read previous issues Our Story As-Saydaliah is an official bulletin published by the Department of Pharmacy under the responsibility of the Drug & Poison Information Services Unit (DIS). As-Saydaliah is derived from the Arabic Language, meaning “Pharmacy”. The bulletin serves as an effective means of professional communication with the physicians, nurses, pharmacists and other healthcare professionals. Additionally, the Department of Pharmacy is also responsible for educating and sharing knowledge with the patients and the general public. The content varies for every issue. It focused mainly on pharmacy-related issues, exciting news and events in pharmaceutics, drug information, awareness of medication and current concerns. As-Saydaliah was first published in 2018 and, since then, has sought to make its entire contents as widely available and accessible as possible. It was planned to be released twice a year, but since 2021, its release has been increased to 3 times a year. Online issues of the publications are available on SASMEC @IIUM website. By The Editor 02 AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 Pronunciation IPA(key): /sˤaj.da.lij.ja/ Noun (ṣaydaliyyaَ •(صْيَدِلَّية (ṣaydaliyyātَ (صْيَدِلَّيات plural 1.(pharmacy) pharmacy, drugstore, apothecary
16 The 0 Healin 6 g Power of Plants A SM 1 AR 2 T Therapy 21 Pharmacy in Action SPIRIVA® RESPIMAT® Table Of Contents E 0 ditor' 5 s Note 24 Reader's Comment AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 03
Copyright Disclaimer and Fair Use Statement © 2018-2022 The Department of Pharmacy, Sultan Ahmad Shah Medical Centre (SASMEC @IIUM) all rights reserved. Copyright and other intellectual property rights in this bulletin belong to the Department of Pharmacy, SASMEC @IIUM. This bulletin may contain copyrighted material, the use of which may not have been specifically authorised by the copyright owner. However, this material is included in an effort to explain issues relevant to the topic presented or to illustrate the content. There is no profit gain or commercial value intended in this publication. The SASMEC @IIUM also authorises healthcare organisations to reproduce any material in this bulletin for educational and non-commercial use only. AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 A d v i s o r C h e R o k i a h I s m a i l c r o k i a h @ i i u m . e d u . m y E d i t o r / D e s i g n e r F a t i n A z z y a t i P a k u r u r a z i f a t i n a z z y a t i @ i i u m . e d u . m y A s s i s t a n t E d i t o r R a i h a h A b d R a h i m r a i h a h @ i i u m . e d u . m y C o l u m n i s t N a j w a N u r d i y a n a A b d u b r a n i n a j w a a b d r a n i @ i i u m . e d u . m y A h m a d S y a u q e y A d n i n H a s n a m a h m a d s y a u q e y @ i i u m . e d u . m y K h a i r u l A z r u l B i n A b d u l R a h m a n k h a i r u l a z r u l @ i i u m . e d u . m y 04
18 BY FATIN AZZYATI PAKURURAZI, REGISTERED PHARMACIST This is it. Everything that has a beginning has an end. I am writing this in my final week at the Department of Pharmacy, before turning the helm over to a new editor and riding off into the sunset to chase yet another dream. Well honestly, “writing” is a strong word; I am typing clunky strings of words, only to erase them once again — trying to write perfect sentences, perfect enough to reflect this bulletin, to display the love and hours I and other columnist put into these pages. It's an impossible task, and yet, like Sisyphus, I hopelessly continue to put words on paper, in search of a new arrangement that feels right. Maybe, for the first time, I, an editor, am without words. My first work as editor and designer of As-Saydaliah started with its very first issue in August 2018, exactly four years ago. I didn’t train as an editor, a designer or a writer, but I’ve found real creative pleasure in every issue. My dream is for a mere department's bulletin to be loved and wanted by readers. My goal is to design and publish articles that colleagues wish to—need to—read. For me, proofreaders and