We performed drug-induced lymphocyte stimulation tests (DLST) and leukocyte migration inhibition tests (LMIT) in an analysis of a traditional Chinese medicine, Xiao-chai-hu-tang (Japanese name : Shosaiko-to) and seven kinds of the constituent herbs in healthy volunteers to study their immunopharmacological effects on the peripheral blood lymphocytes.
The DLST findings were positive at concentrations of more than 0.01mg/mL for the heated suspension of Shosaiko-to and more than 0.1mg/mL for the centrifuged supernatant and the 0.22μm membrane-filtrate. On the other hand, the LMIT findings were positive at concentrations of more than 0.1mg/mL for three kinds of Shosaiko-to preparations. The activities of Shosaiko-to in DLST and LMIT decreased after removing insoluble materials using centrifugation and filtration and were higher in enriched T-cells than in unfractionated peripheral blood mononuclear cells. Scutellariae Radix, Glycyrrhizae Radix and Bupleuri Radix showed higher DLST and LMIT activities among the constituent herbs of Shosaiko-to.
Our findings indicate that DLST should be performed at concentrations of less than 0.001mg/mL using the heated suspension of Shosaiko-to or less than 0.01mg/mL using the centrifuged supernatant and LMIT at less than 0.01mg/mL using either the heated suspension or the centrifuged supernatant to determine whether patients have hypersensitivity to Shosaiko-to, because high concentrations of Shosaiko-to cause in vitro polyclonal stimulation of the peripheral blood mononuclear cells isolated from healthy donors. Furthermore, our results also suggest that the above activities of Shosaiko-to may effect T-cells due to high molecular weight insoluble particles most likely contained in the Scutellariae Radix, Glycyrrhizae Radix and Bupleuri Radix.

抄録全体を表示

We evaluated the comprehension levels of inpatients with diabetes mellitus at the hospital of Shiga University of Medical Science using an originally-developed checklist. The checklist consisted of ten basic points in a written questionnaire and twelve applied points in a hearing questionnaire. The first evaluation was made after the patients were admitted to the hospital. Based on the results, we repeatedly educated the patients regarding any issues that they could not still understand, and their comprehension levels were later re-evaluated using the same checklist just before being discharged. These trials contributed to the general improvement of the patient comprehension levels. Furthermore, the effect of the comprehension levels on HbA _1c was monitored in the forty-three inpatients until six months after discharge. There was no significant difference in the backgrounds of the patients and the prescribed medicines between the checked group and the non-checked group. We classified the checked groups into the improved comprehension group, the non-improved group and the already-good comprehension group, according to the comprehension levels. Although the HbA _1c values of the patients tended to decrease probably due to diabetic therapy, the HbA _1c in the improved group was found to be significantly lower than that in the non-checked group at three months after discharge. These results suggest that pharmaceutical education to improve the patient comprehension level including drug therapy and diabetes resulted in a clinically significant enhancement of the therapeutic effect.

抄録全体を表示

Recently hospital pharmacists have been devoting more energy to inpatients rather than outpatients, and regarding injections it is increasingly more important to predict and avoid interactions between or among them simply to assort them.
In this study, to secure the stability and safety of injections prescribed for inpatients by doctors, we developed a clinically useful computer system to check some incompatibilities between medicines. The database used in the computer system for chemical interactions comprised of information on combinations between two drugs obtained from formal textbooks or the literature, while that for physical interactions included the results of the pH change examination for each medicine.
When comparing the two periods during 6 months before and after introducing this system, the incidence of turbidity due to interactions and economical loss after introduction were substantially smaller than those before introduction, thus suggesting that this system could qualitatively and economically improve the service for injections performed by hospital pharmacists. In addition, suggestions made by doctors and nurses using this system have resulted in clinically favorable findings, and consequently this system is highly evaluated at our hospital.
Furthermore, at one month after introducing this system, it was shown to be very useful for particularly avoiding interactions in the same syringe when mixing two medicines or more.

抄録全体を表示

We conducted surveys on the opinions of patients, doctors and nurses regarding bungyo (separation of dispensing and prescribing drugs) before and after the establishment of a system of dispensing prescription drugs for outpatients. While only 25% of the patients surveyed before the establishment of the system gave a favorable opinion regarding the bungyo, about 40% of those surveyed after the establishment of the system gave a favorable opinion. On the other hand, there were no differences in the opinions of either doctors or nurses regarding bungyo in a survey conducted before and after the establishment of the system. The criterion for choosing a pharmacy by outpatients was not only convenience of location but also the quality of service offered. Although 66% of the doctors surveyed before the establishment of the system expressed concern about possible differences between their explanations to patients and those given at community pharmacies, this percentage decreased to 35% after the establishment of the system. The quality of pharmaceutical care for inpatients by pharmacists after the establishment of this system was highly evaluated by both doctors and nurses, but the evaluation of the duties of pharmacists related to the injection check system was low. The survey results indicate the need for hospital pharmacists to make further efforts to improve the quality of pharmaceutical care for inpatients.

