Prescription endorsement:

-First, screen and check the prescription.

-Second, call the Dr in charge of the prescription

Example of dialogue:

- Good evening, may I speak to Dr (name) ?

- Hi Dr (name), this is (name) calling from the pharmacy.
 - I have a prescription for patient (name) with RN (no).
- I’d like to check with you……..
- According to (reference) …….
- So, I want to confirm again, that the order is to be changed from …. to ….., is that correct?
- Ok, that is all. Thank you Dr (name).

Diagnostic test kit

SMBG

1) Blood lancet

Steps to use blood lancet

1) Swab the finger using an alcohol swab and let it dry

2) Remove the device cover, insert new needle
3) Remove the safety cover of the needle
4) Insert the device cover back
5) Twist the adjustable tip to select the puncture depth (The lower the depth, the lesser the
discomfort the subjects may experience)

Depth Skin

1 delicate skin

2 and 3 normal skin

4 and 5 calloused or thick skin

6) Pull the sliding barrel until it clicks

7) Press the release button to prick the finger

8) Remove the device cover, push the exposed needle into the safety disk and dispose the
needle appropriately
 2) Glucometer

Steps to use glucose meter

1) Switch on the glucose meter and place a test strip in the machine

2) The glucometer is ready when an indicator appears on the screen (droplet symbol)

3) Place the patient’s blood on the tip of the strip. Do not remove the strip from the machine to
collect the blood
4) Wait until the glucometer gives out a reading

5) Wipe away remaining blood from your hand

Result Interpretations

Non-pharmacological management
- Avoid sugary food, drinks
- Well-managed stress
- Exercise regularly
 3) Digital Sphygmomanometer

1. Sit upright, face forward and remain relax

2. Selected arm- free from constricting clothes
3. Select the right cuff size (optional)
4. Wrap the cuff around the upper arm, you should be able to fit 2 fingers between your arm
and the cuff.
5. Ensure the cuff is at heart level.
6. Measure the BP. Make sure not to move your arm or talking when reading is taken
7. Record the result. Rest 30 seconds before repeat.

What affects a blood pressure reading?

1) White coat syndrome
- Advise patient to breathe in deeply and exhale slowly if the patient appears
anxious prior to taking blood pressure
2) Cigarette, alcohol, caffeine, exercise
- Avoid consume/taking/do these stuffs at least 30 minutes before taking blood
pressure
3) Way of sitting
- Avoid crossing the legs (may increase the blood pressure)

Result Interpretations

When to refer?
- Hypertensive crisis
 - High blood pressure with headache or blurred vision
- Blood pressure above 140/90 mmHg in more than two occasions OR
- Blood pressure is usually well controlled but > 120/80 mmHg on more than one occasions

Non-pharmacological management (suggest starting from pre-hypertension)

- Well-managed your stress
- Avoid salty food
- Exercise regularly
- Proper weight management
- Relaxation techniques such as yoga, meditation

Hypertensive urgency Hypertensive emergency

- BP > 180/110 mmHg - BP > 180/110 mmHg

- No acute organ damage - Acute organ damage

4) Urine Pregnancy Test (UPT) - most probably x masuk

- Detect human chorionic gonadotropin (hCG) in the urine

Steps to use
- Pee (better during morning) on the test kit.
- Wait for 1-2 minutes for the result
- 1 line no pregnancy, 2 lines pregnant

*privacy of patient super important, counsel at private place.

5) Ovulation test
- Detect luteinizing hormone in the urine, indicating ovulation is near (ovulation occur when LH
surge)
- Positive result = best time to get pregnant (have sex several days after positive result to get
pregnant)

Steps to use
1) Read the instruction of test kit
2) Dip the tip of strip into urine
3) Wait for 3 to 5 minutes
4) Positive result = two lines (control and test lines - test line should be as dark or darker than
control line), negative result = one line (control line), invalid = no control line
* Some ovulation test cannot tell the difference between LH and hCG due to similar chemical structure
(some women may have positive ovulation test several days after ovulation may be a sign of pregnancy)

6) Cholesterol home test kit

Steps to use
- Insert test strip into the device
- Prick finger with lancet
- Place the blood onto the test strip
- Wait until readings are shown

Respond to symptoms

- Selamat pagi or petang or salam

- Introduce your name & you as the pharmacist-in-charge

Responding to symptoms
1) General questions
● How often have you been experiencing the symptoms?
● Are there any things that make your condition worse?
● Do you experience any other symptoms?
● Do you have any other health conditions and what medication are you on?
● Have you tried any kinds of medications or supplements for your condition?
● Do you have any allergies (medications/food)?

