlighting this with the hope that it does not happen to others.

Ask the pharmacist
1) The writer is smart to read the information leaflets. But how many of the public actually do that?
2) This is how mistake can happens when the pharmacist is not involved in the process. Pharmacist will detect the error at glance for the Augmentin prescribed 3 times a day. Most probably the Dr is confused with the amoxicillin dosage and augmentin.

The patient is not receiving the full pharmaceutical care by a registered pharmacist.
Some of the simple counselling pharmacist can do for Augmentin.
a) This medicine may cause nausea or vomiting. So if the patient experience the symptoms, we will advise them to take small, frequent meals, sucking lozenges or chewing gum to help.
b) For best result, take Augmentin just before meals.
c) Rarely, some people may get slight yellow/brown staining of the teeth. Such staining usually disappears shortly after treatment if teeth are brushed regularly.
d) Report any rash, unusual diarhea, constipation, jaundice, darker urine, unusual bruising or bleeding. (anaphylaxis reaction) Online adverse effect form is available here.

3)If medicines is RM184.63 for 30 tablets panadol, 1 box augmentin, and 1 bottle of Phensedyl, then i can tell the writer, he can get from all these from the community pharmacy for half the price.

4)Always see your familiar or family Dr. He will be the one who understand u better as he has all your past medical record.

Thursday, January 24, 2008

Choosing a cholesterol drug or statins? LDL cholesterol high?

ScenarioWe go for our annual blood test. Then we notice on lipid studies section stated our LDL-cholesterol is high. Then what we usually do? Go to see a Dr, Dr start us on statins, then asked to come and check for our cholesterol lelvel after 4 months?

We was told that LDL will clog our artery and cause heart attack. So we have to take statins to lower the LDL.

But which one?

Ask the pharmacist
1) How to choose between the statins which is most suitable?
Statin of Choice Average LDL reduction
Lipitor 10mg 36%
Lipitor 20mg 44%
Lipitor 40mg 49%
Lipitor 80mg 50%
Vytorin 10/20 52%
Lescol 20mg 22%
Lescol 40mg 25%
Lescol 80mg XL 35%
Lovastatin 20mg 25%
Lovastatin 40mg 31%
Pravachol 10mg 21%
Pravachol 20mg 26%
Pravachol 40mg 30%
Crestor 10mg 43%
Zocor 10mg 30%
Zocor 20mg 35%
Zocor 40mg 40%

Lets say the
Case 1
Patient's LDL is 4.11, and the target is 2.6 so we have to reduce by 35%. We can choose to take Zocor 20mg or Lipitor 10mg.

Case 2
Patient 's LDL is 4.91, and the target is 2.6, so we have to reduce by 48%. We can choose to take Lipitor 40mg or Vytorin 10/20mg.

By now, u should roughly know if the statins u r taking is suitable for u or not. Actually to start a cholesterol medication on a patient, we need to take many things into considerations.
Such as whether the statins taken will reduces the risk of heart attack and death rate. This is becoz even the medicine lower the LDL cholesterol, it does not mean u will have less risk of getting heart attack.
Then they also take into considerations your age, race, gender, muscle tissue damage, liver damage, kidney patients, HIV patient, warfarin patients.
2) But is taking statins good for u?

Interesting extract from BusinessWeek
Statins drugs are the best-selling medicines in history, used by more than 13 million Americans and an additional 12 million patients around the world, producing $27.8 billion in sales in 2006. Half of that went to Pfizer for its leading statin, Lipitor.

The drugs can be life-saving in patients who already have suffered heart attacks, somewhat reducing the chances of a recurrence that could lead to an early death. But for the majority of patients, who don't have heart disease. No benefit has been found in people over the age of 65, no matter how much their cholesterol declines, and no benefit in women of any age. There is a small reduction in the number of heart attacks for middle-aged men taking statins in clinical trials. But even for these men, there was no overall reduction in total deaths or illnesses requiring hospitalization—despite big reductions in "bad" cholesterol.

A current TV and newspaper campaign by Pfizer, for instance, stars artificial heart inventor and Lipitor user Dr. Robert Jarvik. The printed ad proclaims that "Lipitor reduces the risk of heart attack by 36%...in patients with multiple risk factors for heart disease."
The dramatic 36% figure has an asterisk. Read the smaller type. It says: "That means in a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor."

Now do some simple math. The numbers in that sentence mean that for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit. Or to put it in terms of a little-known but useful statistic, the number needed to treat (or NNT) for one person to benefit is 100.

