Created in Canva
OCTOBER 3 ED 2026R D ASTHMA .................................................................... 01 - 02 OSTEOPOROSIS .................................................. 03 - 04 MEDICATION SAFETY ................................................ 05 HAPPENINGS IN PHARMACY DEPT........ 06 - 07 STAFF MOVEMENT....................................................... 08 CONTENT EDITORIAL BOARD ADVISOR Pn Normi binti Hamdan CHIEF EDITORS Rabiatul Adawiah Binti Nazri Hor Cheah Yen Phuah Rou En 05-6896691 farmasihsm@moh.gov.my Pharmacy Department, Hospital Seri Manjung, Perak EDITORS Megat Ahmad Haziq Bin Megat Paizal U Hui Ling BULLETIN FARMASI HOSPITAL SERI MANJUNG
TREATMENT GOALS OF ASTHMA OCTOBER 3 ED 2026R DAsthma is the chronic inflammatory disorder of the airways. It is characterized by bronchial hyper-reactivity andd airway inflammation/narrowing that leads to recurrent episodes of wheezing, breathlessness, chest tightness and cough, particularly at night or early in the morning. 01 The primary goals of asthma management focus on achieving optimal everyday symptom control while actively minimizing long- term risks. This involves reducing the frequency of future exacerbations, preventing permanent airflow limitation, avoiding medication side effects, and ultimately lowering asthma-related mortality. Beyond these clinical benchmarks, it is equally vital to identify and integrate the patient's individual goals into their personalized care plan to ensure meaningful, patient-centered outcomes. PHARMACY DEPT HSM ASTHMA ALL YOU NEED TO KNOW Genetic factors : People with a family history of asthma, allergies, are more likely to develop it. Specific genes influence: Immune system responses (especially IgE-mediated reactions) & Airway sensitivity and inflammation Enviromental factors : Allergens, irritants, air pollution, occupational irritants Childhood/Perinatal : Premature birth, born via caeseran section, exposure to smoke or pollution in infancy, lower pulmonary function of neonates Comorbidities : Obesity, allergic rhinitis, chronic rhinosinusitis, GERD Socioeconomics : Limited access to education/ healthcare CAUSE/RISK FACTORS CLINICAL PRESENTATION 1.Cough : Often dry but may produce mucus, Typically worse at night (nocturnal cough), early morning, after exercise or exposure to triggers 2.Dyspnea (SOB) : Feeling of difficulty breathing. It happens because narrowed airways limit airflow, especially during exhalation. Patients may feel like they can’t fully empty their lungs and worsens during physical activity or at night 3.Chest tightness : Sensation of pressure or constriction in the chest which patients may describe it as “something squeezing the chest”. It is caused by bronchoconstriction and muscle tightening around the airway. 4.Wheezing : A high-pitched whistling sound, usually heard during expiration and is caused by air passing through narrowed airways. The pathophysiology of asthma involves inflammation and narrowing of the airways due to an exaggerated immune response. When exposed to triggers: 1.T-helper 2 (Th2) cells stimulate IgE production and activate mast cells, which release mediators like histamine and leukotrienes, causing bronchoconstriction, mucus secretion, and airway edema (early phase). 2.This is followed by a late-phase response with eosinophilic inflammation that sustains airway swelling. Over time, the airways become hyperresponsive and may undergo structural changes (remodeling), leading to recurrent, partially reversible airflow obstruction. PATHOPHYSIOLOGY Clinicians should emphasize the importance of adherence to medication regimens, avoidance of triggers, and regular monitoring of symptoms. Educating patients about asthma triggers, such as allergens, air pollution, and tobacco smoke, can empower them to make informed lifestyle choices. Patient education should also prioritize the recognition of early warning signs of an asthma attack and prompt seeking of medical attention when necessary. Routine follow-up visits for patients with active asthma are recommended, occurring every one to six months, contingent on the severity of asthma and adequacy of control. During these follow-up visits, clinicians and pharmacists should assess asthma control, lung function, exacerbations, inhaler technique, adherence, adverse effects of medication, quality of life, and patient satisfaction with care. PREVENTION
