Issuu

scientia

potentia est knowledge is power pharmnotts issue 18/19

CONTENTS

Editor-in-chiefâ€™s foreword

Meet the people behind this newsletter

08 Pharmnotts 17/18 Orientation day

Blood Donation Drive November 2017

Ashwagandha

13 Johnson & Johnson Responding to Symptoms Competition 2017

38 Effects of Coffee Consumption on the Liver

40 Pharmnotts Ball 2018 - A Night in Vintage Hollywood

Viva La Vida Night 2017

20 Public Health Campaign 2018 - Bone Health

43 TCM medicines that interact with warfarin

BPSA Annual Conference 2018

Fun and Games

Pharmnotts Ball 2018 - A Night in Vintage Hollywood

32 Guest article - My Life in UNMC as an exchange student

Case Studies

50 Just for Laughs

Editor in Chief's Foreword Dear reader, I hope you are excited with the arrival of this issue! Meanwhile I apologise for the publishing delay due to a lack of manpower as well as the need to implement, review and apply several changes. It does not suprise many that PharmNotts has again, won the ‘Most Active Academic Society’ award for 2017/18. However, we felt that this award would mean nothing if the club does not initiate to make an extra leap forward. Thus, to grant PharmNotts a long term success, our ethos this year would be to question the past and make the necessary reforms. As the past newsletters have always centralled on creating awareness on the happenings of PharmNotts, I came to realise that much can be done to nurture their potential as educational media. Henceforth, the changes made to this year’s newsletter include setting a theme for this year’s issue, along with the incorporation of several pharmacy-related articles written by students of the School of Pharmacy - in other words, a shift from a promotional to an educational character. It is through a unanimous agreement between the executives of PharmNotts that this newsletter should carry the theme of Scientia Potentia Est (Latin: Knowledge Is Power), for we, as an academic society, wish to stress the importance of learning. The concept of student-written articles, which was only recently birthed to secondarily welcome the theme, primarily aims to encourage students to seek for knowledge beyond what has been given in class. In short, the essence of this newsletter is said to be represented by a quote from the humanitarian Malala Yousafzai, which is: “Let us pick up our books and our pens, they are the most powerful weapons.” Indeed, with a knack for and an ability to combine knowledge and creativity, we humans managed to make telling advancements in the health sciences, resulting in many diseases eradicated as well as many lives saved. As such, we as future practitioners of pharmacy and pharmaceutical sciences should continue this legacy by being well-equipped with not only the necessary knowledge, but ultimately the willingness to learn and upgrade what we currently master. Who knows maybe one of us could propel the next scientific breakthrough or spark the flames of the next clinical revolution?Enough with the philosophical discourse, I would like to take this opportunity to thank the assistant editorin-chief, Xin Hui; the supporting editors, Mun Yee and Nabihah; as well as the others who contributed to this newsletter. As trite as it seems to acknowledge the efforts of those who contributed, it rings true that launch of this newsletter will not be successful without the support and encouragement by these people. Lastly, thank you, dear reader! For it is with due honour to admit that you are the reason as to why the creation of an annual newsletter has never ceased to fail. I hope you enjoy reading this as much as we enjoyed creating it, and may this issue possess the capacity for enlightening you at the end! Happy reading!

Chlo e Chan

Chloe Chan Editor-in-chief PharmNotts Publications Officer 18/19 4

Meet the People behin

Let’s have a read on their perceptions on how knowledg By gaining knowledge, it is one of the opportunities for me to contribute and help people around. It gave me satisfaction when I can spark people’s passion towards their goal. Farhana Razak Multimedia Officer

Knowledge sparks my curiosity by encouraging me to take the initiative in learning about the things happening around the world. With sufficient knowledge, I am able to not only empathize and help those whose voice are not heard, but also raise the awareness of others about their plights.

Knowledge not only permits me to get closer to my soul, it ultimately bestows the opportunity to unearth the mysteries behind my physiological and pharmacological functions. We are all health sciences students, aren’t we? Teoh Jia Wei Treasurer

Tan Ying Qian Events Officer

Knowledge is empowering because it aids in my journey of personal development whilst allows me to exert positive influences upon the actions of others. Chai Pei Shan Public Relations Officer

With knowledge, anyone, anywhere can make a difference! Wong Wei Kit President

nd this Newsletter

ge empowers them... The ability to recall what I learned and connect them is a boost of confidence and a skyrocketing of self satisfaction. All in all, knowledge empowers me to be a better me Nabihah Hamzah PHS Representative Knowledge motivates me to find like-minded individuals: those whom I can confidently exchange any intellectual output with, yet impregnate my soul with a strong sense of self worth.

Knowledge empowers me when I am able to link the effects and reasonings of traditional remedies to modern medicine.

Ruby Loo Vice President

Yang Mun Yee Secretary

I believe knowledge not only stays permanently stays within me, it also widens my thinking capabilities and thus allows me to make better judgements and decisions

Knowledge empowers me by allowing me to tell apart truth and lies, giving me confidence in my speech and not placing blind trust on a bunch of theysaids and I-heards Wan Xin Hui Assistant Editor-in-Chief

Shadreen Fairuz Graphics and Design Officer 7

Orientation Day May you be filled with nostalgia in the words of Yang Mun Yee as you reminisce the days of starting university anew. Edits Chloe Chan and Wan Xin Hui

he first official week of the MPharm program for Year 1 students began with a harmonious balance between work and play. While the first day was packed with multiple induction lectures by the school of pharmacy that molded us into withstanding the rigidity of the course, the second was a fun-filled day of Orientation organized by the Pharmacy Society, PharmNotts.

It was 10am in the morning, an ideal time for one to get out of their slumbers and face the rigours of the day. The first years and second-year exchange students from the UK formed a queue outside the venue. Some chatted with their course mates while the shy ones stood around quietly. We waited in line for our turn to mark our presence and collect our team numbers before entering the venue. The numbers in turn, allowed us to meet others in our team, fostering bonds through conversation towards those we haven’t met – or those that we have not had the opportunity to strike a conversation with.

The committee members first presented a mini icebreaking session via a bingo game of personal traits. I can still remember the delightful faces of my peers as the number of signatures on their sheets increased, each time an individual who could fit a criterion was unearthed. After the announcement of the winner, the MC then started to introduce the PharmNotts executives and the club through a PowerPoint presentation. Next, there was a presentation given regarding MyPSA, which stands for Malaysian Pharmacy Students’ Association. It was noteworthy for us newbies that an external body representing the interests of Malaysian pharmacy students not only exists, but is also a host of many educational activities that cater to expanding our extracurricular interests. Besides, we were encouraged to be part of the association by paying a small fee in order to reap its long-term benefits which include opportunities to participate in networking and other activities specifically for members.

When the time for the speeches had elapsed, we separated ourselves according to our numbers before being facilitated to a series of ice-breaking games with our team members. Though all of us were left puzzled after all of the attempts at trying to remember each other’s names, the ice breaking sessions nevertheless, brought smiles to our faces before we headed down for lunch. Before that, each team was required to come up with a team name and cheer. While some were wellthought-out like Pharmily, others such as the Powerpuff Girls were spontaneous with a touch of humour to them, even causing the team members themselves to break out into grins at each call of their team names. After getting our bellies stuffed, we were introduced to part II of PharmNotts orientation which consisted of four station games. The first station game involved team members to pair up and move a soda can from one table to another using only dry spaghetti

dry spaghetti noodles and our mouths. The main challenge of this game was that no hands were allowed, the only exception being at the start of each round where a team member would pick up a spaghetti strand and place it into his/her mouth before inserting it through the soda can. This game was made even difficult when the members were forced to retreat to the starting point if the spaghetti strands snap midway. While some blushed at the notion of having to come into intimate physical contact when our seniors demonstrated the game, embarrassment quickly evaporated as we were more focused on the idea of winning. Aside from several broken spaghetti strands, our team persevered throughout the game, as we devised a different game technique each time this vicious cycle repeats. It was mid-afternoon when we emerged victorious in the first round of games. Upon winning, we were given scraps of paper containing clues to help us with

the next activity. We moved on to the second station, situated at the fountain area which was a few blocks away. The fact that we had to travel such a long distance on foot under the sweltering weather definitely didn’t make things easier for us. When we could scarcely cope with the lethargy as soon as we arrived, we were set to compete against another team for a game of dodgeball. Consequently, we got the short end of the stick . Most of my team-members do not play dodgeball often (including myself) and I’d say our opposition was a tough one– it did not take long before we lost - leaving only one member at the end to defend herself. In spite of that, we enjoyed the thrills this game bestowed, and remained motivated through our previous win as we proceeded to the third station. There, we were engaged in an intense game of rock, paper, scissors. The twist to the game was that the losers needed

to defend themselves against a whack from a rolled-up newspaper. Those who did so with success would gain a point for their team. Really, it was not only a test of reflexes. For some, it was a chance to get even after the previous losses. Here, we gained another win and hence, earned another clue.

for a chance to rekindle our past glory.

sight of the egg unb did all the other tea had a similar idea a As soon as the stations games were too protected their completed, everyone was directed situation meant tha to the final task of the day: Protect clear winners for th the Egg. This challenge required the results were a ti us to devise a system which could ensure that the egg would remain Thus, the winners c intact when it is thrown down determined through from the third floor. My team Before we could bar The final station involved a game created a parachute around the egg from the turbulence of tag with balloons attached to and not before long, it was time the sea of confusion our feet. The objective was to keep for the facilitator to release our egg revealed to us that t as many balloons intact as we parachute. The tension was nearly consisting of Year-2 could. Alas, the final result was palpable in the air as the seniors were inserted into e that we had the least started taking apart layers and turned out that the balloons, causing us to lose layers of newspaper. Finally, it was actually contained t the game and thus one less the moment of truth! We waited to reveal the spies. Th opportunity to gain a clue. with bated breath as the seniors everyone by surpris Swallowing our disappointment, slowly took out the egg but soon throwing spears of a we gathered our hopes and waited burst into jubilant cheers at the each other. While m

broken – but so ams – for they and they had, eggs well. This at there were no his challenge as ie.

could not be h this method. rely settle down e brought by n, the seniors there were spies 2 students that each group! It scraps of paper the clues aimed That took se as we started accusation at my team

managed to pick one out, little did we know that there were actually three spies in each team! Hence three scraps of paper for three individuals. The committee declared the winning team as the one who successfully singled-out all of their spies – and it was sadly, not my team. As the suspense of the atmosphere died down, the buddy system was made known to us. Here, all of us got a chance to meet up with our Year 2 buddies and ask them questions about the course or just have a chat about campus life. At least it was a relief for us first year students to know that our lives at university would be guided by those who went through a similar path.

