EDISI SEPTEMBER 2014

BULETIN FARMASI
UNIT FARMASI, HOSPITAL TENGKU ANIS

DENGUE FEVER
(DEMAM DENGGI)

Contents :
What is Dengue Fever?

Tinta Ketua Pegawai

Farmasi

Signs & Symptoms of

Dengue Fever

Aedes Mosquitoes

Statistic of Dengue Fever

Causes of Dengue Fever

Diagnosis of Dengue
Fever

Prevention of Dengue

Management of Dengue
Fever

10

Crossword Puzzle

12

Poster

13

New Brand Name of

Medicine Available in
HTA

14

Aktiviti 5S

15

Klik-klik Farmasi HTA

16

Dengue is one of the most important arthropod-borne viral diseases in terms of human
morbidity and mortality. Dengue has become
an important
public health problem. It affects tropical and
subtropical regions around the world, predominantly in urban and semi urban areas.
Dengue fever also known as breakbone fever, is a mosquito-borne tropical disease
caused by the dengue virus. Symptoms include fever, headache, muscle and joint
pains, and a characteristic skin rash that is
similar to measles. In a small proportion of
cases the disease develops into the lifethreatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low
blood pressure occurs.
Dengue is transmitted by several species of
mosquito within the genus Aedes, principally
A. aegypti. The virus has five different types,
infection with one type usually gives lifelong
immunity to that type, but only short-term
immunity to the others. Subsequent infection
with a different type increases the risk of
severe complications. As there is no commercially available vaccine, prevention is
sought by reducing the habitat and the number of mosquitoes and limiting exposure to
bites.

BULETIN FARMASI
SEPTEMBER 2014

SEKAPUR SIREH SEULAS PINANG

PAGE 2

TINTA KETUA PEGAWAI FARMASI HTA

Assalamualaikum dan Salam Sihat 1 Malaysia.
Alhamdulillah bersyukur kita ke hadrat Allah kerana
dengan izin-Nya Unit Farmasi Hospital Tengku Anis
dapat mengeluarkan bulletin edisi September 2014
untuk tatapan semua. Setinggi-tinggi penghargaan
kepada semua yang telah menyumbangkan idea dan
kreativiti dalam edisi kali ini.
Edisi kali ini bertepatan dengan situasi yang sedang
melanda seluruh negara kita iaitu DENGGI. Sehingga
9 Ogos 2014, sebanyak 59,790 kes dilaporkan di
seluruh negara dan jumlah kematian yang
dilaporkan adalah sebanyak 123 kematian (http://
kpkesihatan.com). Di Kelantan, sehingga 20 September, sebanyak 12,380 kes denggi dilaporkan
berbanding 1,003 kes untuk tempoh yang sama
tahun lalu (berita harian, 23 Sept 2014).

SIDANG REDAKSI :

Pelbagai usaha telah dijalankan seperti Ops Mega

dan Kempen Perangi Aedes Habis-habisan yang
melibatkan pelbagai kementerian dan agensi, namun jika tahap kesedaran rakyat tidak ditingkatkan
masalah ini sukar diatasi. Selain daripada ubatubatan, banyak wang telah dibelanjakan untuk
aktiviti pendidikan dan advokasi kesihatan
mengenai denggi. Marilah kita bersama-sama berusaha untuk mencegah aedes daripada membiak
dan melindungi orang yang tersayang daripada
menjadi mangsa denggi.
Semoga edisi kali ini dapat memberikan banyak
manfaat kepada kita semua. Akhir kata marilah kita
renungkan kata-kata hikmat daripada Imam AlGhazali untuk dijadikan panduan kita semua:
Menuntut ilmu adalah taqwa, menyampaikan ilmu
adalah ibadah, mengulang-ulang ilmu adalah zikir
dan mencari ilmu adalah jihad.

PN LIJAH BT OTHMAN
KETUA PEGAWAI FARMASI
HOSPITAL TENGKU ANIS

Sekian, terima kasih.

PENASIHAT :
PN. LIJAH BT. OTHMAN

KETUA EDITOR :
HASLIZA BT. ABDULLAH

ANGGOTA UNIT FARMASI,

HOSPITAL TENGKU ANIS

EDITOR :
NURULHUDA BT. ABD. RAFAR

SITI NADIA ADILAH BT. MD. NOR

MOHD. IZZUDIN B MOHD.

