pharmacy bulletin - hospital kuala kubu bharu
TRANSCRIPT
PHARMACY
INSIDE THIS ISSUE
Iron Deficiency Pg. 1-2 Anaemia Unveiling Ketum Pg. 3-4
IRON DEFICIENCY ANAEMIA
PREPARED BY AFIQ AIZUDDIN
HOSPITAL KUALA KUBU BHARU
Volume 1 June 2018
EDITORIAL BOARD Advisor :
Ratna Suny Bt Mohamed Esa
Editors :
Surayya Bt Harun
Tan Cai Ting
Writers :
Afiq Aizuddin Bin Abu Johan
Sadhaswaren A/L Subramaniam
CONTACT US
Pharmacy Resources
Information Center,
Hospital Kuala Kubu Bharu
03-60641333 Ext:279
Iron is an important component of haemoglobin,
which is an oxygen carrier in our blood.
Iron deficiency anaemia (IDA) is a condition in which
concentration of haemoglobin is below the
recommended threshold due to negative iron
balance.
Symptoms of IDA include fatigue, rapid heartbeat,
headaches, having trouble concentrating and
unusual eating habits (eg. craving for ice).
IDA could be caused by:
Inadequate dietary iron intake
Malabsorption of dietary iron in autoimmune
gastritis and H. pylori infection
Higher requirement for iron in pregnancy and
growth
Increased iron losses through menstruation or
blood loss
BULLETIN
WHAT TO EAT?
Eat more
IRON-RICH FOOD
to prevent IDA! EAT WITH
Vitamin C
Haem iron source (meat, chicken)
Fermented vegetable (kimchi, fermented soy sauce)
Increase iron absorption
AVOID EATING WITH
Bran products, cereals, oat and rice
Tea, coffee, cocoa and red wine
Calcium supplements, milk and cheese
Decrease iron absorption
HAEM IRON is more efficiently
absorbed than NON-HAEM IRON.
Chicken
Meat
Fish
HAEM IRON
(Animal source) NON-HAEM IRON
(Plant source)
Vegetables
Legume
Cereals
IRON SUPPLEMENTATION Oral iron supplements such as ferrous fumarate, ferrous sulphate, ferrous
gluconate and ferrous citrate can be taken if supplementation from food alone is
not sufficient.
Parenteral supplementation such as iron dextran, iron sucrose and iron polymaltose
are also available for hemodialysis patient and failure of iron oral therapy.
REFERENCES 1. Ng PY. Overview of iron deficiency anaemia, MIMS Pharmacy, 2017(6) 2. Important Facts About Iron-Deficiency Anemia | Healthgrade. Available from: http://www.healthgrades.com/conditions/
important-facts-about-iron-deficiency-anemia
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UNVEILING KETUM
Ketum which is also known as kratom internationally is a tropical tree that grows
to a height of 4-16 meter which is indigenous to South East Asia region including
Malaysia. The scientific name of ketum is Mitragyna speciosa.
The issues with use of ketum is widely debated due to it’s opioid receptor activity
where locally people consume ketum for a variety of purposes and it is known to lead
to dependence.
TRADITIONAL USES Rural folk ingest ketum leaves to self
-treat (pain, fever, diabetes and other
illnesses)
Used by manual labourer to reduce
fatigue and improve work
productivity.
Used as opium substitute during
opium scarcity in Malaya.
METHOD OF INTAKE In Thailand, ketum are consumed by
chewing on dried leaf.
In Malaysia, the more common method of
use is by drinking the water after boiling the
leaf. Consumer will gulp it in one shot due
to the bitterness.
More than 20 chemical compounds have been isolated from
ketum, including many alkaloids which contribute to its
pharmacological effects.
Mitragynine and 7-hydroxymitragynine are the compounds that
give ketum its analgesics and opioid-like effects used to alleviate pain
in illnesses.
The effects of ketum in humans are dose-dependent: small doses produce ‘cocaine
-like’ stimulation while larger dosages cause ‘morphine-like’ sedative-narcotic
effects.
KETUM EFFECTS ON PAIN
Pg.3
PREPARED BY SADHASWAREN
ADVERSE EFFECTS OF KETUM In the past years, the cases of reported adverse
effects of ketum by its user have increased. The
adverse effects are widely attributed to its opioid-
like effects (sedation, nausea, constipation, itching)
and stimulant effects (anxiety, irritability, increased
aggression).
High dose (more than 15g) uses have been seen to
produce hyperpigmentation of the cheeks, tremor,
anorexia, weight loss, and psychosis effects.
There have also been reports of seizure in patient
taking ketum alone or with drugs such as modafinil.
Anecdotal reports have suggested that ketum is less addictive than classical
opioids. However, many reports suggest that ketum might be highly addictive in
certain individual compared to others.
In South East Asia, individual seeks use of ketum for euphoric and mind-altering
effects. Chronic user have been seen to be physically dependant and addicted
to ketum.
In Europe, the reports of addiction and dependence to ketum among compulsive
ketum user have increased. Opioid-like withdrawal was reported in these cases
when ketum was stopped.
ABUSE & DEPENDENCE
REFERENCES: 1. Cinosi E, Martinotti G, Simonato P, Singh D, Demetrovics Z, et. al. Following “the Roots” of Kratom (Mitragyna speciosa): The
Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries. 2018
2. Fluyau D, Revadigar N. Biochemical Benefits, Diagnosis, and Clinical Risks Evaluation of Kratom. 2018 3. Prozialeck W, Jivan J, Andurkar S. Pharmacology of Kratom: An Emerging Botanical Agent With Stimulant, Analgesic and
Opioid-Like Effects. 2018 4. Vicknasingam B, Narayanan S, Beng G, Mansor S. The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the
northern states of peninsular Malaysia and implications for drug substitution therapy. 2018
Reports suggest that ketum may potentially be
used in pain management, opioid withdrawal
syndrome or other clinical problems. However,
issues regarding ketum abuse and toxic effect still
remain mainly due to lack of regulation regarding
use of ketum.
With proper interventions to handle the issue,
ketum may be an option for medical use in the
future but further research is needed.
POTENTIAL FOR MEDICINAL USE?
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