The session was concluded with a group photo which captured our overall feelings of the day – exhausted, yet overwhelmed with contentment. As we plodded to our respective dorms that evening, we took back with us unforgettable memories. It still feels surreal to know that we fostered bonds with those we never thought we would, whilst strengthened existing relationships all in a day’s span! On a personal note, I look forward to participating in the event again next year as a Year 2 student, possibly as a spy if there isn’t a change of plans?

t was the time of the year again when November approaches, where UNMC would display her valor and benevolence by setting a ground for lifesaving activities.

Though the purpose of this event is to collect as much blood as possible for donation, it is the responsibility of the healthcare professionals involved to ensure the safety of both the blood donors and blood recipients. Fortunately, we are PharmNotts is honored to be able to collaborate with delightful to announce that we were able to collect the National Blood Centre biannually to host a blood 196 bags each containing 450ml of blood within donation drive in UNMC. It was a 2 day event held those 2 days, which sums up to roughly 88 litres of at H1B11, an activity room located in the student blood! In spite of this plenitude, the quantity was association block. The ideality of its location made it missed out by roughly 15 litres if it was not because easily accessible to both students and staff as it was of 34 people who were rejected donation due to a mere stone’s throw away for reasons that could threaten the those having their lunch breaks health and safety of the both the downstairs or those shaking off donors and the receivers. Such their day’s worth of stresses in examples include the donors not the neighbouring game arenas. meeting the weight requirements, This event managed to attract had recently been to a virus people from all demographics of prone country, or recently had the university; which includes any tattoos, body piercing or academic and non-academic acupuncture. staff, PhD students, Masters students, undergraduate students It was rewarding to see that the and foundation students. event once again was met with a high participation rate. In fact, For 2 days, the blood donation the event was almost always drive would begin accepting short-staffed due to the big crowd donors at 9am sharp, and would that turned up at all moments be available for both students throughout the event. Overall, the and staff throughout the day event was considered a success as until 4pm. it not only ran When the without any donors arrived hiccups, but the hall, they also emerged Words: Wong Weng Kit (Ray) were first victorious in Edits: Nabihah Hamzah guided to the being able to registration raise public counter to fill up their personal details. Once the awareness of the importance of blood donation registration process has completed, a blood group whilst constructing a platform for everyone in test was conducted on every potential donor before UNMC to contribute back to the society. they were directed to a screening on their health history and blood pressure by a certified doctor. As the Organising Chairperson (OC), I felt that This is to determine their eligibility for donation. this event was a substantial one for I get to see the Those who were granted a ‘green card’ would then return of many ‘saviors’ (i.e. those who were frequent have their details registered into the National Blood donors) as well as first-timers who were just eager to Centre database, and were subsequently guided to give blood donation a shot. It was a heartwarming empty blood donor chairs where experienced nurses experience to witness the peserverance and the spirit would facilitate the donation. of altruism amongst the donors; many of whom took time out of their busy schedules, and some were Oh one would not expect that the process leading to even late for their lectures arising from the long successful blood donation is such a complex one! waiting time. To this group of people, I would like to extend my appreciation and remind that, you all are HEROES!

Blood Donation Nov 2017

e held our annual J&J competition in UNMC around the 24th of November 2017. It was a refreshing change to see MPharm year 1 students in the position that we were last year - eager to learn and yet anxious about snagging one of the two spots of a fully sponsored trip to England with paid entrance to the BPSA’s Annual Conference. I wish I had been able to judge my juniors’ performance for myself, but I was stationed outside to guide participants (yeah, I actually sat outside to ‘guide’ them, as if they couldn’t find their way to the Pharmacy room of all places… I jest, it was to make sure that the room was reset for the next participant). However, I was told that they performed rather splendidly, most of them getting an E for Exceeding Expectations. Half the class was not from our university’s foundation in science programme so they had ever the slight disadvantage of not having extra exposure to OSCE and patient counselling, but the results but the results seemed to prove otherwise. Instead of reflecting this handicap the students had, what reflected was the amount of effort put into preparation. Anyhow, it was—and is—very good exposure to the daily scenarios that could arise in a UK pharmacy.

more than enough time if compared to the meagre half that was allowed in our usual OSCE examination Regrettably, we had to disqualify a couple of latecomers. I guess it was necessary to iron some discipline into aspiring pharmacists. Waking up late for class is one thing, but arriving late at a job interview would hardly get you the position eh? Other than that, everything sailed smoothly other than the hiccups in the organisation process. Some communication issues arose when liaising with the UK side and this year’s J&J competition was almost not held as a result. Thanks to See Jia’s persistence, we managed to pull it off and I am grateful. We were then faced with the problem of getting lecturers to be examiners under short notice. Booking the venue and choosing the time and date for the event

Johnson and Johnson Responding to Symptoms 2017 Words: Hiew Sheng Yuan (Aelex) Edits: Wan Xin Hui

The theme was Winter Health and the topic of interest was dry skin, a common issue in a cold climate. Simulated ‘pharmacists’ had to question the ‘patient’ about the condition and subsequently recommend a suitable product. Johnson and Johnson did not provide a learning package this year. To be fair, the solutions to the scenario were limited, thus they were judged based on their communication skills and how many of the important points of counselling they managed to cover. Too bad participants would only learn about emollients in their second year. Some recommended the wrong products, but ultimately the competition was mainly about assessing counselling skills so a structured consultation could have saved the day. 8 minutes was

also proved to be difficult because of the clashing schedule of both MPharm year 1 and 2. Not to be forgotten, my deepest gratitude is sent to our lecturers Dr Shamini, Dr Adam and Dr Valerie for being examiners, our PharmNotts helpers Derrick Ngai, Ivy Ng and Crystal Lim for helping with the ushering and being patient actors and fellow organiser See Jia for making this event a success. Finally, congratulations again to winners Calvin Koh and Teoh Jia Wei for winning the competition spectacularly. Also, a side note to a cheeky little junior who told me some time after that she wanted to see how good exactly I and my co-organiser See Jia were able to win the previous competition. Young one, if you’re reading this, there’s a difference between days and nights of preparation and walking into a mock OSCE half-asleep. But sure, hope you are impressed enough by us ;)

Viva La Vida Night Those who think pharmacy students as mere bookworms will definitely have their predujice challenged by us showing our multitalented facades. Follow the words of Ray to gauge what the evening had offered! Words: Wong Weng Kit (Ray) Edits Chloe Chan and Wan Xin Hui

t was a fine evening on the 28th of November, 2017, where PharmNotts 2017/18 was off with a great start with its annual event known as Viva La Vida Night (VLVN). The event not only provides a platform for students of the school of pharmacy to counter the bookworm stereotype and unleash their hidden talents, but also allows students to let loose and have the occasional fun. To broaden our intersocietal networks, we had Cross Edge, a dance group from Sunway University, as well as UNMC’s very own Nottingham Dance Club (NDC), Notty Choir and Mussoc Ambassadors as guest performers. This year’s VLVN was named: “VLVN: Shines On!”. Bright lights, blinding talents that will outshine any star in the night sky! That’s what we are talking about. With this image in mind, let us move on to the night itself~

The event was kick-started by the fellow members of NDC as they conquered the stage by displaying their mastery in an array of dance genres including K-Pop, B-Boy and Shuffle. Notably, a few of our coursemates were part of the dance troupe and it was refreshing to see them beyond the monotony of classroom settings. That with the NDC profusely dishing out spectacular dance moves got the crowd hyped in no time. As the lights dimmed, two spotlights shone and in came a pair in matching checkered shirts. They were Kit and Ruby, our emcees for the night who later turned out to be the president and the vice president of PharmNotts 2018/19. With enthusiastic gestures and clear intonation, they gave the audience a warm welcome before making way for the next performer, Melissa. Melissa is a Year 1 Pharmacy student and she stole the limelight with a solo singing performance. She sang two golden classics that are notorious for their technical difficulty, being

“My Heart Will Go On” and “Flashlight”. With her capability of pampering the crowd’s ears through her powerful voice and her precise melodic control, it is no wonder that she was named ‘Celine Dion’ of the school of pharmacy! The spotlight was later hogged by a band of our Year Two students; with Amy, Carrie, Jason and Derick as singers, Charmayne on the piano and Denise playing the guitar. I am sure most of us are familiar with the songs 至少还有你 and Perfect. As the familiar lyrics “I found a love for me” reverberated in the hall, the crowd cheered in delight and waved their arms in time to the beat. A few members of the audience were even humming the song under their breath, not wanting to disrupt the tranquil atmosphere around them. The audience was only woken up from their reverie as the last few notes died down, unaware that a roller coaster ride of mirth would soon await them. The highlight of VLVN had finally arrived for it 15

eventually the Year 1 students’ turn to prove that they are just as talented as their seniors. The first skit, Hipsters Hobos, was a satirical comedy that took a swing at tech-savvy youths who spend too much time squandering their days in stylish cafes with their funky technological gadgets. The crowd absolutely loved it! Until now, I can still recall the roaring laughter and applause that resonated throughout the hall at each gag. The humour of this skit was especially augmented by Jia Wei dressed in drag, portraying a stereotypical Malaysian ‘Auntie’. He certainly stole the show by making tears of hilarity roll down the audience’s eyes with the exaggerated femininity of his delivery. In fact, I must admit that his ‘Auntie’ interpretation was undeniably more convincing than any other middle-aged Malaysian women! It goes without saying, this performance left me deeply impressed by the innovation and courage of my juniors. It was a brief moment of respite when the crowd was spared from laughing themselves to death as the skit was followed by a musical ensemble performed by a string quartet comprising of year two students- Shi Zhe, Andrew, Rick and Chau Yeh respectively. They performed 小幸运, the OST of an award-winning movie “Our Times” that is very popular in our highschool days. As the bows ran over the strings and narrated a story of budding love and friendships, the audience was reminded of those golden times they had in

their high school days. With the plot inevitably reaching to a resolution, the audience was eventually left wading in a lagoon of nostalgia. The feeling only intensified as two students outside the school of pharmacy, Alice and Sook Sin took their places on stage and delivered us the song你不知道的事. With Sook Sin’s melodious singing enhanced by Alice’s skillful piano accompaniment in the background, this duo told a tale of love and sacrifice. Melancholy descended upon the crowd and enshrouded them, but was soon dispelled as the more upbeat notes of the next song, Starving, boomed through the speakers. I can’t say the same for everyone else but I sure am starving for more promising performances like this!

