NotOnly Dispensing

How to Dilute? Dilution is an important aspect in pharmacy. Everybody knows how to dilute a concentrated solution to a less concentrated one, but not everyone knows how to dilute it to the EXACT concentration. Today, we'll share a bit of insight on dilution method of a solution. Before that, let us have a bit of examples on when will the dilution method be applied. In pharmacy services, some of the solution, or cream that we have were purchased in bulk or in concentrated form for their cost-effectiveness as well as ease of transportation.  For example, benzyl benzoate emulsion (EBB) used in pediatrics. For children above 2 years of age up until 12, EBB 12.5% is recommended. In some facilities, you may also find EBB 6.25%, indicated for pediatric 6 months up to 2 years old. *Do note that 6.25% is not listed in BlueBook * In most of the facilities, we will be getting EBB 25%. So, further dilution is required to prepare an emulsion of 6.25%. Taking this as an example, th...

Intravenous Infusion Today we'll be sharing on intravenous (IV)  infusion calculation. Many medications can be given via IV infusion route for inpatient care. A few commonly used examples are Noradrenaline, Adrenaline, Labetalol, Glyceryl trinitrate . Calculation on IV infusion medications can sometimes leaving one in confusion while figuring out how many vials or ampoules are required, especially for pharmacist who is new to inpatient care like PRP. So, to get your hands on practice, let's start with a few examples. Example 1:  Today, Dr M ordered IV Glyceryl Trinitrate (GTN) 5mcg/min for 5 hours.  What is the infusion rate? How much ampoule do we need? IV GTN available strength: 50mg/10ml Dilution method: Dilute 50mg in 500ml diluent 1.1 First determine the dose required: Dose (mg/hr) = Dose (mcg/min) x 60 min/hr ÷ 1000 mcg/mg = 5 x 60 ÷ 1000 = 0.3 mg/hr 1.2 Determine the concentration that we have: Concentration (mg/ml) = 50mg ÷ 500ml = 0.1 mg...

Calcium supplementation   Greetings,  Calcium is one of the essential elements for maintaining normal physiological process in our body. It can be obtained from our daily diet. Examples of food enriched with calcium includes dairy products such as cheese, milk and yoghurt, nuts and seeds such as almonds, sesame seeds, and vegetables such as ladyfingers and soya beans. When dietary intake of calcium is insufficient, sign and symptoms of calcium deficiency @ hypocalcemia may occur. Calcium deficiency symptoms are usually muscle-related , as in muscle twitching, stiffness, numbness, weakness, or irregular heartbeats. Chronic calcium deficiency may lead to bone demineralization, bone density loss and eventually results in brittle and fragile bone.  *Ever heard osteoporosis?* Calcium supplementation can be an alternative source of calcium to overcome the issue. But, how much of calcium do we actually need? Are the calcium supplements that we are taking is adequate for our dai...

Diltiazem, Amlodipine and Verapamil (DAV) and their interactions with Simvastatin Good Evening, Today I would like to share a tiny bit of information on Diltiazem, Amlodipine and Verapamil (DAV)  and their interactions with Simvastatin . The use of statin may induce myopathy as one of its side effects. High dose of Simvastatin (>80mg) has been associated with increased risk of myopathy .  One may experience muscle-related symptoms such as fatigue, muscle pain or weakness, cramps and it may be aggravated by physical exertion. Simvastatin is metabolized by CYP3A4 enzyme in the body. The DAVs are all CYP3A4 enzyme inhibitors . Concomitant use of the drugs may lead to increased plasma concentration of Simvastatin, which in turn, increases the risk of myopathy. Findings from multiple studies has shown that the coadministration of Amlodipine 10mg and Simvastatin has the potential to increase the plasma concentration of Simvastatin by approximately 2-fold . On the other hand...

Good morning, Oral Iron Supplementation is essential in the management of anemic patient. Ferric Ammonium Citrate (FAC) 400mg/5ml mixture   can be commonly found in government hospital setting in Malaysia, to be used as one of the iron supplementations for pediatric patients. Dosing calculation for iron supplementation requires familiarization of iron content within each iron supplements. One can be quite confused at first when they are new to FAC syrup dose calculation. An important piece of information that should not be overlooked is that the strength of FAC syrup , 400mg/5ml, should NEVER be used in the calculation of amount of FAC required. In fact, 400mg/5ml of FAC contains 86mg of *Elemental Iron* in every 5ml of the mixture .  This is based on the approximation of molar mass ratio between iron and ferric ammonium citrate. Molar mass : Iron = 55.845 g/mol Ferric Ammonium Citrate Citrate = 261.98g/mol Approximation ratio calculation : 55.845/261.98 x 400 = 85.27 (...

Sharing a case today on Asthma inhalers Patient came into Emergency Department with shortness of breath and frequent coughing few weeks ago. After treatment was given, I approach the patient. Had some conversation with him, he complained that the Salbutamol pressurized metered-dose inhaler (pMDI),  which he had received past few weeks was not effective in managing nor relieving his asthma attacks. He had 4 attacks in these recent weeks. After using the MDI, the asthma attack did not relieved. Suspecting the patient might use the MDI wrongly, I asked the patient to demonstrate how he used it. I was right. He did not shake the MDI before using it, neither did he hold his breath after adminster the medication. He insisted that, shaking the MDI before use was an extra work which waste his energy and holding breath is pointless as the medication is already administered. After counselled him on the purpose of doing these actions, he went back home. Today, he came to see me, thanked...

