1ST ASSIST. PHARMACIST TECHNICAL COMMITTEE MEETING

To all Malaysian Assist.Pharmacist,

I will be attending the 1st Assist.Pharmacist Technical Committee meeting at our HQ-Pharmacy Services Division, MOH on 15th July 2010.

If you have anything to raise regarding our profession, please email me at : pfganesh@gmail.com or you can call me also at 012-5172500.

May this meeting will be our first step towards our developments. Together we pray for it !

Ganesan
Senior Assist.Pharmacist
Taiping Health Clinic

Diclofenac: Similar CV Risk to Rofecoxib in Healthy People

Dear readers,
Its shocking to know that the drug we've been using everyday in our life has this potential. This article was taken from MEDSCAPE.COM
This article is intended for primary care clinicians, cardiologists, rheumatologists, orthopaedists, and other specialists who prescribe NSAIDs to adults.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Authors and Disclosure

From Heartwire CME
Diclofenac: Similar CV Risk to Rofecoxib in Healthy People CME/CE

News Author: Lisa Nainggolan
CME Author: Charles P. Vega, MD

Authors and Disclosures

June 14, 2010 — The first study to examine the cardiovascular risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy individuals has found increased morbidity and mortality with diclofenac, rofecoxib (Vioxx, Merck), and high doses of ibuprofen [1]. Naproxen, in contrast, has a safer cardiovascular risk profile, say Dr Emil Loldrup Fosbøl and colleagues in their paper published online June 8, 2010 in Circulation: Cardiovascular Quality and Outcomes.

The increased cardiovascular morbidity and mortality seen with diclofenac, which is similar to that observed with rofecoxib--a drug that was withdrawn from the market in 2004 because of poor cardiovascular safety--is particularly concerning, Fosbøl told heartwire .

Patients and clinicians need to know that [diclofenac] increases the risk of cardiovascular adverse events.

"We've been so much focused on the newer COX-2 inhibitors, but the primary message concerns diclofenac, because there is so much evidence now that this is also a problem; it has been shown quite extensively in many reports. Diclofenac has been used for almost 50 years and is available over the counter [OTC] in many countries, which I think is irrational. This is a major public-health concern, and patients and clinicians need to know that this drug increases the risk of cardiovascular adverse events. "

Also worrying is the fact that the results were dose-dependent, and diclofenac is more often used in high doses compared with other NSAIDs, say Fosbøl and colleagues. "Our results suggest that naproxen could be a safer alternative when NSAID treatment is required," they state.

Large Study, Covering Entire Population of Denmark

The researchers used a nationwide cohort of healthy individuals over the age of 10 in Denmark, made possible by the fact that all residents have a unique personal number, which enables linkage of administrative registries on an individual level. They identified more than 2.5 million people who claimed at least one prescription for NSAIDs from 1997 to 2005; after applying selection criteria regarding comorbidity and concomitant pharmacotherapy, they included just over one million individuals in the analysis.

Ibuprofen was the only nonaspirin NSAID that could be purchased OTC in Denmark during the study period, but it was available only in low doses (200 mg) and in limited quantities, say the researchers. In addition, the system in Denmark would ensure that those requiring higher doses of ibuprofen would have financial incentive to obtain a prescription from their doctor, so OTC NSAID use is unlikely to have had a significant influence on the results, they point out.

Prescription use of the nonselective NSAID diclofenac and the selective COX-2 inhibitor rofecoxib was associated with an increased risk of cardiovascular death (odds ratio 1.91 and 1.66, respectively), with a dose-dependent increase in risk.

Our results further strengthen the association between NSAID use and cardiovascular risk by demonstrating effects on all cardiovascular outcomes.

There was a trend for an increased risk of fatal or nonfatal stroke associated with ibuprofen treatment (OR 1.29), but naproxen was not associated with increased cardiovascular risk (OR for cardiovascular death 0.84).

Although rofecoxib was withdrawn in 2004, another COX-2 inhibitor, celecoxib (Celebrex, Pfizer), is still available. But Fosbøl et al say they were unable to draw any firm conclusions about the cardiovascular safety of celecoxib in this study because the analysis is based on few events, especially at higher doses. The results of the ongoing Prospective Randomized Evaluation of Celecoxib Integrated Safety vs Ibuprofen and Naproxen (PRECISION) trial should shed more light on the risks and benefits of this drug, they say.