Next, we had Cross Edge, a dance duo composed of two Sunway University students named Krystabel and Allyson. They had gone through the hassle to travel all the way down to Semenyih to treat us to an eye-catching dance performance, and it sure was not an easy feat for them to cope with both the exhaustion of travelling and the need to maintain their zest on stage. Despite that, these girls captivated the

audience’s eyes with their dynamic dance moves that complemented each other’s. Ultimately, the audience was marvelled by the energy bursting out of them thus their performance was concluded by a thunderous applause! To supplement the adrenaline rush spurred by Cross Edge , the first-years further fuelled the hype of the crowd with another comedic skit, titled Fart Zen. As the lights dimmed and brightened once again, our MCs transformed into the main characters of the skit. Ruby appeared as an honourable master who taught her followers the art of farting whereas Kit became a pupil who was on a journey to relaxation. Fart! Fart! Fart! The hall burst into peals of laughter at each exaggerated fart but that was not all! Just as the crowd began to settle down from aching cheeks, Auntie Jia Wei

Wei minced up the stage and to everyone’s astonishment, the resounding booms of Boombayah sounded through the speakers! With Auntie Jia Wei in lead, the first-years rode off the hallyu wave and demonstrated their weeks of hard work in the form of vigorous moves alongside some wild head rolls. Just then! A wig flew off the stage past the audience’s eyes, and the audience resolved into bursts of hilarity again! Seems like Auntie Jia Wei was putting his all in provoking laughter from the audience and doesn’t the audience love him for that! After Jia Wei retrieved his wig and slinkerred back behind the curtains, guest performers from Notty Choir, sang A Sky Full of stars. Under the glowing stage-lights, they placed the audience under a magical spell with a

heavenly blend of high and low notes. The spell was then further strengthened as, a Korean Year 2 exchange student, Yeongseo, took the stage and sang Beautiful. It is the theme song of the hottest Korean drama and don’t those K-drama fans appreciate it? Soon, the spell was broken for the Mussoc Ambassadors switched up the mood with 25 dollars! As the hour hand inched closer to ten, the excitement of the night started to ebb, leaving the audience sauntering at the shore of contentment. The audience was treated to one last singing performance, being Amy and Jason singing a duet of Wiz Khalifa’s ‘ See You Again’. Indeed, we sure hope to see you again next year! Nevertheless, Shines On was a howling success! As I stood in the middle of the hall, sorrow began to cover every inch of me like a cloak. It struck me that my last VLVN here would mark an end to those carefree days at university. Yet this feeling was quickly replaced by a sense of solace, as I saw radiant smiles among the audience as they streamed out of the hall; along with congratulatory high-fives among the committee members for a job well done. Lost in my musings, I almost didn’t notice Shi Zhe, the Organizing Chairperson yelling, “Photo time!” Immediately, there was a scramble as everyone struggled to get their faces in the camera viewscreen. Say cheese! The camera shutter went off and the flashlight shone in everyone’s eyes, capturing this moment and keeping it frozen in the passage of time. If you are reading this newsletter and thinking what you need to look out for, this is definitely the event you should join!

Public Health Cam 2018- Bone Health

PharmNotts is known to be the host of UNMC’s annual themed p This year’s campaign was directed towards bone and musculosk Follow Ruby Loo (1st from left) through her encouters as the org this event. Edited by: Chloe Chan

mpaign

public health campaign. keletal disorders... ganising chairperson of

eing an esteemed society that was awarded the prestigious title of the BEST ACADEMIC SOCIETY for five consecutive years, it is no doubt that PharmNotts marched its way to its victory through the purposeful events it organised. The annual Public Health Campaign, a themed event aiming at improving public awareness of selected health issues, is a trademark event of PharmNotts; for it represents the main ideal of an academic society with its emphasis on imparting learning through enjoyment. Throughout the course of the history of PharmNotts, this society hosted multiple public health campaigns with diverse themes ranging from antimicrobial resistance, sexually transmitted diseases to eye health and diseases, that were overall very well-received. ... Though it is a tradition for PharmNotts to elect a theme from a list of public health campaign themes proposed by the Malaysian Pharmacy Student Association (MYPSA), we chose to forgo this convention and instead orient our approach this year to bone health. This iconoclastic decision stemmed from the unanimous agreement of the committee in that health conditions pertaining to bones and body posture are under-emphasized, yet prevalent. We summarised the essence of this event with a catchphrase – ‘Health is not a HUMERUS matter’ to stress the importance of maintaining healthy bones and good posture among staff and students of the University of Nottingham Malaysia Campus. Ultimately, this health campaign aimed to combat the common perception that bone diseases are only prevalent among the elderly; for the ignorance of younger people towards their body posture and their reduced involvement in physical activities led to an increase in cases of back pain, hunching and spinal deformities among the youth. Long before the event started, committees and subcommittees of the design and marketing teams were busy drafting plans on food and merchandise to sell for fundraising and promotional purposes. I was extremely impressed by the creativity of their ideas alongside the effective teamwork between the members of each team. Apart from the sale of these items, a donation box was made for those interested in donating directly to our NGO beneficiary – Osteoporosis Awareness Society (OASKLS). This organisation was chosen as our 21

beneficiary due to its noble ethos; (as it) strives to support research and conduct community education for the improvement of the prevention, diagnosis and treatment of osteoporosis. Though food and merchandise sale ended the week before the event started, calls for donation persisted till the last day of the event.

the event.

We as executives of PharmNotts could restrain our excitement no longer when the long awaited moment had finally arrived! It was a four-day event held from 19th21st of March. (located in H1B18, the activity room.) The event’s main highlight was free spine-screenings done by a professional chiropractor. Ms Jo Wee from ChiroCare was We as executives of PharmNotts invited to execute this for the first could restrain our excitement two days of the event. In addition to spine-screening, she provided useful no longer when the long awaited moment had finally arrived! It was dietary and lifestyle advice to the participants based on their needs. It a four-day event held from 19th21st of March. (located in H1B18, fascinated me as to how some simple moves by the participants along with the activity room.) a few touches here and there

distinction in the superiority of each others’ areas of expertise. (To supplement the spine-screenings, stations providing blood pressure checks and bag-weighing were set up and conducted by the committee members themselves.) As we could not forget our status as an academic society, various educational activities such as guided exhibition and quizzes were carried out during the event in order to enhance the participants’ understanding whilst broaden their knowledge regarding this topic. To conclude the participants’ experience of this event, each of them was given a health voucher and a booklet about bone and posture health before leaving the venue.

We welcomed Mr Gan, an experienced yoga instructor on the third day, to conduct a series of free yoga workshops. Besides introducing the participants some basic yoga poses, he explained to them how they are able to strengthen body muscles and back, hence preventing the occurrence of musculoskeletal problems. It was enjoyable to watch how the participants made their best attempts at twisting themselves into a pretzel. Though giggles could be heard across the room when some participants shrieked in pain while executing the moves, the participants were overall supportive as they also cheered at those who could successfully perform the poses. Most of all, it was a test of endurance for the participants including myself. Though the poses seemed static at first glance, all of us were sporting tired faces, aching limbs and were drenched in sweat at the end of the session. ... With the intention of reaching to a wider audience whilst improving inter-societal relationships, PharmNotts made a momentous leap in this approach this time as we collaborated with a local society â€“ ACE society in their annual Nottingham Charity Run. This charity run was a large-scale, public event held on the 25th of March

with around 1000 participants. Considering the sheer amount of participants and the dynamic nature of this event, we could not help but switch the focus of our venue from a single location to multiple spots that are spread out from each other. Therefore, booths were set up around campus in promotion of bone health as well as providing spine and general health checks after the run. The spine checks were, however, being conducted by Mr Jason Lee & Dr Khai, a chiropractor and a physiotherapist from another organisation â€“ Be Well Physiotherapy and Chiropractic Specialty Centre.... did a great job... Overall, the event was considered a success both internally and externally. Internally, the process of planning and execution served as an excellent opportunity for the organizing committee to foster teamwork and strengthen friendships. Albeit the heavy workload associated, the committee members overall enjoyed themselves and honed some of their soft skills. Whereas externally, people who participated in this event including the healthcare professionals from both organisations were satisfied with our event, judging from the positive feedback we received. Most importantly, we successfully reached out to more than 130 people

and raised RM800 for our NGO beneficiary â€“ Osteoporosis Awareness Society at the end of this event. Despite being a newbie in eventplanning, the success of this event proved that I had underestimated my own capabilities all along. As such, I would like to take this opportunity to express my gratitude to the seniors for unlocking a potential I had never discovered by trusting me in taking up this huge responsibility, and for their unceasing support in assisting me through the difficulties faced during the planning process. This appreciation also extends to everyone in the committee team for all the sleep-deprived nights and countless hours put into ensuring that this event would eventually run smoothly. In short, I will be looking forward for more aspiring members in the near future to continue imparting the spirit of education to the events affiliated with this society. So dear juniors, do not allow yourselves to regret in the future over dedicating all your time at university to your studies! Come and join us in PharmNotts this year if you wish to make a difference to the realm of pharmacy beyond your academic achievements! I can assure that your experiences will definitely turn out to be invaluable assets that cannot be exchanged for.

