Multi-drug therapy is commonly used over the long term for the treatment of patients in psychiatric ward but this may increase the incidence of adverse events and reduce patients' QOL. Patient compliance is therefore lower than in other wards. In the present study, we evaluated whether the medication consultation provided by pharmacists was effective in improving patients' QOL and reducing drug costs. The subjects were 39 patients who received medication consultation in the psychiatric ward between April 2003 and March 2004. The patients' QOL was assessed using our QOL assessment scale (5 grades) both before and after medication consultation. In addition, when drugs were changed or removed from prescriptions, we calculated the resulting differences in drug costs between before and after such changes. Of the 39 patients who received medication consultation, 14 (36%) reported adverse events, indicating a reduced QOL. The mean number of drugs for patients who reported adverse events was significantly higher than that for those without adverse events. As a result of our review of the content of prescriptions for patients with adverse events and requesting their physicians to change drugs or cut them from prescriptions, QOL improved for all 14 patients and a decrease in drug costs of 1, 217.5 yen/day was achieved. These findings suggest that consultation provided by pharmacists on medication and QOL in the psychiatric ward not only improves patients' QOL but also reduces drug costs.
Pharmacists are now being expected to play an increasingly active role in clinical practice but this role has yet to be fully realized. At Kyoto Katsura Hospital, efforts are being made to produce pharmacists who are skilled in maintaining the quality of palliative care for cancer patients through a system which provides clinical training in this area. In the present study, we evaluated the activities of pharmacists trained under our cancer medical care system on their abilities in the care of cancer patients, adopting a qualitative approach. Pharmacists were given repeated training in the following aspects of medical care for cancer : 1) Communication with the patient, 2) Understanding of the patient's condition, 3) Assessment of situation and plan of action, 4) Presentation and discussion, 5) Performing ward rounds, and 6) Execution of plans and evaluation of their effectiveness. We next selected individual cases for the purpose of examining the medical care system. Four major observations were made from the results : 1) Pharmacists visited their patients every day, 2) Pharmacists who had taken the training were providing active support in prescribing medication for cancer patients, 3) Pharmacists were also providing support in prescribing medication in other areas and 4) The cancer medical care system was useful in the training of new pharmacists. In conclusion, if pharmacists can enhance their clinical knowledge through such training, they will be able to provide medication support from the pharmacology viewpoint in various other fields besides cancer.
Progesterone (P) is an important hormone for achieving pregnancy, and administering it is a useful therapy for luteal insufficiency. However, owing to problems with existing oral preparations and injections, P is increasingly administered by the transvaginal route in suppository form in medical institutions. Since vaginal suppositories are not commercially available, each institution has to prepare its own. For P-containing vaginal suppositories prepared in our hospital, we conducted hardness, weight variation, content uniformity, and elution tests as well as a 6-month stability test in cold storage and pharamacodynamics testing in vivo. The results confirmed that they were uniform in quality and stable, and valid for use as pharmaceutical preparations in clinical practice. Furthermore, the sustained-release suppositories prepared by us were found to maintain adequate blood levels of P.
In patients with ischemic heart disease, it has been reported that the incidence of cardiovascular events and mortality may be reduced by improving serum cholesterol levels. In the present study, we looked for a correlation between high cholesterol levels and restenosis, which usually occurs within six months of percutaneous coronary intervention (PCI), since this had not been examined previously. We retrospectively investigated 656 serial patients who underwent PCI during the period 1998 through 2001. Patients whose restenosis was treated by target lesion revascularization (TLR) had higher serum cholesterol levels and the incidence of hyperlipidemia, a risk factor of coronary heart disease, and frequency of TLR were higher in 2001 than in other years. Two-hundred-thirty-one patients who underwent PCI in this year were investigated in the first month after PCI and 6 months afterwards to see whether lowering serum lipid levels affected the frequency of TLR. Patients with high total cholesterol (TC) and low density lipoprotein cholesterol (LDLC) levels prior to PCI had a higher incidence of restenosis and lowering lipid serum levels after PCI did not prevent the restenosis. In patients whose TC and LDLC levels had been controlled prior to PCI through medication, the incidence of restenosis was comparable to patients having ischemic heart disease without hypercholesterolemia. Those who were treated with pravastatin (N=54), simvastatin (N=24), or atorvastatin (N=63) showed no significant difference in the efficacy of lowering TC and LDLC levels among the three groups.
In order to evaluate the usability of ophthalmic solution containers, we measured the torque required by 30 healthy volunteers between the ages of 24 and 70 to open the screw caps of 18 containers used for commercially available brands of ophthalmic solution. The torque necessary to open the screw caps of the containers without shrink packaging ranged from 7.5 to 26.0 cN·m. while that needed to open the screw caps of those with shrink packaging ranged from 19.2 to 88.3 cN·m. Based on our findings, we consider that the torque required to open a screw cap should not be more than 7.5 cN·m. Our results also show that the torque required to open a screw cap is an important index of the usability of ophthalmic solution containers.
As the separation of dispensing and clinical practice has taken hold, opportunities for pharmacies covered by the health insurance scheme to dispense insulin preparations have increased. In view of this, we conducted a questionnaire survey of patient attitudes, degree of compliance and knowledge of warnings concerning insulin therapy since these are important factors in the proper administration of insulin preparations. Patient understanding of the method of use and storage requirements of insulin preparations was generally satisfactory. However, understanding of some aspects of the use of insulin preparations was significantly low among elderly patients and understanding of particular warnings for the use of insulin was significantly low among patients who had not participated in diabetic seminars or other educational meetings. We also found that understanding of sick days was low even for patients who had participated in educational meetings, presumably because symptoms vary from person to person and the way they deal with them also varies. Therefore, pharmacists should focus on giving guidance on how to manage sick day symptoms based on the results of interviewing patients concerning their daily lives.