In an eagerly awaited trial completed in 2006, the companies compared Vytorin, ezetimibe plus a statin with a statin alone in patients with genetically high cholesterol. But the drugmakers delayed announcing the results, prompting scientific outrage and the threat of a congressional investigation. The results, finally revealed on Jan. 14, showed the combination reduced LDL levels more than the statin alone. But that didn't bring added benefits. In fact, the patients' arteries thickened more when taking the combination than with the statin alone.


If cholesterol lowering itself isn't a panacea, why is it that statins do work for people with existing heart disease? In his laboratory at the Vascular Medicine unit of Brigham & Women's Hospital in Cambridge, Mass., Dr. James K. Liao began pondering this question more than a decade ago. The answer, he suspected, was that statins have other biological effects.

Since then, Liao and his team have proved this theory. First, a bit of biochemistry. Statin drugs work by bollixing up the production of a substance that gets turned into cholesterol in the liver, thus reducing levels in the blood. But the same substance turns out to be a building block for other key chemicals as well. Think of a toy factory in which the same plastic is fashioned into toy cars, trucks, and trains. Reducing production of the plastic cuts not only the output of toy cars (cholesterol) but also trucks and trains. In the body, these additional products are signaling molecules that tell genes to turn on or off, causing both side effects and benefits.

Liao has charted some of these biochemical pathways. His recent work shows that one of the trucks, as it were—a molecule called Rho-kinase—is key. By reducing the amount of this enzyme, statins dial back damaging inflammation in arteries. When Liao knocks down the level of Rho-kinase in rats, they don't get heart disease. "Cholesterol lowering is not the reason for the benefit of statins," he concludes.

The work also offers a possible explanation of why that benefit is mainly seen in people with existing heart disease and not in those who only have elevated cholesterol. Being relatively healthy, their Rho-kinase levels are normal, so there is little inflammation. But when people smoke or get high blood pressure, their Rho-kinase levels rise. Statins would return those levels closer to normal, counteracting the bad stuff.

3)Conclusion of above article: In my opinion, I think those who have had a heart attack or heart disease should take statins, but for normal people which have high LDL, ask your dr's advice.
For more reading, pls refer to the article by John Carey (BusinessWeek)

We pharmacist cannot recommend statins as in Malaysia (not like UK), only Dr can. Here, we can just give counseling on how to reduce risk and check for drug-drug interactions and dispense what your Dr prescribed.

4) According to Dr Daniel Stienberg, LDL is not bad, it is the modified oxidized LDL cholesterol that is truly bad as it cause damage and hardening to the artery. So he and Dr Ray recommend to take antioxidants such as Vitamin E, C, Bioflavonoids to reduce oxidation of the LDL. So i think Exercise, eat healthily and taking supplements to lead a healthy lifestyle is the utmost important.
Suggested reading:5)So, always follow your Dr recommendations. But of course, u always can get a second opinions from another Dr if u think the Dr does not put your health in your best positions. U also can consult your pharmacist for advise on how to take the prescribed medications and also the supplements which can help u. Hehe....

Comparing Vitamin B Complex

Which one is the best?

Vitamin B Complexs B1 B2 B6 B12
1 Surbex X-Zinc 15mg 15mg 10mg 12mcg
2 Berocca 15mg 15mg 10mg 10mcg
3 Enervon C 50mg 20mg 5mg 5mcg
4 Blackmores Executive B 7.5mg 8.5mg 10mg 10mcg
5 Blackmores B+C 7.5mg 8.5mg 10mg 10mcg
6 Blackmores Multivitamins 7.5mg 8.5mg 10mg 10mcg
7 Centrum 2.25mg 3.2mg 5mg 20mcg
8 Pharmaton 1.4mg 1.6mg 2mcg 1mcg
9 Vita Mega B+C 5mg 5mg 5mg 2.5mcg
10 Iberet Folic 6mg 6mg
11 Neurorubine Forte 200mg
50mg 1000mcg
12 Neurobion 100mg
200mg 200mcg
13 Neurovit 97mg
50mg 100mcg

Which one is the best? Decide yourself

Tuesday, January 15, 2008

Public Questions: Vitamins in Pregnancy

Hi there...
Found your blog to be very informative! If you don't mind got a few questions need answering...
Vit A is teratogenic but beta carotene form is ok? Been taking pramilet for the last 4 months. Which form of Vit A is it in Pramilet? Thought the rec dose during pregnancy is 770mcg (~2400IU) but Pramilet v high. Is that ok? If Obimin is best should I change?
How about taking essential fatty acids while pregnant? Is it beneficial and what are the side effects? Heard DHA and Omega 3 particularly good for brain development but has it got any teratogenic effects. Like fish oil ..is it because of the vit A in it?