BPSA Annual Con

Year one MPharm students, Calvin Koh (1st from top right) and T top right), participated in the annual BPSA conference at Keele U Follow Calvinâ€™s adventures as he pens here his experience from t Edits: Nabihah Hamzah

nference

Teoh Jia Wei (2nd from University this April. this 7-day event.

he MPharm (Master of Pharmacy) programme at the University of Nottingham Malaysia Campus is a 2 + 2 course which provides its students a chance to spend their first two academic years studying here, and the latter two at its main campus in the UK. As an MPharm student myself, visiting the UK is just a matter of time as long as I pass all my papers and remain financially supported. Even so, when the opportunity arose that I could travel to the UK for free, I could not help but felt immensely keen on the offer. This opportunity is the Johnson & Johnson (J&J) Competition, which is an annual collaborative effort between our School of Pharmacy and the Johnson & Johnson company. It aims to provide outstanding students a better insight into the pharmacy career whilst experience a more diverse and colourful society and culture. This competition is basically an OSCE (Objective Structured Clinical Examination), commonly incorporated into many health sciences practices, including our MPharm course. OSCE is a simulation assessment where one is required to carry out a consultation session with patient(s) by providing professional advice and treatment options for the condition that is presented. The assessor(s) will then judge oneâ€™s performance according to a set marking scheme with various criteria. The most eye-catching part of this competition is none other than its prize. Every year, the J&J company sends the top two students to the UK to attend the annual BPSA conference (British Pharmacy Studentsâ€™ Association). This conference caters towards pharmacy undergraduates, pre-registration pharmacists and first-year registered pharmacists. It is one week long, held at different universities in the UK each year (usually during Easter break) and mainly focuses on enlightening pharmacy students about the pharmacy career and making the profession better. Despite normally being pretty laid back and passive about participating in competitions, I did not sit this one out due to the invaluable reward along with some peer pressure. This year, the theme for the J&J competition was dry skin. I pulled myself together to prepare for the competition and very fortunately, I turned out to be one of the two lucky winners. Jia Wei (the other lucky one) and I flew to the United Kingdom with immense excitement and anticipating to what awaited us. We landed at Manchester airport and took the bus to the conference venue, which was 25

Keele University. The people there welcomed us with open arms, giving us a sense of warmth despite the cold weather. We were told that the conference adopts a rather straightforward structure; for it mainly comprises of two sections, conference business (morning) and social activities (night). We got to experience the best of both worlds as the activities scheduled struck a perfect balance between work and play. Despite Mother Nature’s order for us diurnal creatures to reserve the silent hours of night for unwinding, the organisers instead filled the nights with endless adrenaline rushes through boisterous events such as Barn Dance Night and Cultural Night. For each of the social nights, we were told to follow a designated dress code which could be a little bit tedious but nonetheless chucklesome. The first night was an ice-breaking

session where we got into groups and partake in a treasure hunt. It was very refreshing to see how people are very welcoming and open-minded. I was able to assimilate quite easily and thus made many new friends. Our first exposure to conference business was quite interesting. Basically, imagine a parliament meeting session which you would normally see on television but, full of pharmacists instead of ministers. A conference committee conducted each session where motions were put forth and voted to hopefully benefit the profession, its students or the public. At first, I felt a bit uneasy and somewhat bored for I was not familiar with participating in such activity. Over time though, I got increasingly impressed by how much the pharmacy students cared for their future careers and the wellbeing of the community. There

were some constructive motions that were put forth such as, “pharmacists should strive to become independent prescribers”. If this motion is taken into action, more pharmacists would be able to prescribe on their own and at the same time reducing the workload of the GPs (General Practitioners). So far, the conference business sounded all serious and no fun, right? Well, occasionally some tomfoolery would emerge; and I cannot deny that they possessed greater originality than the ‘constructive suggestions’ which had been debated repeatedly upon over the years only to no avail. I can never forget the moment when a member broad-breastedly blurted out a suggestion of incorporating clown hats and clown noses as part of the conference business dress code. Oh, who wouldn’t yearn a workplace filled with fun and giggles as opposed to a sordid whirlpool of cold fish! All in all, productivity is

what matters most to me; one can wear whatever they want as long as they are happy. In the end, I would say the business was eye-opening and benefiting. Besides the conference business, we had the opportunity to speak to several invited speakers who are greatly experienced in each specialised field; like industry, community, hospital, military, and more. We were given the chance to pose questions after each sharing sessions and I find it to be very fruitful. Apart from that, we also attended seminars and talks organized but various renowned pharmaceutical companies such as Reckitt Benckiser, Boots pharmacy, Lloyds pharmacy, Thea pharmaceuticals and more. Each company shared their visions of a better future ahead and of course, promoted some of their best products or services. There was also a Medical Exhibition (MedEx) where other relevant companies or organizations such as health book publishers and pharmacy students’ support groups provided informative talks. The conference finally came to an end with the extravagant annual BPSA ball where participants would wear their fanciest dresses and showcased their exotic dance moves. I am beyond grateful to be able to gain multiple experiences in this precious one week. I made friends with people from various parts of the world, gain a different perspective of the pharmacy career and profession, obtained vast knowledge, and also most importantly had a wonderful time. One of the highlights of this trip was definitely the famous “English Breakfast”. It was my first time having authentic English Breakfast. However, despite it being delicious and healthy, it was served every single morning! I think different breakfasts on alternative days could have made the experience

Keele university at night - doesn’t it resemble a building from a Harry Potter scene, eh?!

Lo and Behold... The ever so interesting English Breakfast!

a tad bit better. Nevertheless, I’m just nit-picking because this conference was impressively splendid, and I strongly encourage the upcoming batches of pharmacy students to participate in the annual J&J competition. There really is no losing when one takes part in this competition. If you win, you get a

a chance to see the other side of the world. If you do not, you would gain instead an experience in handling patients and conducting consultations. I hereby wish all future candidates the best of luck! Thank you. 27

Pharmnotts Bal

Black ties. Sparkly Dresses: Lights Out and Action. A Night in Vintage H

Come join Kit as he reminisces the night when he celebrated with his co hard work put in bringing this event to live - whilst bidding farewell to Edits: Yang Mun Yee

ll 2018

Hollywood.

ommittee members all the the seniors.

hroughout the years, PharmNotts Ball has been an annual tradition by our society. It resembles many things. A grand and glamorous night dedicated to appreciating our professors, brothers and sisters within the School of Pharmacy; a symbol and would-be memory for the graduating/transferring seniors and of course; a grand finale of PharmNotts celebrating the milestone, the end of the academic year. Out of the myriad of choices, this year’s venue was a cozy, candle-lit ballroom of Hotel Bangi-Putrajaya. Dinner was served buffet style to the suave gentlemen and ethereal ladies of the night. I shall elaborate less on the menu and let pictures tell the story! Tales and laughter graced the tables, over the sparkling dishes of dinner. The energy was robust but soon to be paused by a light tap on the mic. “Ladies and gentlemen, are you ready for the main event?” Attendants were then picked to participate in a minigame. Even Dr Khoo, one of our famed chemistry professors stumbled through the game together with his students. As the emcee was briefing on the combination of people who are required to sit or stand, the participants however bounced up/ collapsed frantically, not knowing how their own teammates would respond. The situation was made stickier as the participants weren’t allowed to discuss their plans verbally. Oh, those poor, confused souls could not fathom when to sit or stand! Although the crowd initially cheered on for their friends’ team fiercely, they ended up in tears of laughter triggered by the participants’ confusion. And with the skillful hosting of the emcee, the first session played out in a frenzy from the entertained crowd. A short intermission was allowed for the attendants to continue dining before the lights dimmed to introduce a Broadway themed performance of ‘This is Me’ from The Greatest Showman by our very own committee. With Melissa Soo from MPharm Y1 as the lead singer in the true-to-theme outfit, the floor went wild.

Later in the night, lucky attendants of the ball boasted cool and functional prizes from our generous sponsor: CIT Travels. Two Barry Smith luggage bags and 8 Barry Smith foldable travel bags were drawn in total. In order to simulate the full Hollywood experience, the committee decided to set up its very own Oscars for the night. Unlike the formality stipulated by the actual ceremony, this one had light-hearted approach. Five awards in total were given out, with the titles of the awards having the property of ‘mocking’ an indidual’s distinct personal trait; such being Beauty and Brains, Most Likely to be Late for Class, Most Likely to Sleep through an Earthquake, Most Likely to Quietly Take Over the World, and Most Likely to Dance with Beyoncé. Instead of a golden trophy, the winners would each take home with them a hand-lettered notebook from the design team alongside a functional item relevant to the award title. Raihan, Shi Zhe, Derick, Peter and Kiran were fortunate to be the recipients of this prestigious award! It was especially an unforgetable moment for them to experience a

celebration of their individual traits, regardless of their nature. To appreciate the efforts put by the guests in presenting their best selves for the night, a best dressed competition was held right after the Oscars. The best dressed male award naturally went to Jason, who looked incredibly smart with his flawless hairdo and well-matching suit. There was a dispute amongst the guests however, in choosing the best dressed female. A significant portion nominated Amy, just to witness the

resurrection of JAmy from VLVN; whilst others voted for Natalie, whose... fit the description of a red carpet celebrity. Fortunately, the audience eventually reached a unanimous agreement on nominating Natalie as the winner of the best dressed female. Who knew that pharmacy students could also make good democrats! It was finally prom coronation, the most anticipated part of the night! There were many nominees to begin with, but it wasn’t a surprise to many when Derick Ngai, the former President and Ai Wei, the former Vice-President were crowned Prom King and Queen. The crowd was hysterical to

witness the ship-sail moment of their supposed ‘One True Pairing’! As the newly appointed ‘Royals’ ascended their ‘thrones’, the room dimmed again for the committee’s finale dance. Playful vibes spread throughout the ballroom like wildfire as the performers made their way through the seated attendants. Some of them even got out of their seats and joined in the classic, cheesy ‘Las Ketchup’ dance. It was definitely a scene to remember! One could say that ended with a bang! But as the emcee started her thank you speech, Maisie Blake from MPharm Y2 initiated an

impromptu ‘Cha Cha Slide’. Absolutely everyone, even Dr Valerie jumped into the random, energetic routine of the song! Well, PharmNotts Ball 17/18 has marked the end of an exciting chapter. It left a bittersweet taste at the tip of the guests’ tongues, for they were once again reminded of the ever-changing disposition of life. Bad news is, time flies. But the good news? We’re the pilots. The memories made here will definitely be remembered, but a new era is to come! This is Kit, the Organizing Chairperson of PharmNotts Ball 17/18 signing out.