抄録全体を表示

To clarify the effects of providing drug information to improve patient compliance, we provided drug information and pharmacist consultations using two methods for 6 months each to outpatients receiving pravastatin at our hypercholesterolemia clinic. To monitor drug compliance, changes in the total serum cholesterol level were evaluated. In 29 patients given pharmacists' consultation using drug history notebooks, the total serum cholesterol level decreased significantly from 228±35mg/dL before consultation to 217±37mg/dL after 6 months. The total cholesterol level of the control patients (n=34) was 230±45mg/dL before pharmacist consultations and 230±36mg/dL 6 months thereafter, showed no changes. From 10 months after the initiation of the investigation, pharmacist consultations were given to all outpatients with hypercholesterolemia receiving pravastatin. In 60 patients (including the above 34 controls) receiving pharmacist consultations using drug instruction sheets but not using a drug history notebook, the serum total cholesterol level decreased from 233±43 mg/dL before to 218±37mg/dL at 6 months after receiving consultations. These results indicated that providing drug information and pharmacist consultations improved the compliance of the outpatients, and thereby resulting in a significant decrease in the serum total cholesterol level.

抄録全体を表示

A critical pathway (CP) in the infant strabismus operation was introduced and improvements in the efficiency of pharmaceutical management and counseling services in a patient were examined. CP was introduced in order to carry out an appropriate drug control and medication instructions during a short period hospitalization of about 1 week, and the medication instructions were thus made. The subjects in this trial of CP consisted of pediatric patients who underwent the strabismus operation and were only hospitalized for 1 week. The vertical line of the CP table for the medication staff consisted of such items as care service and medication performed by doctors, nurses, and pharmacists, On the other hand, items such as inspection, treatment and consultation received by the medication staffs were set on the vertical line of the CP table for the patient. The horizontal line in both CP tables was divided into 8 parts. Each part has columns to check the achievements of these items, which allow both the staffs and the patients to observe the schedule for 1 week. The records of medication instruction were divided into 3 parts, which included entering and leaving the hospital, and pre-operation and post-operation. The instruction items were listed in an orderly sequence, which was easy to explain, and it was confirmed by a check off system. As a result, the compliance improved, because the post-operative medication was chosen from 2 dosage forms, namely fine grain or capsule. It was thus possible to prevent guidance leakage using the checking systems, and thereby standardization and efficiency both improved. In addition to this, it was possible to transmit information to the doctors, nurses, and pharmacists using this CP table sheet. According to the concept of pharmaceutical care, it seemed to be very important to closely monitor the patients' compliance by pharmacists after being discharged from the hospital, because most patients who undergo the strabismus operation are infants.

抄録全体を表示

We investigated the cytotoxicity of erythromycin stearate, roxithromycin, clarithromycin and minocycline using lactate dehydrogenase (LDH) in cultured human intestinal epithelial cells Caco-2, in vitro, and rat intestinal enzymes LDH and alkaline phosphatase (ALP) as end points of toxicity, in vitro.
The cytotoxicity after the addition of roxithromycin and clarithromycin to the Caco-2 cells tended to be larger than that after the addition of erythromycin and minocycline. The intestinal toxicity induced by repeated 5-day orally administered macrolide antibiotics was examined. The reduction in intestinal ALP after the administration of erythromycin and clarithromycin to rats tended to be larger than that after the addition of roxithromycin and minocycline. However, there were no significant changes in the intestinal LDH when macrolide antibiotics were orally administered. In addition, there were no significant changes or differences in either the body weight gain or the histological findings of the rat intestine. These results do not suggest any substantial risk for intestinal disorders related to the use of erythromycin, clarithromycin and roxithromycin.

抄録全体を表示

One-dose package dispensations of tablets and capsules were performed in all outpatients in order to improve the medication compliance and prevent any incorrect drug ingestion and the effect of this method was evaluated based on a questionnaire survey for outpatients. As a result, it became clear that the age of the patient, the interval of taking medicine, the kind of drugs in the one-dose packages, the number of prescriptions and the dosage days were judgment factors in the evaluation process.
In other words, the outpatients who gave “good” answers were aged, had been taking the medicine for a long time, and had received many kinds of drugs in a one-dose package. On the other hand, the outpatients who gave “not good” answers had more types of medicine prescribed, and had been taking the medicine for longer periods of time.
After being the one-dose package method the number of dispensing errors decreased from 6.0 cases to 3.5 cases per day on the average.