02 REFERENCE OCTOBER 3 ED 2026R D PHARMACY DEPT HSM ASTHMA PHARMACOLOGICAL MANAGEMENTInhaled corticosteroids (ICS) MOA: Reduces airway inflammation Side effects: Oral thrush, voice hoarseness, cough, dry mouth, taste disturbances Monitoring: Symptoms control, inhaler technique, oral cavity growth in children Example: Budesonide, Fluticasone Counselling points: Rinse mouth after use, use daily when asymptomatic, correct inhaler technique is essential1.Global Strategy for Asthma Management and Prevention Global Strategy for Asthma Management and Prevention. (2025). https://ginasthma.org/wp-content/uploads/2025/11/GINA-2025- Update-25_11_08-WMS.pdf 2. Goldin, J., Hashmi, M. F., & Cataletto, M. E. (2024). Asthma. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430901/ 3. Management of Asthma In Adults (Second Edition). (n.d.). https://mymahtas2.moh.gov.my/files/e-CPG_Management_of_Asthma_in_Adults_(Second_Edition)%20- %20update%20Oct%202025%20(2).pdfShort Acting B Agonists (SABA) MOA: Rapid bronchodilation via B2-receptor activation Side effects: Hypersensitivity reaction, hypokalemia, tremor, cardiac disorders Monitoring: Frequency of use Example: Salbutamol Counselling points: Use only for quick relief of symptoms, if use >4 puff a day, seek medical reviewLong Acting B Agonists (LABA) MOA: Smooth muscle relaxation after adenylate cyclase activation and increase in cyclic AMP, producing functional antagonism of bronchoconstriction Side effects: Tachycardia, tremor, palpitations, insomnia Monitoring: Adherence, inhaler technique, asthma control Example: Salmeterol, formoterol Counselling points: In combination with ICS, never use LABA alone, not for sudden symptomsLong Acting Anti Muscarinics (LAMA) MOA: Induces bronchodilation via inhibition of muscarinic (M3) receptor on airway smooth muscle, preventing acetylcholine from causing brochoconstriction Side effects: Dry mouth (common), headache, palpitations, cough Example: Tiotropium, Glycopyrronium Counselling points: Maintain hydration to reduce dry mouthLeukotriene Receptor Antagonists (LKA) MOA: Block leukotriene - mediated bronchoconstriction Side effects: Headache, URTI, GI Upset, rare mood/behaviour changes, elevated liver enzymes Monitoring: Caution for neuropsychiatric symptoms Example: Montelukast Counselling points: Report any mood changes or sleep disturbances immediatelySystemic corticosteroids Used for: Short term use of severe acute exacerbations, effective for preventing short term recurrence of severe asthma exacerbations, usually 5-7 days in adult, 3-5 days in children Delivery: Oral (tablets/liquid), IM, IV Side effects: Sepsis, thromboembolism, gastroesophageal reflux increased appetite, hyperglycemia, mood changes Example: Prednisone, prednisolone, hydrocortisoneWhen counseling an asthmatic patient, focus on key lifestyle modifications to optimize control: Trigger Management & Lifestyle: Identify and avoid known allergens and environmental irritants (such as dust mites, pollen, and strong fumes). Consider smoking cessation or avoiding second-hand smoke—as smoking actively impairs medication efficacy and triggers severe airway inflammation. Activity & Rehabilitation: Consider doing regular light physical activity to maintain cardiovascular health without precipitating exercise- induced bronchospasm. Breathing exercises (such as diaphragmatic or pursed-lip breathing) can also improve ventilation efficiency and lower stress during mild symptoms. COUNSELLING POINTS