general readers are teachers. I always try to listen to their opinions on what theme and topic should I bring for the next issue. What colour palette should I use, and what kind of design should I approach? I also tried hard to keep my datelines, but this had not always applied. No words of mine will truly be able to represent how much this bulletin means to me. But the proof remains in the pages, in the words and thoughts of our readers — and really, that's the best I could ask for. Please keep your eyes on this bulletin in the coming issues for other signs of resilience and renewal. Because whatever changes 2022 may hold, one thing remains constant: the As-Saydaliah will always be there. Every day is one of possibilities but only if you say yes to change. THE EDITOR'S NOTE This is my hardest editor's note yet - because it's my first, and last. Until next time, thank you. Fatin Azzyati Editor and designer of As-Saydaliah 2018-2022 AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05
C O V E R S T O R Y T H E H E A L I N G P O W E R O F P L A N T S BY A H M A D SY A U Q EY A D N I N H A S N A M & F A T I N A Z ZY A T I P A K URUR A Z I, RE G I S T ERED P H A R M A CI S T S Humans have produced medicine from plants and other organisms for centuries, hence pharmacognosy being commonly considered the oldest branch of pharmacy. The production of drugs from plants is also referenced in many ancient texts. Through the ages, information has been discovered which refers to humans making medicines from garlic, mustard, cabbage, parsley, and mint. It is believed that the human body finds plant-derived medicines easier to accept because they exist in nature and are not synthetic. AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 06
The term 'pharmacognosy' was coined for the first time by Austrian physician J.A. Schmidt (1759–1809) in his hand-written manuscript 'Lehrbuch der Materia Medica,' published in 1811 after his death and C.A. Seydler used the term in his book on crude drugs 'Analectica Pharmacognostica' in 1815 [3]. Plants are used in a variety of ways in the production of conventional and alternative medicines. The extraction of alkaloids from poppy and other plants contributed to the beginnings of modern medicine in the 19th century. From that point, other active ingredients were extracted from other plants to produce the medications we have now. The beneficial active ingredient of the plant may be found anywhere in its physical structure, such as in the petal or stem of a flower. Recently, the World Health Organization (WHO) estimated that 80% of people worldwide rely on herbal medicines for some aspect of their primary health care needs [2]. Furthermore, around 21,000 plant species have the potential for being used as medicinal plants [2]. Notable examples include White willow (salicylic acid), Goat’s rue (metformin), and Autumn crocus (colchicine), among others. Pharmacognosy / ˌ FⱭːMƏˈ KⱰꞬNƏSI / n o u n L E T 'S L EARN A NEW T E RM IN PHARMACY! THE STUDY OF MEDICINAL DRUGS OB TAINED F ROM P LANTS OR OTHE R NATURAL SOURCES. AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 07
Colchicine is one of the oldest remedies still in use today. It is an alkaloid derived from the Colchicum autumnale plant, also known as autumn crocus. Almost all parts of it contain colchicine - seed, bulbs, leaves and flowers, and have been made into medicine. Colchicine’s name may come from its use as a poison in the district of Colchis in ancient Greek. Medea, the sorceress daughter of the king of Colchis, used it as one of her poisons, and it was referred to in Greek mythology as “the destructive fire of the Colchicon Medea.” Colchicine was first isolated in 1820 by French chemists Pierre-Joseph Pelletier and Joseph-Bienaimé Caventou, and a purified active ingredient was developed in 1833 by Philipp Lorenz Geiger. In the 18th century, a French military officer, Nicolas Husson, used colchicine as the main ingredient in Eau Medicinale, a product he developed as a commercial remedy to treat gout. Podagra (acute gout