抄録全体を表示

As part of the pharmaceutical guidance program using drug history notebooks for each patient and drug information leaflets, we gave pharmaceutical guidance to 37 outpatients with hyperuricemia chosen at random who were administered allopurinol or benzbromarone. The effects of pharmaceutical guidance on patient adherence were evaluated using changes in the serum uric acid level. The patients who were given conventional verbal explanations and shown descriptions on the drug bag were classified as the control group. Those who were given pharmaceutical guidance according to the pharmaceutical guidance program were classified as the intervention group. The baseline uric acid level and the levels 1 and 6 months after the start of pharmacist consultations were determined. Any patients who had changes in their drug prescriptions which affected their uric acid level during the investigation period were excluded. Sixteen patients in the control group and 17 in the intervention group were included in this study. There were no differences in the average value or variance of serum uric acid concentration at the baseline between the 2 groups. However, the average uric acid level decreased significantly 1 month after the start of consultations in the intervention group, while it did not changed in the control group. In patients showing baseline uric acid levels over 7 mg/dL, the uric acid levels showed a significant reduction in all patients in the intervention group, while the changes were not significant in the control group. These results showed that the pharmaceutical guidance performed by pharmacists enhanced the patients' medication compliance, thus resulting in an improvement of hyperuricemia.

抄録全体を表示

A 25-year-old woman diagnosed to have infective endocarditis by Haemophilus aphrophilus was treated with gentamicin (GM). An initial GM dose of 40 mg was infused over a period of 1h three times a day. The pharmacokinetic analysis of GM was carried out according to a 1-compartment model by using the Bayesian estimation method. In the pharmacokinetic analysis, the 1h-infusion of 100mg GM 4 times a day was adopted in order to obtain serum concentrations of 6-10μg/mL as the estimated peak levels and less than 2μg/mL as the trough levels, respectively. The GM therapy was continued for 38 days. The final serum concentrations of 8.4μg/mL as the peak levels and 1.4μg/mL as the through levels were obtained. At 38days from the start of GM therapy, infective endocarditis was diagnosed as cured after symptoms of stroll appeared. After the administration of GM was stopped and any unexpected episodes were treated, all symptoms of unsteadiness disappeared.
It is thus possible to administer high doses of GM, by performing TDM which allows us to avoid any irreversible adverse events and thus help the patients to recover. In addition, GM should be administered 4 times a day, to allow high density GM to reach the heart in the above case in a timely manner.

抄録全体を表示

In this study, a pharmacokinetic model of cibenzoline in healthy volunteers was examined in order to design a pharmacokinetic model for establishing a relevant dosage regimen for patients with arrhythmias.
Seven healthy volunteers between 25 and 43 years of age participated in the study. Each volunteer received two 100-mg capsules of cibenzoline with 150mL of water at 9 am after overnight fasting. Blood samples were collected before and 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 5, 6, 7, 8, and 24 hours after the oral dose.
The serum cibenzoline concentrations were measured by a high performance liquid chromatography (HPLC) with ultraviolet detection at 230nm. The pharmacokinetics of cibenzoline in the healthy volunteers could be described using the one-compartment model (ke=0.283hr^-1, Vd=0.249L/kg, ka=0.953hr^-1) in healthy volunteers. The means of t_max and C_max were 1.32 hr and 631ng/mL, respectively. A significant correlation was found between the predicted concentrations using our obtained one-compartment pharmacokinetic parameters and those observed in patients treated with cibenzoline for one month or longer. These results indicate that the one-compartment model is therefore useful for studying the pharmacokinetics of cibenzoline after oral administration.

抄録全体を表示

We have developed a system for the automatic checking of drug interactions when physicians order drugs using prescriptions. This checking is based on drug interaction data obtained form the package insert, which includes not only contraindicated combinations but also cautions. As these data can be printed out, it is easy to pass on such drug information to patients.
The system also has a function whereby contraindications are always shown on the screen, whereas administration cautions and other information may be optionally omitted, or included where necessary. Therefore physicians can also order excess doses of some drugs or certain interacting drugs by prescribing them under special circumstances. These items of information are indicated with an asterisk in the prescription and are also provided to community pharmacies through legal prescriptions.
The system displays the referred data on an order screen without any reduction in the response time of the host computer. The average response time was 3 s for up to a total of 17 different prescription drugs, and 4 s for more than 17. The response time from 10 : 00 a.m. to 2 : 00 p.m., when the frequency of outpatient prescription orders is the highest, was about the same as during other periods.
These results suggest that this system is useful for checking of drug interactions on prescription in three hospitals affiliated with our medical college.

