医療薬学
Online ISSN : 1882-1499
Print ISSN : 1346-342X
ISSN-L : 1346-342X
31 巻 , 9 号
選択された号の論文の12件中1~12を表示しています
  • 西川 翠, 平田 純生, 川口 博資, 和泉 智, 古久保 拓, 太田 美由希, 藤田 みのり, 松永 千春, 山川 智之, 高良 恒史, ...
    2005 年 31 巻 9 号 p. 695-700
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    This study involved 180 hemodialysis (HD) patients using anti-MRSA antibiotics. The subjects were divided into a survival group (n=100) and a dead group (n=80), and the factors affecting the prognosis were investigated and compared between the two groups. Factors examined were age, sex, dry weight (DW), duration of HD, presence of DM, and laboratory data {Alb, BUN, Cr, IP one month before starting administration of anti-MRSA antibiotics, and the maximum CRP, WBC and neutrophil fractions (maxCRP, maxWBC and maxNeut, respectively) from one month before to after starting the administration of anti-MRSA antibiotics}. A decrease in DW, increase in age, presence of DM, decrease in Alb, BUN, Cr and IP (taken as markers of the nutritional status of the HD patients) and increase in maxCRP, maxWBC and maxNeut (taken as inflammatory markers) were significant factors in exacerbating the prognosis of MRSA infections. Further, a decrease in DW and IP, presence of DM and increase in maxCRP were found to be significant factors in death due to MRSA infections, as determined by multiple logistic regression analysis. Also, when the factors of total fat mass (TFM), body mass index (BMI) and estimated-lean body mass (E-LBM) were compared between the two groups, while TMF was not significantly different between them, a decrease in BMI and E-LBM were significantly associated with death due to MRSA infections. Thus, muscle content appears to be a more important factor than TFM. These results suggest that nutritional supervision can play an important role in the prevention of MRSA infections in HD patients.
  • 寺岡 麗子, 杉本 功, 柿木 宏一, 松田 芳久
    2005 年 31 巻 9 号 p. 701-706
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    Mequitazine, a phenothiazine derivative having a quinuclidine ring, is a long-acting antihistamine drug which is sensitive to light. The colour of both a syrup and an isotonic buffer solution of the drug changed to rose-pink under irradiation with a D65 fluorescent lamp and then the mequitazine content of these preparations was measured by high-performance liquid chromatography. This showed that the mequitazine in both the syrup and the isotonic buffer solution was readily decomposed by light from the lamp. Next the photostability of the mequitazine syrup and isotonic buffer solution in various prescription bottles was investigated and it was found to decompose more quickly in a white prescription bottle. These mequitazine preparations were completely stable in a black-brown bottle. The photostability of mequitazine was closely related to the percentage transmittance of the containers.
    The effectiveness of the light absorbers methyl p-hydroxybenzoate, propyl gallate, and vanillin in stabilizing the mequitazine isotonic buffer solution against light was then investigated. Vanillin exhibited an excellent photo-stabilizing effect and this was enhanced as the concentration of vanillin increased. The photostabilizing effect was closely related to the UV absorption spectrum of the additives and those having absorption spectra similar to that of mequitazine were more effective in this respect.
  • 岩田 政則, 久保田 ひとみ, 佐々木 琢也, 縄田 修一
    2005 年 31 巻 9 号 p. 707-713
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    An injectable medicine dispensing system based on an auto ampule dispensing (AAD) system was introduced at Yokohama City University Medical Center. We made a drug interaction check list and a dose check list for pediatrics on which to base inquiries concerning prescriptions for injectable medicines for inpatients and over a three-year period, investigated the effectiveness of the inquiries and interventions resulting from them. There were a total of 865 inquiries and the number of inquiries increased 1.5-fold after residents were reassigned. Inquiries concerning dose accounted for approximately 66% of the total.
    The number of inquiries for the five main clinical departments comprised 50% of the total number of inquiries. This suggests that careful instruction of residents before their reassignment to the main clinical departments is important. Inquiries were effective in avoiding adverse events for 64% of all adverse events. These inquiries were also effective in reducing medical expenses.
    Inquiries concerning the injectable medicine dispensing system at Yokohama City University Medical Center based on a drug interaction check list and dose check list for pediatrics were therefore useful.
  • 鶴居 勝也, 脇坂 賢昇, 田中 基裕
    2005 年 31 巻 9 号 p. 714-722
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    As a member of the medical team for preventing malignant outcomes from pressure ulcers, we pharmacists established a management system for pressure ulcers using electronic medical records and local area networks. Our system comprises assessment records based on DESIGN, a list of ointments and dressing materials and progress reports for each patient. This system has helped medical staff to give more attention to individual patients with pressure ulcers and unified treatment for pressure ulcers in our hospital. Under the system, we have been participating in the assessment and treatment of pressure ulcers in the wards and advised medical staff on pharmacological effects, dosage, and adverse effects. We have also been monitoring malignancy and managing drugs and dressings. Our system has helped discover pressure ulcers at an early stage and improved clinical outcomes for individual patients.