occurring in the first metatarsophalangeal joint) was first identified by the Egyptians in 2640 BC and mentioned in the oldest Egyptian medical text, the Ebers Papyrus. It was later recognized by Hippocrates in the fifth century BC, who referred to it as 'The Unwalkable Disease'. Colchicine An c ien t drug for t he ' T he Unwal kable Di sease’ The Ebers Papyrus is one of the most important medical documents from ancient Egypt. It was produced ca 1550 BCE, and is currently housed in the library of the University of Leipzid, Germany. Image is public domain from the National Library of Medicine NIH Archives Autumn crocus (Colchicum autumnale) Colchicine works by inhibiting neutrophil migration, chemotaxis, and phagocytosis in the inflamed area thus reducing the inflammatory reaction towards urate crystals, but has no effect on uric acid production or excretion. Despite colchicine’s long history of use, it was not until 2009 that the U.S. Food & Drug Administration approved colchicine to treat gout and familial Mediterranean fever (FMF) under the Unapproved Drugs Initiative. Beyond gout and FMF, colchicine is widely used to treat a variety of dermatologic conditions, and its role is being investigated for the treatment of coronary artery disease and even COVID-19 infection. AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 08
Metformin THE P R E F E R R ED F I RST - L INE ORAL B LOOD GLUCOSE - LOWE R ING AGENT TO MANAGE TYP E 2 DIAB E T ES. Metformin is one of the preferred agents for controlling blood glucose levels. It belongs to the biguanide class, which originates from the French lilac or goat's rue (Galega officinalis), a plant used in folk medicine for several centuries. It was found to be rich in guanidine, which, in 1918, was shown to lower blood glucose. It is said that metformin works by decreasing hepatic glucose production and intestinal glucose absorption as well as increasing peripheral utilisation of glucose which helps to improve insulin sensitivity. It was used to treat hyperglycaemia, back in 1920 to the 1930s because it is less potent but has a superior safety profile and is well tolerated compared to other biguanides like Phenormin and Buformin; which were then discontinued around the 1970s due to the high risk of lactic acidosis and the increased availability of insulin. Metformin was then discovered again while searching for antimalarial agents around the 1940s and proven to treat influenza simultaneously, with another effect of lowering blood glucose. Jean Sterne, a French physician then continue to study the property of Metformin’s hypoglycaemic effect, which led to the use of this medication as an antidiabetic agent in 1957. In 1995, Metformin was introduced again in the USA after intensive research on its ability in countering insulin resistance and addressing adult-onset hyperglycaemia without weight gain or risk of hypoglycaemia, managed to grab the attention of researchers and healthcare practitioners in Europe. In 1998, UK Prospective Diabetes Study (UKPDS) provided a new rationale for adopting Metformin as the initial therapy in treating Type 2 Diabetes as it is having long-term cardiovascular benefits for this disease. A few decades after its introduction, Metformin has now become the most prescribed antidiabetic agent worldwide. Being forgotten, rediscovered, repurposed, rejected and many more does not stop the researchers from continuing the journey in finding further therapeutic applications for this medication. AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 S C A N H E R E F O R R E F E R E N C E S 09