They also showed that all NSAIDs except for celecoxib were linked to a substantial increase in risk of serious bleeding, a well-known adverse effect of NSAIDs "that needs to be kept in mind."

Dr Florian Krötz (University Hospital Munich, Germany), who has recently published a review on the risk of MI associated with diclofenac [2] but was not involved with this study, told heartwire : "Concerning diclofenac and rofecoxib, I agree with the increased risk of CV death that the authors find."

However, a "major weakness" of such observational trials is the problem of correlating doctors' certificates on causes of death with numbers of prescriptions, he says. And it is unknown whether the individuals have actually taken these drugs or whether they had cardiovascular risk factors or even any history of CV disease. "As such, I think such studies must be interpreted with great caution," Krötz commented.

Fosbøl et al acknowledge these shortcomings of their trial but note that it also has its strengths, including the size and completeness of data, covering the entire population of Denmark, and the fact that two independent and different statistical approaches were employed to examine the relationship between exposure to NSAIDs and the chosen outcomes.

First Study to Show NSAIDs Affect All Cardiovascular Outcomes

The study was also the first to look at quite specific cardiovascular end points rather than just MI or MI and overall death, says Fosbøl. No previous study has reported results on specific end points such as fatal/nonfatal stroke or coronary death combined with nonfatal MI.

"Therefore, our results further strengthen the association between NSAID use and cardiovascular risk by demonstrating effects on all cardiovascular outcomes."

Population of NSAID Initiators and Sex-, Age- and Time-Matched Controls of Non-NSAID Initiators: Hazard Ratios for Specific Causes of Death Associated With Exposure Stratified According to Daily Dosagea
Drug (mg/day) CV death Coronary death or nonfatal MI Fatal or nonfatal stroke
Ibuprofen
Any use 0.88b 1.31b 1.47b
<1200 0.79b 1.24b 1.39b
>1200 1.63b 1.94b 2.22b
Diclofenac
Any use 1.20b 1.83b 2.00b
<100 0.80 1.39b 1.33c
>100 1.46b 2.10b 2.41b
Rofecoxib
Any use 1.64b 1.84b 1.12
<25 1.60b 1.82b 1.10
>25 2.77c 2.36 1.79
Celecoxib
Any use 1.24 1.44b 1.27
<200 1.19 1.44c 1.16
>200 1.51 1.49 1.95
Naproxen
Any use 0.86 0.78 1.54b
<500 0.84 0.69c 1.55c
>500 0.92 1.22 1.48

a. Compared with no use (HR=1.00)

b. p<0.05

c. p<0.01

Fosbøl says the findings underline the fact that individual NSAIDs have different degrees of cardiovascular safety, so doctors should always make an individual assessment of cardiovascular risk and carefully consider the balance between benefit and risk before starting therapy with any NSAID.

Also, because adverse CV events observed were dose dependent, it is important that NSAIDs are prescribed at the lowest possible dose for the shortest period of time, he adds. He and his colleagues were not able to examine duration of use with regard to cardiovascular risk in this study, but will do so in a future analysis, he says.

The authors declare that they have no disclosures.

References

1. Fosbøl EL, Folke F, Jacobsen S, et al. Cause-specific CV risk associated with NSAIDs among healthy individuals. Circ Cardiovasc Qual Outcomes 2010; DOI:10.1161/CIRCOUTCOMES.109.861104. Available at: http://circoutcomes.ahajournals.org.
2. Krötz F, Struthmann L. A review on the risk of myocardial infarction associated with the NSAID diclofenac. Cardiovasc Hematol Disord Drug Targets 2010; 10:53-65. Abstract

Clinical Context

The use of the COX-2 inhibitor rofecoxib has been associated with a significant increase in the risk for cardiovascular disease, and a study by Solomon and colleagues, published in the April 22, 2008, issue of Circulation, examined whether another COX-2 inhibitor, celecoxib, was also associated with cardiovascular risk. Researchers pooled data from 6 randomized trials of celecoxib and found a significant 60% increase in the risk for a combined cardiovascular endpoint associated with the use of celecoxib. However, the 400-mg daily dose of celecoxib was not associated with a higher risk for cardiovascular disease, and the rate of cardiovascular events related to the use of celecoxib was most pronounced among patients at high baseline cardiovascular risk.