Ask the pharmacist

1) Beta carotene is metabolized to vitamin A, but the proportion converted to vit A decreases as beta carotene intake increases.So therefore no toxicity of Vit A. But u have to limit your daily beta carotene consumptions to 7mg max/day.
Studies have shown that supplying 20mg daily for 5-8 years to smokers will increase the risk of lung cancer, prostate cancer, stroke, heart attack etc. This is becoz smoking produce carcinogenic beta carotene oxidation metabolites. So for smokers out there, if u want to die faster, remember to take beta carotene. If want to live longer, pls stop smoking right now.

2) Vitamin A in obimin is higher than pramilet. Recommended daily allowance of vitamin A during pregnancy is 2700IU, although it shall be ok if u r not taking more than the max daily doses of 10,000 units.
Pls aware that this 10K units will include vitamin A from dietary units, esp animal liver, and even some breakfast cereal. Be extra careful in first trimester. Remember never to take 2 tablet of Obimin or Pramilet in one day. Always consult your pharmacist b4 choosing any supplements. As i say b4, if u r a healthy mother, there r no reason for u to take any extra supplementations also except folic acid.

3) Follow your dr recommendations would be the best choice in choosing supplementations becoz dr is the one who checked u. Of course u can always consult your pharmacist.

4) Essential Fatty acids is not necessarily to take during pregnancy. Insufficient evidence for its use.
Hopes it help. Let me know if u want to know more.
Previous post Comparing Vitamins in Pregnancy

Monday, January 14, 2008

My students days: 2001

Looking at the past...on 2001 our first year in pharmacy course....

Here r some of the discussions which i able to extract from our previous students forum..

Dispensing separation has been greatly "advertised" to the public. There are various comments from both the consumers and other health professionals. As a pharmacy student, what is your opinions about the issue and how do you think the profession should proceed?
10/31/2001 3:22:06 PM

I am so glad to hear that so many all mine coursemate concern on their right.I strogly agree with all of yours recommendation.Anyway, i prefer that if we could focus our srength on looking the way on how to improve pharmacist right it will be better.
I came across a lot of mine cousemate doing their pharmacist curiculum simply without THINKING that this professinal is to care patient,i feel strongly to say that we have to having a great sense of loving of caring is not to compete each other to see people in suffering i mean so that each one shall be more focussing on improving their own morality.
In here we having a place to caring each one.HOW?A lot friends here need help to go through life here is not for what others purpose inside but to share the LOVE to each one.
Then we have a great unity power to influence GOVERNMENT to change of Pharmacist right...
I wish all supporting one acting today by loving , caring our cousemate sincerely.
12/31/2003 11:49:06 AM

Recent changes in the healthcare system have resulted in greater responsibilities for pharmacist. I have attended the National Gathering of Pharmacy Students held in University Malaya, and had a chance to listen to one of the plenary speakers, DR. Rajen M. According to Dr Rajen, the honorary secretary of MPS, pharmacy profession is now evolving to include pharmaceutical care, in which pharmacy practice is shifted from products and services to patient care. Due to the increasingly importance of patient – focused care, I strongly agree that the dispensing rights should be “RETURNED” to the pharmacist, but not owned by other healthcare professionals. Pharmacists are the drug experts whom are well trained to provide reliable drugs-related information. Doctors are only trained to diagnose a disease but not dispense. As we can see in most clinics in Malaysia, dispensing is simply done by a young lady who probably has no idea what drugs are about! Some of them can’t even pronounce the names of the medications. This will lead to serious consequences such as patient receiving wrong medications. We are talking about a human’s life here! As professionals trained in the subject of drug therapy, pharmacists are best suited to fulfill the role of dispensing.
Keat Hoon
11/13/2001 1:30:29 PM

Hi, I am Woon Shin. One of my medical friends who was doing her 2nd year study last year, told me that as medical students, they just spent 1 semester in studying the Pharmacology subject. Nevertheless, they only need to study the certain topics that selected by their lecturer. I was so surprise when I heard this.
As pharmacy students, we have to spend our precious 4 years time to study everything about the drugs e.g. Pharmacodynamic & Pharmacokinetic of drugs, the mechanism of actions, adverse reaction, drugs-drug interactions, the dosage of the drugs etc.
So, pharmacist is the one who should do the dispensing, but not doctors or nurses.
Therefore, as pharmacy students, WE MUST FIGHT FOR OUR DISPENSING RIGHT!
11/12/2001 10:23:55 AM

