Malignant gliomas are common,aggressive brain tumors in adults and despite modern treatments with surgery,radiotherapy and chemotherapy,their prognosis remains dismal,with a poor median survival.The blood-brain barrier (BBB) restricts the delivery of many drugs to the central nervous system,contributing to the failure of treatment.Also,the effectiveness of traditional chemotherapy agents is limited by their adverse effects and their inability to cross the BBB in sufficient concentrations.
Recently developed agents,such as the oral alkylating agent temozolomide (TMZ),and irinotecan,a potent topoisomerase I inhibitor,have demonstrated efficacy against malignant gliomas and there are now new treatments that target molecules in the growth and survival pathways,whose goals are increasing specific efficacy and minimizing toxicity.Monoclonal antibodies and low molecular-weight kinase inhibitors are the most common types of agent in such targeted cancer treatment.Many molecular targeted agents,such as selective protein kinase inhibitors,are now in preclinical and clinical development for patients with malignant glioma.Oncology pharmacists have to contribute to the treatment of patients with malignant gliomas by taking part in such research and applying its results.They must also become highly skilled specialists in optimizing drug therapy for cancer patients through the design,recommendation,implementation,monitoring,and modification of individualized pharmacotherapeutic plans in collaboration with other members of healthcare teams.

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The purpose of this study was to evaluate the quality of the original and 3 generic formulations of Iopamidol injection.To do this,the free iodine concentration and osmotic pressure were measured.In addition,impurities were tested for using high performance liquid chromatography-tandem mass spectrometry.
There were no major differences between the original and generic formulations as regards free iodine concentration and osmotic pressure measurements,though one lot of the original formulation failed the free iodine concentration test.However,in the HPLC analysis,some substances not present in the original product were detected in the generic formulations.One of them was identified as DM 1/2,a substance related structurally to Iopamidol.

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To treat sympathetically maintained pain (SMP),we prepared an ointment containing clonidine hydrochloride,an α adrenergic agonist,as an in-hospital preparation and observed SMP alleviation in patients treated with it.No redness or other abnormalities were observed in the ointment application area,and there was no blood pressure fall,a pharmacological effect of orally administered clonidine.Plasma clonidine concentrations after applying the ointment were 40 -80 pg/mL,which were sufficiently lower than those required for blood pressure control.These results suggest that clonidine ointment is safe and effective against SMP.It can be used at home and is therefore useful for improving the quality of life (QOL) of patients with chronic pain.

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We conducted a pharmaceutical study to evaluate the quality of oral dried jelly preparations,a new type of medicine for patients with dysphagia.Four kinds of acetaminophen-containing dried jelly preparations (A,B,C,D) consisting of three layers of film were produced.For Preparation A,the outer dried jelly film layers consisted of treharose and carrageenan,and the inner drug-containing film was gelatin-based.Preparations B,C,and D consisted of gelatin-based outer films and a gelatin-based drug-containing film,gelatin-based outer films and a hydroxypropyl methylcellulose-based drug-containing film,and gelatin-based outer films containing hydroxypropyl methylcellulose and a gelatin-based drug-containing film,respectively.
A content uniformity test showed that the acetaminophen content was close to 100% in all preparations,meeting the criterion of Japanese Pharmacopoeia XV.In an initial dissolution test,Preparation A had the lowest dissolution rate and Preparation B the highest.A stability test in which the preparations were stored in aluminum film packages under the conditions of 40°C and 75% RH for 8 weeks showed that the acetaminophen content was more or less stable for all of them.However,in a dissolution test performed after storage for 8 weeks,the dissolution rates for Preparations A,B,and C were significantly lower than they had been previously though most of the acetaminophen had dissolved in the test solution within 45 minutes for preparations B,C,and D.
Among the 4 preparations,Preparation D had the best quality profile as regards stability and dissolution,and our findings overall suggest that oral dried jelly preparations are suitable for clinical use as a new type of medicine.

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Recently,the use of generic drugs has been steadily increasing,and more medical institutions are dispensing single-dose packages to improve compliance among elderly patients.In view of this,we prepared single-dose packages for several generic products containing the laxative agent magnesium oxide and compared their stability with that of an original product when the packages were stored long-term under constant conditions.
We examined a total of four types of product-two plain tablets (ML and MM) and a film-coated tablet (KM) as the generic products,and subtle granules (SM) as the original product.They were evaluated with respect to appearance change as well as quantitative test,hardness test (SM excluded) disintegration test (SM excluded) and dissolution test results after storage for 90 days under three sets of constant conditions (25°C and 75% RH,30°C and 75% RH,40°C and 75% RH).
The appearance of the products did not change under any of the sets of conditions and the results of the quantitative test showed an average content of more than 96%.However,hardness increased under all of the storage conditions and there was a significant difference among the three product types in this regard.In the disintegration test,a delayed collapse was noted for all products except ML under each of the set of conditions.In the dissolution test,as compared with SM,the elution rate for KM was significantly lower,and it tended to be lower with ML and MM as well.
In our study,as we noted differences among the 4 types of product as regards physicochemical stability when packed in single dose packages,generic products must be carefully selected with regard to stability when adopting them for specific dispensing strategies.