The risk for cardiovascular disease may not be limited to COX-2 inhibitors; other NSAIDs have also been implicated. The current study uses a large patient database to examine this issue.
Study Highlights

* Researchers queried patient databases in Denmark for information pertaining to events between 1997 and 2005. Specifically, researchers examined a national mortality registry and a national database of inpatient admissions. They also examined a national database of prescriptions, which offers virtually complete prescription data across Denmark.
* The study group was aged 10 years or older in 1997. The main study outcome was the relationship between NSAID use and the risks for cardiovascular outcomes, which were defined by cardiovascular death, MI, and stroke. Researchers also examined rates of bleeding associated with NSAIDs.
* The study analysis adjusted for age, sex, and calendar year.
* The study cohort consisted of 1,028,437 apparently healthy individuals with a median age of 39 years; 58% of subjects were men.
* 44.7% of study subjects had an NSAID prescription claim; 2204 individuals died during treatment with an NSAID during the study period.
* The use of diclofenac and rofecoxib were associated with a higher risk for cardiovascular death (OR, 1.91 and 1.66, respectively). There was a dose-response effect in the risk for cardiovascular death associated with these medications.
* In contrast, ibuprofen, celecoxib, and naproxen were not associated with a higher risk for cardiovascular death.
* However, the use of ibuprofen (OR, 1.52), diclofenac (1.82), and rofecoxib (1.72) increased the risk for coronary death or nonfatal MI.
* The use of ibuprofen and naproxen were associated with an elevated risk for stroke.
* Overall, naproxen was associated with the lowest cardiovascular risk for the different NSAIDs examined.
* All NSAIDs, except celecoxib, were associated with a higher risk for fatal or nonfatal major bleeding. The risk of bleeding was dose dependent.
* Slightly more than half of individuals who died during NSAID treatment died of noncardiovascular causes. However, NSAIDs were not associated with a higher risk of dying of causes other than cardiovascular causes.

Clinical Implications

* A previous study evaluating randomized trial data found a significant increase in the risk for cardiovascular disease associated with the use of celecoxib. This risk was most pronounced in higher doses and among patients with a higher baseline cardiovascular risk profile.
* The current study demonstrates that NSAIDs can increase the risk for cardiovascular disease. Rofecoxib and diclofenac were particularly associated with a higher risk for cardiovascular outcomes, whereas naproxen had a safer cardiovascular risk profile.

Reaching Out to an Impaired Physician

MEDSCAPE PHARMACIST

Joseph R. Yancey, MD, CPT, MC; Harry D. McKinnon Jr., MD, LTC (Ret.), MC

Authors and Disclosures

Posted: 04/29/2010; Family Practice Management. 2010;17(1):27 © 2010 American Academy of Family Physicians

Abstract and Introduction

Abstract

Effectively addressing a colleague's impairment requires care, planning and courage.

Introduction

Imagine that you are a family physician in a small, private group practice where for 10 years you've practiced with a colleague we' ll call Dr. D. Dr. D's responsibilities are similar to your own and include both outpatient medicine in your practice and inpatient medicine at three local community hospitals. He has earned a reputation as a superb physician and eager team player. However, in recent months, colleagues and staff have expressed concern to you about behavioral and personality changes in Dr. D. He has become confrontational about trivial things and is increasingly withdrawn. You witness him yelling at a member of the nursing staff over a minor issue. When you approach Dr. D, he is dismissive and states that he is "just stressed out."

Health care providers and behavioral health professionals have made great effort to characterize psychiatric illnesses such as addiction and depression as diseases rather than as moral failings. Nevertheless, physicians who suffer from such illnesses often have difficulty acknowledging that they are susceptible, while in fact addiction and depression are as common in health care providers as in the general population.^[1,2] In addition, other mental illness – such as dementia, bipolar disorder or a personality disorder – or physical injury can lead to an inability to safely perform one's duties as a health care provider.^[3]

Any health condition that could interfere with a health care provider's judgment or other faculties needed as a clinician is referred to as impairment. An impaired physician may have deleterious effects on his or her patients and medical group. As a colleague of an impaired physician, you face a tough moral question: What is my responsibility? The importance of intervening with a struggling colleague cannot be overstated. This article offers advice that may enable you to address the situation productively.