OCTOBER 3 ED 2026R D Osteoporosis is a skeletal disorder characterised by compromised bone strength predisposing a person to an increased risk of fracture. Osteoporosis-related fractures have been recognised as a major health problem in the elderly. The common sites of fracture are the spine, wrist and hip. Hip fractures are associated with high morbidity and mortality. 03 CLASSIFICATION Most patients are asymptomatic until fractures have occurred Common clinical presentations include: Increasing dorsal kyphosis (Dowager’s hump) A low-trauma fracture, e.g. after a fall from standing height or less Historical height loss of >4cm Acute back pain following seemingly innocuous activities, e.g. bending, lifting objects, coughing or sneezing PRIMARY OSTEOPOROSIS Causes include: Postmenopause - due to accelerated bone loss related to estrogen deficiency Age-related - occurs in men and women Idiopathic - rarely occurs SECONDARY OSTEOPOROSIS Causes include: Endocrine - primary hyperparathyroidism, hypogonadism, Cushing’s syndrome, T2DM, thyrotoxicosis Drugs - glucocorticoids, heparin, immunosuppressants, thiazolidinediones, anticonvulsants (e.g. phenytoin) Chronic diseases - CKD, SLE, rheumatoid arthritis, stroke, Parkinson’s disease, chronic liver disease Nutrition - anorexia nervosa, malabsorption syndrome, inflammatory bowel disease Others - Multiple myeloma and malignancy RISK FACTORS DIAGNOSIS & INVESTIGATIONS Bone mineral density (BMD) measurement via dual-energy x-ray absorptiometry (DXA) at the femoral neck, total hip or lumbar spine remains the gold standard for diagnosis BMD is reported as a T-score PHARMACY DEPT HSM OSTEOPOROSIS CLINICAL PRESENTATION ALL YOU NEED TO KNOW Non-modifiable risk factors: Advancing age Ethnic group (Oriental & Caucasian) Female gender Premature menopause (<45 years) including surgical menopause Family history of osteoporotic hip fracture in first degree relatives Personal history of fracture as an adult Modifiable risk factors: Low calcium and/or vitamin D intake Sedentary lifestyle Cigarette smoking Excessive alcohol intake (≥3 units/ day) Excessive caffeine intake (≥3 drinks/ day) Low body weight (BMI <19kg/m )2 Estrogen deficiency Initial investigations include FBC, ESR, bone profile (serum calcium, phosphate, albumin), RFT, LFT, 25-hydroxy vitamin D [25(OH)D] level PREVENTION Adequate calcium and vitamin D intake Maintain healthy body weight Regular physical activity, e.g. weight-bearing exercise Avoid smoking and excessive alcohol intake Prevention of falls Hip protectorsREFERENCES1.Clinical Practice Guidelines (CPG) on Management of Osteoporosis 3rd Edition (2022). Ministry of Health, Malaysia.
04 REFERENCES OCTOBER 3 ED 2026R D PHARMACY DEPT HSM OSTEOPOROSIS PHARMACOLOGICAL TREATMENT Bisphosphonates (bone resorption inihibitors) Contraindication: esophageal abnormalities, hypocalcaemia, inability to stand or sit upright for at least 30 or 60 minutes Precaution: should not be used during pregnancy or in breastfeeding women, not recommended for patients with renal impairment (eGFR < 30 ml/min) Complications: Atypical Femoral Fractures, Osteonecrosis of Jaw Examples: 1.Alendronate Sodium 70mg Tablet Dose: 70mg once weekly, preferably taken on the same day every week 2.Alendronate Sodium 70mg + Cholecalciferol 5600IU Tablet (Fosamax Plus®) Dose: 1 tab once weekly, preferably taken on the same day every week 3.Ibandronic Acid 150mg Tablet (Bonviva®) Dose: 150mg once monthly, preferably taken on the same date each month Denosumab 60mg/ml Prefilled Syringe (Prolia®) MOA: an IgG that inhibits the formation, function, and survival of osteoclasts by inhibiting RANK ligand, thus reducing bone resorption an effective anti-resorptive treatment for osteoporosis especially for those at high risk of osteoporotic fractures Dose: 60mg once every 6 months by SC inj Teriparatide 20mcg/80mcl Injection in Prefilled-Pen (Forteo®) anabolic agent indicated for individuals with very high risk for fractures or osteoporosis not responding to treatment Dose: 20mcg once daily by SC inj, Max duration: 24 months1.Clinical Practice Guidelines (CPG) on Management of Osteoporosis 3rd Edition (2022). Ministry of Health, Malaysia. 