Myth of Paracetamol Seen by a pediatric patient's mother today. Worried and anxious, she asked regarding the dose and myth of  Paracetamol before giving it to her child.    " Legends says that, when Paracetamol is taken, it will remain in the body until the day one dies. " *Staring at her in disbelief*   (  O_O) This is what was told by her, with a concern that her newborn child will have to bear the Paracetamol in its body until the day it passes away. Sounds funny and unbelievable, but this is what happens right now in reality due to misinformation. Paracetamol (PCM)  @ Panadol®, also known as Acetaminophen (AAP) @ Tylenol® in some regions, especially in the US, is a wonderful drug. It is can be found worldwide in different brands and strength. PCM can be used as either mild  analgesic or  antipyretic for treating fever. However, how it actually works is still a mystery itself.  Some debate that it works through prostaglandin ...

Recently, the number of scabies infestation has been seen to increase drastically. Scabies @ Kudis Buta infestation is a condition caused by mites that burrow underneath the skin layer. Female mites will lay the eggs in the burrow.  The mites, as well as the eggs, will make the infested to feel itching and, most of the times, rash will occur. *Feeling the bugs move around your skin is really geli* Scabies can be transmitted via skin contact . Do note that it can also be acquired through sexual intercourse or exposed to infested beddings. Once infested, the bugs may have an incubation period over 2 to 6 weeks before the symptoms appear. *Yes, it can be this long* Benzyl Benzoate Emulsion (EBB)  is one of the topical medication for antiscabitic treatment. It is widely accepted as it is inexpensive. The strength for this medication can be found at several concentrations. For adults, EBB 25% is commonly used. For children above 2 years of age up until 12, EBB 12.5% is recommen...

Greetings, Today we'll talk about how to differentiate beta-blockers based on their beta receptor selectivity . Beta-Blockers  are a group of drugs that inhibits beta-adrenergic receptors.  They are usually ended with a suffix of -olol. So how do we memorize their beta receptor selectivity? The answer is based on their  alphabetical   letter . Beta-blockers with their name start with: A - M : Cardioselective beta-blockers * With the EXCEPTION for Nebivolol i.e : Atenolol, Bisoprolol, Carvedilol, Metoprolol N - Z : Non - selective beta-blockers i.e : Nadolol, Propranolol, Timolol It is easier to know which beta-blockers grouping based on their names now, isn't it?

Prescriber Category Under MOH Malaysia, a formulary, namely Ministry of Health Medicines Formulary (MOHMF) @ Formulari Ubat Kementerian Kesihatan Malaysia (FUKKM), a.k.a Bluebook , is created with the intention to serve as a policy to control and promote rational and quality use of medicines across all MOH healthcare institutions. Prescriber category provides an insight for a person on the power of initiating a prescription . Below are the list of prescriber categories: A* - Consultant/Specialists for specific Indications only A - Consultant/Specialists A/KK - Consultant/Specialists/Family Physician Specialists B - Medical Officers C - Paramedical staff C+ - Paramedical Staff doing midwifery For example,  Loratadine 1mg/ml Syrup falls under Category A, while Loratadine 10mg tablet falls under Category B. Both are the same medication but different in formulation. A medical officer can prescribe Loratadine 10mg tablet to a patient, but he/she will require authorization from a Con...

Good day everyone , Encountered a question by a physician regarding Gliclazide dose conversion today. Currently Gliclazide tablet is available in two formulations, i.e plain tablet and also Modified Release (MR) tablet. The switching between these two formulations can be done as follows using Total Daily Dose : Plain tablet 80mg = MR tablet 30mg For example, patient is currently on Gliclazide 80mg BD. Total Daily Dose = 160mg Conversion = 160/80 x 30mg Gliclazide MR Dose = 60mg As simple as that ! Hope this helps those who needs it  ; ) Find out more about Ramadan Gliclazide dose adjustment. 

Greetings, As Ramadan month is just around the corner, today I'll be sharing bits and pieces about diabetic medication - Sulfonylureas (SU). What are  Sulfonylureas ? They are a group of medicines used to treat Type II Diabetes Mellitus a.k.a Kencing Manis (In Malay) / 糖尿病 (In Chinese). Currently, under Malaysian government healthcare facilities setting, Gliclazide is the most commonly used Sulfonylurea medication. So, how does it works in our body? Sulfonylureas are insulin secretagogues ,  where it stimulates beta cells in our pancreas to produce more insulins. With more insulin produced, the excess sugar in our body will be converted and stored in our cells as energy reserve. Hence, the amount of sugar in our blood is lowered. TLDR; it's an insulin-releasing pill. Why we need to take note about how it's working? During Ramadan month, Muslims fast during the day up until Iftar, which will be in the evening. They may be facing risk of hypoglycemia (where blood sugar is t...