Dispensing rights for pharmacists only? Of course! Simply because it belongs to the PHARMACISTS. I want to share something from MPS President, Mr.John Chang on this topic.
The doctors are trained to diagnose whereas pharmacists are trained to dispense. Each has his own duty. At present, the doctors are extremely busy with both their own duties as well as the pharmacists’. So what happens? The patient comes into the room, the docpharm spends a minute or so to talk to ask him / her what’s wrong and in that short period of time is able to fully understand the patient’s problem. HOW INGENIUS!!! The next thing…..he writes the prescription because it is the prescription that brings him money, not the time that he spends caring for the patient. He writes as fast as he can so that he can see the next patient. (No wonder sooo horrible)
At the back of his mind……..
Rule 1: Have to prescribe PROFITABLE drugs.
Rule 2: Manufactured by companies that can afford expensive “CONFERENCES” overseas.
Rule 3: Patient must come for SECOND VISIT to secure my income for next month.
Rule 4: Money coming at the counter outside.
Rule 5: Patients must come to me only for medication, so NO LABELS.
With all these more interesting things to think of, who can be focussed and care what’s wrong with the patient? And one way we can take away all these distractions is by returning the dispensing rights to the pharmacists.

I am sure most of us think like this……
After I graduate, I’ll have to serve the government for 3 years….no choice.
Then, I will open up my own pharmacy in a place where I can monopolize the market.
Then I can make money from the sales of drugs – if the dispensing rights is given to the pharmacists, better still because I can make even more money…..I will waitlah….maybe someday it will comelah….(that passive)

Unless we all work together to demand it back, the dispensing rights won’t just fall from the sky. Nothing is going to change even if you wait till your grandchildren become grandparents. Do you actually realize who we are fighting with for this right? The doctors are a much proactive and united group of people who are highly respected by the public. We too have to work hard to earn the respect and confidence or the public.

As students, I think we should try to find out and be sure of our role as pharmacists. Stop telling people that when you come out of college you will just be a shopkeeper and count tablets. We should also participate actively in activities that bring pharmacists together so that we can discuss current issues on the profession, exchange views, solve problems and strengthen relationships as UNITY is STRENGTH.....swee luan:)
11/12/2001 10:17:12 AM

HEllo ! Jason here..Basically, I think everyone has answered what should be said all these while. Although we are still studying now at the moment, I think it is right that we should start fighting for our rightful "RIGHTS" and hopefully with the dispensing right we can serve and provide much ethical/professional healthcare to the people. HOwever, I believe this is an ever going debate between the profession of Med and Pharm, this does not bring any good or benefits to the patients. Practically we just need more ''capable'' students graduating from pharmacy schools around Malaysia, when we have a larger pool of pharmacists, perhaps we can demand back our dispensing right, and then only the squables between pharm and med can stop. We should work togerther to give the patients confidence so that they can rely on and trust us.How are we going to treat a patient when he/she doesnt has any confidence in us? Imagine the scenario where the doctor and pharmacist arguing what is best for the patient..DUhh!

For those who did not go to NOGAPS..Its a pity as I believe that we actually learnt alot from the programmes organized there. It was a sneak preview of what we are going to face in future.

I dont believe in dispensing with a machine. Who the hell came up with that idea? DInt they read or study some elective subjects like Communication Skills or Pharmacy Practise? If we can dispense with a machine, Then why do we have pharmacists? They can just load some programmes and some softwares into a machine and say look here...Just key what is ur sickness or just insert your prescription and the machine will dispense what you need.You can pay by cash or card, THANK YOU! Hey, NO ADVICE GIVEN, NO COUNSELLING GIVEN! What about non complience of the patient while under dangerous medication? Hey even ''harmless'' Panadol can be dangerous if it is over consumed. What we need is outright communication between pharmacists and the patients.We need to talk to the patients, listen to them, layan them a bit, take them out if they are pretty chics..ooops..sorry ..Got carried away...WEll...From the experience at NOGAPS...It seems that Counselling is an IN thing at the moment. Trust me ...Computers dont work in dispensing and diagnosis.

AS my father said , Healthcare field is always a hands on ''thingy''.

Another thing I wanna highlight here is something mentioned at NOGAPS. A doctor ''u know who lar'' wrote a letter to local ''daily'' and sort of ''bang'' at the pharmacists in Malaysia. He said that pharmacist should stop playing doctors. Actually we should have replied that ''DOCTORS SHOULD STOP PLAYING PHARMACISTS''.