  • 吉田 直子, 長村 英理子, 林 高弘, 津川 透, 仙田 典保, 内藤 宏, 長村 洋一
    2005 年 31 巻 9 号 p. 723-728
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    Calcium polycarbophil has been found to be useful in the treatment of irritable bowel syndrome. It is activated through transformation to polycarbophil by decalcification under the acidic conditions in the stomach. Polycarbophil absorbs water in the small intestine, where conditions are neutral, causing it to swell and form a gel.
    We encountered a patient in whom calcium polycarbophil was effective when given alone but developed diarrhea when it was administered together with lithium carbonate. When these two agents were taken separately, the diarrhea was relieved. In order to ascertain how lithium carbonate affected calcium polycarbophil, we carried out an in vitro experiment whose results showed that lithium carbonate caused an increase in pH. This inhibited decalcification, and reduced the extent of swelling of polycarbophil. These results suggest that the efficacy of calcium polycarbophil would be reduced when administered together with lithium carbonate.
  • 藤井 友和, 藤目 光良, 斎竹 達郎, 水藤 博章
    2005 年 31 巻 9 号 p. 729-734
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    With pharmacists now actively involved in chemotherapy for outpatients at Atsumi Hospital, it has become possible for us to help ensure that pharmacotherapy is conducted properly. To make sure that antineoplastic agents are used properly, we changed the system so that these drugs were dispensed individually to patients rather than collectively for all patients as they had been before. As a result, we could monitor individual prescriptions (by height, weight, and body surface area and drug regimen, dosage, interval, and route) and prevent overdosing. In addition, we have been able to provide a pharmaceutical counseling service when adverse effects, such as delayed emesis, occur at the site of chemotherapy (outpatient drip infusion room) which has improved patients' quality of life.
    We therefore consider that pharmacists can play an important role in chemotherapy for outpatients.
  • 古川 裕之, 塚本 均, 空閑 正浩, 土屋 文人, 木村 昌臣, 大倉 典子, 宮本 謙一
    2005 年 31 巻 9 号 p. 735-743
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    The effectiveness of printing an “Indication Symbol” and the product name on a systemic transdermal absorbent preparation of isosorbide dinitrate (Frandol® tape-S) in preventing medication errors was evaluated through a questionnaire survey of health care professionals and patients. The numbers of completed questionnaire sheets collected for health care professionals were 7, 078 from physicians, 7, 018 from nurses, and 7, 361 from pharmacists (collection rates 70.2-73.6% of the target of 10000). The number of completed questionnaire postcards collected from patients was 1, 339 (44.6% of target of 3, 000).
    Both health care professionals and patients thought it was a good idea to print an indication symbol, a heart, and the product name on the preparation as a measure to prevent medication errors. Some differences were observed in the answers given to some of the questions among the former, however, indicating the importance of asking many different health care professionals to evaluate measures for preventing medication errors. Sixty percent of the patients returning the questionnaire said that they though it was a good idea to print an indication symbol and product name on the preparation and they had not seen any other product with this feature, but they were not particularly concerned about this.
    We hope that unified indication symbols will be adopted by all pharmaceutical companies and that their use will be expanded to all categories of systemic transdermal absorbent preparations in order to prevent medication errors.
  • 佐藤 弘希, 丸山 徹, 荒平 光利, 吉田 節, 前田 敦司, 桑原 賢司, 岡山 善郎, 山崎 啓之, 安楽 誠, 小田切 優樹
    2005 年 31 巻 9 号 p. 744-748
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    In order to clarify the interactions between drugs and natural polymer supplements, the binding tendency of warfarin, ketoprofen and chlorpromazine with six kinds of commonly used natural polymer supplements-low molecular weight alginate, chitosan, guar gum degradation products, wheat albumin, dietary fiber derived from beer yeast and indigestible dextrin-were investigated by means of ultra-filtration. Though each of the drugs bound to the supplements, the degree of the binding varied largely with the different combinations of the drugs and the supplements. Specifically, acidic drugs showed significant binding with chitosan, which was probably due to electrostatic interaction. Binding between chitosan and warfarin was found to be dose-dependent and binding between all of the drugs and chitosan was found to vary with the type of chitosan product. In this regard, among widely available products, some hardly bound to the drugs at all whereas others bound very easily. These results suggest that the absorption of drugs could be inhibited when natural polymer supplements are taken simultaneously. Therefore, patients taking physiologically active drugs such as warfarin or TDM drugs should be instructed to avoid polymer supplements.
  • 高野 幹久, 上田 千秋, 田川 茉希, 湯元 良子, 村上 照夫
    2005 年 31 巻 9 号 p. 749-754
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    Burow's solution, an aluminum acetate solution used in hospitals, exhibits excellent antibacterial activity against various microorganisms that are commonly observed in chronic supprative otitis media, including methicillin-resistant Staphylococcus aureus (MRSA). However, its method of preparation and formula vary among countries.