JAAFFAR

NIK MOHD FADHIL B. NIK MAT

FATHIEN NAJJIHAH BT A. AZIZ

Berdiri dari kiri : Wan Hamidah, Roshita, Amran, Mohd. Izzuddin,

Md. Asyraf, Nik Mohd Fadhil, Arzehar, Zainul Abidin
Duduk dari kiri : Fathien Najjihah, Hasliza, Lijah, Nurulhuda,
Siti Nadia Adilah, Siti Nursafarina

SITI NURSAFARINA BT MOHD. SABRI

SIGNS & SYMPTOMS OF DENGUE

PAGE 3

Typically, people infected with dengue virus are asymptomatic (80%) or only have mild

symptoms such as an uncomplicated fever. Others have more severe illness (5%) and in a
small proportion it is life-threatening.
There are several signs and symptoms of dengue fever. The symptoms as below:-

PAGE 4

AEDES MOSQUITOES
Can any type of mosquito carry dengue? The dengue virus is carried and spread by
mosquitoes in the genus Aedes, which includes a number of mosquito species. Of
these species, the primary vector of the dengue virus is the species Aedes aegypti. It is the principal dengue vector responsible for dengue transmission and
dengue epidemics. Other mosquito species in the genus Aedes including Aedes albopictus, Aedes polynesiensis, and Aedes scutellaris have a limited ability to serve as dengue vectors.
Aedes aegypti is a small, dark mosquito that can be identified by the white bands
on its legs and a silver-white pattern of scales on its body . Where are these mosquitoes found? Aedes aegypti dwell in tropical and subtropical regions all over
the world, mainly between the latitudes of 35N and 35S where the winter temperature is no colder than 10C. Although some mosquitoes may travel farther
north or south of these latitudes, they are unable to survive cold winters. Because

How Is Dengue Transmitted to Humans?

The dengue virus is spread through a human-tomosquito-to-human cycle of transmission. Typically, four days after being bit by an infected Aedes
aegypti mosquito, a person will develop viremia, a
condition in which there is a high level of the dengue virus in the blood. Viremia lasts for approximately five days, but can last as long as twelve
days. On the first day of viremia, the person generally shows no symptoms of dengue. Five days after
being bit by the infected mosquito, the person develops symptoms of dengue fever, which can last
for a week or longer.

Dengue Transmission : The dengue virus is

spread through a human-to-mosquito-tohuman cycle of transmission

STATISTICS OF DENGUE FEVER

PAGE 5

KES DENGGI DILAPORKAN PADA MINGGU 25/2014 (15 hingga 21 Jun 2014)

CAUSES OF DENGUE FEVER

Dengue is caused by any one of four related viruses transmitted by mosquitoes.

The dengue mosquito, or Aedes aegypti, is the main type of

mosquito that transmits dengue fever and is found in many
tropical countries around the world.

Aedes aegypti

DENGUE VIRUS

PAGE 6

PAGE 7

AEDES MOSQUITO LIFE CYCLE

AEDES VIRUS LIFE CYCLE

DIAGNOSISOF
OFDENGUE
DENGUEFEVER
FEVER
DIAGNOSIS

PAGE8 8
PAGE

The diagnosis of dengue fever is usually made when a patient exhibits the typical
clinical symptoms:
1.Headache

2.Fever

4.Severe muscle aches

3.Eye pain,
5.Petechial rash

and has a history of being in an area where dengue fever is endemic

WARNING SIGNS

Abdominal pain or tenderness

Persistent vomiting

Clinical fluid accumulation (pleural effusion, ascites)

Mucosal bleed

Restlessness or lethargy

Liver enlargement > 2 cm

Laboratory : Increase in HCT with rapid decrease in platelet

Dengue fever can be difficult to diagnose because its symptoms overlap with those
of many other viral illnesses, such as West Nile virus , Cikungunya, Leptospirosis,
Typhoid fever, Yellow fever, Scarlet Fever, Rocky Mountain spotted fever, Meningococcemia and several others if the patient has severe symptoms.

EXAMS AND TESTS

Tests that may be done to diagnose Dengue Fever include:

Antibody titer for dengue virus types

Complete blood count (CBC)

Polymerase chain reaction (PCR) test for

dengue virus types

Liver function tests

PREVENTION
PREVENTIONOF
OFDENGUE
DENGUEFEVER
FEVER

PAGE
PAGE 9 9

Preventing insect bites and stings

-There
is no vaccine to prevent dengue.
The best way to prevent getting the disease is to avoid being bitten by an infected mosquito.

