Vol. 8 No. 2 (2022): Malaysian Journal of Pharmacy


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Published: 31 December 2022

In this issue:

Editorial

The Paradigm shift of Pharmacy Profession at Post-COVID-19 Era in Malaysia

Original Research Articles

  • Systematic Review of Population Pharmacokinetic Models of Isoniazid in Children and Adults with Tuberculosis
  • Evaluation of the Impact of Clinical Pharmacists’ Educational Intervention on the Knowledge of Patients with Chronic Kidney Disease
  • An Evaluation of Medication Adherence to Tyrosine Kinase Inhibitors Among Chronic Myeloid Leukemia Patients Underwent Medication Therapy Adherence Clinic in a Malaysian Tertiary Hospital
  • Cyclosporine use in post haematopoietic stem cell transplant: Factors affecting the initial cyclosporine concentration and its association with acute graft-versus-host-disease

Supplementary

  • Proceedings of 28th Federation of Asian Pharmaceutical Associations, MPS-National Pharmacists Convention 2022
  • Proceedings of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022

The Paradigm shift of Pharmacy Profession at Post-COVID-19 Era in Malaysia

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    Abstract

    Malaysia currently has a total 19,260 registered pharmacists with active practising certificate which is regulated by the Pharmacy Board of Malaysia and relevant pharmacy laws and regulations. In tandem with the evolvement of medicine, pharmacists are responsible for ensuring the safe and effective use of medications, and they play a key role in providing healthcare to the public as a frontliner, educator and clinician. For instance, in community pharmacies, pharmacists dispense prescription and over-the-counter medications, compound extemporaneous preparation, provide medication, immunization, travel medicine and disease advice to patients, and offer other value added services such as medication adherence tool, blood pressure and blood glucose monitoring. It is worth noting that with the implementation of Regulation 23 of Poison Regulation as early as year 1952, dispensing separation have been fully implemented in all public hospitals whereby all supply of medications should be solely on prescription and the supply to be recorded, labelled and dispensed at the pharmacy. With medication dispensing as the core professional duties, hospital pharmacists are also responsible for the procurement, storage, and distribution of medications, as well as the preparation of radioactive diagnostic, cytotoxic drug and sterile products. They also actively involved in patient care, such as pharmacokinetics, pharmacotherapy services, medication therapy adherence clinic, medication reconciliation, reviewing medication orders and providing drug and poison information to healthcare professionals.

    Systematic Review of Population Pharmacokinetic Models of Isoniazid in Children and Adults with Tuberculosis

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      Abstract

      Introduction: Isoniazid (INH) is one of the first-line anti-tuberculosis (anti-TB) drugs that have both bactericidal and bacteriostatic properties depending on the rate of mycobacterial growth. Several population pharmacokinetic (PPK) models of INH were established. This systemic review aims to summarise published PPK parameters of INH in the models and to identify covariates influencing the INH pharmacokinetic parameters of models. Method: A search of publications for PPK analyses of INH in volunteers or TB patients from 2011 to 2021 was conducted in PubMed and Scopus databases. Reviews, methodology articles, non-compartmental analysis, in vitro, and animal studies were excluded. Result: Twelve studies were included in this review. Most of the included studies described the pharmacokinetics of INH as two-compartmental with first-order absorption and elimination in most of the included studies. Eleven studies reported N-acetyltransferase 2 (NAT2) genotype polymorphism as the most common significant covariate affecting the pharmacokinetic parameters of INH. Other common significant covariates reported include body weight (n = 2) and body mass index (BMI) (n = 1). Conclusion: The variability of population clearance parameters of INH was explained mainly by the NAT2 genotype polymorphism. This indicates that to optimise and rationalise the dosing regimen of INH, a patient’s NAT2 genotype should be considered. At the same time, body weight and BMI values should be considered when making dosing adjustments for INH to achieve the therapeutic range.

      Evaluation of the Impact of Clinical Pharmacists’ Educational Intervention on the Knowledge of Patients with Chronic Kidney Disease