Now he said that we should not diagnose the patients, do the BP thing,etc. What I wanna ask here is one thing only, are we human?
YEs we are..Imagine this, when a patient comes up to you and complained of some ailment, will you start thinking of what is the cause of the sickness? This is called mental diagnosis. PLS BE REMINDED THAT IT IS OK TO DO MENTAL DIAGNOSIS. And then , from we know, it is ok to do BP test and glucose test, But we cannot tell them like, "Hello Uncle, U have diabetes or blah blah"

WE can only inform them that, ''Pakcik, your blood pressure is a bit high lar, malam buat apa?"
Then we ask this ''uncle'' to go for a medical checkup at a nearby clinic or hospital. Always refer them to a good doc, perhaps someone u know or ur family members, then can get commision mah....Just Joking...!
WEll the glucose test is quite high, we can always tell to the patient that he /she should monitor his/her diet of sweet stuff. ASk the patient to see a doc. GIVE COUNSELLING ON HOW TO LIVE HEALTHY, THis scenario is where our class''s dietician comes in, DR LAU. He can give advise to the patient then....
11/11/2001 1:29:48 PM

Nadia has some new perspectives into the issue of dispensing separation as she mentioned that it will abolish unethical practices of pharmacists at the moment. Since everyone is watching each other when dispensing separation is here, and with the increased revenue to pharmacys, they will tend to focus on providing extra services as to compete with everyone else. As thus bringing the profession to a higher level. A new insight.
11/10/2001 9:45:37 AM

I’m Nadia, well I’m from Dubai, U.A.E., and where I come from pharmacists have got dispensing rights. The pharmacist should practice what they have been taught and trained for i.e. the pharmacists are the ones who study the pharmacological actions of drugs, patient counseling, etc.

The pharmacists in Dubai, practice legal dispensing, and this makes their practice professional and in my opinion, Malaysia should allow pharmacists to dispense as this will lead to less illegal practices. Thus making them less money-minded and geared towards their professionalism.
11/9/2001 1:11:21 PM

As a pharmacist to be, we are concerned about the patient’s health and regard it as our first priority. One thing for sure we will be trained for doing dispensing (and many pharmaceutical usage and counseling) and the doctors are still not very happy about it. Pharmacist now is more into the dispensaries and plays an active role in clinical decision. For the sake of patients' benefits, medical doctors should concentrate their efforts on diagnosis and surgery which they are trained of, and let the pharmacists do the dispensing and patient counseling on practical drug usage. We have to ensure the patient’s right for taking the correct medication at the right time with minimal and unnecessary side effects. Pharmacist can provide a free, convenient and detail counseling for patient, compared to busy a doctor with tons of patients waiting to be treated.
11/9/2001 2:43:00 AM

Of course there must be a separation between prescribing and dispensing!! The task of dispensing should be given solely to pharmacist, as is the practice in countries such as Britain, India, US, etc. Not to say we want to be a copycat but pharmacists are best suited for the job as they have been trained in all aspects of the preparation, distribution, action, uses and side-effects of drugs and medicines. Why does it take four years to learn how to put tablets in a bottle?

As we can see today the present system where the dispensing in private clinics is often carried out by doctors’ assistant who might not be in the patient’s best interests. In fact the role of pharmacists is important in giving advice, counseling, education on the consumption of drugs by patients, and can also help in giving the issue of misuse of drugs. Why should we put the patients health in their “non-professional” hands?? Consumers deserve the rights to get details on what they eat(drug) & what they buy, right??
As my classmates have mentioned that doctors making big income from dispensing. HOW ? There is also incentive for them to push unnecessary medications on patients!!
Remember that a pharmacist is trained as a profession in its own right to serve the society at large, and to play a complementary role to other healthcare providers, not necessary just doctors. Thus I think ministry should transfer the medication dispensing function to pharmacists in order to result in improved services from both doctors and pharmacists. Then doc. will have more time to diagnose and counsel patients & their income will then come only from their consultation fees and thus avoiding a potential conflict of interests in unnecessary medications on patients.

