Safe handling of cytotoxics (ASHP)

Wah scary

http://www.straitstimes.com/ST%2BForum/Story/STIStory_134414.html

June 30, 2007

Cough syrup should have been allowed after checks
WE
REFER to the letter by Ms Ong Seok Hwee, 'Airport needs to be clearer about
medication' (ST, June 26). We have contacted Ms Ong to address her concerns and
would like to thank her for her feedback.

Since May 8, restrictions have
been implemented on the amount of liquids, aerosols and gels that can be taken
in hand-carried luggage on flights from Singapore. Liquids, aerosols and gels
must be in containers with a capacity of less than 100ml each. These containers
are to be placed in a transparent re-sealable plastic bag of a capacity not
exceeding one litre and presented at the security screening point. Liquids,
aerosols and gels in containers larger than 100ml will not be accepted, even if
the container is partially filled.

Medications in liquid, aerosol or gel
form (such as insulin, cough syrup or nasal sprays) in quantities needed for the
flight are exempted from the restriction. A doctor's letter or prescription,
while not mandatory, would help to facilitate the security screening. If the
medications are in containers of a capacity of less than 100ml, passengers are
encouraged to place them in the re-sealable plastic bag. If this is not
possible, or if the medications are in containers larger than 100ml, the
medications will be subjected to further checks at the security screening point. Passengers may also be asked to taste their
medications. We encourage travellers to visit Changi Airport's website
http://www.changiairport.com/to find out more about the guidelines.

In
Ms Ong's case, the security screening staff should have allowed her to take on
board her cough syrup in the 125ml bottle, after making the necessary checks. We
regret the inconvenience caused to her. We would also like to reassure her and
the public that our screening procedures allow for flexibility without
compromising security.

Phillip Mah
Head (Aviation Security)
Civil Aviation Authority of Singapore


Toh Boon Ngee
Assistant Director
(Media Relations) (covering)
Singapore Police
Force

I think the following "Passengers may also be asked to taste their medications." is rather scary.
-The sample taste is of an unknown quantity - may lead to O/D
-The timing of tasting may be close to previous dose - may lead to O/D
-There may not be an experience doctor on the flight - so patient may die of O/D
- If bottle not handcarried may break in cargo hold, patient no med to take - patient may get a U/D.

What are they thinking!? They think that medicine as mere sugary placebos?! They are potent drug substances where a little will trigger a therapeutic effect and a little more may kill. I soooo dun wan to be at the scene where the patient is told to sample liquid digoxin.

Migraine @@

Have you ever taken so much paracetamol/acetaminophen that you can just march down Geylang, swear at the uncles there and get a beating so bad yet not feel anything.

PS my so much = 6 x 500mg. Max allowed = 8 tabs (500 mg each).

My body feels numb but my inaugural headache continues pulsing.

Photophobia developed after my first lecture of the day - felt like a vampire in the sun.

Never knew there was a foundation for migraine suffers and they are selling aura art?!

Chewren dosing for paracetamol
= 10-15mg/kg/dose q4-6hrs
Max 600mg/kg/day
Max max 4,000mg/day (adult dose)

One of my friends have a interesting comment, "Kids grow so fast that I have to reweight them every time I dose paracetamol!" =.=

I may be the only one with odd CNS s/e from paracetamol - can get a bit manic next morning (not my regular class room mania but more of the dun care, just run across the express way kind)

Reminder to self - CVS patients

Most patients with CVS disorders (HF, HTN, Arrhythmias, PVD, etc) usually have a multitude of drugs (aka medication hamper) and most of the time drugs are used in combination and patients may have multiple co-morbidities.

Today's counselling session was fun, way too funny as the instructors were pulling all kinds of tricks as difficult patients - last day anyway so play play. Some simple questions with DIFFICULT PATIENTS =.= love Challenging cases, so next time go out and work - like a bed of roses ^^. After today's challenge, I think it is time to resurrect a project which I started while I was in Guardian Pharmacy - a emergency list of language translation. This one was my farewell gift - we had a Japanese clinic in the medical centre. After exams then settle. Planning to come out with a list of commonly used terms and phrases and translate them with phonetics or if possible the spelling - so the patient can read if dun understand what the heck talking me. The instructor hit me at a weak spot - my failure in the use of mandarin (still remembered during my Secondary Skool days, the Mandarin teacher ran up to me after I merely passed the exam:"...不要充考了hor.及格就夠了!")

Patients come from all walks of life and we should be able to communicate with the patient in whatever language he/she is comfortable with. Cannot speak the language, seek help from a relative or a patient or staff nearby.

Cimetidine is a drug to look out for in prescriptions as it inhibits a plethora of enzymes common with most hepatically metabolised drug-substrates.
- Need to increase the dose of drugs that need prior activation by the liver, e.g. Acyclovir
- Need to decrease dose of drugs that are active moieties
- Interacts with warfarin (increase bleeding time)
- Can be substituted with other H2-antagonists such as famotidine

Amiodarone (Affectionately known as Amy要打人) is a drug that is used to treat arrhythmias
- Interact with cimetidine (may cause heartblock)
- Outpatient use should be that of a tapering dose as patients who are on long term amiodarone has chances of heart block
- May cause drug induced problems in patients with thyroid disorders because it contains 2 iodine atoms (attached to phenyl ring)

RALES found that the combo of Spironolactone + ACEi + Loop Diuretic decreases mortality in HF patients

Pharmacist main roles with patients prescribed medication hampers are to
-Intervene on potentially lethal D/Is
-Monitor and counsel patients on drug combos that may require monitoring and not necessary to stop

Pesticides - trawl through the Ministries

Ever wonder who exactly regulates the pesticides you use on plants?
This caught my eye:

AVA's website

Here's the confusion: if you are growing plants in a HDB and start spraying away - who is going to regulate? Who does toxicity studies and monitors? Shouldn't it be the authorities involved with plants rather than those dealing with the environment?

It is interesting to know that the list of approved pesticides do not include a lot of very potent agents sold in smaller (yet potentially lethal) quantities on your super market shelves. There is a major discrepancy when the same potent agent is regulated with stringency by AVA when sold in bulk but exempted from regulations when sold in smaller volume. In fact, about 90% of the horticultural poisons sold off the shelves in DIY and supermarkets are not registered (and I assume to be not monitored).

It also gives a big headache to the poison centre here to monitor safety issues and have treatment protocols on hand without knowing the prevalence. it would be very confusing if one agency handles agri poisons and the other handles household horti poisons - unification is needed. You can imagine a scenario where you are thrown back and forth agencies when they say that a brand or chemical entity is not within their scope - time is ticking in emergency cases.

I was in shock when a friend told me that a box of extra potent pesticide was bought from across the Causeway only to read off "Streptomycin" as the active ingredient - talk about blaming hospitals for bacterial resistance!

Some people may criticise me for being a kan chong spider (ants on a hot pan) but then why want to allow preventable or controllable things to happen?