Background: The concentrated potassium chloride injection is a high-alert medication and replacing it with a pre-mixed formulation can reduce the risks associated with its use. The aim of this study was to determine the clinical characteristics of patients receiving different potassium chloride formulations available at a private institution. The study also assessed the effectiveness and safety of pre-mixed formulations in the correction of hypokalaemia. Methods: This was a retrospective observational study consisting of 296 cases using concentrated and pre-mixed potassium chloride injections in 2011 in a private hospital in Kuching, Sarawak, Malaysia. Results: There were 135 (45.6%) cases that received concentrated potassium chloride, and 161 (54.4%) cases that received pre-mixed formulations. The patients’ clinical characteristics that were significantly related to the utilization of the different formulations were diagnosis (P < 0.001), potassium serum blood concentration (P < 0.05), and fluid overload risk (P < 0.05). The difference observed for the cases that achieved or maintained normokalaemia was statistically insignificant (P = 0.172). Infusion-related adverse effects were seen more in pre-mixes compared to concentrated formulations (6.8% versus 2.2%, P < 0.05). Conclusion: This study provides insight into the utilization of potassium chloride injections at this specific institution. The results support current recommendations to use pre-mixed formulations whenever possible.
Potassium Chloride ; Electrolytes ; Drug Utilization Review

Muslim consumers have special needs in medical treatment that differ from non-Muslim consumers. In particular, there is a growing demand among Muslim consumers for Halal medications. This descriptive exploratory study aims to determine the Halal status of selected cardiovascular, endocrine, and respiratory medications stored in an out-patient pharmacy in a Malaysian governmental hospital. Sources of active ingredients and excipients for each product were assessed for Halal status based on available information obtained from product leaflets, the Medical Information Management System (MIMS) website, or manufacturers. Halal status was based on the products’ sources and categorized into Halal, Mushbooh, or Haram. The proportions of Halal, Mushbooh, and Haram products were at 19.1%, 57.1%, and 23.8%, respectively. The percentage of active ingredients for cardiovascular/endocrine products that were assessed as Haram was 5.3%; for respiratory medications, it was only 1.1%. For excipients, 1.7% and 4.8% fall under the category of Haram for cardiovascular/endocrine products and respiratory products, respectively. Ethanol and magnesium stearate were found to be the common substances that were categorized as Haram and Mushbooh.

Low-molecular-weight heparins (LMWHs) are antithrombotic agents utilised in the treatment of acute coronary syndromes. They have been shown to be more effective than unfractionated heparins (UFHs) in reducing ischeamic events, which include death, myocardial infarction (MI) and urgent revascularisation. Enoxaparin is one of the products of LMWHs. Its safety and efficacy has been proven in the ESSENCE and TIMI IIB studies. This study was carried out to identify risk factors that may affect bleeding complications associated with the use of enoxaparin for non-ST-elevation MI (NSTEMI) or unstable angina (UA) in Universiti Kebangsaan Malaysia Hospital (HUKM). This observational, longitudinal study was conducted on patients who were admitted to the Coronary Care Unit (CCU), Coronary Rehabilitation Ward (CRW), Medical 1 and Medical 2 wards at HUKM and initiated on enoxaparin for NSTEMI/UA from 22nd of March until 22nd of April 2004. A total of 40 patients were included in the study with median age of 65 years, male to female ratio of 3:1, diagnosed with NSTEMI (55%) and UA (45%). 45% of patients developed an episode of bleeding and among them 83.3% (15 patients) characterised by haematuria. Higher percentages of women (80%) and those with creatinine clearance of < 30ml/min (100%) had incidence of bleeding as compared to men (50%) and those with creatinine clearance ≥ 30 ml/min, respectively (p <0.05 for both parameters). Age, enoxaparin dose and duration of therapy, smoking and concomitant aspirin/ticlopidine therapy did not significantly affect the incidence of bleeding. In conclusion, renal impairment and gender were associated with bleeding in relation with the use of enoxaparin that may require dose adjustments.

This study investigates the views of general medical practitioners (GP) to the extended role of the community pharmacists (CP). A self-administered questionnaire was distributed to all private clinics (n=438) run by GPs in the state of Penang. The questionnaire asked GP’s views on ideas for new services provided by community pharmacists. Three hundred and twenty-seven questionnaires were collected, giving a response rate of 74.5%. More than 50% of respondents were in favour of the community pharmacist involvement in activities of providing public health education (58.7%), contacting GPs on matters related to prescribing and prescription errors (56.0%), and referring patients who exhibit drug-related problems (53.0%). However, the respondents had a mixed opinion regarding the roles of CPs in smoking cessation programme (34.8%) and providing drug information to physicians (43.0%). Additional research is needed to explain GPs attitudes towards the acceptability of the new role of the pharmacist.

Infective endocarditis (IE) is the one of the most important causes of increased mortality and morbidity among haemodialysis patients. The reason for this increasing prevalence of infection among these patients is the use of haemodialysis catheters during dialysis, as these patients are highly susceptible to infections that are easily transmitted via blood access points. The present case was a geriatric end stage renal disease (ESRD) patient who was readmitted to the hospital two days after her scheduled haemodialysis session with symptoms of nosocomial endocarditis. Her concurrent medical complications were hypertension, non-insulin dependent diabetes mellitus, and ischemic heart disease. Based on her previous medical history and current examination, the patient was suspected to have IE due to catheter related infection. The goal of therapy is to manage the comorbidities and infection by provision of appropriate treatment based on close monitoring of the patient condition.