Avoid being bitten by a mosquito by:

using insect repellent through the

day and night to avoid being bitten
products containing Ndiethylmetatoluamide (DEET) are effective, but products containing this ingredient should not be used in babies
younger than two years old

eliminate the places where the

mosquito lays her eggs, like artificial
containers that hold water in and
around the home.

There are a number of precautions you can take to

avoid being bitten or stung by insects.

move away slowly and don't panic if you encounter wasps, hornets or bees don't wave your
arms around or swat at them

cover exposed skin if you're outside at a time

of day when insects are particularly active, such as
sunrise or sunset, cover your skin by wearing long
sleeves and trousers

wear shoes when outdoors

apply insect repellent to exposed areas of skin,

particularly in summer or early autumn, when stings are most likely to occur
repellents that contain diethyltoluamide (DEET) are most effective

avoid using products with strong perfumes, such as soaps, shampoos and
deodorants they can attract insects

avoid flowering plants, outdoor areas where food is served, rubbish and
compost regularly and carefully remove any fallen fruit in your garden and
keep a well-fitting lid on dustbins

never disturb insect nests wasps build nests in sheltered areas such as
trees and roof spaces; if a nest is in or near your house, arrange to have it removed

wearing loose-fitting but protective

clothing mosquitoes are able to bite
through tight-fitting clothes; trousers,
long-sleeved shirts and socks and shoes
(not sandals) are ideal

sleeping under a mosquito net to

avoid being bitten at night

be aware of your environment

mosquitoes that cause dengue breed in
standing water in crowded urban environments; this can range from communal toilets to water that gathers inside a
stack of old tires

avoid camping near water, such as ponds and swamps mosquitoes and
horseflies are commonly found near water

keep food and drink covered when eating or drinking outside, particularly
sweet things wasps or bees can also get into open drink bottles or cans you're
drinking from

keep doors and windows closed or put thin netting or door beads over
them to prevent insects getting inside the

PAGE 10

MANAGEMENT OF DENGUE FEVER

1) Monitoring
- Treatment is mainly supportive thus monitoring is essential. Parameters that
should be monitor closely are hydration status, mental status, hemodynamic status,
skin colour, extremities-cold @warm, capillary refill (normal < 2 seconds), pulse rate
and volume, blood pressure and pulse pressure, respiratory status (respiratory rate,
oxygen saturation), urine output, bleeding tendency, abdominal tenderness, ascites,
pleural effusion and laboratory parameters: such as full blood count and haematocrit.
- The frequency or intensity of monitoring depend on which phase the patient is in.
Closer monitoring for 24-48 hours is needed for patients who are in critical phase.

2) General measures
- Antipyretics: paracetamol. Avoid giving aspirin and NSAIDs to reduced bleeding
tendency.
- Hydration with intravenous isotonic crystalloid solution: eg : normal saline to keep
optimal pulse volume and fluid status.

3. Treatment of severe dengue

-Assessment of fluid status plays the main role in management.
-Fluid deficit is the result of third space loss through plasma leakage and should be
managed with fluid resuscitation.
-Whole blood, platelet and FFP transfusion may be needed in cases with significant
haemorrhages.

PAGE 11

1) DIET
Patients are recommended to drink plenty of water at
least 3litres per day or any liquid juices , coconut water, ORS etc to prevent dehydration
2) FOODS THAT CAN HELP TO INCREASE
PLATELET COUNTS

Leafy green vegetables. They are high in Vitamin K, calcium and other minerals that have been shown to help blood to clot.

Sesame oil has been found to be especially helpful in increasing platelet count.

Papaya leaves are rich in complex vitamins and are known to contain high amounts of Vitamin A, C, E, K, and B .It is also known to increase the white blood cells and helps in the production of platelets when taken in the form of juice

Fruits containing anti-oxidants such as berries, pomegranates,oranges,tomatoes, broccoli, cashew nuts, and grapes are rich in minerals and vitamins. They help in the eliminating
the free radicals in the blood.

Vitamin C tablets dissolved in water can easily be absorbed by the body which quickly helps
restore the platelet count.

According to a study that appeared in the September 1999 issue of The American Journal of
Clinical Nutrition, researchers found that antioxidants such as vitamin E and phytoestrogens
found in whole grains appear to increase blood platelet levels by reducing the plateletaggregating effects of the blood.