2) Situational questions Non-specific

● Kalau patient tu ambik kat farmasi & tanya your opinion, make sure tanya
dulu sama ada ubat tu untuk dia atau orang lain
● Kalau XX muda, tanya pregnancy and lactation status. Are you planning on
having kids?
Vaginal thrush

What u need to know:

-Age-common in childbearing age, pregnant(sbb hormonal change) and diabetes(sbb
higher blood glucose). If child below 16 refer dr for any vaginal symptom
-Duration, some women delay jumpak dr and dh try otc lain dulu.
 -Symptom: itch, soreness, discharge
-colour-creamy,thick n curdy, klu yellow greenish mostly bacteria,
consistency, odour-fungal ifx does not have unpleasant odour but bacteria produce foul
odour), dysuria(sakit bila kencing), dyspareunia(sakit time romen intercourse),previous
history,
Medication-oral contraception, antibiotic

Practical points
-Privacy. Pt malu nk bagitau so kita kena ensure privacy.
-Treatment of a partner if symptomatic. Candidal balanitis. Azole cream BD on the glans
of the penis, for 6 days. Oral fluconazole
-Jgn guna foam bath, soap dkt vagina sbb destroy protective lining. Guna warm water
cukup.
-wipe anus after berak. Wipe from front to back.
Medication given:
-Simple:oral azoles eg fluconazole 150mg every third day(day 1,4,7)
-Complicated: pregnancy. Topical ja. Oral takleh. Clotrimazole cream 500mg
.Clotrimazole pessaries 100mg
Give fungal vaginal ifx cream- cream 1 or 2% clotrimazole 2/3 times per day at least 2 weeks.
Clotrimazole ada steroid. Takleh pakai lama2.
Miconazole don’t have steroid.
If 3 days not getting better, jumpa dr.
Acne

Advice:
- Manage stress
- Maintain good proper hygiene

Keratolytic Benzoyl peroxide Apply 1 or 2 times, after - Optimal effects after

- Exfoliate dead skins Salicylic acid cleansing 6-8 weeks
- Begin with low dose,
gradually increase as
tolerance builds

Topical Retinoids Tazarotene Apply thin film to - Condition worsen for - CI in pregnancy
- Breaks up comedone Adapalene affected area, 1 time first month, then
- Prevent comedone Isotretinoin nightly - Optimal effects after
- Prevent acne Tretinoin 6-8 weeks
- Begin with low dose,
gradually increase as
tolerance builds

Topical antibiotics Clidamycin

- Suppress bacteria Erythromycin
growth Metronidazole

Corticosteroids (when necessary to - Acne worsen if used

(injection) cause immediate continuously
 improvement)

Multivitamin Antioxidant
Calendula tincture
Contraception

1. Refer to physician (within 120 hours)

- SA
- Unprotected sex e.g. missed birth control pill consecutive days
- Condom failed

Lactational Amenorrhea ALL 3 criteria must - STOP when:

Method (LAM) met: - Menstruation
- Breastfeeding causes - No menstruation 2 - Bottle feeding started
release of hormone months postpartum - Breastfeeding
that prevents - Baby frequency reduced
production of an egg EXCLUSIVELY - Baby >6mo
breastfed at least q4H
during the day, q6H at
night
- Baby <6mo
Allergic Rhinitis

Treatment:
- Antihistamine + decongestant + nasal CS (if >4 days/week AND >4 weeks)

1st gen antihistamine Diphenhydramine 25-50 mg tid-qid - Drowsiness: do not

Max: 300mg/day drive or operate
machinery
- Avoid alcohol use

2nd gen antihistamine Loratadine 10 mg OD or 5 mg BID - Avoid alcohol use - CI in pregnancy

Nasal Decongestant Oxymetazoline - Use max 5 days - CI in pregnancy

- Clear stuffy nose - Caution in asthma.
quickly, in comb with HPT, CV, diabetes,
AH BPH
- Vasodilation of nasal
mucosa

Nasal Corticosteroids Budesonide Need to use before - No SE of oral CS

Fluticasone exposure - Max effect at 2 weeks
If use when present, - Need to use before
max effect takes up exposure. If use when
several days present, max effect
takes up several days
- Taper dose once
symptoms improve.
Constipation