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        Abstract

        Introduction: Chronic kidney disease (CKD) is a progressive disease associated with high morbidity and mortality at all stages. Objective: To determine the impact of pharmacists’ educational interventions on the CKD knowledge and knowledge levels of patients with pre-dialysis CKD, and to identify potential predictors of good CKD knowledge. Method: Two main healthcare facilities in Maiduguri, Nigeria, were the study settings for this randomised, controlled, prospective study with a 12-month follow-up. Participants were randomised to the usual care (UC) and pharmacists’ intervention (PI) groups on a 1:1 ratio. The PI group was offered usual care plus face-to-face CKD education and self-management of CKD, an educational CKD infographic leaflet, and telephonic interventions. Categorical data were compared using Chi-square or Fisher exact tests where relevant, while an independent sample T-test was used to compare the mean values of the two study groups. A p-value of less than 0.05 was considered to be statistically significant. Result: Baseline characteristics were similar between the PI (n = 73) and UC (n = 74) patients, although participants in the PI group were significantly more female (71.2% vs. 52.7%; p = 0.021). The overall mean knowledge score of the PI group was significantly higher than the UC group at 6 months (18.9 ± 3.4 vs.14.6 ± 4.4, p < 0.001), and at 12 months (19.5 ± 3.8 vs.16.8 ± 6.0, p < 0.001), respectively. At 6 months, a significant proportion of the participants in the intervention group had high knowledge compared with those in the UC group (16.4% vs. 9.0%, p < 0.001). At the end of the study, the adjusted analysis revealed that those between 40 and 64 years of age (AOR 26.3, 95% CI 2.1 – 331.0) and 65 years of age or more (AOR 10.1 95% CI 1.1 – 89.7) were more likely to have good CKD knowledge. Also, participants in the intervention group (AOR 2.7, 95% CI1.0 – 7.2) had a higher likelihood of having good CKD knowledge. Conclusion: Educational interventions provided by pharmacy students/clinical pharmacists resulted in significant improvements in the CKD knowledge of patients with pre-dialysis CKD.

        An Evaluation of Medication Adherence to Tyrosine Kinase Inhibitors Among Chronic Myeloid Leukemia Patients Underwent Medication Therapy Adherence Clinic in a Malaysian Tertiary Hospital

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          Abstract

          Introduction: The treatment of chronic phase chronic myeloid leukemia (CML) has changed dramatically within the last two decades with the emergence of tyrosine kinase inhibitors (TKI). Treatment adherence to long-term TKI is pivotal to improving clinical outcomes in CML patients. Objective: To evaluate medication adherence to TKI and contributory variables affecting medication adherence among CML patients underwent Medication Therapy Adherence Clinic (MTAC). Method: This was a single-centre cross-sectional study conducted between January and December 2021. Malaysia Medication Adherence Assessment Tool (MyMAAT) was employed to assess medication adherence among CML MTAC patients. Descriptive statistics were used to summarise adherence information. Fisher’s exact test was performed to examine relationships between TKI adherence level, demographic and clinical variables. Result: Records of 41 patients (61% male, 39% female) at average age of 51 years old (range = 26 to 75) were analysed. They had been taking imatinib (48.8%) and nilotinib (51.2%) for an average of 6.3 years (range = 17 days to 18 years). Overall, 90% of the patients were adherent (MyMAAT score ≥ 54) to their TKI treatment (95% of patients on imatinib, 86% of patients on nilotinib). Medication adherence to TKI was not significantly influenced by demographic variables (i.e. age, gender) and clinical variables (i.e. years on TKI, number of TKI pills per day, type of TKI therapy). Conclusion: Majority of the CML MTAC patients (90%) were adherent to their TKI therapy. Adherence scores were not affected by the demographics and clinical variables investigated in this study. This affirms the role of pharmacists in implementing an individualised and comprehensive intervention strategy.

          Cyclosporine use in post haematopoietic stem cell transplant: Factors affecting the initial cyclosporine concentration and its association with acute graft-versus-host-disease

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            Abstract

            Background: Cyclosporine (CSA) is required as a prophylaxis of graft-versus-host disease (GVHD) following allogeneic haematopoietic stem cell transplant (HSCT). However, subtherapeutic CSA concentration will increase the incidence of acute GVHD which is one of the major concerns. Objective: This study aims to identify the incidence of patients who achieved therapeutic initial CSA level with a standard intravenous CSA dose of 1.5 mg/kg BD, the occurrence of acute GVHD and factors associated with subtherapeutic CSA at the initial concentration in post-HSCT patients. Method: A retrospective single-centred study was conducted which involved 69 patients who underwent allogeneic HSCT between January 2020 and December 2020 in Hospital Ampang. The factors assessed were patients’ demographics, concurrent medications, liver and renal functions. Mann-Whitney test, Kruskal Wallis test and Spearman correlation test were used to identify the factors associated with sub-therapeutic CSA initial concentration. Result: 17.4% had therapeutic initial CSA level (200-400 ng/mL) and among 69 patients, 37.7% of them developed acute GVHD post-transplantation. Besides, only ethnicity and serum creatinine significantly affected the initial CSA levels. There was no significant association between the initial CSA level and the occurrence of acute GVHD. Conclusion: With the standard intravenous CSA dose of 1.5 mg/kg BD, only 17.4% were able to achieve a therapeutic initial CSA level due to the drug pharmacokinetic variability in different individuals. Hence, this study served as a baseline study for the future prospective clinical study to develop a population pharmacokinetic model in optimising the intravenous CSA dose to achieve the desired therapeutic range and improve the transplant outcomes.

            PROCEEDINGS of 1st International Postgraduates Conference of Pharmaceutical and Health Sciences (IPCPHS) 2022

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              Abstract

              11th – 14th October 2022. Venue: Zoom Virtual Platform, School of Pharmaceutical Sciences, Universiti Sains Malaysia. Theme: 50th Anniversary of School of Pharmaceutical Sciences – Global Opportunities