T H E B I R T H O F V I N C R I S T I N E A N D V I N B L A S T I N E VincaAlkaloids Vinca alkaloids are originally derived from the Madagascar periwinkle plant, also known as Catharanthus roseus or Vinca rosea. It is a pretty plant, with five-petalled flowers that come in a range of hues from bright white or rich red to shocking pinks and purples. But there’s more to these attractive garden plants than their appearance – they are also the source of powerful cancer drugs. The indigenous people of Madagascar were the first to figure out the periwinkle’s medicinal properties, initially using extracts of the plant to treat diabetes. But the plants have been used all over the world for ailments ranging from eye infections and eczema to malaria, mouthwash for toothache, high blood pressure and wasp stings. The historical hearsay prompted phytochemical investigations of its properties in 1949. Vinca alkaloids were found in the 1950s by Canadian scientists, Robert Noble and Charles Beer. At first, they were studying the hypoglycaemic properties of this plant, but eventually, neither of them could prove the result. The attempts to verify the anti-diabetic properties of the extracts led instead to the discovery and isolation of two complex indole alkaloids - vinblastine and vincristine. They observed its oncolytic properties in rats, leading to the development of anticancer drugs. The vinca alkaloids work by interfering with the polymerization of tubulin, a protein responsible for building the microtubule system which appears during cell division in proliferating cancer cells. Both Vinblastine and Vincristine were then introduced into the market for the treatment of cancer around the 1960s, and have been amongst the most-used class of chemotherapy drugs, clinically, to this day. The flowers of Catharanthus roseus G. Don. Catharanthus roseus (syn. Vinca rosea) Editor's note: Although vinca alkaloids have an important place in the chemotherapy armoury, they aren’t that simple to produce. For example, manufacturers have to start with around 500 kilograms of periwinkle leaves to make just one gram of vinblastine. AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 10
SASMEC @IIUM MEDICINE FORMULARYDRUG & POISON INFORMATION SERVICES UNIT (DIS) DEPARTMENT OF PHARMACY Available now ! Go to i-pesakit > Reference > Pharmaceutical References It provides: 1) List of medications available in the hospital 2) List of Standard and Special Formulary 3) Prescribing category and restrictions
A SMART THERAPY By Najwa Nurdiyana Abdubrani, Registered Pharmacist Asthma is a chronic inflammatory disorder of the airways associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. Until recently, the typical approach to asthma involved two inhalers. In its first update since 2007, the National Asthma Education and Prevention Program now recommends the use of Single Maintenance and Reliever Therapy (SMART) for selected patients. 12 A S-S A Y D A LIA H AUG 2022 ISSUE 02 VOLUME 05
Asthma care with one inhaler, not two. An estimated 235 million people worldwide suffer from asthma. Approximately, 250,000 deaths are reported due to asthma every year [1]. In recent years, considerable evidence has been gained in the optimal management of adult asthma. SMART is recommended as an improved method of using inhaled corticosteroids (ICS) and long-acting B agonist (LABA) therapy. It means using one inhaler every day to prevent asthma — and then using the same inhaler as a reliever/treatment when you have asthma symptoms. It has recently been recommended as a first-choice treatment for people over age 5 with asthma — even if they don’t get symptoms very often [2]. In GINA 2021, the first line treatment for asthma has changed to SMART therapy in the adult and adolescent category [4]. The SMART approach augments antiinflammatory coverage during times of increased symptoms, when airways may be more inflamed. Each time patients use their inhaler to manage increased symptoms, they also receive some steroid medication for long-term asthma control [4]. AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 13
