No abstract

The term "triple whammy" refers to a drug interaction following the concurrent use of angiotensinconverting enzyme inhibitors or angiotensin-II receptor blockers, diuretics and non-steroidal antiinflammatory drugs, the combination of which greatly increases the odds of acute kidney injury.Here, we report a case of a 66-year-old gentleman who was admitted into a tertiary care hospital for elective orthopaedic intervention. He had previously been prescribed sacubitril/valsartan and frusemide and had newly been started on celecoxib during hospitalisation. Upon the initiation of celecoxib, a mild increase in his serum creatinine was immediately observed, and this occurrence is believed to be due to the "triple whammy" combination. The combination of perindopril, frusemide and celecoxib continued to be overlooked throughout his hospitalisation. He was subsequently planned to be discharged with celecoxib on top of his existing chronic medications. However, upon discharge, the dispensing pharmacist took notice of the drug interaction and successfully intervened to withhold celecoxib.

Chronic pain has a significant impact on sufferers' quality of life. Furthermore, treatment inadequacies are often reported in the literatures. This study aims to investigate the prevalence of the different dosing behaviors in analgesics use in chronic, non-cancer pain and their correlation to pain control. This is a cross-sectional study and a convenience sampling method was applied. Brief Pain Inventory-Short Form and Pain Management Index was computed to assess pain control. Statistical analysis was performed with Pearson chi-square test and alpha value was set at 0.05. A total of 127 patients were analyzed. 70.9% of the patients reported inadequate pain control with their prescribed analgesic(s). 88.2% patients only took oral analgesics whenever they felt the pain while 11.8% patients took around-the-clock despite the absence of pain. Among them, 11.8-34.7% of patients did not follow their prescriber's instruction for oral and topical analgesic use respectively. However, no statistically significant result was found between the dosing behaviors and pain control (p>0.95). It was also reported that 98% of patients were not aware of the maximum daily dose of their prescribed analgesic(s). The prevalence of 'as needed' dosing is higher than around-the-clock dosing in the management of chronic, non-cancer pain, with deviation from the prescribed instructions between 11.8-34.7%. However, those differences were not significantly associated with the pain control.

Objectives: To calculate the total revenue under a hypothetical 1 Malaysian Ringgit (MYR) prescription cost sharing model in government healthcare facilities in Pahang, Malaysia.Methods: A cross-sectional study was conducted at outpatient pharmacy in all government healthcare facilities in Pahang from year 2013 to 2017. Each dispensed medication was calculated as 1 MYR and contributed to the total revenue.Results: A total of 11 hospitals and 81 health clinics were recruited into the study. A hospital could generate 0.311 million MYR per year, and a district health department could generate 0.623 million MYR per year, giving a total of 10.268 million MYR revenue every year in Pahang, Malaysia. Under the prescription medicines cost sharing scheme, it was shown that an average of 9.4% of the total pharmaceutical spending could be recovered. The recovery percentage was approximately fourfold higher in health clinics (16.5%-21.7%) when compared with that in hospitals (4.3%-5.2%). Conclusion:An estimated 10 million MYR or 10% from the total Ministry of Health pharmaceutical spending could be collected under the proposed 1 MYR prescription cost sharing model.