    In this study, the prescription for Burow's solution in Japan was compared with those in BP and USP. In BP and USP, Al (OH) (CH3CO2) 2 is prepared by mixing aluminum sulfate, acetic acid and calcium carbonate at a molar ratio of 1 : 4 : 3, and in the preparation procedure in USP, more acetic acid is added at the time of use to produce Al (CH3CO2) 3. In Japan, the method in the Teine-Keijin Hospital manual is commonly used, and the above 3 ingredients are mixed at a molar ratio of approximately 1 : 2 : 1.5. The discrepancy in the mixing ratio arises from the difference in the aluminum sulfate used. The aluminum sulfate stipulated in BP and USP is a hydrous compound containing 51.0-59.0% anhydrous aluminum sulfate, whereas the ingredient used in the Teine-Keijin Hospital manual consists only of anhydrous aluminum sulfate. In the latter case, the use of anhydrous aluminum sulfate results in very low dissolution rate (>24 hr for 1 L preparation), and the amount of acetic acid to produce Al (OH) (CH3CO2) 2 is lacking.
    In conclusion, the use the hydrous aluminum sulfate stipulated in BP and USP (formula : Al2 (SO4) 3·14-18 H2O) instead of anhydrous aluminum sulfate would enable a highly stable Burow's solution to be prepared easily.
  • 北村 佳久, 圓尾 奈緒美, 松浦 素子, 帯刀 江里, 荒木 博陽, 柴田 和彦, 黒崎 勇二, 川崎 博己, 五味田 裕
    2005 年 31 巻 9 号 p. 755-760
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    The dosage of medications must often be adjusted for pediatric patients. When drugs are in tablet or capsule form, the dosage may be adjusted by breaking up tablets or removing the drug form capsules but when a capsule contains a liquid, dosage adjustment is difficult. For example, until November 2002, it was quite common for the antihypertensive drug Adalat® to be aspirated into a syringe from the capsule and then administered. We therefore investigated the safety of aspirating the liquid contents of 5 types of capsules into a syringe.
    Through giving consultation on patient medication, we discovered that it was not possible to aspirate the contents of Lastet® S25 into a syringe and for this reason decided to study ways of safely administering half of the etopside content (12.5 mg) of Lastet® S25. We found that Lastet® S25 readily disintegrated in hot water (55 °C) and that half of the etopside content could be obtained by stirring the water. This study showed that the direct aspiration of the liquid content of capsules into a syringe for the purpose of dosage adjustment is hazardous and in the case of Lastet® S25, this problem could be solved by dissolving the capsule in hot water, stirring and then taking the liquid into the syringe. This method should be useful for administering less than standard doses of capsule dosage forms to pediatric patients when the capsule contains a liquid.
  • 尾鳥 勝也, 田口 祐子, 矢後 和夫
    2005 年 31 巻 9 号 p. 761-767
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    We studied the quality and stability of generic sodium ozagrel solution products for injection. Through the use of inspection apparatus, we noted exfoliation of the surface layer of glass ampoules filled with sodium ozagrel solution drug products for injection. Also, foreign insoluble matter, such as oil droplets, which was assumed to be silicone that had been applied to the internal surface of syringe barrels, was observed in pre-filled syringe products. In a stability study performed under accelerated conditions (40°C/75% RH) the generic sodium ozagrel solutions yielded a degradation product that was not detected in the lyophilized original product. The degradation product content of some of the generic products was over 16 mg/mL of sodium ozagrel, exceeding the specification for the original lyophilized product. These results indicate that some of the generic products are inferior in quality and stability to the original lyophilized drug.
  • 中野 暖子, 伊勢 雄也, 加藤 あゆみ, 渡邉 暁洋, 片山 志郎, 西澤 健司, 平野 公晟, 千田 英理子, 山下 いずみ, 矢崎 知 ...
    2005 年 31 巻 9 号 p. 768-776
    発行日: 2005/09/10
    公開日: 2011/03/04
    ジャーナル フリー
    Palliative care for cancer patients should consider individual preferences with the focus on health-related quality of life (HRQOL). In this regard, the recent participation of clinical pharmacists as important members of the palliative treatment team has achieved efficient management of medicines and effective symptom control.
    Assessment of HRQOL is necessary for improving medical services provided to patients by the palliative care team (PCT). EuroQol 5-Dimension (EQ-5D) is a questionnaire for this purpose which is being widely used by clinical researchers in a variety of clinical areas, e.g. diabetes mellitus, cerebrovascular diseases and rheumatic disease, and the objective of this study was to examine the possibility of the PCT using EQ-5D. Validity was assessed by reliability analysis of EQ-5D scale scores, correlation measures of pain at rest and with movement in a range of from 0 to 10, adverse effects of opioid analgesics (nausea, constipation and drowsiness) in a range from 0 to 3, total dosing days of opioid analgesics and lifespan with utility-based scores.
    Thirteen cancer patients in whose medication the PCT had intervened were enrolled. The Cronbach alpha score was calculated as 0.7801. Correlations were found between utility-based scores and pain at rest (r=-0.553, P<0.01), pain with movement (r=-0.538, P< 0.01), constipation (r=-0.475, P< 0.05) and total dosing days (r=-0.667, P< 0.001). Other results did not show any correlations (P >0.05).
    These findings suggest that EQ-5D may be adopted by the PCT in Japan for measuring utility-based HRQOL for cancer patients, though further investigation will be necessary.
feedback
Top