My li

ife in UNMC as an exchange student Tammy Chan, a third year MPharm student from the UK campus completed her final year project over here in the Malaysian campus. Do have a read if you wish to explore life at UNMC in the perspective of an international student! Edits: Chloe Chan and Yang Mun Yee

break from three long years of endlessly swallowing and regurgitating lecture notes had finally arrived! It was five months ago when us third year students including myself began to embark on the journey of academic research and dissertation writing. This transitory moment was especially significant to me for it served as a mark of independence by bestowing me the right to control my own pursuit of knowledge. I am fortunate to be a student of the University of Nottingham’s school of pharmacy as this institution provides, each year, a diverse series of research topics affiliated with not only the school itself, but also other universities within and beyond the borders of the UK. Therefore some students were granted the opportunity based on their topics of interest to carry out their final year projects abroad across different universities in Europe, Asia and Australasia. As fate had it, I was assigned to the Malaysia Campus for a qualitative research project about MPharm Year 1 and Year 2 students’ perception on the use of virtual reality (VR) in professional practice classes. I was overwhelmed with excitement upon receiving this news, for I had long yearn to explore this Southeastern nation I had never set foot on. I recalled the day I travelled to Malaysia by plane, picturing the

twin towers, sandy beaches, exotic fauna, rainforests, and perhaps, lots of mosquitoes…Most of all, I envisioned from this experience a good balance between work and play - I foresaw that it would continue to nurture my interest in learning as a pharmacy student whilst satiate my inner wanderlust. Albeit the insecurity associated with integrating oneself with the customs of a foreign country, my experiences in this exchange program were overall positive. Undeniably, Malaysian food was the main contributor to the joyful moments throughout my stay in Malaysia. Being better in taste, variety and price in contrast with those of the other countries I have been to. Besides, the outlook of the Malaysia Campus granted me a sense of familiarity as soon as I arrived; in that its layout is a miniature of the UK Campus with the characteristic Trent Building sitting near the lake at the school’s main entrance. Due to the copious amount of deadlines brought by this project, spare times were, essentially, blessings to be savoured as much as possible. I enjoyed visiting iconic shopping malls in KL with my friends whenever I could afford the time. As in other metropolises, these were a shopper’s paradise that not only cater for shopping sprees but also include 33

entertainment hubs such as karaoke parlors, cinemas, bowling alleys and game arcades. My friends and I could not resist the temptation to indulge in these leisure activities as they not only cost more, but are also less abundant in the UK. On top of that, I enjoyed playing badminton and going swimming with my friends; for it was a privilege to utilise the sport complex facilities for free at the Malaysia Campus. Happy moments, low prices - what more can you ask for? As compared to the UK campus, the Malaysian counterpart has a more vibrant extracurricular culture. Instead of email invitations, mountains of posters were stuck all around the campus for the promotion of numerous extracurricular activities. My friends and I were spoilt for the choices of evening entertainment available. We could not get enough of the heavenly voices brought by the choir and chamber music orchestra, the vigor of dance troupes of SWAG, as well as the impeccable acting of the cast of Les Misérables. They certainly opened an escape path from the brain-intensive labour we had to endure in the daytime. A visit to a country is not complete without a stop at its landmarks, and the University of Nottingham sure did an excellent job in providing its students the best experience. All of the exchange students were granted a school trip to KL Tower, and I sure did brought back with me wonderful memories from this experience. As far as I remember, we exchange students were not only greeted with a rush of excitement as we ascended the tower via its highspeed elevator, we also enjoyed the panoramic views of KL from the tower’s 360 degrees revolving buffet restaurant. Dignified skyscrapers amidst bustling vehicles, who dare say Malaysians live in trees! Nuff said about all the fun I had in Malaysia; the purpose of this exchange is to complete my final year project, isn’t it? Well, the research I undertook was, unlike what a scientific degree would typically offer, a qualitative instead of a quantitative one. It is a form of research that concerns perceptions, observations and opinions; in other words, it deals with the social aspect of pharmacy. I chose to carry out a qualitative research project for I was initially expected an ease of project completion and a taste of “doing something different” that a qualitative project could offer. But I knew my naiveté had proven my former expectations wrong as soon as the project started. Though this experience spared me from the life of lab rat,

the amount of dedication and intellectual output required certainly did not differ from those who undertook quantitative research. As the main part of my research involved interviewing the MPharm Year 1 and 2 students, I can still remember the load of the preparation work required before it began. I started from drafting a proposal to detail my study design, then proceeding to obtaining ethical approval from the school’s ethics committee. After those were settled, I had to bash classes to recruit participants; and it was certainly a test for my reserved, timid nature to speak persuasively in front a large crowd. By the time I could get a sufficient number of participants for my investigation, I was faced with time constraints as the interviews had to be straightforward, yet in-depth to explore the participant’s perspectives whilst elicit their reasons and implications underpinned. It was a great relief for me as I managed to collect the relevant results for my investigation in time. This meant that the time for transcription generation and data analysis had eventually made its way. The process of understanding the theories and framework underlying different data analysis and interpretation methods was especially challenging for me. Unlike quantitative research, there were no universal standards to follow. Instead, the “same” theory could be extensively used and modified by different researchers to the best fit of each research canon. In addition, the unavoidable question of subjectivity in quantitative research probed me into conducting a series of trial and error on an array of research techniques to validate the results. Hence it took time to experiment on different approaches to discover one that best fit my own project. Ultimately, this project honed my ability to think reflectively, as well as my mastery in applying “non-subjective” approaches to solve a subjective problem. In spite of all the difficulties faced, there were certainly some pleasant moments from this research experience. The ability to meet the juniors and retain friendships with them was the most rewarding experience from the entire research. Furthermore, I enjoyed the flexibility that lies within the project. I learned, from that, to take control of the research process and secure help from my supervisor and others when needed. My supervisor, Dr. Jim Chai was especially a wonderful figure who not only supported me through the ups and downs of the research process, but also widened my horizons in grasping

the magic of qualitative research on depicting the social world. After 3 months of research, I can confidently conclude I have learnt more than I initially expected. I certainly do not regret choosing a qualitative research project after all. In fact, I would describe qualitative research as a key to unlock the full potential of exploring the social world of interest. All in all, it was a valuable opportunity to experience qualitative research in a science degree in a foreign land. I do hope to come back to Malaysia to make up

for the missed opportunities for visiting its hidden gems. I am indeed already looking forward to seeing my junior friends on the UK campus. Trust me, your final year projects could be your livesâ€™ next turning point. If you are still uncertain in choosing a research topic, just remember to follow your heart and grasp the opportunities given. Whilst exposing yourself to a new dimension, a rewarding experience will also await you at the end. Moreover, I cannot wait to see what the future potentially holds for me in the research world! 35

Ashwagandha

Commonly known as Indian Ginseng or Winter Cherry, the herb has a central and prominent place in Ayurvedic medicine. Words: Yang Mun Yee, Edits: Chloe Chan

yurveda is an ancient medical system which originated from the Indian subcontinent. It is still practiced today, thanks to its principles being passed down through the verbal tradition. The earliest written manuscript found, in Sanskrit, was dated more than 2000 years ago. Ayurveda believes one to be composed of five basic elements found in the universe: space, air, fire, water and earth. These elements combine in the body to form three life forces or energies, known as doshas. These dosha include Vata (space and air); Pitta (fire and water) and Kapha (water and earth). Hence, a person is a unique mix of each dosha, and diseases is a result of an imbalance of these doshas. Physical fatigue for instance, is linked to an imbalance of the

Kapha dosha.

Phytochemical Constituents The main constituents of Ashwagandha are alkaloids and steroidal lactones. Withanine is the main constituent of the various alkaloids. The leaves contain steroidal lactones which are known as withanolides. Much of Ashwagandha pharmacological activity has been attributed to two main withanolides, Withaferin A and Withanolide. Most of its healing properties of Ashwagandha are contributed by the presence of withanoloides found in its roots. Withanoloides are steroidal and bear a resemblance, both in action and appearance, to that of Ginsenosides found in Asian Ginseng.

Taxonomical Classifications Kingdom: Plantae; Plants Subkingdom: Tracheobionta; Vascular plants Super division: Spermatophyta; Seeds plants Division: Angiosperma Class: Dicotyledons Order: Tubiflorae Family: Solanaceae Genus: Withania Species: Somnifera Dunal

Botanical Description:

A small woody shrub at 2 feet, its leaves are a dull green and elliptic, usually up to 10 â€“ 12 cm (4 or 5 inches) long. The flowers are small, green and bell-shaped. Ripe fruits are orangered.

accelerate as well. This proves helpful in athletes or for those aiming for fast recovery between sessions of exercise or physical activities. Ashwagandha helps the body improve its own natural production of steroids that in turn enhance protein synthesis. As steroids acts as a promoter for muscle growth, Ashwagandha supplementations can help increase muscle mass and strength. While studies have demonstrated Ashwagandha’s efficacy in combating fatigue alongside other therapeutic benefits, further clinical trials should be collected to support each of its proclaimed properties. Meanwhile, other methods to reduce fatigue in accordance to Ayurverda recommendations include an early night and an avoidance of mental work right before bed. These may seem impossible, especially among us students; but as all cases, doable.