There are two main formulations, using budesonide or mometasone as the preventive component and formoterol as the rescue component. Only formoterol-containing formulations should be used. Formoterol has a rapid onset bronchodilator effect, similar to albuterol. For budesonide/formoterol, the most commonly used formulation, a maximum of eight puffs are recommended for children aged 5 to 11 and 12 puffs for children aged 12 and older. It has been suggested that the SMART strategy provides greater clinical efficacy at lower doses of ICS than the traditional combination regimens and that the corticosteroid works more effectively when inhaled at the onset of exacerbations following the onset of symptoms rather than preventively [3,4]. In addition, patients are able to more rapidly adjust their treatment up and down according to their symptoms. Using a single inhaler for both maintenance and rescue can also improve adherence. And it eliminates medication confusion for patients who tend to mix up their two inhalers. Why the change? While there is no cure for asthma, inhaled medications can control and manage symptoms. AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 S C A N H E R E F O R R E F E R E N C E S 14
Medication Administration and Dilution Requesting new medication Drug-Related question Medication availability and alternative PHARMACIST ONCALL SERVICE An expanded role means more reasons to serve you better DEPARTMENT OF PHARMACY WEEKDAYS Emergency Pharmacy (+609-5912600) operates at this hour with one Asst. Pharmacist. Urgent and relevant query can be made to the passive call pharmacist +6014 - 919 0473 11.00 PM - 8.00 AM: PASSIVE CALL 5.00 PM - 11.00 PM: ACTIVE DUTY ONE active Pharmacist available at Inpatient & Ward Supply Pharmacy Unit Inpatient Pharmacy (+609-5912591) opens until 11.00 pm and Emergency Pharmacy (+609-5912600) opens until 7.00am. Urgent and relevant query can be made to the passive call pharmacist +6014 - 919 0473 06.00 PM - 10.00 AM: PASSIVE CALL 10.00 AM - 06.00 PM: ACTIVE DUTY ONE active Pharmacist available at Inpatient & Ward Supply Pharmacy Unit WEEKENDS AND PUBLIC HOLIDAYS
SPIRIVA® RESPIMAT® T I O T R O P I U M B R O M I D E I N H A L A T I O N S P R A Y Tiotropium bromide is a medication commonly used for long-term maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema and to reduce exacerbations in COPD patients. Does asthma take your breath away? A S-S A Y D A LIA H AUG 2022 ISSUE 02 V OLUME 05 By Khairul Azrul Abdul Rahman, Registered Pharmacist 16
CURRENTLY, SPIRIVA HANDIHALER® WAS REPLACED AND ALL PATIENTS WHO WERE PREVIOUSLY STARTED ON SPIRIVA HANDIHALER® WILL BE CONVERTED TO SPIRIVA RESPIMAT® . In many countries worldwide, the long-acting anticholinergic drug; tiotropium is available as a dry powder formulation delivered by means of the HandiHaler® inhalation device and as an inhalation spray delivered via the RESPIMAT®. Actually, SPIRIVA RESPIMAT® contains the same medicine as SPIRIVA HandiHaler®. But, it delivers the content in a soft mist that eases the effort to inhale. And, unlike your SPIRIVA HandiHaler® (which requires you to insert a capsule with every use), SPIRIVA RESPIMAT® uses a single cartridge that lasts all month. The high fine-particle fraction of droplets produced by the RESPIMAT® inhaler optimizes the efficiency of drug delivery to the lungs, resulting in a lower dose of a drug required than HandiHaler®. Therefore, it is important for all health care professionals to understand the correct technique of administration with the new inhaler before conveying messages to their patients. WAIT, WHAT'S THE DIFFERENCE? AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 17
STRENGTH DOSAGE PACKAGING Handihaler: 18mcg capsule Respimat: 2.5 mcg tiotropium/actuation Handihaler: One capsule once daily Respimat: Two inhalations once daily. Max: 2 inhalations in 24 hours Handihaler: Blister packs of 30 capsulesRespimat: Cartridgeof 30 doses (60 puffs)HANDIHALER VS RESPIMAT MORE INFO AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 S C A N H E R E F O R R E F E R E N C E S 18
AS-SAYDALIAH AUG 2022 ISSUE 02 19 VOLUME 05
Pharmacy in Action C O L L E C T I O N O F E V E N T S I N T H E D E P A R T M E N T O F P H A R M A C Y F R O M M A Y - A U G U S T 2 0 2 2 I N T E R N A L A U D I T 1 6 - 1 7 T H A U G U S T 2 0 2 2 "You are not one of the best departments, but you ARE the best department". - AUD IT O R C O N G R A T U L A T I O N S ! D E A R A L L S T A F F , Y O U A R E A W E S O M E ! ! 21