Epidemiology

Not only are physicians as likely to suffer from the spectrum of addictive disorders as the general population,^[1] but it has also been suggested that psychosocial factors which influence people to choose the medical profession are also associated with addiction.^[4] Alcohol, the most commonly abused drug in the United States, is used more frequently by medical professionals than by the general population, although the prevalence of alcohol use among medical professionals is thought to be similar to the prevalence among others of similar socioeconomic status. Physicians as a group are less likely than the overall population to abuse "street" drugs but are more likely to abuse prescription drugs and narcotics, to which they have ready access through self-prescribing or through prescriptions from colleagues. Differences in access to specific drugs are also thought to create variances in drug use among different specialties. Anesthesiologists are more susceptible to narcotic dependence, while emergency medicine physicians are thought to be more prone to illegal drug addictions. Psychiatrists are more likely to abuse prescription mood-altering substances.^[1]

Depression is as common in physicians as in the general population. Gender differences in the prevalence of depression are also similar between physicians and the general population, with 12 percent prevalence for male physicians and 19.5 percent prevalence for female physicians. Suicide rates are higher for physicians than for the general population, and suicide is a disproportionately high cause of mortality in physicians, particularly among female physicians.^[2]

It should be mentioned that data regarding rates of addiction and mental illness are collected by survey or from physicians' health programs. Self-reporting bias in surveys is likely to produce underestimation of the prevalence of impairment. Information from physicians' health programs will not include impaired physicians who are not being treated or those who have sought treatment without informing their health program. Thus, it is difficult to find reliable figures on physician impairment.

Confrontation

The staff has noticed that Dr. D is working very unusual hours. Rumors are swirling that he and his wife are having problems at home. Patient complaints about Dr. D have increased. Many say that he seems tired, constantly distracted and uninterested in conversation. A member of the hospital nursing staff reluctantly mentions to you that she smelled alcohol on his breath.

Most people would agree that it is difficult to confront someone who is impaired. The level of denial, especially for addicts who work in health care, can be surprising and challenging.^[5] The level of importance that is placed on work by those in the health professions is often very high; as a result, social, financial and interpersonal decay often occur before the addiction interferes with the job. Dr. D's wife and children are likely to have suffered the effects of his illness long before you noticed it at work. By the time a physician's job performance is impaired, the disease is often getting out of control.^[6]

If Dr. D is truly under the influence of alcohol at work, then his patients' safety is being compromised. Even if he has made no overt error, the patient-physician relationship is harmed by his impairment. A physician is less likely to recognize mental illness in a patient while suffering from one himself.^[2] Colleagues of the impaired physician suffer from increased workloads and a negative work environment. In the event of a malpractice suit, colleagues should expect legal scrutiny, particularly if they knew about the physician's impairment and did not intervene.^[4]

The first approach to Dr. D in the scenario described might be a simple personal communication. A genuine expression of concern – just asking "How are you?" – is a good start, but the denial that comes with impairment often limits the question's effectiveness.^[7] Most experts recommend a more formal group process known as an intervention. The purpose of an intervention is to present the evidence of impairment to the impaired person in a controlled setting in the hopes of being able to convince him or her to accept help. Participation from co-workers and family members is encouraged, and if possible someone who is experienced with interventions should be present to facilitate the communication. A physicians' health program is a good place to look for a facilitator; contact information for each state's program can be found at the Federation of State Physicians' Health Programs. It is important that those conducting the intervention be prepared to help the impaired physician get treatment immediately following the discussion, including transfer to an inpatient facility as appropriate. Finally, individuals involved in the intervention must establish and clearly communicate consequences for rejecting help, such as suspension of clinic or hospital privileges, a report to the state licensing board and even separation from a spouse.^[5] Without the threat of consequences, an impaired colleague is less likely to accept help and patient safety remains compromised. (See additional suggestions for interventions in the box below.)

Treatment

Dr. D's condition has grown more serious. There are increasing absences from the clinic, more adverse confrontations with staff and more patient complaints. Nurses in the hospital have been paging you to correct some of his erroneous written orders. As a result, you and your partners decide to do an intervention. You anonymously contact your state's physician health program to find someone to assist you with the intervention. After meeting with the intervention expert and conducting a rehearsal, you select a date and time for the intervention. Dr. D enters the meeting to find you, the expert, his wife, two other physicians who know him well and the head nurse for the clinic. Each attendee calmly presents evidence to Dr. D about his impairment, detailing his absences, his behavior at home and at work, and his errors. At the end of the presentation, Dr. D is silent and appears angry. The intervention expert then presents Dr. D with his options: either he reports to an inpatient facility immediately for evaluation and treatment or he will be terminated from the practice and have his hospital privileges suspended. The practice will also file a formal complaint regarding Dr. D to the state medical board if he refuses treatment. Dr. D chooses to report to treatment and boards a plane that evening with bags that his wife has already packed.