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Accidental falls among hospitalized patients may have unfavorable effects on their quality of life (QOL),among them delaying recovery from diseases and impairing activities of daily living (ADL).Drugs can be a cause of accidental falls in hospital patients and their labels include adverse drug reactions that could be causally related to falling.In the present study,we studied the adverse effects of drug treatment that might cause falls and determined whether such adverse effects were listed in the labeling or not.We investigated the frequency that such adverse drug reactions were stated in drug labeling as well as the number of stated adverse drug reactions that might lead to falls,by drug type and by pharmacological action.
The results indicated that the labeling for psychotropic drugs,such as antipsychotics,anxiolytics,antidepressants,narcoleptics,and anticonvulsants,more frequently listed adverse drug reactions that might lead to falls and these types of drug listed a larger number of such adverse drug reactions.A characteristic relationship was found between pharmacological action and numbers and types of adverse reactions included in drug labeling.However,we concluded that the frequency of listing such adverse drug reactions did not necessarily have a direct effect on the frequency of accidental falls.

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We investigated the relationship between the development of aconite poisoning-induced arrhythmia and time of ingestion or the ingested aconite plant parts as well as the outcome of treatment for such arrhythmia for 10 patients.Three of them exhibited ventricular tachycardia (VT) and ventricular fibrillation (Vf),which are potentially fatal arrhythmias.Two of these patients ingested aconite roots in June or November,and the third patient ingested aconite leaves in April.The other seven patients did not develop any potentially fatal arrhythmias.Four of these patients ingested aconite leaves in April or May,and the remaining three patients ingested aconite roots in March,August or September.Nine of the ten patients ingested aconite leaves or roots at the same time as they gathered them.
The antiarrhythmic agent lidocaine was ineffective against the VT and Vf that 3 patients developed.It was effective against the other ventricular arrhythmias with the effect differing depending on the part of the plant ingested.Effectiveness was seen for patients who had ingested leaves but not for those who had ingested roots.
Our data did not show that the severity of the arrhythmia was influenced by the part of the plant ingested or the time of ingestion.They do however suggest that the effect of lidocaine was influenced by the type of arrhythmia and the part of the plant ingested and therefore should prove useful in determining the suitability of lidocaine treatment for arrhythmia due to aconite poisoning.

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As hypoalbuminemia is a risk factor of severe hematological toxicity occurring in anticancer chemotherapy,we examined serum albumin levels in outpatients receiving several different chemotherapy regimens.The data of 4215 samples collected from 946 outpatients receiving anticancer chemotherapy were investigated.Mean (±SD) serum albumin was 3.8±0.4 g/dL with levels in the 2.0-2.9 g/dL,3.0-3.9 g/dL and 4.0-4.9 g/dL accounting for 2.5%,56.6% and 40.9% of the total number of samples,respectively.Serum albumin levels differed by disease and chemotherapy regimen.The mean albumin levels for each chemotherapy regimen were significantly directly correlated with hematocrit (rs=0.752,p<0.01),BMI (rs=0.581,p=0.02)and inversely correlated with age (rs=-0.578,p=0.02).The frequencies of hypoalbuminemia were higher in patients with gastric,pancreatic and esophageal cancer than in patients with breast and colorectal cancer (70.5-91.4% vs.20.3 -63.1%) since the former were older and had a lower BMI.These data suggests that the risk for a severe hematological toxicity and an alteration of pharmacokinetics in highly protein-bound anticancer agents increase in patients with gastric,pancreatic and esophageal cancer.

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Using the case of a patient receiving home enteral nutrition,we evaluated the usefulness of information provided by pharmacists in team medicine,as well their contribution to the quality of medicine practiced by teams.Problems were solved in the use of an enteral nutrition product through pharmacists instructing the community medical team with regard to changing the product,the hospital team concerning dosage,addition of water,formulation and antisepsis and providing guidance to the patient’s family.Pharmacists were evaluated on the usefulness of their pharmacy knowledge in solving problems,and communication skills.The medical care practiced by the teams was evaluated from the standpoint of its specialty-oriented,patient-oriented,paramedical-oriented,and coproduction-oriented characteristics.
The pharmacy knowledge of pharmacists was found to be useful in solving problems and their communication skills to raise the effectiveness of team medicine.Having a good balance between the above four characteristics helped the medical teams to solve problems.We consider that pharmacists can make a good contribution to community medical teams when they appreciate the roles of the paramedicals who form them,and offer pharmacy knowledge in the most appropriate manner.

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We carried out a survey to investigate the situation of insulin usage by diabetes patients and that of the pharmaceutical care currently provided with the aim of improving it.The survey targeted 246 patients visiting 8 hospital and community pharmacies which were members of the Pharmacists’Diabetes Research Society.
The results showed that though patients were aware of the number of units to be used and injection times,27% of them either forgot to inject themselves or were late in doing so.An analysis by type of injection device,revealed that patients using a multiple insulin kit (including very fast type) and a fast type injection device were better at keeping to injection times and had better compliance.
The survey also revealed that the majority of problems experienced by patients were daily life-related (34%) or device related (33%) and that 83.7% of them were satisfied with the care provided by pharmacists.In addition,we feel it showed a clear need for pharmacists to be more proactive in providing pharmaceutical care that considers the problems of patients.

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