Rx Note

Introduction Miliaria, also known as heat rash, sweat rash or prickly heat, is a common skin disease caused by blockage and/or inflammation of eccrine sweat ducts. The blockage leads to backflow of eccrine sweat into the dermis or epidermis, resulting in a rash comprised of sweat-filled vesicles under the skin. The type of miliaria that develops depends on the depth at which the duct is blocked. Miliria crystallina - Occurs when the duct is blocked superficially, within or close to the stratum corneum. Miliaria rubra - The most common type; occurs when the duct is blocked deeper within the epidermis. Miliaria profunda - Occurs when the eccrine duct is blocked at or below the epidermal-dermal junction. Common triggers include hot and humid environments (especially shortly after moving to a tropical climate), strenuous physical activity, febrile illness and occlusion of the skin. Management The rash is usually self-limited and resolves without medical intervention. The primary treat...

Introduction In a community pharmacy or hospital setting, you will frequently see patients purchasing or using an incentive spirometer after abdominal/thoracic surgery or during a lung illness (such as pneumonia). Incentive spirometry is performed using devices which provide visual cues to the patients that the desired flow or volume has been achieved. The purpose is to facilitate a sustained maximal inspiration (a slow, deep breath) . There are two main types you will encounter: Volume-oriented -  The patient inhales to raise a single large piston to a specific target volume market. Flow-oriented -  The patient inhales to raise two or three lightweight balls in separate chamber. How to Use Patient technique is critical. The most common patient error is attempting to blow into the device like a balloon, rather than inhaling through it. Patient should be in a relaxed position suitable for deep breathing (e.g. sitting upright in a chair or side lying if extra volume is require...

Introduction Pulse oximetry measures peripheral arterial oxygen saturation (SpO 2 ) as a surrogate marker for tissue oxygenation. It has become the standard for continuous, non-invasive assessment of oxygenation. Pulse oximetry uses spectrophotometry to determine the proportion of haemoglobin that is saturated with oxygen (i.e. oxyhaemoglobin) in peripheral arterial blood. How to Use a Pulse Oximeter NOTES: Ensure the finger you are going to use ( index finger or middle finger ) does not have any nail varnish, polish or a false nail on it, as these block the light sensor. The best reading is achieved when your hand is warm, relaxed and held below the level of your heart . Skin pigment significantly impacts the accuracy of pulse oximetry. Extensive recent data shows that in patients with darker skin tones, pulse oximetry often overestimates oxygen saturation, leading to clinically important hypoxaemia remaining undetected and untreated. Motion can induce considerable error into pulse...

Introduction When I chose pharmacy as my future career in secondary school, I had little idea of what I had actually signed up for. In my grandmother's simple description, it was an officer sitting inside an air-conditioned room, telling patients or customers how many tablets to take and how many times a day. Or, in a netizen's description, it was a high-paying job that merely involved putting medications into plastic envelopes and pasting medical instruction labels on them. However, the truth you come to learn through a university education is that there is much more beneath the surface. Beyond the physical tasks, there are constant clinical decisions, critical thinking, and dosage verifications happening in our brains. We share a portion of the responsibility when medication errors inevitably occur at any stage. As a practicing pharmacist of more than ten years, I can frankly tell you that most pharmacists working in government clinics and hospitals earn a stable but moderat...

Introduction Controlling glycemia is an integral component of diabetes mellitus management. Patients are often advised to do self-monitoring of blood glucose with a glucometer. Glucometer - Capillary Blood Glucose Glucometers are highly sophisticated (requiring only a single drop of blood) and are conveniently sized and portable. It provides an instantaneous glucose level result. There is a misconception among the public that glucometer result reflects overall blood glucose control. They often choose to fast the night before performing the test or avoid recording the measurement after a binge eating, which then gives a false impression on blood glucose control. Normal ranges for serum glucose concentrations are often quoted as Non-fasting <11.1 mmol/L Fasting 3.3-6.0 mmol/L Fasting (Impaired glucose tolerance) 6.1-7.0 mmol/L NOTE: Inpatient glycemic target, ICU and non-ICU is 7.8-10 mmol/L. In selected patients, stricter target of 6.1-7.8 mmol/L can be considered while avoidin...

