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A common viral illness that usually affects infants and children younger than 5 years old. It can sometimes occur in older children and adults. It is caused by enterovirus named coxsackievirus a16 & enterovirus 71.

From 1ST Jan until 23rd July 2018 , 35886 cases of Hand,

Foot & Mouth disease HFMD reported nationwide

Enterovirus 71 which causes hand-foot-and-mouth

disease

• Hand Foot & Mouth Disease can be transmitted through:

Saliva Nasal mucus Blister fluid Feces of an infected person Close contact eg. Hugging

or touching surfaces that are contaminated

• Infected persons are most contagious during the first week of the illness, BUT the period of communicability can last for several weeks

• HFMD is not transmitted to or from pets or other animals.

May involve ALL of the following signs and symptoms OR SOME of them. They include:

Most common complication is dehydration. If severe enough, intravenous (IV) fluids may be needed.

It can cause sores in the mouth and throat, making swallowing painful and difficult.

Hand-foot-and-mouth disease (HFMD) is a minor illness causing only a few days of fever and relatively mild signs and symptoms. However, it can also cause complications such as:

Viral meningitis. This is a rare infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord. Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. However, it rarely occurs.

Currently there is NO vaccine to protect against the viruses that cause HFMD & there is NO any specific treatment for this disease. However, precautionary measures can definitely lower the risk of being infected. Some of the things that can be done to relieve symptoms: -Take over the counter medications to relieve pain and fever -Use mouthwashes or sprays that numb mouth pain

Ways To Prevent HFMD

Adopted from:www.mypositiveparenting.org

&

-NST June 7,2017

42.5 32.6

31.8 28.2

27.6

0 10 20 30 40 50

Malaysia

Singapore

Philippines

Prevalence of overweight (BMI≥25) among adults, ages 18+, 2016

Percentage of Overweight (%)

Classification BMI

Underweight < 18.50

Normal range 18.50 – 24.99

Overweight ≥25.00

Obese ≥30.00

Source: WHO 2016 Available at http://apps.who.int/bmi/index.jsp?introPage=intro_3.html

)Height(mx Height(m)

(kg)Weight

BMI is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults.

BMI=

/UNHEALTHY LIFESTYLE HABITS

lack of exercise (sedentary lifestyle), increased intake of fast

food/calorie-rich, nutrient poor food

AGE

high incidence during childhood & for adult, the risk increases with

age until 60-65 years old

FAMILY HISTORY & GENETICS

Obesity risk is 2-8 times higher with family history of obesity

RACE & ETHNICITY

Studies shows in Malaysia, rates were higher in Indian & Malay

women, while for men; Chinese men have higher incidence of obesity

Source: WHO Global Health Observatory (GHO) data Available at http://www.who.int/gho/ncd/risk_factors/overweight/en/

UNHEALTHY ENVIRONMENT

Increased usage of vehicle rather

than walking/cycling

SEX

Greater in female than male.

However, women tends to store less

unhealthy fat in the abdomen than men

SOME MEDICAL CONDITIONS

endocrine disorders :

Hypothyroidism, Cushing syndrome & tumors (eg.

craneopharingioma – tumor that develop

near parts of the brain that control hunger)

MEDICATIONS

Some medications from these category can cause weight gain,

leading to overweight & obesity:

-Antipsychotics: Atypical antipyschotics

-Antidepressants: eg. amitriptyline, imipramine , phenelzine,

paroxetine & mirtazapine

- antiepileptics: sodium valproate, carbamazepine, gabapentin

-Antihyperglycemics: Insulin, meglitinides, sulfonylureas &

thiazolidinediones

&

(increase in BP, causing stroke)

(Fat cells may release hormone that affect cell growth, leading

to cancer eg. breast, colon, rectum, endometrial,

gallbladder & kidney cancer)

(studies shows 87% DM type 2 patients are obese &

overweight)

(Extra fats build up at liver causing liver injury )

(Increased in fat stored around neck,

making airway smaller, causing difficulty in breathing)

(since heart need to pump harder to supply blood to all cells)

(Increase in BP, cholesterol & sugar, increases risk for heart diseases)

(Increase in blood pressure & blood sugar level, causing risk for kidney disease)

(Pain & stiffness of joint, due to extra pressure on joint/cartilage)

Drug therapy is considered along with diet, exercise and behaviour modification after a careful evaluation of risks and benefits. Anti-obesity drugs should be used only under careful medical supervision and should be part of a long-term management strategy. A patient should only be started with drug therapy if they have tried diet and exercise modification for 6 months and have: 1. BMI between 25 and 27.5 kg/m2, and at least two of these

co-morbidities such as type 2 diabetes mellitus, coronary heart disease, cerebrovascular disease, hypertension, hyperlipidemia or waist circumference more than 90 cm for men whereas, more than 80 cm for women.