2.Alendronate Sandoz Product Leaflet 3.Fosamax Plus Product Leaflet 4.Bonviva Product Leaflet 5.Formulari Ubat HSM Vitamin D supplementation (at least 800 IU/day) in combination with calcium (1200 mg/day elemental calcium) is recommended for fracture and fall prevention in people above 50 years of age who are at risk of fractures, particularly when initiating active osteoporosis therapies 1.Calcium supplements - Calcium Carbonate 500mg Tablet, 500mg Capsule & Calcium Lactate 300mg Tablet 2.Vitamin D supplements - Calcitriol 0.25mcg Capsule & Alfacalcidol 0.25mcg, 1mcg Capsule To allow adequate absorption, Alendronate & Fosamax Plus® must be taken at least 30 minutes whereas Ibandronate must be taken at least 60 minutes before the first food, drink (other than plain water) or other medication of the day To facilitate delivery to the stomach and thus reduce the potential for esophageal irritation, 1) oral bisphosphonates should only be swallowed upon waking up for the day with a full glass of plain water while standing or sitting, 2) should not crush or chew the tablet, 3) should not lie down for at least 30 minutes for Alendronate & Fosamax Plus® and 60 minutes for Ibandronate and until after their first food of the day, 4) oral bisphosphonates should not be taken at bedtime or before waking up for the day Receive supplemental calcium and vitamin D if dietary intake is inadequate Overdosage: Milk or antacids should be given to bind oral bisphosphonates. Due to the risk of esophageal irritation, vomiting should not be induced and the patient should remain fully upright. MEDICATION AVAILABLE IN HSM COUNSELLING POINTS
OCTOBER 3 ED 2026R D DIABULYN R GENSULIN RVisual Inspection for Gensulin R: should have yellow strip on the bottom of the penfill and solution inside must be completely clear. 1.Reassure on Brand Change: Inform patient that Gensulin R / Wosulin N contains the same insulin molecule and potency as previous Insugen brands. Re-emphasize color coding and new package appearance.1. 2.Pen Compability: Both new Gensulin and Wosulin penfills are fully compatible with existing Insupen devices, so no immediate hardware change is needed for patients. The hospital will also be receiving the new Pennova pen devices soon (guidelines for Pennova usage and dispensing will be shared in an upcoming announcement). 3.Resuspension Technique, Priming Routine & Storage Condition for Gensulin/Wosulin penfill is the same as existing Diabulyn brand. 4.Hypoglycemia & Self-Monitoring: Remind patient to log blood glucose closely during the first 2 weeks of brand transition and carry fast-acting carbohydrates in case of hypoglycemic event. 1.Pharmacists must double-check every prescription to verify the exact new brand (Gensulin R vs. Wosulin N). 2.Always cross-check the insulin name instead of box/penfill color coding to ensure safe patient delivery. 3.Stay vigilant against Look-Alike Sound-Alike (LASA) mix-ups, taking extra care when dispensing or administering Wosulin N due to its strong visual resemblance to the current Diabulyn 30/70 packaging and penfill labeling. WOSULIN N Look-Alike 05 PHARMACY DEPT HSM MEDICATION SAFETY INSULIN PENFILL BRANDS TRANSITION MEDICATION SAFETY AT FILLING & CQDC STATION KEY COUNSELLING POINTS AT DISPENSING STATION Hospital Seri Manjung (HSM) will soon transition its insulin penfill stock, changing short-acting Diabulyn R to Gensulin R and intermediate-acting Diabulyn N to Wosulin N. DIABULYN N WOSULIN NVisual inspection for Wosulin N: Read the label at aluminium foil of penfill packaging for the correct medication. DIABULYN 30/70
Sambutan hari farmasi sedunia 06 peringkat Jabatan Farmasi, pada 25hb September 2026
07 hari pelancaran kempen kesedaran kerintangan antimikrob sedunia peringkat negeri Perak 6hb Oktober 2026
1 Nur Izzah Binti Mohd Khairuddin PF UF9 (K) 2 Chong Lin Zheng PF UF9 (K) 3 Nurul Hidayah bt. Abdul Habib PT N2(TBK 1) S T A F F M O V E M E N T Transferred Out 08 PHARMACY DEPT H S M 2026 OCTOBER 3 ED 2026S T 1 Zawiah binti Zainal KJF 2 Azreem Izziana binti Abu PT N2 (TBK 1) Transferred In