Ashwagandha, is a direct translation of “smell of horse” from Sanskrit - as the person who consumes is believed to develop the strength and vitality to that of a horse.

Evidence Based Therapeutics As a natural, stable and sustainable energy enhancer, research suggests that Ashwagandha promotes greater levels of physical performance. This is done through the support of the nervous system and adrenals, helping to maintain energy levels during stressful times and hence, preventing the body from “burning out”. At a micro level, it promotes an increase in ATP (the energy-store for just about anything we do) in every cell. Following the increase in levels of ATP, cell repair and muscle recovery process in the body may

As ashwagandha aids in promoting muscle strength and recovery, it may be useful in conjunction with a resistance training programme. References: Chatterjee A et.al. The Treatise on Indian Medicinal Plants 1995; 4:208-212. K. Chandrasekhar et al. A prosprective, randomized double-blind, placebo-controlled study of safety and efficacy of a high concentration full-spectrum of Ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine 2012; 34: 255-262 C. Lakshmi et al. Scientific Basis for Therapeutic Use of Withania somnifera (Ashwagandha): A Review. Alternative Medicine Review 2000; 5: 334-344 KSM-66 Ashwagandha. Retrieved from https://www.ksm66ashwagandhaa.com/index.html Kumar.V, et.al. Chemistry and Pharmacology of Withania Somnifera: An Update. Tang Humanities Medicine. 2015;5:1 Narinderpal.K et.al. A Review on Pharmacological Profile of Withania Somnifera (Ashwagandha) 2013; 2: 6-14

Effects of coffee consumptio

The go-to fluid to fuel one through a late night reduces the health r student lifestyle – or does it? In this article, we explore the impacts Words: Yang Mun Yee, Edits: Chloe Chan

rinking coffee can protect one from developing liver disease and for those already affected, thus reducing the risk of the disease from progressing.

What does the liver do?

As the largest internal organ in the body, the liver is largely involved in all aspects of metabolism by playing a central role in fat, protein and carbohydrate processing. Besides, it acts as a purifier against infectious organisms, alcohol, drugs or other poisons from the blood; through secreting enzymes that modify the chemical structures of these xenobiotics in order to ease their excretion by the kidneys. This is what a healthy liver does.

spectrum of accompanying symptoms ranging from chronic fatigue to decreased appetite. (As certain symptoms may overlap with other disease, it’s the role of healthcare professionals such as pharmacists to identify the cause and suggest appropriate actions!)

A central role for liver enzymes?

GGT (Gamma-Glutamyl transferase) is an enzyme found at its highest concentration in the liver. It is elevated in the blood when diseases that cause damage to the liver or bile duct are present. This elevation forms part of the liver’s defence mechanism which caters for the increased need to detoxify the chemicals that could cause further harm to the liver. Fortunately, the constituents of However, an unhealthy lifestyle could coffee exhibit hepatoprotective effects through reducing fat cause healthy liver tissues to become disposition, inflammation and partly replaced with fatty tissue, oxidative stress on the liver; which leading to fatty liver indigestion. If left untreated, the repeated damage to could then decrease the liver’s the liver could trigger scar tissues to need for producing the enzyme form. As the formation of scar tissues GGT. According to studies from is an almost irreversible process, Japan, Europe and USA, the data the excessive development of scar from these countries suggests tissues (cirrhosis) may eventually an effect in genetically different lead to complete liver failure, which populations. For instance, data is often fatal. While the first step in from Japan suggests that GGT the management of liver disease is levels were approximately 30% diagnosis, this is often difficult for lower in those who drank 5 or the liver, being a ‘silent’ organ, does more cups of coffee per day, not display any visible symptoms for compared to non-drinkers. Those many. In cases where symptoms are who regularly consume alcohol present, they often present a

on on the liver

risk imposed by the typical of caffeine on the liver.

tend to have higher GGT levels initially, and the coffee consumption seems to have a greater effect in these individuals.

Liver Cancer

Coffee consumption is evident in mitigating the risk of liver cancer. Experts proposed that this phenomenon may in fact link back to an effect of caffeine on liver disease, for it is well established that liver cancer typically develops from an existing liver disease. Research also showed a dose response effect; whereby increasing coffee intake was associated with a lower risk of liver cancer.

Cirrhosis

Research from the US and Italy implied that coffee consumption could reduce the risk of cirrhosis, potentially by 25-70%. The correlations were higher in patients with alcoholic liver cirrhosis. The data also suggests that the relationship is consistent between different groups,

including those with pre-existing hepatitis B and C, and those who consume alcohol.

Chronic Liver Disease

Likewise, coffee consumption is discovered to prevent chronic liver disease, with an average risk reduction of 25-30% in low coffee consumers, and up to 65% in high coffee consumers. However, researchers agree that further research is needed to help define the ideal amount of coffee one should consume in relation to chronic liver disease reduction.

Summary

To conclude, research has suggested that moderate coffee drinking (defined as 3-5 cups per day by EFSA) is associated with a reduced risk of liver disease. While this may erase the guilt that comes with drinking 5 cups of Starbucks frappes or three-in-one coffee a day, Remember the key phrase of everything in moderation and you are well on your path on a longer and happier life.

References: Coffee&Health. November 2017. â€œRoundtable Report: Looking after the liver: lifestyle, coffee and caffeineâ€? Institute for Scientific Information on Coffee in association with British Liver Trust. Coffee and the Liver. (n.d.). Retrieved from https://www.britishlivertrust.org.uk/liver-information/diet-and-liver-disease/coffee-and-the-liver Coffee consumption and liver function. (2013, January 02). Retrieved from https://www.coffeeandhealth.org/2013/01/coffee-consumption-andliver-function. Gamma glutamyl transferase. (2001. Jan 1). Retrieved from https://www.tandfonline.com/doi/abs/10.1080/20014091084227?casa_token=g9nuBti5zG8AAAAA:VhzcBggmju4KdYOS_wuka5RtuhTFZwa5 ma5hWe9m8MJ19wawJ8RxKH1-ozRyNmF05rVQX6Bcb_E Coffee reduces liver damage in a rat model of steatohepatitis: The underlying mechanisms and the role of polyphenols and melanoidins. (2010, August 19). Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.23902

DANGEROUS DRU ONCE SOLD OVER

rom a layman’s point of view, medicines sold over-the-counter (OTC) can be easily obtained without a legal prescription. The mitigation of the control on these medicines might display them as “harmless”, however history has not quite reflected the same. In fact, many of the medicines in the past few centuries are definitely far from being “harmless”. Imagine a time traveller who brought back to the present day with him some cough drops from an apothecary. His initial enthusiasm to share his discovery with the rest of the world would only be met with an imprisonment sentence or in Malaysia, a death warrant. You might speculate that those medicines contain drugs that are considered illegal today, which is what this article aims to unfurl. Now, let’s take a look at some dangerous drugs that were once considered “harmless” and were sold on OTC shelves.

which caused many fatalities in children each year in the 20th century. This product was being sold without being labelled as an opioid medicine even though morphine (active ingredient of opium) was contained in it. The situation had only improved after the establishment of Pharmacy Act in 1868 which limited the availability of opium to the public.

Codeine

Opium Though not considered as a drug in the medicinal sense, opium is still regarded as a significant contributor to the birth of modern pharmacy stemming from its rich source of opiates. Albeit its obsolescence in this era due to the advancement of pharmaceutical research, opium once held the status of a miracle medicine, especially as a potent painkiller. In fact, it was so popular that bottles of opium dissolved in a tincture known as laudanum could be found on over-the-counter shelves in apothecaries throughout 19th century Europe. Opium was not only used as a painkiller, it was also indicated in asthma treatments and given to young children in syrup form. In spite of these therapeutic effects, the prolonged intake of opium induces a narcotic effect, leading to wide population dependence and many deaths due to overdose. One example would be Mrs. Winslow’s Soothing Syrup

The chemical structure of codeine is derived from morphine, which is the major active ingredient of opium. This opiate was highly common as a painkiller and was a typical ingredient in many over-the-counter cough syrups. However, similar to morphine, the intake of codeine gives out a narcotic effect and easily induces addiction among its consumers. It was not until the year 2010 that the purchase of codeine-containing medicines such as Panadeine, a painkiller which contains both paracetamol and codeine was made illegal in the EU. This is a result of accumulated reports that show many patients succumbing to the addictive effects of codeine, which is further escalated by the lack of prescriptions needed in procuring these medicines. One patient confessed that he had to consume Nurofen Plus tablets daily for his migraines for a pain-free day, for he would not only experience a relapse of his migraines, but also began to suffer from withdrawal symptoms such as insomnia and irritability once he stopped taking the tablets. The case above is not the only example; this vicious cycle is,

UGS THAT WERE R-THE-COUNTER unfortunately, still prevalent in most parts of the world until stricter pharmacy laws are enforced.

Heroin This is a familiar drug for many Malaysians, as Malaysian laws implicate that one would receive a death penalty once they are caught with 15 or more grams of heroin. Alarmingly, this drug used to be abundant on OTC shelves and was sold as cough medicines and migraine suppressants from 1898 to 1910. Founded by a scientist in what used to be Bayers pharmaceutical company, it was initially marketed as a non-addictive morphine substitute aimed to counter morphine addiction. However, studies soon discovered that heroin is not only metabolised into morphine in the body, its high fat solubility also granted its improved ability in penetrating the blood brain barrier. On that premise, Bayer had unfortunately opened a colossal Pandoraâ€™s box for the medicines it manufactured contained an ingredient that turned out to be more potent and fast-acting than morphine!

