Vol. 9 No. 1 (2023): Malaysian Journal of Pharmacy


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Published: 30 June 2023

In this issue:

Case study

  • Focal Epilepsy in Pregnancy with Underlying Antiepileptic Drug Allergy: A Case Report

Original Research Articles

  • Contraceptive Awareness, Knowledge and Attitude among Unmarried Young Adults in Malaysia
  • Pharmacy Staffs’ Perceptions and Opinion on the Drive-Through Pharmacy Service During Covid-19 Pandemic at One of the University Teaching Hospitals in Malaysia
  • Exploring Patients’ Experiences with a Pharmacy Drive-Through Medication Dispensing Service: A Qualitative Study
  • Deriving a more Accurate Method to Calculate Creatinine Clearance when using Two Levels of Serum Creatinine (C0 and C24) in Patients with Rapidly Improving Kidney Function – A Simulation Approach
  • Cost Outcomes of Conversion from Simple Syrup to X-Temp® Suspension in Production of Extemporaneous Oral Morphine Solution in Hospital Tengku Ampuan Afzan
  • Exploring Job Satisfaction, Organizational Commitment and the Intention to Stay or Leave the Public Workforce Among Fully-Registered Pharmacists (FRP) in Miri Hospital
  • Psychological morbidities amongst trainee pharmacists in major government hospitals in Sarawak

Focal Epilepsy in Pregnancy with Underlying Antiepileptic Drug Allergy: A Case Report

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    Abstract

    Background: The first-line antiepileptic drugs (AED) approved for focal epilepsy are levetiracetam, carbamazepine, phenytoin, and zonisamide. Uncontrolled seizures can be caused by non-adherence, inadequate treatment, drug tolerance, or adverse drug reactions. In a resource-limited setting, a patient can run out of treatment options if having an AED allergy and is pregnant. Case presentation: A 24-year-old woman with temporal lobe epilepsy was admitted to the hospital due to a breakthrough seizure. Because of her allergy to carbamazepine, with contraindication of sodium valproate in pregnancy and women of childbearing age, clobazam was added to levetiracetam as her treatment regime for focal epilepsy. The patient has reduced seizure frequency since the commencement of clobazam treatment. Conclusion: Clobazam is feasible as an add-on treatment option for focal epilepsy in childbearing-age women with AED allergies. Future studies are needed to establish the safety and dosing adjustment of clobazam in pregnant women.

    Contraceptive Awareness, Knowledge and Attitude among Unmarried Young Adults in Malaysia

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      Abstract

      A lack of accurate sexual knowledge can lead to unwanted pregnancies, unsafe abortions, sexually transmitted diseases (STDs), substantial morbidity and social problems. The aim of this study was to determine awareness, knowledge and attitude toward contraceptives among unmarried young adults in Malaysia. A cross-sectional, survey-based study among unmarried young adults aged between 18-35 years was conducted. Of the 406 participants, male and female respondents were 20.4% (n=83), and 79.6% (n=323) respectively, with 406 (100%) aware of at least one contraceptive method. Overall, the mean total knowledge score obtained was 4.76 ± 2.90 (maximum knowledge score of 12). The total attitude score of the participants was 29.92 ± 4.12 (maximum score of 50). There was a significant positive correlation between knowledge and attitudes towards contraception (ρ=0.317, p=0.000). There is an urgent need to educate Malaysian youths about the importance of contraception for the prevention of unintended pregnancy and STDs.

      Pharmacy Staffs’ Perceptions and Opinion on the Drive-Through Pharmacy Service During Covid-19 Pandemic at One of the University Teaching Hospitals in Malaysia

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        Abstract

        Amidst the COVID-19 pandemic that imposed movement control order, most patient had difficulties in collecting the medication. Therefore, drive-thru pharmacy was perceived as the safer and most convenient option to minimal the infection risks. This study aimed to assess the perception and opinion of the pharmacy staffs about the necessities of drive-thru pharmacy service during COVID-19 pandemic. A cross-sectional study was conducted in one of the university teaching hospitals in Malaysia, from February to May 2022. The respondents were among staffs in various pharmacy units. The staff perceptions and opinion of drive-thru pharmacy in preventing the spread of infectious diseases in the community was determined using descriptive analysis while the open-ended question was analyzed thematically. All (n=109) respondents positively acknowledge the importance of drive-thru pharmacy in reducing the risk of virus infection. The staff agreed that drive-thru service is helpful for patients who are busy with their daily routine (n=103; 94.5%), reduces patients’ waiting time for picking up their medications and perceived that drive-thru Services are useful for senior citizen or caretaker (n=95; 87.2%). In conclusion, although 89 (82.0%) of the respondents highlighted the importance of drive-thru service especially during the spike of the COVID-19 pandemic, thirteen respondents (12.0%) raised hesitate to agree with the implementation of this service due to issue of manpower and satisfied with the existing pharmacy value added services (PVAS) at the hospital. Therefore, re-evaluation of the needs of drive-thru pharmacy during COVID-19 pandemic based on the patients and caregivers’ perception should be conducted in future