2. BMI ≥ 27.5 kg/m2. 3. Symptomatic complications of obesity such as severe

osteoarthritis, obstructive sleep apnea, reflux oesophagitis, and the compartment syndrome.

Anti-obesity drugs can be divided into two groups which are those acting on the gastrointestinal system to reduce fat absorption such as orlistat and those acting on the central nervous system (CNS) to suppress appetite such as phentermine and sibutramine.

Achieve more than 5% weight

loss by 3 to 6 months without

any weight regain

Orlistat Available brands in Malaysia : Xenical, Cuvarlix Both are available in capsule form

Sibutramine Registration of products

containing sibutramine has BEEN SUSPENDED Drug Control Authority (DCA) on October 2010 due to safety concern.

Sibutramine Cardiovascular

Outcomes (SCOUT) study conducted by Abbott Laboratories on their product Reductil®, confirmed an increase in cardiovascular risk in obese and overweight patients taking sibutramine .

Phentermine Available brands: Adipex Retard, Duromine Phentermine is a group B poison & it is strictly

controlled by doctor’s prescription

Surgery is indicated in patients with severe obesity (BMI ≥ 40 kg/m2 or between 35 and 40, with major weight related comorbidities), when other measures have failed, and who are suffering from serious complications of obesity. Surgical therapy can result in sustained weight loss from 50 kg to as much as 100 kg over a period of 6 months to 1 year. The aim of surgery is to alter the gastrointestinal tract to reduce net food intake. It may cause nutrient deficiencies and gastrointestinal symptoms such as “dumping syndrome” or gallstones. Surgical interventions commonly used in Malaysia include gastric partitioning (Vertical gastric banding) and gastric bypass (Roux-en-Y).

Vertical gastric

banding

Gastric bypass

Counselling for lifestyle

changes

Contingency management

Cognitive & behavioural

strategies

Weight loss support

groups

Stress management

Stimulus control (eg. avoid

snacking when watching

TV)

Portion control Self-monitoring

Physical activity

should be an

INTEGRAL part

of weight loss

therapy and

weight

maintenance

because it

contributes to

weight loss,

decreases

abdominal fat

and increases

cardio-respiratory

fitness.

45–60 min/day

Low Calorie

Diet

Lower-Fat Diet

Very Low-Calorie Diet

Provides a calorie deficit of 500 to 1000 kcal/d from maintenance requirement & is important for weight loss and prevention of weight regain

Lowering fatty food intake produce weight loss primarily by decreasing caloric intake

Intake of 200 to 800 kcal/day indicated for moderately to severely obese patients & results in most rapid weight loss

Dietary education

Limit fats and oils during cooking

Evaluate energy value & nutrition labels

Reduce of portion sizes

Reduce intake of both high-fat & high-carbohydrate food

Maintain adequate water intake

Limit alcohol consumption

GOAL

NAMA GENERIK JENAMA LAMA JENAMA BARU

AMLODIPINE 5MG Tablet AMCARDIA

(Unique Pharmaceutical Laboratories, India)

NULOP 5 (Sai Mirra Innopharm Pvt. Ltd,

india)

JENAMA LAMA JENAMA BARU

JENAMA LAMA JENAMA BARU

NAMA GENERIK JENAMA LAMA JENAMA BARU

METFORMIN 500mg tablet GLUMET DC

(Pharmaniaga Manufacturing Berhad)

CCM METFORMIN (Duopharma (M) Sdn. Bhd)

JENAMA BARU

NAMA GENERIK JENAMA LAMA JENAMA BARU

DONEPEZIL 10MG tablet DEMEALRAN

(Sun Pharmaceuticals Ind. Ltd)

TORPEZIL (Torrent Pharma)

Sila isi borang aduan produk (BORANG BPFK 418.4)

sekiranya terdapat sebarang masalah selepas ubat

ditukar dari jenama lama ke jenama yang baru

Sila hubungi Seksyen

Farmasi Maklumat Ubat (DIS) untuk maklumat lanjut

di talian sambungan 6083 atau 5609.