There have been few reports on valproic acid (VPA) -mediated pain control in multiple mono-neuropathies accompanied by vasculitis. We present a case of the successful treatment of Churg-Strauss Syndrome (CSS) -induced neuropathic pain with VPA. The patient was a 74 year-old man who was diagnosed with CSS based on the history of bronchial asthma, multiple peripheral neuropathy, eosinophilia, and vasculitis. The degree of neuropathic pain was assessed using the pain score. He had been given prednisolone, diazepam, carbamazepine, naproxen and amitriptyline before treatment with VPA but their analgesic effects were not sufficient. The administration of VPA was started at a dose of 400 mg/day and when the dose was increased to 800 mg/day, there was a marked decrease in Pmax and it stayed at a low level thereafter. The mean area under the daily pain score vs. time curve (AUC) during the treatment with VPA at 800 mg/day was significantly less than that for 600 mg/day. The steady-state plasma concentrations of total and free VPA at a dose of 800 mg/day were 62.1μg/mL and 8.8μg/mL, respectively. Our results indicate that when administered in the therapeutic range for patients with epilepsy, VPA is also effective in the treatment of neuropathic pain induced by CSS.
A pharmaceutical study was carried out to evaluate the quality of five Sodium Ozagrel (OZG) injection products. The quality of these products initially and after 12 weeks and 24 weeks of accelerated stability testing was evaluated based on characteristics such as pH, foreign insoluble matter, content and impurities. One brand name injection and four generic injections were evaluated. The brand name product and one generic product were in freeze-dried form and the other three generic injections were in liquid form. The pH of one generic injection was higher than that of the others. No foreign insoluble matter was observed in any product during the period of the study. The OZG content of the freeze-dried injections was approximately equal to that indicated on the labels but that of the liquid injections was appreciably higher, one of them having at least 15 % more than the indicated content. In the accelerated stability testing, the OZG content was still around 100% of the initial content after 24 weeks, showing that it was very stable. Quaternary salts were detected in the brand name injection but the concentration was only 0.02%. The cis form of OZG was detected in one generic injection but the concentration was only 0.03%. Accelerated stability testing did not increase the quantities of these impurities. Two unknown impurities were detected in one generic injection and one of them was detected in the other three generic injections. Our study showed that there was a difference in quality between the generic injections and the brand name OZG injections in terms of pH, content and impurities, suggesting that not only cost but also quality should be considered when deciding whether to use generics or not.
Fentanyl patches and oxycodon tablets are new forms of opioid that have recently been approved in Japan, and may be useful for opioid rotation. In this study, we investigated the result of switching from morphine to fentanyl patches, considering 257 cases in which fentanyl patches were prescribed at the Cancer Institute Hospital between March 19, 2002 and December 31, 2004. The major reasons for switching from morphine to fentanyl patches were poorly controlled pain in 106 cases (44%) and nausea in 78 cases (32%). Out of the total of 185 cases, fetanyl patches were prescribed for more than 2 weeks in 164 cases (88.6%). The use of fetanyl patches was stopped within 2 weeks of switching in some cases when the major reasons were drowsiness in 6 cases (28.6%) and poorly controlled pain in 4 cases (19.0%). The results of our study indicate that switching from morphine to fetanyl patches may be useful when pain is poorly controlled with morphine.
Amid the increasing use of supplements due to people's growing interest in their health and deregulation, there have been cases of supplements adversely affecting people's health and interacting with drugs. For this reason, pharmacists are often required to give guidance on the use of supplements. We conducted a questionnaire survey concerning the use of supplements by persons visiting the Gifu Pharmaceutical University Pharmacy, which had the following findings. Of those surveyed, 41.8% had used supplements. A large number of younger people used vitamin and mineral preparations for health maintenance and dieting purposes, and many older people used various supplements for health maintenance and as an additional treatment for diseases. Eighty-five percent of those surveyed said that they read the precautions for use, but only 55% checked warnings and adverse effects and just 59% said they were aware of interactions with drugs, indicating a lack of awareness of the risks of supplements. When pharmacists are consulted concerning the use of supplements, they should base their advice on knowledge of the patient's use of drugs and emphasize the need to improve their lifestyle so that they do not have to depend on supplements.
We previously reported the results of a questionnaire survey indicating that it would be feasible for training pharmacy students from general hospitals to take part in group practical training conducted in the pharmacy departments of psychotherapeutic hospitals. In the present study, we conducted a group hospital internship for pharmacy students from five psychotherapeutic hospitals and one general hospital. Having the practical training at psychotherapeutic hospitals significantly increased the students' knowledge of psychotherapeutic drugs and enabled any prejudice concerning psychiatric therapy to be quickly dispelled. However, since there were certain aspects of general pharmaceutical training that could not be covered by the psychotherapeutic hospitals, their pharmacists requested the pharmacists at the general hospital to conduct training in such aspects at a later date. Upon evaluating their pharmacy students, the pharmacists at the general hospital concluded that the group hospital internship had not reduced the knowledge or practical skills gained by the students. We would next like to develop a method for quantitatively evaluating such group internships.