Cannabis

Recreational use of cannabis has been present for years in human history due to the euphoric effects it conjures. Oddly, this hallucinatory property grants cannabis a sacred status as its use is encouraged by several world religions. Despite its long history of human consumption,

it was only until the 19th century that pharmaceutical research on cannabis begun. Meanwhile, it was discovered that cannabidiol (CBD), a biologically active compound isolated from cannabis, exhibit anticonvulsant properties. This finding then expanded a whole market range of OTC products, including fluids and extracts for menstrual pain, cough and insomnia. Due to the low prices, these OTC products mostly gained popularity among immigrants and the poor. Unfortunately, it also turned out that cases of non-therapeutic use of cannabis among these demographic groups increased in frequency. As a result of the conflict between the medicinal value and the propensity for recreational abuse of cannabis, its legal use is currently subjected to tight governmental scrutiny. Thankfully, dependence on cannabis was low among the general British population hence minimum resistance was met at that time. However, recent studies reflect that the use of cannabisbased medicine is an effective way to control epileptic seizures among child patients. As a result, the demand for the eligibility of cannabis as a therapeutic agent by the healthcare professionals appeared. Due to this increasing demand backed up by scientifically proven effectiveness of cannabis against the patients, cannabis is promoted to a Schedule 2 Controlled Drug from Schedule 1, which meant that it can be lawfully possessed by a person with a prescription. This relaxation of law will be taking place 41

this autumn, allowing doctors to prescribe the use of cannabis-based medicines with approval from the government.

psychoanalysis, who recommended cocaine for the treatment of depression and the appetite loss associated. Regardless of whether the drug is suited for the indications mentioned, cocaine is a highly addictive psychoactive drug whose prolonged intake may cause hallucinations, anxiety and eventual death. The general intoxicative effect made it a prime target for drug misuse. Thankfully, we have lidocaine today as a substitute without the “rush” cocaine brought.

Cocaine

“Stay away from drugs.” That is what the public is being told these days. However, the use of cocaine as a medicine gained extensive popularity back in the 19th century. It was sold in the form of OTC products, with a prominent example being a cocaine-containing toothache analgesic for children. In addition, it was added into elixirs and tablets to treat minor ailments such as nasal congestion, sleeplessness and hayfever. The use of cocaine was made even notable by Sigmund Freud, the founder of

The rarity of drug discoveries, along with a lack of scientific validation of the existing drugs’ therapeutic efficacies and adverse reactions in the earlier days, led to an exaggeration of their therapeutic uses. Hence most of those drugs aforementioned were falsely marketed as “miracle drugs” to the public, no thanks to the laxer laws of the previous centuries. Their cheaper prices and easier access to the public OTC only served to heighten the production of medicines containing these drugs. Furthermore, research methodologies were often poor at that time, and the practice of clinical trials was not widespread; which meant that public retrieval of medicines would only continue until the emergence of severe adverse drugs reaction or even worse, fatalities. Of course, these stories were from another passage of time. It was with a thankful thought in mind that we live in the 21st century and the OTC medicines we have are considered “safe”... or are they?

Which tooth hurts? All of them

Words: Wan Xin Hui Edits: Chloe Chan

TCM medicines that interact with warfarin

arfarin as an oral anticoagulant has the unique ability to stop and prevent blood from â€˜thickeningâ€™. It is commonly used in the treatment of blood clots, and in preventing blood clot formation among high risk individuals. Warfarin was initially registered for use as a rodent poison upon its discovery in the 1940s. Only after multiple clinical studies in humans it was then approved for medical use in 1954. Its anticoagulant action is due to its interference with vitamin K metabolism in the liver; for vitamin K is required to activate proteins in the blood that trigger clotting (clotting factors). As metabolic processes often require the presence of enzymes, it intervenes with the metabolism of vitamin K via irreversible inhibition of an enzyme (Vitamin K epoxide reductase) that functions as a catalysis for the reduction of vitamin K. This chemical reduction in the body is essential in the activation of the clotting factors. Because of its narrow therapeutic window, warfarin is notorious for its predisposition to drug and food interactions, with roughly 120 substances being documented to associate with this. Even common culinary plants such as garlic and soy are outlined to interact with warfarin. In fact, herb/food-warfarin interactions account for a significant portion of hospital admissions stemming from their adverse effects with warfarin. This phenomenon is suggestive of the low awareness among healthcare professionals regarding warfarinâ€™s capability for interacting with natural products, which could be a result of a lack of

available literature. As the use of alternative medicine is becoming increasingly popular among the general public, it is crucial for prescribers and dispensers of conventional medicine to be educated on the different types of alternative medicine available in the market, especially on their ability to interact with conventional medicines. Much research has been done on herbs used in the west, however studies on medicinal plants of the east is still very limited. Considering that eastern alternative medicine such as traditional Chinese medicine (TCM) remains favoured among Chinese communities across the world, prescribers and dispensers of conventional medicine need to heighten their knowledge in the types of TCM herbs that interact with conventional medicine.With pharmacists having to take up the role of public health education as a part of their profession, it is their duty to educate the public on safe medicinal use. Therefore, this article provides a comprehensive guide on the TCM medicinal plants documented to interact significantly with warfarin, along with their respective mechanisms of interaction. Mechanisms of herb-drug interaction can be split into two categories: one is how the body affects warfarin (pharmacokinetic, PK) and the other is how warfarin affects the body (pharmacodynamic, PD). The interactions of TCM medicinal herbs stated below with warfarin include the interference with metabolic enzymes of warfarin (PK), platelet

function (PD), vitamin K cycle (PD) and coagulation cascade (PD). Warfarin is mainly metabolised by cytochrome P450s (CYPs), which constitute a large group of non-specific metabolic isozymes. Of all of the CYPs, CYP2C9, 1A2 and 3A4 participate in the metabolism of warfarin. CYP2C9 accounts for the metabolism of S-warfarin, the optical isomer with a greater potency, whereas CYP3A4 and 1A2 metabolise the R-isomer. Medicinal herbs that interfere with platelet function and coagulation cascade both inhibit the conversion of soluble fibrinogen to insoluble fibrin, thus heightening the action of warfarin. Fibrinogen is a protein found in the blood plasma that needs to be converted into fibrin in order for blood clot formation to occur. Fibrin on the contrary exerts its action by acting as a ‘net’, trapping blood cells. The only difference in their mechanisms of action is that medicinal herbs interfering with platelet function inhibit the secretion of thromboxane, which is a lipid prostanoid synthesized within platelets that triggers platelet aggregation. Medicinal herbs interfering with coagulation cascade instead affect the expression of thrombomodulin, which is an integral membrane protein of endothelial cells acting as a cofactor for thrombin in converting fibrinogen to fibrin. Below are some TCM medicinal plants that are clinically evidenced to interact with warfarin:

Angelica Sinensis 当归 Lycium Barbarum 枸杞 Panax Ginseng 人参

Chinese Angelica is first recorded in Shennong Ben Cao Jing（神农本草经）, the earliest materia medica of TCM, around 1800 years ago.The roots of this plant species are used in TCM to treat menopausal symptoms, menstrual disorders, hypertension and allergies. It garners the nickname ‘female ginseng’ for its use in the maintenance of female sexual health. Furthermore, it is used as a blood tonic, possibly due to its high coumarin levels that could give rise to vasodilatory and antiplatelet effects. Several clinical cases of interaction between Chinese Angelica and warfarin, involving an escalation of warfarin’s clinical effects have been reported. Two possible elucidations exist for this phenomenon: one is that Chinese Angelica inhibits CYP2C9 and CYP3A4, whereas the other is attributed to its high level of coumarins causing

With their increasing popularity as a superfood in the west in recent times, berries of this plant species however, have been used in TCM for over 2000 years to treat short sightedness, kidney and liver complications as well as diabetes. The berries are also often added into herbal soups, flower-based teas and desserts in Chinese cuisine. Though they may seem very tempting to be snacked on, concomitant intake of goji berries and warfarin can lead to internal bleeding. This is because goji berries are not only potent CYP1A2 and CYP3A4 inhibitors, they are also proven to inhibit CYP2C9 in vitro. This combinative inhibition would halt the metabolism of warfarin, an increase in plasma concentration of eventually leading to an increase in its plasma concentration. anticoagulants.

Ginseng root is used in TCM as a health tonic for the enhancement of the body’s tolerance to stress and the improvement of physical and mental wellbeing. It also has purported uses as a stimulant and an aphrodisiac.The proposed interactions between ginseng and warfarin seemed to be contradicting, as cases of both decreased and increased warfarin efficacy have been reported. Results proving the potentiation of warfarin by ginseng include the presence of ginsenosides believed to inhibit thromboxane function hence platelet aggregation in vitro, alongside their ability to inhibit CYP1A2, and their metabolites in inhibiting CYP3A4. However, other studies showed that ginseng reduces the AUC (area under the curve, an indication of the percentage of warfarin that enter the systemic circulation) of warfarin, thus decreases the anticoagulant effects of warfarin, though the mechanism of such still remains undiscovered.