Thus pharmacists and future pharmacists should be UNITED & work together to protect our right in order to improve the community primary healthcare system.
--- Hong Ying ---
11/8/2001 1:02:05 PM

i think i agree with what Won Zee said. In addition, the future health care will no longer focus on the treatment of diseases, the prevention of diseases will become more and more important. We, as future pharmacists, are health care professions too. Besides dispensing, we provide the information of health care as well as the knowledge of drugs to the public.i think this role will become more important in future time because we will be the health care professions the public meet always. therefore, as pharmacists, we should always upgrade ourselves and provide help to the patients. We are doing the things that a robot or machine can never does.
besides, the aim to fight for dispensing right is to promote a more complete health care system in our society. doctors is no longer the only "soul" to the patients. more health care profession will join to the team in future and we are supposed to work in team. a team works is always better than a individual works, right? so, the seperation of dispensing is the first step to reach a complete health care system.
11/8/2001 12:41:17 PM

helo.i m liang second year student.about the dispensing separation, well is already a long debate bet docs and pharmacists. as we know,pharmacists are the professional in managing drugs but in M'sia the
dispensing right is still under the docs.
according the current trend,the dispensing right has to be separated as what they did in the developed countries like UK, America.....why this debate is still carry on untill today, well i think the most important reason is the business which worth millions of RINGGIT MALAYSIA.

the reason why the right is not returned to the pharmacist might due to the community is still not confident with them. but at least, they would be given a chance to prove themselves that they are well qualify to do their jobs well and not just stay at the stage of argueing. another reason why the right is notreturned is they claimed that the numbers of pharmacist is still not enough. so i think steps have been taken to increase the quality and quantity of the pharmacists population in the country in order to meet the requiremant so i hope the right will be return to the pharmacist as soon as posible.
11/8/2001 9:51:27 AM

I’m Poh Kheng, one of the 2nd year Pharmacy students.It’s shocking to know that there are some people out there who actually think that PHARMACISTS work in FARMS!! This shows how na├»ve the society is towards our profession. For this reason alone, I strongly agree that dispensing rights should be given to pharmacists.
After all, we are the ones trained to do that, not the doctors.
According to Dr.M Rajen, a pharmacist and also a columnist for the Star,“Doctors are only experts in diseases, pharmacists are experts in drugs.”
It sounds ridiculous that doctors are taking over our expertise!
In an article dated 8th March 2001 in the NST by Datuk P.Krishnan,
president of MMA, he pointed out reasons why doctors should continue dispensing.
It’s sad to say that he has got a point there.On second thoughts, maybe we should work out a healthy compromise.
11/8/2001 9:37:40 AM

Generally speaking, the dispensing separation issue has caused a hue and cry among the patients and doctors. The pharmacists generally welcome this move. The consumers main worries lies in the doctors consultation fees and pharmacy medicine cost hike. The doctors worry about the less income coming from the practice if the dispensing separation comes true.
The pharmacists should continue to press on for the separation and find means and ways to tackle any hindrances like proposing ways to control or standardize relevant costs or even organizing forums and seminars as to educate the public on this matter or even citing successful European health service which practices dispensing separation.
By doing this we pharmacists and pharmacists to be can excel in the field that we had been trained for and allow to develop a profession of pharmacists who are not only well trained but also responsible for the own area of expertise.
11/8/2001 9:19:16 AM

Dispensing right???
It has been such a long argument with the physician and the pharmacist who are supposed to have the rights!! This issue was first brought up since 1980s…and the doctors, all the time gave the same answers…

the pharmacist attitude problems,
not enough pharmacist…lah,
cost pay to middle man..lah, inconvenience of traveling to buy drugs..lah, waste of time…lah, lack of drugs storage…lah,
no 24 hours pharmacy..lah,
generic substituted,……blah blah blah…
Don’t we ever get tired of hearing this nonsense?
Actually, the main problems lies in ourselves, as future pharmacist….as PHARMACIST!! In other words, we won’t able to get our dispensing right if we are not united.

We must totally, TOTALLY BELIEVE IN OUR ROLE, which we are certainly trained for, FOR 4 YEARS ….NOW add another 3 YEARS for our housemanship…..TOTAL 7 YEARS……7 YEAR!!!! Some of us has to spend 9 years if they study STPM...
Ask anybody….Who is going to spend 7 years of hard work and then finally become a salesman, or a STORE KEEPER (selling sweets, comestics, etc)?

Let us think actually our problem can be solved at no time…

There are around 2,000 pharmacist in our country…
If 1500 pharmacist united to give our best services to the customers, (counseling services, kind to them, care, etc) this is what will happen…. Assume 30 different customers enter each pharmacy everyday in our country……for 10 DAYS….30X10=300…..for just 10 DAYS, the numbers would be 300X1500 =NEARLY HALF A MILLIONS…

If a survey is taken at that time by the authority about dispensing ……Again, IMAGINE: BIG

Headlines in Star, NST:
These half a million may convince another half a million of their friends…….HOW???
Soon, all the MALAYSIANS WOULD TOTALLY AGREE that the pharmacist care more for their health and they no longer want the doctors to dispense their medication…..
When the public wants it,…the Datuk Chua Jui Meng cannot say no, right? Who dares to offend the publics? (hehe…they want votes ma)

