Cancer chemotherapy may cause a number of potentially serious adverse drug reactions (ADRs) that contribute significantly to morbidity and mortality. Because of this, pharmacists have to be responsible for verifying chemotherapy prescription orders, ADR monitoring and patient education. However, this is often complicated by the variety of cancer chemotherapy regimens that are used. Also, the shortage of hospital pharmacists and their lack of experience in pharmaceutical care during cancer chemotherapy make things even more difficult and leads to inefficiency. Thus, pharmacists need innovative tools to assist them in providing pharmaceutical care to these patients. With this in mind, we have recently developed work sheets for the verification of prescription orders for chemotherapy agents, monitoring for potential ADRs, patient education, and providing information on ADRs and countermeasures to medical staff. Using the ADR monitoring sheet, we monitored a total of 671 ADRs, comprising 311 of grade 1 toxicity, 236 of grade 2, 98 of grade 3 and 26 of grade 4 according to the National Cancer Institute-Common Toxicity Criteria (version 2.0), in the oncology wards of our hospital. Of these ADRs, 538 cases (80.2%) were anticipated and occurred during the expected period, and most unanticipated events were either grade 1 or 2 toxicity. We concluded that our work sheets are potentially useful in the provision of efficient pharmaceutical care to patients undergoing cancer chemotherapy.
The purpose of the present study was to quantitatively evaluate the palatability of various total enteral nutrients and the effect of adding various flavors using gustatory sensation tests, the equivalent concentration examining method, and the SD method. Although the protein-based nutrients had comparatively good palatability, palatability was poor for the other groups of nutrients. However, palatability was improved by adding a sweet or sour flavor to decrease bitterness. Factor analysis performed on the results of evaluation by the SD method showed that the palatability of enteral nutrients is influenced by two factors : “ease of taking” and “persistence (aftertaste)”. Sweetness and sourness were found to be important in determining “ease of taking” while bitterness was the most important factor in determining persistence. Our results also suggested that the physical factor texture, the chemical factor smell, and patient preference are important elements in determining overall palatability.
To establish drug therapy for climacteric disorders based on CA repeat polymorphism in the estrogen receptor β gene, the present study investigated the issuance of prescriptions to patients with climacteric disorders in relation to CA repeat polymorphism. Prescription data used in this study included that for drugs that were prescribed for more than 3 months to 63 patients undergoing treatment for climacteric disorders. The 195 prescriptions analyzed included traditional Kampo medicines (49.7%), central nervous system medicines (26.7%) and Hormones (21.5%). The scale of combination therapy with Kampo to monotherapy with Kampo was 2.14 for SS genotype subjects, 1.43 for SL genotype subjects and 0.86 for LL genotype subjects. Thus the usage of combination therapy in SS subjects was 2.5 times greater than that in LL subjects. The percentages of the medicines predominantly prescribed for treatment of climacteric disorders-Kamishoyosan, Keishibukuryogan and Tokishakuyakusan-for each genotype were 72.7% for SS, 47.1% for SL and 38.5% for LL, and the percentage for the SS genotype was significantly higher than that for the LL genotype. The prescription rate for Keishibukuryogan for patients with the SS genotype was 31.8% versus 10.0% for the other 2 genotypes, the rate for SS being significantly higher. In conclusion, the use of CA repeat polymorphism in addition to symptoms in the selection of drugs for climacteric disorders may allow therapy to be personalized.
We analyzed the number of inquiries concerning doubts in prescriptions and the nature of the doubts for prescriptions issued at the University of Ryukyus Hospital during the period June—September 2004. Out of the 34,838 prescriptions issued, there were 545 inquiries (1.56%) and for 373 (68.44%) of them, changes were made. The change rate for inpatient prescriptions was 71.2%, much higher than the 54.4% for outpatient prescriptions. The greatest number of inquiries concerned administration and dosage details which were doubted and the rate was 65.7%. The number of such inquiries decreased with the introduction of inputting default administration and dosage details showing that this had been effective.
We sent a questionnaire to 48 pharmacy schools in Japan to evaluate the status of undergraduate palliative care education in fiscal 2003, and replies were obtained from 36 of them. Eighteen schools provided classes in palliative care but in all of them, it was not an independent subject but taught alongside other subjects. They mostly provided palliative care classes for 1 or 2 hours in the 3 rd year or later. Only 3 of the colleges considered that the present number of hours for palliative care classes was adequate. Regarding the 18 schools without palliative care classes, 14 considered that palliative care education is necessary, but only 2 had a plan to introduce them. Irrespective of whether pharmacy schools had palliative care classes or not, the following 7 items were taught in more than 50% of them : team medicine, WHO cancer pain relief, characteristics of opioids depending on dosage form, management of adverse drug reactions, pharmaceutical counseling services, different uses of NSAIDs, neuropathic pain, and drugs that aid analgesics. Nine schools provided palliative care classes in their graduate schools, and one of them provided practical training in palliative care for four weeks. Overall, palliative care classes were considered to be necessary because they provide the opportunity to learn about life ethics and drug treatment, and the reason for the absence of classes was a full curriculum. The revision of the curriculum accompanying the change to a 6-year course in pharmaceutical education should facilitate the provision of widespread systematic palliative care education.