Pharmacy in Action C O L L E C T I O N O F E V E N T S I N T H E D E P A R T M E N T O F P H A R M A C Y F R O M M A Y - A U G U S T 2 0 2 2 From left: Asst. Pharmacist U29 Muhamad Syahmi Ridhwan Bin Abd Rahim. Pharmacist UF 41 Raihah Abd Rahim, and Pharmacist UF44 Fatin Azzyati Pakururazi T o o q u i c k l y t h e t i m e h a s p a s s e d b y , N o w i t ' s t i m e f o r u s t o b i d f a r e w e l l , b u t n o t g o o d b y e . We ' r e w i shing you the be s t of luc k in the ne x t s t ep of your c a r e e r and l if e . O ur depa r tment i s g l ad to ha v e you, and w e ' r e g r a t e ful for your cont r ibutions to the depa r tment and the hospit a l a s a w hol e . Ma y your ne w ende a vour br ing you much happine s s and fulfi lment. Thank you & all the best! 22
Pharmacyin Action C O L L E C T I O N O F E V E N T S I N T H E D E P A R T M E N T O F P H A R M A C Y F R O M M A Y - A U G U S T 2 0 2 2 SAY HI! TO THE NEW S TAF F Five new Asst. PharmacistS U29 has joined our crew. From left, Syahleny Affida bt Shamsul Affandi, Jiefatihah bt Johan, Che Ku Farhana Bt Che Ku Zamzuri, Syed Khairul Izzat Bin Syed Ahmad Shukri, Amir Akashah Ahmad. One Medical Health Assistant U11, Nor Faizal bin Buang. And two new pharmacists UF41, Abdul Rashid b Adenan and Syakirah bt Ahmad Hamedon. 23
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I like As-Saydaliah because ... As -Saydaliah FROM PREVIOUS ISSUE READER'S COMMENTS it gives me MORE and NEW knowledge about pharmacy (: - M Amin Great knowledge and teamwork are synergistically important in saving lives - Mastura keep updating hidden lessons in healthcare to enhance quality treatments - Azrin Azly It i g n r s a t b an s my attention - N taneously. ur Munirah attractive, informative, colourful, complete, trusted SASMEC@IIUM pharm - ac S o h logy bulletin! ahiera I learn a lot of new knowledge about the Pharmacy world. - Effa It provides beneficial information for me and all SASMEC@IIUM community - Rehan Encourage staff to read and gain new knowledge about the pharmacy-related matter, eventhough I'm an administrative staff. - Intan We get lots of ideas from your comments. It makes us want to work harder. So please share your thoughts! AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 25
I like As-Saydaliah because ... As -Saydaliah FROM PREVIOUS ISSUE READER'S COMMENTS A good source for pharmacy practice and info regarding Islamic Scholar. - Tarmizi pub D li i c f a ferent themes were used in every int t e io r n e , making it more attractive and sting to read each time! - Raihah I get new information and the design of the digital booklet is attractive - Munirah It promotes an undervalued profession and provides the latest information. - Bryan Can gain knowledge plus the ebook is so beautiful! good job! - Aida Nazirah Simple, nice & fruitful content - Suhaiza Very informative, and easy to understand for non-medical background readers. - Rusianti Has much exciting news on drug information, and awareness of medication. - Khaizan We get lots of ideas from your comments. It makes us want to work harder. So please share your thoughts! AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 26
QU IZ THE Starbucks giftcard worth RM60.00 each! THREE WINNERS WILL BE SELECTED BASED ON CORRECT ANSWERS AND CREATIVE SLOGANS. 27
Special thanks to all proofreaders of As-Saydaliah August 2022 Geethaavacini Nur 'Aina Syakirah proofreader noun [ C ] UK /ˈpruːfˌriː.dər/ US /ˈpruːfˌriː.dɚ/ a person whose job is to check text before it is printed or put online we couldn’t have pulled this off without you 28
O U R L O C A T I O N Drug & Poison Information Services Unit (DIS) 2nd door, Level 1, Inpatient Pharmacy, Sultan Ahmad Shah Medical Centre @IIUM 09-591 2672/2558 [email protected] Mon-Fri, 8.00am - 5.00pm DIS
65THappMALAYINDEPENDENWi shing you DEPARTMENT OF PHARMACY
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AS-SAYDALIAH AUG 2022 ISSUE 02 VOLUME 05 WE HOPE YOU ENJOY THIS EDITION to err is human; to edit, divine.