ANTIBIOTICS: WHICH DRUGS

COULD HARM YOUR UNBORN CHILD........................... 1

PHARMACY BULLETIN

01/2013

HOSPITAL RANAU

CANCELLATION OF
NOTIFICATION OF COSMETIC PRODUCTS ................... 2

MENOPAUSE AND INSOMNIA. ..................3 HUMAN PAPILLOMA VIRUS (HPV) ..........................4 ARTICLE REVIEW:
RETASPIMYCIN PLUS TRASTUZUMAB IN HER2 BREAST CANCER ...........

HEALTH IS AN IMPORTANT CONCERN FOR ALL WOMEN.

Womens health
D Tetracyclines
X -

Recent research shows children whose mothers took antibiotics during their pregnancy were more likely to develop asthma, compared to those whose mother did not take antibiotics.

Antibiotics: Which Drugs Could Harm Your Unborn Child? By: Siti Noramalina
A
Reference: MIMS 110th, 2007

FDA PREGNANCY CATEGORY B C Penicillins Sulphonamides and Penicilinasetrimethoprim resistant Carbapemes penicillins Aminoglycosides Cephalosporins Quinolones Macrolides Vancomycin Metronidazoles parenteral Vancomycin PO

SHE: Stronger, Healthier, Every day

The U.S. Department of Health and Human Services Office on Womens Health recognizes the full week following Mothers Day each year as National Womens Health Week. National Womens Health Week is important because it encourages women to take time for their health. says Vivian Lockary, IPHA president.

Cancellation of Notification of Cosmetic Products By: Nur Hazlizat

Use of cosmetic products adulterated with chemicals can cause serious adverse events. Public advised to avoid buying and using cosmetic products as listed below. Such products have been found to contain banned substances, including unauthorized scheduled poison in cosmetic products. Below is the list of products to be removed in 2013.

Product Name

Notification No (NOT)

Chemicals detected

Acrena Pure Herbal Papaya Soap White Complex SS Pearl Cream SS Vita C Night Repair

NOT100802337K NOT100801451K NOT110602263K NOT110602264K

Tretinoin Tretinoin Mercury Mercury

Reference: Biro Pengawalan Farmaseutikal Kebangsaan (BPFK), http://portal.bpfk.gov.my/index.cfm?&menuid=118&parentid=116

Peeling of skin

Irritation of skin

Dryness of skin

Hyperpigmentation

Redness of skin

Photosensitivity

Discoloration of skin

Hypopigmentation

References: 1. The Internet Drug Index, http://www.rxlist.com 2. Dr Mukta Sachdev (Professor and Head of the Department of Dermatology at Manipal Hospital, Bangalore) retrieved from http://thealternative.in/inclusivity/health-alert-mercury-face-creams/

Menopause and Insomnia By: Lim Kok Han

Hormonal fluctuations like the magnitude of those that take place during menopause can wreak havoc with your emotional and physical state and disrupt sleep enough that they can produce insomnia symptoms. Because menopause occurs over a period of years, usually, insomnia symptoms can go from transient and temporary, to chronic and severe

TIPS:
What the Research Says About Sleep Duration?

How is sleep affected by perimenopause, menopause, and post-menopause? Sleep can be impacted by many things, such as hormonal and lifestyle changes. Hormonal changes. During the course of perimenopause through menopause, a woman's ovaries gradually decrease production of estrogen and progesterone, a sleep-promoting hormone. The shifting of ratios of hormones can be an unsettling process, sometimes contributing to the inability to fall asleep. Hot flashes. A hot flash is a surge of adrenaline, awakening your brain from sleep. It often produces sweat and a change of temperature that can often be disruptive to sleep and comfort levels. Depression/Mood Swings. About 20% of women will experience depression during this time frame and some cases have been linked to estrogen loss. Precipitants such as life stress and a history of menopause are the contributing factors. Coincidental Social Issues. Aside from the hormonal changes, social changes in ones life may also affect the sleep quality. Whether your children and moving out of the house, retiring, moving to a smaller home or you are just feeling some of the "midlife crisis" stress of getting to a new phase in life, these issues can interfere with your ability to sleep.