Increased awareness of substance abuse among health care professionals in recent years has contributed to an increased emphasis on identification and reporting of concerns as well as on the establishment of monitoring and assistance programs.^[8] The Joint Commission has recently insisted that "medical staffs implement a process to identify and manage matters of individual physician health that is separate from the medical staff disciplinary function."^[9] In addition to local committees at the hospital or medical school level, nearly all 50 states have established programs for identifying and monitoring the impaired physician. These programs are typically composed of an addiction medicine specialist, a psychiatrist and legal counsel. Their overall goal is to provide guidance and resources focusing on the education, rehabilitation and post-treatment monitoring of the impaired physician. The process should not be considered punitive in nature; it is important to treat these physicians as patients rather than criminals. Acceptance and willingness to participate in treatment may depend on this approach.

A treatment plan should be established only after completion of a comprehensive evaluation. The ideal components of a successful treatment program for physicians include these: immediate intervention, evaluation and triage to an appropriate facility, uninterrupted therapy and family involvement followed by rapid re-entry into practice, close monitoring and a contingency plan.^[10] The evaluation should include identification of any comorbid psychiatric or medical diagnoses that may influence treatment success. Once the initial evaluation is completed, efforts should focus on designing a treatment program best for the individual. Most substance abuse programs include detoxification, rehabilitation, ongoing group therapy and attendance at 12-step meetings such as Alcoholics Anonymous or Narcotics Anonymous.^[8] In addition, the Caduceus Society offers a support program especially for recovering health care providers. Many physicians will require inpatient treatment because of the severity of their dependence.^[5]

Treatment does not end with discharge from an inpatient program. The ultimate treatment goals are abstinence and successful return to practice, so it is imperative that a realistic and comprehensive outpatient program be initiated immediately upon discharge. Once physicians have completed the inpatient program and demonstrated commitment to an outpatient treatment plan, consideration should be given to returning them to practice. It is common to have the physician sign a contract detailing the expectations for continued recovery and professional conduct.^[13] In many cases, the contract specifies that failure to adhere to its specific conditions will result in a report to the state licensing board for public citation or potential suspension of license. Periodic monitoring is an integral part of outpatient treatment, and although the specific requirements may vary, the duration is typically no less than five years.^[8] Inclusion of family members has been shown to produce better outcomes in the treatment and rehabilitation process.^[11,12]

Outcomes

The majority of physicians will return to practice, and prognosis for recovery is better than among the general population.^[5] A 2008 British Medical Journal article discussing physicians monitored by several state physician health programs shows that 78.7 percent of monitored physicians were licensed and working five years after admittance to a program.^[14] It may be necessary to modify the work environment for some physicians by decreasing stress levels and restricting access to certain drugs. A factor that may be important to a successful return to practice is the possibility that relapse will entail financial, personal and professional losses. Modifiable factors that contribute to relapse include failure to understand and accept illness, continued denial, a dysfunctional family, poor mechanisms to cope with stress, overconfidence, poor relationship skills, shame and guilt.^[15,16] Nonmodifiable factors that are associated with relapse are a strong family history of addiction and the use of strong opioids with a coexisting psychiatric disorder.^[17] The struggle with addiction is often lifelong, and success typically depends on the level of support in both personal and professional settings.

As for Dr. D, he reported to an inpatient treatment facility for addictive disorders that specializes in physician impairment. His practice agreed to pay the required $35,000 for treatment with the understanding that Dr. D will repay the practice over time. Upon admission, a physician presented him with a treatment plan contract, which he signed. A full psychiatric evaluation revealed that he was suffering from depression as well as alcohol dependence. A physician at the center monitored his treatment and started him on a selective serotonin reuptake inhibitor for his depression. He attended twice-daily meetings similar to those of Alcoholics Anonymous. After six weeks of intensive rehabilitation, Dr. D returned home with a plan for continued monitoring.