Introduction Mal de Débarquement Syndrome (MdDS), which translates to "sickness of disembarkation", is a rare and often misunderstood neurological condition. It is characterized by a persistent phantom perception of self-motion, typically described as rocking, bobbing, or swaying. Essentially, the brain continues to feel as though it is in motion even after the person has returned to stable ground. While these sensations are common immediately following an ocean cruise, a long flight or a cross-country road trip, MdDS occurs when the symptoms fail to resolve. Current research suggests that MdDS results from the central nervous system’s inability to "re-adapt" to a stable environment after being habituated to rhythmic motion. Symptoms The primary symptom of MdDS is a constant feeling of being "at sea". Common experiences include: Persistent rocking, swaying or bobbing sensations Unsteadiness and impaired balance Cognitive symptoms: "Brain fog", co...

Introduction In a community pharmacy setting, almost on a daily basis, we recommend oral antihistamine to our customers, which could be for prevention and treatment of symptoms in allergic rhinitis , allergic conjunctivitis, urticaria , or a variety of other allergic diseases. 1st and 2nd Generation As an overview, antihistamines can be classified into 1st and 2nd generation. This dichotomy was introduced in 1983 to indicate a major pharmacological difference between terfenadine and astemizole. Being less lipid soluble, the second generation antihistamines is thus believed to be less readily penetrated the blood brain barrier, and hence does not cause drowsiness. However, second generation antihistamines are still able to penetrate the blood brain barrier and may cause drowsiness (thought it rarely occurs). In fact, there are textbooks using the terminology of "less sedating antihistamines" to describe the second generation antihistamines, instead of "non-sedating antih...

Introduction One of the key principles that we were taught in pharmacy school is "first, do no harm". If we are unable to help the patients, but at least we should not make it worse. Hence, apart from providing remedies for common symptoms, it is just as vital to recognise the instances that you should refer your customers (patients) to seek medical attention from clinicians. Few valuable community pharmacy references available on the market include Australian Pharmaceutical Formulary and Handbook, 2024 Community Pharmacy: Symptoms, Diagnosis and Treatment, 2026 - Highly recommended Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 2020 MIMS Pharmacy Patient Counselling Guide, 2025 Minor Illness or Major Disease, 2016 Patient Assessment in Clinical Pharmacy, 2025 Symptoms in the Pharmacy, 2025 Australian Pharmaceutical Formulary and Handbook, 2024 Still vivid in my mind, in my first week of community pharmacy placement in university years, my preceptor ...

Introduction Cough is the most common respiratory symptom and is usually self-limiting (will resolve in 3-4 weeks without the need for antibiotics). Coughing is the body's defence mechanism to clear the airways of foreign bodies and particulate matter . Questions to Ask the Patient Some important information to be gathered include Duration of the cough Duration longer than 2-3 weeks with no improvement or is getting worse suggests non-acute cause of cough and requires further investigation, such as tuberculosis , asthma , chronic bronchitis, COPD , lung cancer, heart failure and gastroesophageal reflux . Chest pain, haemoptysis (coughing up blood), shortness of breath and wheezing Suggest possible sinister pathology or severe cases of simple viral infection, and requires further investigation. Age Children or adult? If children, how many years old? Persistent nocturnal cough in children Suggests possible asthma , especially those with family history. Nature of cough Coughs can b...

Introduction Every day, patients enter a pharmacy, requesting remedies for their ailments. Some may have initial ideas about their condition. However, as frontline healthcare providers, community pharmacists must carefully assess the symptoms presented by patients, make clinical decisions for minor ailments, and refer patients to doctors when necessary. However, there are some factors that make this clinical decision particularly challenging for us. Poor knowledge and skill in differential diagnosis Lack of access to patient's medical history or full medications profile Some patients did not disclose sufficient history of presenting illness , due to poor health literacy, perceived lack of privacy, stigma and embarrassment, language barrier, fear of discrimination, cultural beliefs and practices or past negative experiences with healthcare. Unavailability of diagnostic testing The symptoms may be presented on behalf of another people A detailed conversation needs to be initiated ...

Introduction During my first year of university, the first key point that I was taught to remember is that the maximum recommended dose of paracetamol (acetaminophen) is 4 grams per day. In fact, the lecturer even highlighted that this will be in the final examination. Only later did I learn that a reduced maximum dose (typically 3 grams per day) is recommended for patients at increased risk of liver toxicity . Uses and Dosage Due to its safety profile, paracetamol is a very commonly used drug in both fever and pain management. Often, adult patients (customer) are counselled to take 2 tablets of paracetamol 500 mg up to 3 or 4 times a day (i.e. not more than 8 tablets of 500 mg paracetamol a day). Nonetheless, looking across the products available in the market, paracetamol presents in a number of Brands, such as Uphamol, Panadol, Pamol and Paracil. Combination with other medications (such as cough and cold or muscle relaxants), such as Febricol, Decolgen FX, Maxigesic, Norgesic, Sun...