What should you do if menopause is preventing you from getting a good night's sleep? If you are finding symptoms of perimenopause keeping you up or waking you up every night or on going, see you gynecologist or general practitioner. There are some things you can control (like your sleep habits) and things you can't control (like your hormones, without medication).

What treatments are available for women whose sleep is affected by menopausal symptoms? When lifestyle changes fail to remedy insomnia, talk to your doctor. Hormone replacement therapy (HRT) works by supplementing estrogen hormone which reduces hot flashes, vaginal symptoms, and difficulty with urination. HRT is recommended for shortest possible term in the lowest possible dose due to some precautions. In addition, there are some other conditions that may be causing your sleep problem. For example, if depression is causing your sleep problems, your doctor may prescribe an antidepressant.

There is no "magic number in defining sleep duration. Not only do different age groups need different amounts of sleep, but sleep needs are also individualdepending on a persons basal sleep need the amount of sleep our bodies need on a regular basis for optimal performance and sleep debt, the accumulated sleep that is lost to poor sleep habits, sickness, awakenings due to environmental factors or other causes.

Build a very tight sleep structure and sleep environment by paying attention to your sleep environment (sleep hygiene). * Make your room dark quiet and safe. * Keep your room as cool as you can. * Skip alcohol and tobacco. * Keep a cloth in a bucket of ice near our bed so that we can cool ourselves quickly

Menopause insomnia symptoms may be improved through sleep hygiene and improvement in diet, exercise and other important daily routines or some may want to try natural/herbal therapies!

Reference: http://www.sleepfoundation.org/article/ask-the-expert/menopause-and-insomnia

Human Papilloma Virus (HPV) By: Peggy Chong

Most people with HPV never develop any signs and symptoms or health problems.
Most people with HPV never develop any signs and symptoms or health problems as our body immune system can defeat HPV infection. Thus most HPV infections (90%) will go away by themselves within 2 years before they develop any symptoms or health problems as below: Genital warts It appears as raised or flat, small cauliflower shaped bumps in the genital area, where it occurs after sexual contact with infected partner. Eventhough the infected partner did not have signs of genital warts, transmission of virus still occurs. Cervical cancer There are two specific strains: HPV 16 and HPV 18 are responsible for the cause cervical cancer. In fact, these two strains that cause cervical cancer do not cause warts. Thus normally woman would not realise they are infected until at the advanced stage. Screening for cervical cancer such as pap smear test and HPV test can be done to detect the problems

Risk Factors
Multiple sex partners
The greater number of sex partners, the risk of getting to contract with person who has HPV will increase.

Human papillomavirus is the most common sexually transmitted infection (STI) which can infect the genital areas of males and females, in addition to the mouth and throat. There are more than 40 types of HPV that can infect genital areas of male and females. In fact, HPV is different from herpes or HIV that causes AIDS.

Other cancers caused by HPV HPV might cause cancers in areas of vulva, vagina, penis, anus and oropharynx. Recurrent respiratory papillomatosis (RRP) RRP is a condition where the warts grow in the throat. It can be either juvenile onset or adult onset. In juvenile onset, this occurs in children whom mother has HPV pass to the children during childbirth. For adult onset, it occurs when oral sex was practiced. The warts growth will block the airways, hoarseness and trouble in breathing.

Weak immune system

People who have weak immune system especially those have HIV/AIDS or who is on immunosuppressant drugs are at greater risk

HPV are transmitted through sexual intercourse, anal sex, oral sex or genital to genital contact. The virus enters the body through abrasion or small tear in outer layer of skin or genital area. Rarely, a pregnant woman with HPV may pass the virus to her infant during delivery. This leads to exposure of HPV in infants genital or upper respiratory system.