A few days after returning home, Dr. D returned to work. His partners were eager to see him return, both from collegial concern and because they had been sharing his workload during his treatment period. He admitted that returning to work was awkward, but that everyone had been supportive. His reintegration at home was not as smooth. The pain of past events proved too much for Dr. D's marriage, and his wife filed for divorce. He continues to be monitored by a physician outside the practice and submits to unannounced monthly urine drug testing per his treatment contract. His patients remain unaware of his treatment, having been told only that Dr. D had a prolonged illness.

Rosiglitazone, Ticagrelor, Dabigatran All Up for FDA Review

Dear readers,

Here are some very good article from Medscape.

www.medscape.com

Shelley Wood

Authors and Disclosures

June 10, 2010 (Gaithersburg, Maryland) — So much for the dog days of summer: three of the most closely watched drugs in recent memory are now scheduled to go before their respective FDA advisory panels in the next few months.

First up is the much-anticipated two-day rosiglitazone (Avandia, GlaxoSmithKline) discussion. As previously predicted by heartwire , the rosiglitazone panel meeting will take place July 13–14 and will be a joint meeting of the Endocrinologic and Metabolic Drugs and the Drug Safety and Risk Management advisory committees. According to the FDA's calendar posting, the committees will review results from the Rosiglitazone Evaluated for Cardiac Outcome and Regulation of Glycemia in Diabetes (RECORD) trial, as well as observational data, health-claims data, and a meta-analysis of controlled clinical trials. The FDA also plans to present its meta-analysis of several trials of pioglitazone (Actos, Takeda Pharmaceuticals) to help panel members understand the relative risk and benefits of the two market-approved thiazolidinediones.

Rosiglitazone was first approved by the FDA in 1999, but concerns over its risk/benefit profile have led to mounting calls to stop the ongoing comparator trial addressing cardiovascular safety, TIDE, and to pull the drug from the US market.

Two weeks later, ticagrelor (Brilanta, AstraZeneca) makes its debut before the Cardiovascular and Renal Drugs Advisory Committee, July 28. As previously reported by heartwire , ticagrelor first set chins wagging at the European Society of Cardiology (ESC) 2009 meeting with the presentation of the phase 3 PLATO results, showing that the new, twice-daily, oral antiplatelet agent reduced the rate of MI/stroke/CV death in ACS patients, as compared with clopidogrel. PLATO data resurfaced in late-breaking clinical-trial sessions for at least two additional meetings, where additional subset analyses were presented. AstraZeneca submitted its new drug application for ticagrelor to the FDA last November.

Next up is dabigatran (Pradax, Boehringer Ingelheim). While the drug is not formally scheduled in the confirmed FDA advisory committee calendar, heartwire has learned that dabigatran will be the focus of the September meeting of the Cardiovascular and Renal Drugs Advisory Committee. A date of September 17 is listed in the tentative calendar but may still change. The FDA publishes a Federal Register notice 15 days in advance of each upcoming advisory committee meeting to formally announce the drug being discussed and will not currently confirm or deny the topic of the September meeting.

As reported by heartwire , dabigatran jostled for the limelight with ticagrelor at ESC 2009, where the RE-LY results were first presented showing that the new oral anticoagulant dosed at 150 mg twice a day reduced the annualized risk of the primary end point--stroke, peripheral embolic events, and the risk of hemorrhagic stroke--compared with warfarin, without increasing the risk of bleeding. Subsequent analyses were presented at the 2010 International Stroke Congress and AHA 2009 meetings. The drug is already approved for venous thromboembolism (VTE) prevention during hip- and knee-replacement surgery in the European Union and Canada.

Dabigatran is one of several new anticoagulants in late-stage testing, hoping to become the number-one warfarin competitor and obviate the need for cumbersome INR testing.

Each FDA meeting will be covered in depth by heartwire ; receive up-to-the-minute updates on how the meetings are progressing by following theheart.org on twitter.

MALAM MESRA PPF MALAYSIA

Semua Pen.Pegawai Farmasi adalah dijemput menghadiri malam mesra PPF 2010 di Hotel Flemington, taiping (kawasan Lake Garden).

Bayaran adalah sebanyak RM50.00 seorang dan tambahan RM40.00 jika membawa pasangan atau anak. Penginapan di Hotel RM118.00 twin sharing.

Aktiviti : Live band, Permainan, cabutan bertuah dll...