Min Shen: Let us unite and give all our best to serve the public. Our future is in our own hands. WE CAN BE THE BEST OF THE BEST IF WE WANT TO!! 11/7/2001 4:43:56 PM

I strongly agreed that dispensing rights should be in the hands of the pharmacists. Pharmacists are trained to specialised in drugs, knowing every pharmacological action, side effects and contrindications, therefore they are more suitable in dispensing drugs compared to the physicians. However, looking at the more relistic point of view, we still need to build up the quantity of pharmacists in Malaysia. Let us create the awareness on the role of pharmacist as a profesional health care provider and let us fight for our dispensing rights.
Robots can be programmed to dispense drug but can they think like humans??? It is undeniable that the role of pharmacists is still in demand for dosage checking, counselling and reading medical files of patients.
11/7/2001 10:46:53 AM

Hi, this is Won Zee here. Dispensing separation has been practiced for such a long time in the developed countries. Pharmacists are the only ones who have the adequate and right knowledge to handle drugs, not the physicians. This is because we are trained to do so in our proffessional course. We are the experts in this field and so I totally agree with dispensing separation. Unlike humans, robots cannot think and are only programmed to read the prescription, count pills, label and dispense the medicine. We as a pharmacist plays a greater role than that. In a community pharmacy, we not only dispense but also give proper advice and counselling to patients, check patient's medical profile, device a suitable dosage regimen to suit individual patients to avoid paitent compliance, check presciption for mistakes (too many same drug, drug interactions, etc..)before dispensing. Can a robot do all these? Maybe in the future, but pharmacists are humans and robots are programmed by humans. Even if the role of a community pharmacist is replaced by a robot, a pharmacist can still be involved in the clinical and research part of pharmacy. All I want to say is that, the role of the pharmacist will always be there no matter how many robots they build.
11/7/2001 9:34:40 AM

In the Western countries, there are automated machines which can dispense from just feeding in a prescription. The pharmacy store with this multi-task machine only need a pharmacist to check the end product before dispensing it out to patients. If we, as pharmacists, are talking about dispensing separation, our role will be taken away easily by the robots in near future; if we are just talking about counting pills, putting in bottles. label it and to dispense to patients.
Is dispensing separation the right term to use or is there more you want to do as pharmacists?
11/6/2001 5:29:15 PM

Endless debates particularly between doctors and pharmacist on who should have dispensing rights have brought great attention and serious concern.
As a pharmacy student, i feel that pharmacist SHOULD have the rights to dispense drugs. It is undeniable that earning BIG MONEY is one of the attraction. However, what i feel is most important is the CONSUMERS SAFETY!! Consumers are taking drugs that could cause death due to toxic effect if taken at a wrong dosage. In terms of toxicity, side effect,dosage and pharmacology, pharmacist are specialised in these areas.don't u all think so?
Doctors are specialised in diagnosing diseases and they should not take a role of a pharmacist. Each profession has its own professional duties.
In the near future, i think that dispensing separation will be practice in Malaysia. i strongly agree with Win-Son that we should start practicing from big cities first instead of waiting until there is sufficient pharmacist.
regards, mel.
11/5/2001 4:37:22 PM

Hooi Ling here.As a future pharmacist, I strongly agreed that dispencing right should be given to pharmacists. In a more materialistic point of view, dispencing right provide a very good oppurtunity to pharmacists to earn more.Isn't this a good news to all of us who spend so much money and time studying. Pharmacists handle drugs more professionally than doctors just because they know more.
To make this dream comes true, pharmaceutical societies and all the pharmacists around the world should put their hands together.Although, this cannot be done at once, but we can try it slowly-step by step,starting from town to suburbs. Lack of pharmacists is no more a problem because there are many institutions provide pharmacy course.
11/2/2001 2:47:42 PM

~~~~~~For those who concern:~~~~~~
Every year malaysia spent million of ringgit in pharmaceutical products. Million & million of prescription items are dispensed out in community pharmacy each year.
This has spells out the role of pharmacist in implementation of
pharmaceutical care & distributing medicine among other health care professionals & public.
Getting the "Dispensing Right" from where it belong is not mainly for profit but is a responsibility & professional practice toward the goal of improving national health status.
"Dispensing function" always lies in the life of a pharmacist from the first day he/she practices.Their specilised duties may ranged from the review of prescription, provision of information & advice & to ensure handling of medicine always safe, effectives & cost benefit.
Taking away the "Dispensing Right" from pharmacist is actually a "PROFESSIONAL ISOLATION" toward the goal of improving national health.
Now & forever we will stand together to removes the obstacles which have built over many years..........
Hope that the same day will not be the same story anymore,,,,,,,,,
~~~~~~~~ Alister (99005990)~~~~~~~~ 11/2/2001 2:27:40 PM

