Pharmacy Unit
PEJABAT KESIHATAN DAERAH ALOR GAJAH (PKDAG)
78000 ALOR GAJAH, MELAKA
Issue 2/2017
Pharmacy Bulletin
Inside this issue:
1. Rabies
2. Leptospirosis
3. What is Scabies?
4. Do you have Depression?
5. Aktiviti Kenali Ubat Anda
PKDAG 2017
6. Staff Contoh Sesi 1/2017
EDITORIAL BOARD
CHAIRMAN:
Dr. Hazlinda Bt Datuk Hj. Hamzah
ADVISER:
Pn. Azliah Bt Sakiman
EDITOR:
En. Chan Wei Jyh
CONTRIBUTORS:
Pn. Anida Bt Daud
En. Fakaruddin Bin Karim
Cik Jenny Shum Kam Hong
Cik Lim Fei Ting
En. Muhamad Lutfi Bin Abdul Samat
Pn. Nur Syafinaz Bt Asmuni
Pn. Nurul Rahimah Mohd Khair
Pn. Saidatul Akmar Bt Borhan
Rabies Contributed by:
Cik Lim Fei Ting
IntroductionRabies is a zoonotic disease (a disease that is transmitted to humans from
animals) that is caused by a virus.
Mode of TransmissionDog is the main transmitter. It can be spread to people through close contact
with infected saliva via bites or scratches.
Clinical ManifestationThe incubation period is typically 1–3 months, but may vary from 1 year.The
initial symptoms of rabies are fever and often pain or an unusual or
unexplained tingling, pricking or burning sensation (paraesthesia) at the
wound site. As the virus spreads through the central nervous system,
progressive, fatal inflammation of the brain and spinal cord develops. 2
forms of disease can be followed:
i. hyperactivity, excited behaviour, hydrophobia and sometimes
aerophobia. After a few days, death occurs by cardio-respiratory arrest.
ii. Paralytic (muscle paralysis) A coma slowly develops, and eventually
death occurs.
Prevention and control of Rabies in Malaysia
3 case definition:
i. Suspected: A case that is compatible with the clinical case
definition and with history of dog bite or scratch.
ii. Probable: A suspected case plus history of contact with a
suspected rabid dog.
iii. Confirmed: A case that is laboratory-confirmed.
REFERENCES:
1. INTERIM Guideline for Human Rabies Prevention & Control in Malaysia.Disease Control Division Ministry of Health Malaysia.
Rabies
Phamacy Bulettin PKD Alor Gajah 2
REFERENCES:
1. INTERIM Guideline for Human Rabies Prevention & Control in Malaysia.Disease Control Division Ministry of Health Malaysia.
Contributed by:
Cik Lim Fei Ting
RISK
CATEGORY
TYPE OF
EXPOSUREACTION TO BE TAKEN
1
Touching/feeding
animal. Licking of
intact skin.
Nil if history is reliable. If history not reliable, treat as category 2.
2
Nibbling of
uncovered skin.
Superficial
scratch, no
bleeding. Licking
of broken skin.
Apply wound treatment. Administer vaccine. Do not administer
anti-rabies immunoglobulin. Stop vaccination if animal is rabies
negative in laboratory tests, or remains healthy after 10 -14 days
observation (dog or cat). Continue vaccination if animal is not
found/captured
3
Bites/scratches
which penetrate
the skin and draw
blood. Licking
mucous
membrane.
Multiple bites. Any
wild animals bites.
Apply wound treatment. Administer vaccine. Administer anti-
rabies immunoglobulin. Administer anti-tetanus and antibiotic
treatment. Stop vaccination if animal is rabies negative in
laboratory tests, or remains healthy after 10 - 14 days
observation (dog or cat). Continue vaccination if animal is not
found/captured.
General Guideline for Dog Bite Management According to Category of Exposure
Post Exposure Management
i. Local treatment of the wound:
• immediate and thorough flushing and washing of the wound for a minimum of 15 minutes
with soap and water, detergent, povidone iodine or other substances that kill the rabies
virus.
ii. Post-exposure vaccine (PEP) and Rabies Immunoglobulin (RIG)
• PEP is given for risk category 2 and 3 accordingly. RIG is given for risk category 3 only.