Several injectable drugs with different dosages and prices are used in anti-cancer treatments. It is difficult for pharmacists and medical staff to select optimal combinations of products that meet the prescribed dosages at the minimum price. In view of this, we developed a support program for determining such product combinations using NaU DSP®, a processing software. Our program has a simple calculation function that enables us to find the optimal product combinations among the potential matches. We applied it in the analysis of the combined use of the products in cisplatin (2,082 prescriptions), carboplatin (829 prescriptions), methotrexate (1,029 prescriptions), and cytarabine (893 prescriptions) preparations over the period from July 2001 to March 2003 in our hospital. Compared with not using the program, a reduction in the costs of product combinations was achieved for 147 prescriptions (7.1%) with cisplatin, 79 (9.5%) with carboplatin, 192 (19.0%) with methotrexate, and 249 (28.0%) with cytarabine. The reduction in total cost [median (range)/prescription] was ¥1,890 (250-6,445) for cisplatin, ¥2,909 (1,202-19,655) for carboplatin, ¥485 (485-9,146) for methotrexate and ¥2,103 (174-42,000) for cytarabine. The program that we developed can thus be used effectively to find optimal product combinations and reduce drug costs.
Spectral analysis was applied in analyzing the daily variations in the number of formulations dispensed at the Tanashi Yakuhin pharmacy. The power spectral density (PSD) of the variations for an influenza anti-viral agent was observed to trend downwards to the right, whereas the PSDs for a vasodilator and antidiabetic agent were horizontal. We found that for infectious diseases, prescription amounts for consecutive days were correlated, but for non-infectious diseases, they were independent of each other. Common cold drugs came under a category between the above types, possibly because they are also used for prophylactic purposes. This paper shows that a city pharmacy can provide the useful information.
We assessed the clinical efficacy of Pyoktanin® in the treatment of refractory decubitus accompanied by MRSA infection in the orthopedic ward of Chugoku Rosai General Hospital. The subjects were 5 patients with refractory decubitus in whom disinfection with povidone-iodine had been ineffective. Two patients were cured of their decubitus and in the 3 others the decubitus was reduced. None of the patients developed skin damage.
Several methods have been tried in reducing the adverse effects of chemotherapy, one of them divided dose schedules for chemotherapy agents. In the present study, we evaluated the impact of a divided dose schedule for cisplatin (CDDP) on the development of peripheral neuropathy. The study subjects were 7 Non Small Lung Cancer patients who developed peripheral neuropathy. All patients treated received CIC therapy (CDDP : 20 mg/m2, day 1-4, ifosfamide : 1500 mg/m2, day 1-4, irinotecan : 60 mg/m2, day 1, 8, 15) according to a divided dose schedule. We based our neuropathy evaluation on the medical records, medication history and nursing records of these subjects. As for neuropathy symptoms, there were 6 cases of numbness and one case of distal paresthesia in the hands or legs, which were considered to be caused by CDDP. Peripheral neuropathy is generally expected to occur after the administration of approximately 300 mg/m2 of CDDP. In our study, the mean total dose of CDDP was 330.1±67.3 mg/m2, that for ifosfamide 25716.8±6013.1 mg/m2 and that for irinotecan 662.3±158.0 mg/m2. The conclusion of our study was that peripheral neuropathy occurred after the administration of approximately 300 mg/m2 of CDDP for both the conventional and divided dose schedules.
We conducted a survey on the practical training of pharmacy students in 47 community pharmacies and 76 hospital pharmacies in Hyogo Prefecture. Items surveyed included the acceptance system for pharmacy students, practical training curriculum, problems and difficulties. In many community pharmacies and hospital pharmacies, instruction in practical training was recognized as worthwhile despite the workload involved. Though the content of the practical training varied, dispensing and medication instruction were the most common items in the practical training for both community pharmacies and hospital pharmacies. Communication with patients and management of medication history were the focus of training in community pharmacies, while the major aspects of training in hospital pharmacies were dispensing of injections and TDM (therapeutic drug monitoring). Many pharmacists were of the opinion that the content and goals of the training should be reviewed and that it needed to be further evaluated. Revision of the practical training in universities was also recommended. Further, in order to achieve an efficient practical training curriculum it was felt that the training should be more linked to the special characteristics of community pharmacies and hospital pharmacies.
In the present study, the possibility of an interaction between prescription drugs and over-the-counter (OTC) drugs was investigated by monitoring plasma drug concentrations in rats. When a levodopa preparation (Madopar®) indicated for patients with Parkinson's disease was orally administered with Saclon®, an OTC drug for upset stomach, the AUC and Cmax for levodopa were significantly lowered and Tmax was significantly prolonged. These results indicate that there may be an interaction between a levodopa preparation and Saclon® when administered together, which leads to a reduction in the bioavailability of levodopa. Similar results were obtained when the levodopa preparation and the main ingredient of Saclon®, a copper chlorophyllin salt, were concomitantly administered. Taken together, our results indicate that the copper chlorophyllin salt in Saclon® may interact with levodopa preparations. The possibility of such an interaction should therefore be kept in mind during levodopa therapy for patients with Parkinson's disease.