Omega-3 fatty acid foods boost your immune system and can naturally increase your platelet
level count.

SEPTEMBER 2014

BULETIN FARMASI

PAGE 12

PAGE 13

PAGE 14
NEW BRAND NAME OF MEDICINES AVAILABLE AT HOSPITAL TENGKU ANIS
2014
Bil
Generic Name
1 Amlodipine 10mg Tab
2 Amlodipine 5mg Tab
3 Amoxycillin + Clavulanic Acid 1.2g Inj
4 Calcium Polystyrene Sulphonate Powder
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

Cefuroxime 125mg Tab

Clopidogrel 75mg Tab
Donepezil HCL 5mg Tab
Doxazosin Mesylate 4mg MR Tablet
Ethinyloestradiol 30mcg & Desogestrel 150mcg Tab
Ethinyloestradiol 30mcg & Levonogestrel 150mcg Tablet
Finasteride 5mg Tab
Flumazenil 0.5mg/5ml Inj
Heparin 50ii in 5ml NaCl 0.9% Inj
Ipratropium Br. 0.25mg+Salbutamol 2.5mg UDV
Latanoprost 0.005% Eye Drops
Levetiracetam 500mg Tab
Losartan 50mg + HCTZ 12.5mg Tab
Losartan 50mg Tab
Mecobalamin 500mcg Tab
Metformin 500mg+Glibenclamide 5mg Tab
Montelukast 10mg Tab
Nystatin 100,000 units/ml Susp
Recombinant Human Synthetic Insulin Biphasic Inj
Recombinant Human Synthetic Insulin Intermediate Acting
Recombinant Human Synthetic Insulin Short Acting Inj
Sod. Bicarb., Citric Acid, Sod. Cit., Tartaric Acid Granules

Trade Name
Norvasc
Norvasc
Augmentin
Kalimate
Zinnat
Plavix
Aricept
Cardura XL
Marvelon
Rigevidon
Proscar
Romazicon
Heparin Saline
Combivent UDV
Xalatan
Keppra
Hyzaar
Cozaar
Methycobal
Glucovance
Singulair
Mycostatin
Mixtard
Insulatard
Actrapid
Ural

Previous Brand
Current Brand
Vamlo 10
Hovasc 10
Vamlo 5
Hovasc 5
Clavicin 1.2g
Co-Amoxiclav 1.2g
Kalimate 5g

Resincalcio 5g

Zinnat
Auroxetil
Clopivid
Clopi-75
Aricept
Torpezil
Cardura XL
Kamiren XL
Marvelon
Desolon
Rigevidon
Oralcon
Proscar
Finaintas
Antabenz
Flumazenil-Hameln
Heparin Saline
Heparinol 10
Ipramol UDV
Combivent UDV
Xalatan
Latandrop
Keppra
Torleva
Hyzaar
Acetan
Cozaar
Losartan-Winthrop
Mecomin
Vecobal
Glucovance
Diamide
Singulair
Airlukast
Tystatin
Mikosat
Mixtard
Insuman Combo
Insulatard
Insuman Basal
Actrapid
Insuman Rapid
U-Lite
Utix

27 Tramadol HCL 50mg Cap

Tramal

Acugesic

Pangesic

28 Vitamin B1, B6, B12 Tab

Neurobion

Neurobine

Vitbion

Page 15

AKTIVITIAKTIVITI 5S

LOGO 5S UNIT FARMASI HTA

GOTONG-ROYONG 5S

SEBELUM 5S

SELEPAS 5S

BULETIN FARMASI
SEPTEMBER 2014

PAGE 16

PAMERAN KENALI UBAT ANDA & PENGGUNAAN UBAT BERKUALITI

SEMPENA PROGRAM SEMARAK KOMUNITI 1 MALAYSIA DAN PELANCARAN
UNIT KOMUNIKASI BELIA RAKAN IT NEGERI KELANTAN

SEPTEMBER 2014

BULETIN FARMASI

PAGE 17

Salam Takziah kepada keluarga Allahyarham En. Arzehar

bin Mohd Yakzan, Penolong Pegawai Farmasi HTA yang
telah kembali ke rahmatullah pada 4 September 2014.
Semoga Allahyarham ditempatkan bersama-sama orang
yang beriman.
AL FATIHAH