High Alert Medication - Hospital Seberang Jaya



Volume 1, Issue 1 SEPTEMBER 2013





Dr. Azlina Muhd Radzi

Atisha bt. Abdul Hanif

Member s of the Team:

Nurazrina bt Yuzrin

Yu Soo Kuan

Ooi Lee Hwang

Tan Say Li

Liew Lee Yoon

Tan Yee Chiun

Inside This Issue:

High Alert Medication 1-2

DPP-4 Inhibitors 3-4

High Alert Medication


High Alert Medications

are medications that bear a heightened risk if causing significant patient harm when these medications are used in error


Medication errors are significant and often preventable healthcare problems. Some medications have a very narrow margin of safety and can cause severe patient harm when implicated in an adverse drug event and hence require heightened vigilance.

These medications are identified as

High Alert


The institute of Safe Medication Practices

(ISMP) recommends that High Alert Medications should be packed differently, stored differently, prescribed differently and administered differently than others.

Classes/ Categories of High Alert Medications

Managing High Alert Medications

High alert sticker for containers or product packages.

High alert stickers for ampoules or vials

High alert labels for storage shelves in pharmacy.

High alert labels for storage container.

DOPamine hydrALAZINE

Use TALL man lettering for label on storage container.

List of High Alert

Medications are displayed & distributed to all wards.

Reference: Guideline On Safe Use of High Alert Medications, Pharmaceutical Services Division, MOH, 1st Edtion 2011

DPP-4 Inhibitors

The dipeptidyl peptidase-4 (DPP-4) inhibitors are a newer class of oral drugs for the treatment of type 2 diabetes.

Glucagon increases blood glucose levels, and DPP-4 inhibitors reduce glucagon and blood glucose levels. The m e c h a n i s m o f D P P - 4 i n h i b i t o r s i s t o increase incretin levels (GLP-1 and GIP), which inhibit glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.

DPP-4 inhibitor that is available in Hospital Seberang Jaya:

1. Sitagliptin 100mg (Januvia®)

2. Saxagliptin 5mg (Onglyza®)

3. Vildagliptin 50mg (Galvus®)

4. Vildagliptin 50mg + Metformin 1000mg (Galvus Met®)

Sitagliptin, Saxagliptin and Vildagliptin have been shown to reduce HbA


by 0.6

– 0.7% when used either as monotherapy or in combination with metformin, sulphonylureas (SUs) or a combination of both.

Rates of hypoglycaemia 6 – 10 times lower than with sulphonylureas.

Do not increase hypoglycaemia episode due to its glucosedependent stimulation of insulin secretion and inhibition or glucagon secretion.




N.A. Thonrberry & B.Gallwitz. Mechanism of action of inhibitors of dipeptidyl-peptidase-4 (DPP-4).

Best Practice & Research Clinical Endocrinology & Metabolism. 2009. 23(4): 479-486.

C. McDougall, G. A. McKay & M. Fisher. Drugs for diabetes: part 5 DPP-4 inhibitors. The British

Journal of Cardiology. 2011. 18 (3): 130-132.






MedlinePlus, “Glucosamine Suphate” 12 September 2011. http://www.nlm.nih.gov/medlineplus/druginfo/natural/807.html (5 September 2013)

Wikipedia, “Glucosamine” 7 September 2013. http://www.en.wikipedia.org/wiki/Glucosamine (9 September 2013)