Previously
unvaccinated people
•4 doses at day 0, 3,7, and 14 and a doseof RIG at the sametime as the first doseof the vaccine toprovide rapidprotection thatpersists until thevaccine works
Previously vaccinated
people
•2 doses at day 0 & 3
and RIG is unnecessary
and should not be
given.
Immunocompromised
patient
•5 doses at day 0, 3, 7,
14 and 28 and a dose
of RIG at the same time
as the first dose of the
vaccine to provide rapid
protection that persists
until the vaccine works.
Nicorette & Zincofer Drug Talk
Bilik Seminar KKIA, Alor Gajah
13 July 2017
Phamacy Bulettin PKD Alor Gajah 3
Contributed by:
Cik Nurul Rahimah
Seretide Accuhaler Drug Talk
Bilik Seminar KKIA, Alor Gajah
29 July 2017
“Leptospirosis is
an infectious
disease caused by
pathogenic
bacteria called
leptospires,”
Leptospirosis
Phamacy Bulettin PKD Alor Gajah 4
REFERENCES:
1. Medscape- Feb 22, 2016, Leptospirosis, Sandra G Gompf, MD, FACP, FIDSA; Michael Stuart
Bronze, MD MPH, FACP, FACOEM
2. World Health Organization. Human leptospirosis : guidance for diagnosis, surveillance and control
3. Paul N. Levett, Leptospirosis, 2001 Apr; 14(2): 296–326.
4. Sarawak Handbook of Medical Emergencies 3rd Edition
Contributed by:
Pn Nur Syafinaz
Treatment of Leptospirosis
Treatment of leptospirosis differs depending on the severity and duration of
symptoms at the 6me of presentation. Treatment with effective antibiotics should be
initiated as soon as the diagnosis of leptospirosis is suspected. Mild cases can be treated
with oral antibiotics such as amoxycillin, ampicillin, or doxycycline. Severe cases of
leptospirosis should be treated with high doses of intravenous penicillin. Third-generation
cephalosporins, such as ceftriaxone and cefotaxime, and quinolone antibiotics also
appear to be effective.
Patients with severe cases of leptospirosis also require supportive therapy and
careful management of renal, hepatic, hematologic, and central nervous system
complica6ons. If renal failure ensues, early initiation of hemodialysis or peritoneal dialysis
may reduce mortality by nearly two-thirds. Additional supportive care may include inotropic
agents, diuretics, or ophthalmic drops.
“Scabies is a
contagious skin
condition caused
by tiny mites
Sarcoptes scabiei
that burrow into
the skin. ”
What is Scabies?
Phamacy Bulettin PKD Alor Gajah 5
REFERENCES:
• GUIDELINE FOR MANAGEMENT OF SCABIES IN ADULTS AND CHILDREN 2015, Ministry of Health Malaysia
• Formulari Ubat Hospital Canselor Tuanku Muhriz
Contributed by:
En. Fakarrudin
The main symptoms of scabies are intense itching and skin rash on areas
where the mites have burrowed. The intense itching associated with
scabies is thought to be caused by immune system reacting to the mites
and their saliva, eggs and faeces. Without effective treatment, the life
cycle of the scabies mite can continue indefinitely. Scabies mites are
resistant to soap and hot water and cannot be scrubbed out of the skin.
Treatment Options For ScabiesClinical
condition
Recommended therapy Alternative therapy Additional measures Comments
Classical
scabies
i. Infants < 2
months
6% Sulphur in Calamine
Lotion. Rinse off after 24
hours and then reapply every
24 hours for the next 3 days
- Treat whole body
including the face
(avoid eyes and
mouth)
Treat all family
members/close
contacts
simultaneously
ii. Children <
2 years
2 applications of Permethrin
5% lotion for 8-12 hours at
one week apart
6% Sulphur in Calamine
Lotion. Rinse off after 24
hours and then reapply
every 24 hours for 3 days
Treat whole body
including the face
(avoid eyes and
mouth)
Crotamiton 10%
cream TDS for 5-
7days for nodular
scabies.
iii. Children <
12 years
2 applications of Permethrin
5% lotion for 8-12 hours at
one week apart
Benzyl Benzoate 12.5%
lotion* Whole body neck
and below. Rinse off after
24 hours then reapply for
3 consecutive days.