Personal contact
Touching warts by not wearing any protection especially when a person have wound will predispose risk of having HPV infection.

Prevention
Starting from 2010, Malaysia government had implemented National HPV Immunisation Programme where free HPV immunisation is given to all Malaysian girls at aged 13 years old. Dose Dose 1 Dose 2 Dose 3 Schedule 0 month 1 month after Dose 1 6 month after Dose 1

HPV vaccine available in the market Cervarix Gardasil

Only available for female to protect against HPV

Available for male and female to protect against HPV

References: 1. National Cancer Institute: HPV and Cancer. http://www.cancer.gov/cancertopics/factsheet/Risk/HPV 2. MayoClinic: HPV. http://www.mayoclinic.com/health/hpv-infection/DS00906/DSECTION=risk-factors 3. National HPV Immunisation Programme. Malaysia www.unfpa.org/.../HPV%20IMMUNISATION%20-%20Malaysia.pdf 4. Centers of Disease Control and Prevention (CDC): Genital HPV infection- Fact Sheet. http://www.cdc.gov/std/hpv/stdfact-hpv.htm

Article Review: A multicenter trial evaluating retaspimycin HCL (IPI504) plus trastuzumab in patients with advanced or metastatic HER2- positive breast cancer
By: Ou Yen Peng

Since both locally advanced and trastuzumab-refractory HER2 + breast cancer are
What is Retaspimycin?
susceptible to the effect of heat shock protein (Hsp90) inhibition, this trial was carried out to evaluate the anti-tumor effect of combination of retaspimycin HCl and trastuzumab. In pre-clinical studies, retaspimycin HCl, a potent Hsp90 inhibitor has shown promising activity in multiple models of solids and hematologic malignancies. Adults with measurable, locally advanced or metastatic HER2+ breats cancer and prior trastuzumab treatment with adequate baseline organ function were enrolled in a pjase 2 trial. A regimen of weekly 300mg/m2 retaspimycin HCl with 6mg/kg trastuzumab every 3 weeks was employed. Patients received a median of three treatment cycles (range 1-12). No dose-limiting toxicities were observed. Most adverse events were grade 1 or 2. This study did not show synergistic anticancer activity. Moreover, therapeutic index of trastuzumab was insufficiently tested. From this trial, retaspimycin HCl at 300mg/m2 weekly in combination with trastuzumab was well tolerated and without significant toxicities. Therefore, higher dose of retaspimycin can be employed for further study.
Reference: Shanu Modi, Cristina Saura and et al. (2013). A multicenter trial evaluating retaspimycin HCL (IPI-504) plus trastuzumab in patients with advanced or metastatic HER2- positive breast cancer. Breast Cancer Res Treat. DOI 10.1007/s10549-013-2510-5.

IPI-504 (generic name retaspimycin) targets Heatshock protein (Hsp90). Hsp90 is one of a class of chaperone proteins enable cancer cells to survive and even thrive despite genetic defect which would normally cause such cells to die. Thus, blocking of Hsp90 and related chaperone proteins may cause cancer cells to die.
Adapted from GIST Support International

Did you know?

Charlotte Hayley, who had battled breast cancer, introduced the concept of a peach coloured breast cancer awareness ribbon. She attached them to cards saying, "The National Cancer Institute's annual budget is 1.8 billion US dollars, and only 5 per cent goes to cancer prevention. Help us wake up our legislators and America by wearing this ribbon."

EDITORIAL BOARD

HOSPITAL DIRECTOR
DR. CLARENCE D. SIRISANI

EDITOR
MS OU YEN PENG

Aging is not lost youth but a new stage of opportunity and strength.
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CONTRIBUTORS
MS PEGGY CHONG (Y/M) MS SITI NORAMALINA MS NUR HAZLIZAT MR LIM KOK HAN

Betty Friedan, author of The Feminine Mystique

UNIT FARMASI HOSPITAL RANAU 89300 RANAU RANAU Tel: 088-875266 Fax: 088-875223