JENAMA LAMA

NO NAMA UBAT CATATAN

1. Dothiepin HCl 25 mg Capsule/Tablet Product discontinued (Mesy JKUT 1/2018)

2. Ketoconazole 200 mg Tablet

Product discontinued. Alternative Griseofulvin 125mg Tab (ultramicrosize) (Mesy JKUT 1/2018)

3. Glibenclamide 5 mg Tablet Removed from FUKKM list (Pindaan

FUKKM Bil 1/2018)

NO NAMA UBAT CATATAN

1. Methylphenidate HCl 18 mg & 36 mg Extended-release Tablet (Concerta®)

Refer to 16.04.02 (Mesy JKUT Bil 1/2018)

2. Atomoxetine HCl 40mg Capsule (Strattera®)

Refer to 12.05.04 (Mesy JKUT Bil 1/2018)

3. Permethrin 1% w/v Lotion Refer to 06.07.07 (Mesy JKUT Bil 1/2018)

Formulari Ubat HBUK boleh dimuat turun dari laman web rasmi hospital

http://hbuk.moh.gov.my

NO NAMA UBAT CATATAN

1. Bromhexine HCl 8mg Tablet Change from B to C (Pindaan FUKKM Bil 1/2018)

2. Hyoscine N-Butylbromide 10 mg Tablet

3. Mefenamic Acid 250 mg Capsule

4. Miconazole 2% Cream

Kad Informasi Ubat Allopurinol boleh didapati di HBUK untuk

pesakit yang telah diberikan ubat Allopurinol. Kad ini mengandungi informasi tentang indikasi, risiko kesan sampingan ubat Allopurinol

& tindakan yang perlu diambil sekiranya berlaku kesan sampingan seperti yang disenaraikan dalam kad

Allopurinol tersebut. Kad Allopurinol ini diberikan kepada pesakit di bawah Jabatan Pesakit Luar yang pertama kali dipreskrib

dengan ubat Allopurinol.

Kad Informasi ‘Valproate & Pregnancy’ boleh didapati di HBUK. Kad ini diberikan khas kepada pesakit wanita yang telah diberikan ubat sodium

valproate (Epilim). Kad ini mengandungi indikasi Epilim,

kesan sampingan Epilim kepada wanita yang mengandung &

berpotensi mengandung. Kad ini juga mengandungi nasihat

umum kepada wanita yang sedang menggunakan ubat

Epilim. Kad ini diberikan kepada wanita yang berpotensi

mengandung & dipreskrib dengan ubat Epilim buat

pertama kali.

Valproate is an effective medicine to treat generalized or partial epilepsy and bipolar disorder. It is know that valproate is associated with the risk of abnormal pregnancy outcomes.

DEVELOPMENT DISORDER Exposure to valproate in utero can have adverse effects on mental and physical development of the exposed children. The risk seems to be dose dependent but the threshold dose below which no risk exists. Studies in preschool children exposed in utero to valproate show 20-30% experience delays in their early development such as talking, walking later, low intellectual abilities, poor language skill and memory problems.

CONGENITAL MALFORMATIONS Data derived from a meta-analysis has shown that 10.73% of children od epileptic women exposed to valproate monotherapy during pregnancy suffer from congenital malformations (95%, Cl: 8.16-13.29), which represents a greater risk of major malformations than for the general population whom the risk is equal to 2-3%. The risk is greater at higher dose above 1g daily.

Valproate can be harmful to unborn

children when taken by women

during pregnancy.

Valproate can cause serious birth defects,

which effects the child develops as

grow.

Birth defects include spina

bifida; facial & skull

malformation; heart; kidney;

limbs.

30-40% of preschool (3yrs-5yrs) children

whose mothers took valproate during

pregnancy may have problems with early

childhood development.

Sodium valproate should not be used in female children, female adolescents, woman of childbearing potential and pregnant women.

Sodium valproate should not be used in female children, female adolescents, woman of childbearing potential and pregnant women.

Sodium valproate should be prescribed as monotherapy and at lowest effective dose. Prolonged release formulation is preferred to avoid high plasma concentrations. The daily

dose should be divided into at least 2 single dose.

Women of childbearing potential must use effective contraception during treatment and be informed of the risk associated with the use of sodium valproate during pregnancy.

Patient is advise to contact healthcare professional immediately if they become pregnant or think they might be pregnant.