Rx Note

Introduction For hypertension management in patients without comorbidities , recommended options in most guidelines include: ACE inhibitors - especially for nonblack patients and may reduce mortality ARBs - especially for nonblack patients but they may not reduce mortality and have limited data on comparative efficacy Calcium channel blockers - have limited data on mortality reduction Thiazide-type diuretics - shown to reduce mortality The drug of choice for hypertension in pregnancy is still methyldopa (first line) and labetalol (alternative first line) with nifedipine as second line. Methyldopa, oral 250 mg TDS, doubling every 48 hours (up to 1 g TDS) until BP well controlled. Labetalol, oral 100 mg BD, doubling every 48 hours (up to 400 mg BD) until BP well controlled. Nifedipine, oral 10 mg TDS, up to 20 mg TDS, when BP poorly controlled despite maximum doses of methyldopa ± labetalol. Beta Adrenoreceptor Antagonists Beta-blockers are a class of drugs that slow down the heart rat...

Introduction Giving medicines to infants and children can be challenging because they may refuse to take medications for many reasons, such as fear, taste, embarrassment or inconvenience. Choosing the Right Formulation When selecting medicines for children, it is important to consider factors such as Child's age Swallowing ability Ease of administration Accessibility of suitable formulations of the product Often, oral liquids are the preferred formulation for younger children as they are easier to swallow and allow for flexible dosing based on the child's age and weight. Multiple formulations of the same active ingredient are available and may contribute to dosing errors, such as paracetamol 120 mg/ml and 250 mg/ml suspension. Also, when choosing an oral liquid medicine, the following must be considered: Excipient content, including quantity and suitability Cumulative daily excipient intake from all products being taken Potential adverse effects due to excipients The risk-b...

Introduction Medication administration errors can have a number of negative consequences, including Increased costs Prolonged hospital stays Psychological distress Loss of public confidence in healthcare Patient morbidity or mortality To help prevent medication administration errors, it is important to have clear and accurate guidelines for the dilution and administration of injectable drugs. Malaysia Published in 2011, the Dilution Guide for High Alert Medications serves as a general resource for the approppriate use of HAMs . While informative, the JKN Selangor Dilution Protocol 2017 only covers a select number of drugs. The Dilution Guideline for Injectable Drugs, 2020 is a general reference for healthcare professionals on how to prepare dilutions of certain injectable drugs before administering them to patients. The guideline currently only covers Part 1, which focuses on antimicrobials. In 2022, Antidote Quick Guide (Adult Dose) is prepared to facilitate the healthcare prof...

Introduction Beyond standard swallowing, some oral medications require specific methods for optimal absorption and effectiveness. Sublingual Sublingual tablets are placed under the tongue until completely dissolved for a rapid absorption, bypassing the liver first-pass metabolism . Asenapine (Saphris) - Do not split, crush, chew or swallow. Avoid eating or drinking for at least 10 minutes after administration. Desmopressin (Minirin) - Minirin oral lyophilisate 60 mcg is calculated to correspond to Minirin 0.1 mg tablet. Glyceryl Trinitrate - Do not chew, crush, or swallow sublingual tablet. Orodispersible Tablet Orodispersible tablets are solid unit dosage forms similar to conventional tablets, but they contain super disintegrants, which help them dissolve readily in saliva within a minute in the mouth, eliminating swallowing difficulty. Bilastine 10 mg (Bilaxten ODT) - The orodispersible tablet disperses rapidly in saliva and can be easily swallowed. Alternatively, it may be disp...

Introduction I have encountered some patients who asked about the appropriate timing for taking their oral medication (morning, afternoon or night) when they were advised to take it once a day. Generally, I inform them that the specific timing for taking the medicine is not crucial and they can select a suitable time that suits them best . More importantly, they should take the medications at the same time each day to establish a regular habit. Below are some medications that require specific timing. NOTE: Administration of medication before, with or after food is discussed at a separate post. Chronotherapy Chronotherapy involves the administration of medication in coordination with the body's circadian rhythms to maximise therapeutic effectiveness and minimise/avoid adverse effects. This is a promising aspect, but more extensive research is needed. Medications that Cause Drowsiness Logically, medications that can cause drowsiness, such as benzodiazepines , opioids, first-gener...