        Exploring Patients’ Experiences with a Pharmacy Drive-Through Medication Dispensing Service: A Qualitative Study

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          Abstract

          Introduction: The pharmacy drive-through service (P.D.T.S.) is an innovative medication dispensing service that aims to reduce the hurdles of collecting medications. Through the P.D.T.S., patients may have the convenience of getting medication at the drive-through pharmacy counter. By conducting a qualitative study, we explored the user’s experiences of P.D.T.S. in a public specialist hospital in Miri, Sarawak State of Malaysia. Methods: The P.D.T.S. users who consented to participate were invited to a semi-structured phone interview. We go in-depth on the awareness, barriers, application, improvements, and benefits of the P.D.T.S. The interviews lasted, on average, 15 minutes or until achieving data saturation. Audio recordings were transcribed verbatim, and the transcripts were analysed thematically. Result: Participants perceived the P.D.T.S. as convenient and gave them a sense of safety through physical distancing while collecting their medications. On the contrary, they experienced confusion with the instructions on using P.D.T.S. and some degree of inflexibility, especially in the appointment setting. Conclusion: The users of P.D.T.S. had both positive and negative experiences with P.D.T.S. The negative aspect must be improved, especially the user’s instructions and the appointment system.

          Deriving a more Accurate Method to Calculate Creatinine Clearance when using Two Levels of Serum Creatinine (C0 and C24) in Patients with Rapidly Improving Kidney Function: A Simulation Approach

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            Abstract

            Background Acute kidney injury (AKI) is a common complication in hospitalized patients and is associated with a high mortality rate. A precise estimation of creatinine clearance (Clcr) is of great importance in daily clinical practice, particularly among critically ill patients with unstable kidney function, in guiding drug dosage adjustment. Clcr can be determined precisely through a simple laboratory method (amount of total urinary creatinine divided by the average of two consecutive serum creatinine concentrations) in patients with stable kidney function. However, in patients with rapidly improving kidney function, Clcr determined by the laboratory method can produce highly variable and inaccurate results due to the non-linear changes in plasma creatinine concentrations. Aim To determine the magnitude of discrepancies of Clcr calculated using the two-point average method to the actual Clcr and derive a correction factor for creatinine clearance determined by the two-point average method. Methods Patients with improving kidney functions were simulated. The actual urinary creatinine clearance, Ae 0-24, was subsequently calculated using area under the curve (AUC) 0-24 hours via Simpson’s approximation. Creatinine clearances were then calculated using Ae 0-24 / AUC0-24 and the 2-point average method. Results When Clcr improved greater than 35 ml/min, Clcr estimated by the 2-points method deviated significantly in progress from the actual Clcr whereby it underestimated the Clcr by 38%. The derived correction factor is 65 • [Clcr(ne)/ 33]. The correlation between actual Clcr and Clcr with correction factor was reported as R2 = 0.9882. Conclusion During the improvement kidney function, measuring urinary creatinine clearance using the 2-points average method can produce highly inaccurate Clcr measurement, particularly at Clcr ≥ 35 ml/min. The correction factor derived is found to be able to address the mentioned pitfall with low error.

            Cost Outcomes of Conversion from Simple Syrup to X-Temp® Suspension in Production of Extemporaneous Oral Morphine Solution in Hospital Tengku Ampuan Afzan