Crotamiton 10%
cream TDS for 7- 14
days for nodular
scabies.
iv. Adults 2 applications of Permethrin
5% lotion for 8-12 hours at
one week apart
Benzyl Benzoate 25%
lotion* whole body; neck
and below. Rinse off after
24 hours then reapply for
3 consecutive days.
People in close
physical contact, even
without symptoms,
should receive
treatment at the
same time.
v. Pregnancy/
lactating
women
2 applications of Permethrin
5% lotion for 8-12 hours at
one week apart.
-
Crusted
scabies
Apply Permethrin 5% lotion
every 2-3 days for 1-2weeks
PLUS
Ivermectin*(200ug/kg/dose)
should be taken with food.
Depending on the infection
severity, ivermectin should
be taken in 3 doses (days
1,2,8), 5 doses (days
1,2,8,9,15) or 7
doses(days1,2,8,9,15,22,29)
Oral
Ivermectin*(200ug/kg
single dose and repeat
after 2 weeks) alone or in
combination with
permethrin OR several
applications of Benzyl
Benzoate 25%.
Apply keratolytic
agents (salicylic acid
in vaseline) to
hyperkeratotic areas
to help reduce
crusting of the skin
and aid in the
absorption of the
topical permethrin or
benzyl benzoate.
Keep nails short and
apply medication to
subungual areas.
Patients may need
admission. Strict
control to prevent
spread of infection.
Do You Have Depression?
“According to the
latest (fifth) edition
of The Diagnostic
and Statistical
Manual of Mental
Disorders, someone
is diagnosed as
depression if he or
she has at least five
of the following
symptoms for nearly
every day.
Phamacy Bulettin PKD Alor Gajah 6
REFERENCES:
• Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5
Contributed by:
Cik Jenny Shum
1. Depressed Mood
Feel irritable most of the day, nearly every day for more than
two weeks. He or she may appear sad, empty or tearful to the
people around him or her.
2. Lack of Interest
The person shows decreased interest or pleasure in most
activities, including activities that he or she previously enjoyed,
most of each day.
3. Significant Weight or Appetite Change
Medically, a weight change of 5% (gain or loss) may be an
indication of depression.
4. Change in Sleeping Habit
Some people may have problems falling asleep (insomnia),
while others may sleep more excessively than usual
(hypersomnia).
5. Fatigue
The affected person seems listless and lacking in energy most
of the time, often showing little inclination to snap out of the
mood.
6. Guilt
The person feels an excessive or inappropriate amount of guilt
over a past incident. He or she may also feel helpless to
change a situation, or that he or she is worthless to people
around him or her.
7. Lack of Focus
He or she has a reduced ability to concentrate or think, and is
also indecisive.
8. Suicidal Thoughts
The person frequently entertains the thought of death or
suicide, perhaps even has a plan in mind on how to carry out
the suicide
Aktiviti Kenali Ubat Anda PKDAG 2017
Phamacy Bulettin PKD Alor Gajah 7
Contributed by:
Pn Anida Daud
Program Jelajah Masjid Di Masjid Kg Sungai Jernih Sempena Ramadhan 1438
Masjid Kg Sungai Jernih
17 Mei 2017
Pameran Kenali Ubat Anda Masjid Padang Sebang
Masjid Padang Sebang
2 Jun 2017
Program Sembang Kopi
Gadek
28 Februari 2017
Program Sembang Kopi & Lawatan ke Rumah
Alor Gajah
20 April 2017
Phamacy Bulettin PKD Alor Gajah 8
Jalan Hospital,
78000 Alor Gajah
Melaka .
Phone : 06-5566235/
06-5566237
Fax : 06-5566236/
06-5566249
Aktiviti Kenali Ubat Anda PKDAG 2017 Contributed by:
Pn Anida Daud
Ceramah oleh Pegawai Farmasi PKDAG
Sekolah Kebangsaan Sungai Jernih
17 April 2017
Pameran bersama Duta Farmasi
Restoran Astana
8 Jun 2017
Staff Contoh Sesi 1/2017 (Januari – Jun 2017)
Pameran QUMC di Klinik Kesihatan Tebong
KK Tebong, Alor Gajah
5 Ogos 2017
Puan Nur Atikah Binti Yaakub
Pegawai Farmasi UF 52
Klinik Kesihatan Masjid Tanah
Contributed by:
Pn Saidatul