Refer to physician:
- Diarrhea alternates with constipation, Blood in stool, Unexplained weight loss
- Fecal impaction (give laxative also)
- Use of medication: Al antacids, Fe supplements, TCA, anticholinergics (seek medical advice)

Treatment:
- Transit constipation: Laxative + lifestyle mod
- Laxative-induced constipation: STOP laxative + lifestyle mod
- IBS: Antispasmodic + lm

Bulk Laxatives Diphenhydramine Slow, does not interfere - Drowsiness: do not - Not to be used in fecal
with normal bowel drive or operate impaction
activity machinery
- Avoid alcohol use

Osmotic Laxatives Lactulose Chronic constipation - Cause stomach

cramps
- Electrolyte imbalance

Glycerin (enema) Occasional constipation

Stimulant Laxatives Bisacodyl When other treatments - Not given >1 week
Cascara have failed - Cause stomach
Phenolphthalein cramps
- Electrolyte imbalance

- Pregnancy
 Lubricants Mineral Oil Elderly - Use max 5 days
Fecal impaction

Cough (Productive)

Refer to physician:
- Chest pain, during coughing or deep breaths (Pneumonia, TB)

Treatment:
- Cough & Cold preparations +patient advice

Non- pharmacological management

● Stay hydrated ,steam - productive
● Try honey -nonproductive
● Rest well
● Warm tea -nonproductive
Dermatitis
(probably tak masuk)

Refer to physician:
- Chest pain, during coughing or deep breaths (Pneumonia, TB)

Treatment:

Contact Dermatitis Topical CS + Antihistamine

Atopic Dermatitis (common on elbow, Emollient + Topical CS + Antihistamine

behind knees)
Discoid eczema

Seborrheic Dermatitis (adult dandruff) Seborrheic preparations

Infant Seborrheic Dermatitis Emmolient, after washing

Diarrhea

Refer to physician:
- Blood/pus, fever, fatigue, weight loss (IBD, Crohn’s Disease, Colitis)
- Travel to poor sanitisation country, consume contaminated food (infection)
- Lower ab pain, bloating, diarrhea alternate with constipation (IBS)
- Medication: Mg antacids, antibiotics, antihypertensives
- Diarrhea persists >3 days, severe vomiting, fever, pregnancy

Treatment:
- Lactose intolerance: Limit dairy

Adsorbents Kaolin Makes firmer feces - Do not use >2

Attapulgite and less fluid days
Activated charcoal Absorbs toxin - Avoid use
during fever

Narcotic Loperamide - Cause drowsiness

antidiarrheals Diphenoxylate - May cause
dependence

Enkephalinase Racecadotril Prolongs

inhibitors (HIDRASEC) antisecretory action

Antimuscarinics Atropine sulfate Diminish GI

Dicycloverine motility

Probiotics Saccharomyces Acute diarrhea in -

(BIOFLOR) children
Bacillus clausii Diarrhea prevention
in post-antibiotic
 Electrolytes Oral rehydration salts Not for diarrhea - Mix in proper
(ORS) quantity for
optimal effect

Non-pharmacological management
- Eat vegetables & adequate fluid intake

Dry/Red Eye

Dry Eye: Blurred, gritty, sting/burn, excessive tearing, photosensitive,

Allergic - Significant itchiness Ophthalmic lubricants + antihistamine
conjunctivitis - Exposure to allergens

Viral - Significant itchiness Self-limiting

Conjunctivitis - NO exposure to allergens (Maybe can give lubricants)

Dry eye (by - Diuretics, antihistamine, Advise pt to consult his physician before
medication) anxiolytics & antidepressants, oral discontinuing or switching medication
contraceptive, B-blocker, sleeping
pills

Dry eye - Due to windy, smoky, very dry Ophthalmic lubricants

place
- Contact lenses
- Looking at computer / reading /
other activities for a long time

Red Eye: Red & itchy

Emergency - Eye injury Emergency - seek medical attention
 - Foreign body in eye immediately

Bacterial - Gritty eye; thick yellow/green Refer to physician

Conjunctivitis discharge

Viral - Gritty eye; clear watery discharge Resolve sendiri

Conjunctivitis Ophthalmic lubricants + topical
vasoconstrictors for irritation

Allergic Rhinitis - Watery eyes, runny nose Antihistamine + decongestant + nasal CS (if >4
days/week AND >4 weeks)