抄録全体を表示

All students in the 4 th year at our university, perform 4 -week training in pharmaceutical health care practice (practical training in hospital pharmacy and community prescription pharmacy). We carried out a consciousness survey of 149 students who received training at a community prescription pharmacy.
A questionnaire on the interest in community prescription pharmacy work revealed the reply, “the training arouse my interest” in 58% of the students who wish to work in hospital after graduation and in 60% of those who wish to work in pharmacies but only in 49% of those who wish to work at pharmaceutical companies and in 40% of those who wish to go graduate schools. Among the types of work of community prescription pharmacy, those that particularly arouse student interest were “home medical care”, “patient compliance instructions” and “patient reception”. Interest in patient compliance instruction was frequently observed in students who wish to work in hospitals, home medical care and the sale of OTC drugs in those who wish to work in pharmacies, and DI work in those who wish to go to graduate schools.
Concerning the questions about the image of community prescription pharmacies (or the work performance), students who felt a strong attitude of pharmacists toward their work showed more interest in training in community prescription pharmacies. To enhance the students' consciousness of practical training in community prescription pharmacy, the contents of training should be improved by evaluating the training items students wish to learn and adjusting by classifying the pharmacies requested to accept students for training.

抄録全体を表示

The control of drug use for Parkinson's disease is very important for both the QOL and ADL of patients. Nowadays, patients with Parkinson's disease are treated with the concomitant use with L-dopa, dopamine receptor agonists and norepinephrine receptor agonists. However, these drugs elicit some adverse effects. Therefore, we tried to search for the effects and adverse effects, based on patient histories. As a result of our investigations, most patients broke out with tremors and were administered anticholinergic drugs, while a few patients were treated with L-dopa as the first drug of choice. Avoid the administration of L-dopa at first seemed to help prevent the onset of Wearing-off or On-off phenomenon. Gastric mucosal cytoprotective drugs appeared to be effective for preventing of gastric symptoms due to drugs for Parkinson's disease. Moreover, we found that mental symptoms only rarely occurred after the readministration of anticholinergic drugs. We must be careful to treat patients with brain infarction after the onset of mental symptoms. These results are valuable for helping to improve the treatment of Parkinson's disease, and may also help in performing further studies on the use of new drugs.

抄録全体を表示

When renal excreted agents are administered to patients, it is important to understand the kidney functions of patients. We therefore investigated the use trend of renal excreted agents and the kidney function on inpatients after undergoing digestive organ surgery in order to select the most suitable agents in nephropathy. Antibiotics were most frequently used in digestive organ surgery are mostly renal excreted agents. These agents were often administered to patients whose creatinine clearance levels were less than 60 mL/min. These patients require an optimal dosage of antibiotics because most antibiotics correlate with the creatinine clearance level. The predicted creatinine clearance, as calculated by the Cockcroft-Gault formula, is often used in clinical practice to evaluate the kidney function. In this case, we must consider the difference between the observed and the predicted creatinine clearance level. If we determine the optimal dosage by the predicted creatinine clearance, the dose of flomoxef or levofloxacin were underestimated in approximately 30% of patients treated with these agents. Therefore, the creatinine clearance of patients must be assessed by evaluating such vital signs as the urine volume in addition to the serum creatinine level. In addition, pharmacists must pay careful attention to the clinical characteristics in addition to the kidney function of patients when determining the optimal dosage of renal excreted agents.

抄録全体を表示

According to the guidelines of Japanese Society of Hospital Pharmacists, pharmacists should prepare medicine bags or labels for dispensing injectable medicines. However, it is not easy to establish a new system for printing these bags and labels quickly and efficiently all hospitals. At the moment many hospitals seem to let nurses write the information by hand directly on the transfusion bottles. This involved the risk of serious accidents due to miscommunication between pharmacists and nurses.
Because we established a successful advanced system to achieve a maximum output with a minimum effort, its effectiveness is herein reported.
We prepared labels using the data of our audit manual for the dispensing of injectable medicines. These labels included essential comments and information for both doctors and nurses.
It takes 60-120 minutes to creating labels for 60 to 90 inpatients, while some additional time is needed to double check of the labels. As a result, this system has increased our workload by one and half times. In contrast to our increased workload, clear printed letters and useful comments and information has contributed to a decrease in the workload of the nurses in the ward. This cost effective, efficient system has received high acclaim from the staff members of other departments, and strongly confirms the role of pharmacists as risk managers.
We now intend to further improve this system for proper dispensation of injectable medicines more properly and efficiently in the future.

抄録全体を表示