Salvia miltiorrhiza Ginkgo Biloba Camellia Sinensis 银杏/白果丹参绿茶

The seeds of this plant species are used in The leaves of this plant species The roots of this plant species are used in TCM as a lung tonic in the treatment of are used to make green tea, which TCM to promote blood circulation and asthma, bronchitis and leukoria. On the is a popular beverage among improve blood flow. The interactions other hand, the leaf extracts are currently east Asians. This beverage hails between danshen and warfarin mostly popular as a health supplement, which its origins from the legendary occur at the pharmacokinetic level, are mainly used in the treatment of stroke father of Chinese medicine- Shen though a pharmacodynamic interaction and coronary heart disease. In addition Nong, who used it as an antidote is also reported. Danshen is indicated to to Ginkgo biloba’s medicinal use, the in treating his poisoning by the increase the absorption rate, AUC and seeds of this plant species are often added plants he tasted. It is rich in Cmax (maximum plasma concentration) to congee, soups and desserts in Chinese polyphenols, particularly flavonolsof warfarin meanwhile decreasing cuisine. Several reports on bleeding due and flavanols, whose radical the t1/2 (time taken for the plasma to ginkgo and warfarin intake exist, which scavenging action contribute to itsconcentration to decrease by half) in is a result of its endogenous compounds anticancer properties.46 In spite rats. Danshinone IIA, a compound such as ginkgolides, terpenoids and of its purported benefits, green isolated from danshen, is shown to flavonoids. However, the results tea is reported to interact with compete with warfarin over its albumin pertaining to the interaction between warfarin, though the results of the binding site, resulting in an increased ginkgo and warfarin are conflicting as the reports seem to be contradictory. plasma concentration of warfarin. actual mechanism of interaction remains Two studies had shown that Contradictory mechanisms of danshen’s uncertain. Ginkgolides are found to green tea reduces the efficacy of effect on warfarin’s metabolism have have antiplatelet and anti-inflammatory warfarin, resulting from its high been identified: one is that it induces properties whilst having the ability to amount of vitamin K antagonisingCYP3A4 in humans, and the other being induce CYP1A2 and 3A in mice. It is the inhibitory action of warfarin that it inhibits CYP1A2 and 3A in rats. said that ginkgo exerts its antiplatelet on vitamin K epoxide reductase. On the contrary, the pharmacodynamic activity through inhibiting the binding of In contrast, another study interaction between danshen and platelet activating factors to the receptors showed that green tea potentiates warfarin involves the augmentation on platelet membranes by ginkgolide B. the effect of warfarin. This is of anticoagulation via affecting the Flavonoids and terpenoids in ginkgo on attributed to phytochemicals such expression of thrombomodulin by the other hand, inhibit CYP1A2 and 3A4. as catechin and caffeine contained danshen, leading to a reduced efficiency Another study indicated that gingko has in the leaves, which can exert in the conversion of fibrinogen to fibrin. no effect on CYP3A4 in elderly volunteers, antiplatelet effects by stopping which might be due to the cancelling arachidonic acid release from of the effects of the ginkgolides and platelets. flavonoids on CYPs.

Moreover, interactions of warfarin with TCM herbs such as Chinese liquorice (Glycyrrhiza uralensis 甘草), five-flavored berry (Schisandra chinensis 五味子) and kudzu (Pueraria lobata 葛根) have also been reported, though there is no clinical evidence available thus far to support these interactions. Overall, the available information regarding the interaction between TCM herbs and warfarin is clouded with a great uncertainty, implying that further research is needed to affirm the veracity of the findings. Words: Chloe Chan Edits: Yang Mun Yee and Wan Xin Hui 45

P hc r o as s w ro r dmacy

Drug Names Wordsearch L I R P I M A R E T H A M B U T O L U I E L X D Z

V A L I U M G T S A L B U T A M O L C N N J K C D

B G L D E X T R O M E T H O R P H A N D O M X H C

H C C O O E K O D K C Q R S A O U E O O L O A R C

N V I Q D N N E E N I E W X A Q M D Y M C K V V V

L V M N K I Q I T N N G L A N E S I U E I J A K E

E H E U H L R F T O O P U E F E V M P T P A W Z L

AMITRIPTYLINE ATORVASTATIN BISOPROLOL BUPRENORPHINE CARBAMAZEPINE CIMETIDINE DEXTROMETHORPHAN DIGOXIN ENOXAPARIN ETHAMBUTOL FLUOXETINE FUROSEMIDE GABAPENTIN

L N T O B Y V E L N C X F T T Q D E Y H O N U P B

C C I U Q T Q O P L E O A E R E V S J A Z A R D J

N U D H O P S U O O R P N P M K R O U C Q F I K R

O J I G P I T R I P L O A A A Z E R A I U I T H Y

S M N I N R A B U N S O I B Z R N U N N O H C Z O

L W E D G T O B Y I I A H U A O I F I R Y B A L W

M I E P I I I N T J T N B E E G L N F I K J P A X

N R D D R M J R E O T I E N T I C E E S Z K R O D

P E I I K A O K R R S R I I M D Y H D P U F L Y P

GENTAMICIN HOLOPERIDOL HYDROCORTISONE IBUPROFEN INDOMETHACIN KETOCONAZOLE LIDOCAINE LORATIDINE METHOTREXATE MINOXIDIL NAPROXEN NIFEDIPINE OMEPRAZOLE

D N X B X C Z V X O P T H A P I C F I E A U W X X

E A O O O O A O P I E U P C A G A M P R Z O O I K

I E M R R S N R L X M A B O D O R C I D C F T H F

P Z D O T P O I O E R H J D E X T N N A R G Z R P

A Y K A D L A U M E U K V I J I E C E L K E L Z K

H B T Q O T L N V J I X H L V N T A M O X I F E N

B I V L P F K Z E N I P E Z A M A B R A C V N K T

N A T P I R T A M U S N I C I M A T N E G G D F B

M E T H O T R E X A T E Q R N I O T Y N E H P W X

PHENYTOIN PREDNISOLONE QUININE RAMIPRIL RISPERDAL SALBUTAMOL SUMATRIPTAN TAMOXIFEN TETRACYCLINE VALIUM VERAPAMIL WARFARIN ZOPICLONE 47

Case studies by Wan Xin Hui

Case 1

EN is a 45-year-old w pharmacy to pick up a inhaler. She has a past seasonal allergies and include 10 mg of lorat of albuterol 6 hours as breath, and 2 puffs of dry powder inhaler tw that her asthma symp the last few weeks and albuterol inhaler â€œa co She states that her fath inhaler to manage his pulmonary disease (C great. EN asks you wh an option for treating

What recommendati to EM?

Tiotropium is an inhaled long-acting muscarinic antagonist (LAMA) that was originally approved for the treatment of COPD and has recently gained approval for management of asthma. In patients like EN who are already taking an inhaled corticosteroid, adding a LAMA such as tiotropium has shown to improve symptoms and reduce the incidence of asthma exacerbations compared with an inhaled corticosteroid alone. Adding a LAMA to an inhaled corticosteroid has similar effects on asthma control as adding a long-acting beta-agonist. Advise EN that a LAMA such as tiotropium could be an option in addition to her fluticasone for management of her asthma and recommend that she speak to her physician about whether it is an appropriate choice for her. (Adapted from Pharmacy Times July 2017 â€“ Case Studies)

a w

Case 2

woman who comes to your a refill of her fluticasone t medical history of d asthma. Her medications tidine once a day, 2 puffs s needed for shortness of a 250-mcg fluticasone wice a day. EN mentions ptoms have been worse in d she has had to use her ouple of times per day.” her uses a tiotropium s chronic obstructive COPD) and he is doing hether tiotropium could be g her asthma.

AK, a 23-year-old woman, wants a recommendation for a medication to treat her vaginal discharge. She reports experiencing a thin, gray vaginal discharge and a ‘fishy’ odor for the past 2 days. AK is not taking any prescription medications and does not recall being treated for any type of vaginal disorder previously. She discloses that she has a new sexual partner and would like to remedy this problem as quickly as possible to avoid further embarrassment. Based on AK’s symptoms, what is her most likely diagnosis? Is she a candidate for self-care? What recommendations should you provide?

ions would you provide

ans ers

From the patient’s description, it appears that AK is suffering not from a vaginal yeast infection or vulvovaginal candidiasis but, more likely, from bacterial vaginosis, a polymicrobial infection of the vagina attributed to an increase in Gardnerella vaginalis and anaerobic organisms and a reduction in the normal colonization of Lactobacillus species.3 Although patients suffering from vaginal yeast infections typically experience severe pruritus, irritation, and a thick, white discharge, bacterial vaginosis is classically associated with a thin or watery malodorous discharge that increases after intercourse or with menses.3 Nonprescription vaginal antifungal products will not alleviate symptoms of bacterial vaginosis. In AK’s case, recommend referral to her primary care provider or gynecologist for evaluation and treatment with a vaginal antibacterial preparation (Adapted from Pharmacy Times Feb 2018 – OTC Case Studies) 49

3 pregnant women are sitting in the OB's waiting room knitting sweaters for their soon to be newborns. The first stops, pulls a pill bottle out of her pocketbook and says "multivitamin, good for mommy's health" and proceeds to take one. The second woman pulls a bottle out of her purse and says "prenatal vitamin, good for mommy and baby's health" before taking one. The third woman stops knitting, takes a bottle out of her pocketbook, and says "Thalidomide, because I can't knit sleeves to save my life".

JU S

FO Who is a WWE wrestler that clears a crowded area? John Senna

L U A G

A: Iâ€™m so DomperiDONE with this. B: METOOclopramide

I thought you were my ALLI, but youâ€™re just my ENEMA

S H G

At a medical symposium a doctor is preparing to give his speech on a new form of treatment that could save many lives. He has terrible memory and gets nervous quite easily so he writes his notes before hand. When he finally gets on stage to present his discovery is horrified to realize he cant read any of his notes! After a moment of silence he asks, "Is there a Pharmacist in the audience?"

What will become when you put the national animal of Malaysia on a trishaw? A tigecycline

You must be a box of BD needles because you are ultra fine

credits Designed by: Chloe Chan Ke Yi, Shadreen Fairuz Articles arranged and edited by: Chloe Chan Ke Yi, Wan Xin Hui, Yang Mun Yee, Nabihah Hamzah Articles provided by: Yang Mun Yee, Wong Weng Kit (Ray), Hiew Sheng Yuan (Aelex), Loo Wei Li (Ruby), Koh Calvin, Wong Wei Kit, Chan Loke Yee (Tammy), Wan Xin Hui, Chloe Chan Ke Yi