Rx Note

Introduction A hiccup occurs due to an involuntary, intermittent, spasmodic contraction of the diaphragm and intercostal muscles. Although hiccups most commonly are self-limited (last for <48 hours), they can become prolonged and decrease quality of life by interrupting eating, drinking, sleeping and conversation; exacerbating pain; causing insomnia, fatigue and mental stress; or adversely affecting moods. Hiccups lasting >48 hours are classified as persistent, while those lasting >1 month are considered intractable. Management Treatment of hiccups should be focused on the underlying cause when possible. For patients not known to have an advanced malignancy and who experience hiccups lasting more than 48 hours, a thorough history, physical examination and some laboratory testing should be performed to try to determine the underlying aetiology, even though in many patients a specific cause is not found. Medications associated with hiccups include dexamethasone, diazepam, midaz...

Introduction Medications can cause ocular adverse effects. Most disappear once the drug is discontinued (such as blurry vision from an anticholinergic). In other cases, the damage can be permanent (such as vision loss with a PDE-5 inhibitor). Common Drugs Known to Cause Vision Changes or Damage Eye inflammation Bisphosphonates (e.g. alendronate) - conjunctivitis, episcleritis, scleritis, keratitis or uveitis Retinal changes/retinopathy Chloroquine Hydroxychloroquine Optic neuropathy Amiodarone (plus corneal deposits) Ethambutol Linezolid Intraoperative floppy iris syndrome (IFIS); causes difficulty in cataract surgery Alpha-blockers (e.g. tamsulosin) Colour discrimination Digoxin (with toxicity) - yellow/green vision PDE-5 inhibitors (e.g. sildenafil) - greenish tinge around objects Voriconazole - Colour vision changes Vision loss/abnormal vision Clomiphene - blurred vision, reduced visual acuity, phosphenes (flash in the visual field), scintillating scotomas (spots in the visual...

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 Dysphagia is the symptom of difficulty or discomfort during swallowing . Oropharyngeal dysphagia - Difficulty initiating swallowing or coordinating the movement of food or liquid from the mouth to the upper esophagus. Esophageal dysphagia - Difficulty transporting the food or liquid through the esophagus into the stomach. The 3 most significant consequences of dysphagia are Choking risk Aspiration pneumonia Malnutrition Common Causes Optimally, the assessment of swallowing function is performed by a speech therapist or speech language pathologist. The most common cause of oropharyngeal dysphagia is neurological , associated with conditions such as stroke or Parkinson disease, and swallowing can also be affected by drugs such as antipsychotics, barbiturates, anticholinergics, diuretics and mucosal anesthetics. Dysphagia occurring after stroke is reversible or improvable in a majority of cases; however, dysphagia associated with dementia or Parkinson disease has a poore...

Introduction A customer walking to your community pharmacy, complained that after he started taking the vitamin B supplement that you previously recommended, his urine turned yellowish. Yellow urine is a harmless side effect that is caused by a pigment called riboflavin, which is vitamin B 2 . In reality, it is not uncommon for certain medicines, including complementary medicines and vitamins, to cause changes in the colour of urine, faeces or bodily secretions. Most urine discolorations due to medications are harmless and temporary. However, abnormal urine colour can be distressing to patients. Hence, it is good to counsel patients on possible discolouration. NOTE: Certain foods and medical conditions can also cause urine discolouration. Medicines that Can Cause Discolouration of Urine Medicines that Can Cause Discolouration of Faeces Medicines that Can Cause Discolouration of Skin, Nails and Eyes Examples of medicines that can cause skin and nail discolouration are as follows: Amio...

Introduction An enteral feeding tube (EFT) provides a means of maintaining nutritional intake when oral intake is inadequate or when there is restricted access to the gastrointestinal tract , e.g. owing to obstruction. It is also increasingly being used as a route for drug administration. Types of Feeding Tubes The type of feeding tube used will vary depending on the intended duration of feeding and the part of the GI tract the feed needs to be delivered to. Nasoenteric tubes are used for short- to medium-term feeding (days to weeks), whereas Ostomy tubes are used for long-term feeding (months to years) Enteral Feeding Tubes The external diameter of the feeding tube is measured in French unit (Fr) where 1 Fr = 0.33 mm. Small bore tubes may be between 5-12 French. Large bore tubes are those which measure more than 14 French. Enteral feeding tubes are made up of polyvinyl chloride (PVC), polyurethane (PUR), silicone or latex. Silicone and latex tubes are softer and more flexible than po...

Introduction Ramadan Ramadan is the 9th month of the Muslim calendar and the daylight fasting that accompanies it is 1 of the 5 pillars of Islam. The month-long (29-30 day) fast is obligatory for all healthy Muslims who have reached puberty. Followers must refrain from eating and drinking between dawn and sunset, and must also abstain from using oral medications, sexual activity and smoking. Exemptions include the elderly, children, the sick, those who are traveling (journey >89 km) and breastfeeding or pregnant women. Instead, they can honour Ramadan through charity, such as by feeding a less privileged person in lieu of fasting. Medical Treatments that DO NOT nullify fasting Use eye drops, ear drops and ear cleaning (provided no limit to the eardrum). Sublingual tablet (beneath the tongue) provided placed beneath the tongue and not swallowed. Perform dental procedures; fillings, extractions, cleaning teeth or brushing provided the individual who fasted did not swallow any su...

Introduction In Malaysia, pharmaceutical products including vitamins & health supplements are controlled under Poisons Act 1952 Dangerous Drugs Act 1952 Sale of Drugs Act 1952 Control of Drugs and Cosmetics Regulations 1984 Only pharmaceutical product inclusive vitamins and health supplements which is registered with the Drug Control Authority, Ministry of Health Malaysia (MOH) and notified cosmetic with MOH is allowed to be imported and the importation shall be done by an importer who is licensed to import such product or the notification holder for the notified cosmetics. Traveller's Guide for Personal Use International visitors and any person returning from overseas can bring in medicines for personal use based on requirement of the Acts & Regulations mentioned above. Any person entering Malaysia is allowed to carry their medicines with them for their own personal use or the use by an immediate family member who is travelling with them. Section 8(2) Poisons Act 1952 Reg...