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              Abstract

              Introduction: Oral morphine solution is produced extemporaneously in Hospital Tengku Ampuan Afzan (HTAA). Currently, X-Temp® oral suspension system (OSS), a commercially produced drug vehicle, is used to substitute Simple Syrup in the production of oral morphine solution. Within general hospitals, particularly in HTAA, there are no published documents or official studies on the cost comparison of using Simple Syrup and X-Temp® OSS in the production of extemporaneous oral morphine solution. Materials and method: This is a retrospective study on the batches of oral morphine solution produced using Simple Syrup and X-Temp® OSS. Data were obtained from Psychotropics and Dangerous Drug Registers, Excel data and other relevant databases. All data were further analysed and presented in tables, graphs, and charts whenever applicable and necessary. Results: The median cost per batch of oral morphine with Simple Syrup is RM71.73 (IQR: RM 0.986), which is cheaper than oral morphine with X-Temp® OSS (RM547.68, IQR: RM273.84). There is a significant difference in terms of cost per batch of production between both groups (p=0.0001), where oral morphine with X-Temp® OSS has a higher median score compared to oral morphine with Simple Syrup. Oral morphine with X-Temp® OSS was produced less frequently than oral morphine with Simple Syrup. Thus, the total time spent for production per year is lesser with the use of X-Temp® OSS. The odds of disposing of oral morphine solution were significantly lower in oral morphine with X-Temp® OSS, compared to oral morphine with Simple Syrup. (OR = 43.52; 95% CI = 20.33 – 93.13; p=0.0001). Conclusion: The direct cost of X-Temp® OSS in the production of oral morphine solution is higher, but the indirect costs are lower, hence making it more beneficial in terms of reducing the use of human resources, saving time & minimizing wastage.

              Exploring Job Satisfaction, Organizational Commitment and the Intention to Stay or Leave the Public Workforce Among Fully Registered Pharmacists (FRP) in Miri Hospital

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                Abstract

                Background: Pharmacy services have expanded tremendously over the past few decades to provide comprehensive patient-centered pharmaceutical care. This expansion inevitably places a growing demand on the pharmacy workforce. Positive correlations have been established between job satisfaction and key factors such as motivation, job performance, productivity, organizational commitment and most importantly patient safety and satisfaction. Methods: A cross-sectional survey was conducted among all fully registered pharmacists (FRPs) in Miri Hospital using a questionnaire that has been previously validated (n = 47). This questionnaire consists of four parts with aims to capture the demographic profile of the respondents, factors affecting job satisfaction, assessment of job satisfaction and organizational commitment and assessment of decision to stay or leave their current employer, the Ministry of Health (MOH). Participants were also invited to express their opinion on how to improve the pharmacy service in the public workforce through open- ended question. Results: A total of 42 pharmacists (response rate 85.7%) in Miri Hospital participated in this survey. Most of the respondents in this study were female (81%) and of Chinese ethnicity (78.6%), with a median age of 31 years old. The proportion of single and married respondents were similar (54.8% and 45.2% respectively). The length of employment of the respondents in MOH ranged from 3 to 13 years, with a median of 7 years. The mean job satisfaction and organizational commitment scores were 60.81 (standard deviation (SD) 8.70) and 56.48 (SD 7.21) respectively out of a maximum possible score of 90.0. 95.2% of the respondents indicated strong inclination to remain in their current job. Conclusion: Gaining insight into the factors which influence job satisfaction and organizational commitment holds significance in reducing the turnover rate of pharmacists and enhancing their productivity levels. Our study showed moderate job satisfaction and organizational commitment among pharmacists in Miri Hospital. Job satisfaction does not seem to differ for all respondents; nevertheless, female respondents were found to be more committed the organization.

                Psychological Morbidities among Trainee Pharmacists in Major Government Hospitals in Sarawak

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                  Abstract

                  Introduction: Trainee pharmacists in Malaysia are required to undergo a one-year training program during which they have to fulfill the requirements of their training logbooks. The logbook outlines the jobs and tasks that should be performed by the trainee pharmacists during their attachment at various pharmacy units. Upon the completion of their internship, they should acquire adequate professional knowledge, skills, and attitudes in order to prepare themselves to deal with life-long professional challenges independently. Objective: The objectives of this study were to determine the prevalence of depression, anxiety and stress among trainee pharmacists in major government hospitals in Sarawak, to compare the level of psychological morbidities among trainee pharmacists among training centers, and to explore the factors associated with the psychological morbidities during pharmacy training. Method: This was a cross-sectional study involving 55 trainee pharmacists in major government hospitals in Sarawak over a period of two months, from 24th December 2019 to 28th February 2020, using a validated questionnaire, the Depression, Anxiety, and Stress Scale (DASS 21). Additional questions regarding socio-demographic variables were also included in the survey. Results: The prevalence of psychological morbidities for trainee pharmacists was found to be 14.5% for depression, 38.2% for anxiety, and 7.2% for stress, respectively. Local program graduates had 5.41 times higher odds of developing depression as compared to foreign or twinning program graduates. Furthermore, non-Sarawakian trainee pharmacists had 7.9 times higher odds for developing anxiety as compared to trainee pharmacists who originated from Sarawak. Conclusion: Anxiety was found to be the most common psychological symptom experienced by trainee pharmacists in Sarawak training centers. The origin of trainees and place of graduation were significantly associated with anxiety and depression,n respectively. Attention should be focused on the early recognition of psychological morbidities among healthcare professionals.