I am Angela.In others developed countries, pharmacists are the one who do the dispensing but not the physicians. I deeply believe that no one understand better than a pharmacist concerning about drugs. Physicians may prescribe medicines but not dispense. Pharmacists are trainned with adequate skills to handle drugs. Therefore, i feel that dispensing right should belong to the pharmacists.
11/1/2001 8:48:30 PM

Win-Son here. I agree that pharmacists should dispense drugs instead of physicians. If Malaysia wants to be a developed country, the roles of a pharmacist and physician should be clearly differentiated. Currently, community pharmacists acts more like a shopkeeper who manages a pharmacy. Their skills are not being fully utilized. In the clinical aspect, physicians might be better than pharmacists but when it comes to drugs, pharmacists are the experts and not physicians. We don''t spend 4 years just studying about drugs and pharmacology for nothing. I suggest that pharmacists be allowed to have the dispensing right in Malaysia by stages. Big cities like KL should be the first to start.
11/1/2001 6:36:39 PM

Ask the pharmacist

1) 2001-2008... Health Minister had changed twice. But is the pharmacy professions going forward?
2) Pray hard for dispensing right..maybe we need a divine intervention...hahaha.....
3) Any idea how we can get our dispensing right?

Saturday, January 05, 2008

How to take Postinor 2? Morning After pills

How do u take postinor-2?
According to,
1)Manufacturer leaflet: one Postinor-2 within 72 hours following intercourse and another 12 hours after taking the first pill.2) Martindale reference: levonorgestrel may be given alone by mouth in a single dose of 1.5 mg (2 tablets) within 72 hours of coitus (preferably as soon as possible).
Alternatively, a dose of 750 micrograms (1 tablet) is given within 72 hours of coitus (preferably as soon as possible), and repeated after 12 hours.

3) BNF 53rd Ed Sept 2007: 1.5mg as a single dose as soon as possible (preferably within 12hours but no later than after 72 hours.

Ask the PharmacistDue to popular search, I have decided to answer most of the questions posted by my reader here

1) I would advise them to take as single dose, ie 2 tab at once as soon as possible for increased compliance and to follow the latest advise from British National Formulary. Actually the pills can be taken up to 120 hours after sex, without regard to menstrual cycle, but the efficay reduced as the time pass. The pregnancy rate if taken after one day is 0.4%, 2 days is 1.2% and 3 days is 2.7%.

After u have taken the 2 pills, u may experience menstrual bleeding within one week of the expected time. If u took the pills late into the cycle, your next menses will be prolonged.

2) After u have taken postinor, if u have unprotected sex again, u may become pregnant. So u can take another 2 pills again as the max doses is 4 pills /month.
If u vomited within one hour, take a vomiting pills together with postinor again.

3) The safest unprotected sex is few days before your menses come.
Just use the other methods if u r not sure, ok? Dont understand? Use barrier. DONT UNDERSTAND? USE CONDOM lar ...hehe....

4) Consult a pharmacist if u take any anti convulsant or epileptic medicine such as phenytoin, carbamazepine, and valproic acid etc. Sorry as i wont be replying to the comments here anymore. If you have further questions, pls click like on my facebook account and message me there.

Wednesday, January 02, 2008

Fungus Growing explained....

How do you grow a fungus?

This is the fungus i have been growing in pharmalogik.
Do u know this fungus eat chicken? Dont believe? See the chicken bones?
Now i can do some serious testing for my antifungal solution and cream. Hahaha.....

Actually, i accidentally grow it as i forget to wash my dishes. After 2 days, it become like this .......Hahaha.....
I dont keep it for long, after some experiment, i throw it off liao.
I wonder whether it will grow to become mushrooms if i keep it longer. Mmmmm.....

Ask the pharmacist
1) Dont forget to wash the dishes.
2) If the fungus growing there, take the opportunity to do testing with the antifungal medicine. Then u will know which antifungal medicine will act better towards common type of fungus.
3) Wet and expired Gardenia bread is the easiest way to grow some fungus. That type of fungus is different from this species.
4) Don't try to eat the fungus u r growing.
5) You can take pictures and name the new species with your name.
6) Do not put your camera near the fungus to take its pictures. Unless u plan to grow "lens fungus".

Have fun.....