医療薬学
Online ISSN : 1882-1499
Print ISSN : 1346-342X
ISSN-L : 1346-342X
33 巻, 1 号
選択された号の論文の14件中1~14を表示しています
一般論文
  • 祝 千佳子, 矢野 育子, 桂 敏也, 園部 誠, 田中 文啓, 和田 洋巳, 乾 賢一
    2007 年 33 巻 1 号 p. 1-7
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    Gefitinib (Iressa®), a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, is effective in patients with advanced non-small cell lung cancer (NSCLC). However, since interstitial lung disease, a fatal adverse event, has occurred more frequently since gefitinib came on to the market, and ISEL and SWOG 0023 examinations have not shown any significant life-extending efficacy, patients have started to feel uneasy about being treated with it. In these circumstances, in the present study, we created a system under which pharmacists can be directly involved in treatment with gefitinib and monitor for adverse events. The subjects were 98 patients with NSCLC who were treated at our hospital, and received gefitinib at a dose of 250 mg once daily. We made a leaflet describing gefitinib and a check sheet for adverse events, and using them, explained the expected adverse events to patients and monitored their conditions. Common drug-related adverse events occurring were rash (54%), pruritus (29%) and diarrhea (23%), and most were graded as mild in degree (grade 1 or 2). Interstitial lung disease was observed in 10 of the 98 patients (10.2%), but none died. Liver injury of grade 3 or 4 occurred in 25 of 92 patients (27.2%), and some patients experienced liver injury one year after the administration of gefitinib. It is therefore necessary to monitor for adverse events in the long-term, especially liver injury. In conclusion, we consider it important for pharmacists to reassure patients about gefitinib and detect the adverse events early.
  • 本郷 文教, 戸田 貴大, 高田 寛奈, 洞田 克己, 佐藤 誠二, 黒澤 菜穂子, 大和田 榮治, 田中 繁道
    2007 年 33 巻 1 号 p. 8-14
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    Since the biguanide metformin lowers blood sugar levels in the absence of insulin secretion it should be useful for elderly patients with type 2 diabetes mellitus.
    In this study, the authors examined the pharmacokinetics, efficacy and safety of metformin in the elderly. All analyses were conducted on 86 outpatients given metformin hydrochloride tablets continuously. They were divided into two groups according to age : elderly group (age>=65, n=35) and non-elderly group (age<65, n=51).
    Creatinine clearance (CCr) was significantly lower in the elderly group than the non-elderly group (p<0.001). In 43 patients from whom plasma samples were collected 2-6 hours after taking metformin, the metformin concentration per dose (Cp/D) increased in pace with the decrease in CCr (Cp/D=3.00·CCr-0.595, r=0.413, p<0.001). On the other hand, in the same CCr group, there was no difference in Cp/D between the elderly and non-elderly patients. In 69 patients to whom metformin was newly prescribed, there was no correlation between patient age and decrease in Hemoglobin A1c (HbA1c). In patients with no hepatic dysfunction, the incidence of side effects in the elderly group was the same as that in non-elderly group (23.3% and 24.4%, respectively).
    In conclusion, since no difference in metformin pharmacokinetics, efficacy or safety was observed between the two patient groups, we consider that metformin is a useful drug for the elderly with normal renal and hepatic function.
ノート
  • 高木 昭佳, 吉田 直子, 渡部 有貴, 中川 洋子, 北澤 英徳, 三村 泰彦, 足立 伊佐雄, 川上 純一
    2007 年 33 巻 1 号 p. 15-22
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    To improve the drug information service and standardize pharmaceutical care for inpatients of the Department of Japanese Oriental Medicine, Toyama University Hospital, we created a Kampo (Oriental) medicine database and used it in the preparation of medication instruction sheets. The database was configured on a Power Mac G4 (Apple Computer, Inc. ; Cupertino, CA, USA) personal computer operating on Mac OS 10.4 using FileMaker Pro 6 database software. The database comprised 5 interlinked files-patient registration file, constituent crude drug registration file, Kampo formula registration file, and a file for the making and storing of instruction sheets. Information on 239 crude drugs and 560 Kampo formulae obtained from our “Hospital Manual for Japanese Oriental Medicine” was recorded in the database. Further, color photographs of the plants from which the herbal medicines were derived and other natural medicines were included in the instruction sheets to give patients a better understanding of Kampo pharmacotherapy. The database has made it easy to prepare personalized instruction sheets, which can be done by only entering the patient's ID and the Kampo formulae prescribed or crude drug name. In addition, the medication instructions for each inpatient and the indication(s) of prescribed Kampo formulae have been recorded in the database for later use in the management of inpatient histories and to provide utilization statistics for Kampo medicines.
    When a questionnaire survey of inpatients of the Department of Japanese Oriental Medicine was carried out to evaluate the usefulness of the medication instruction sheets prepared using the database, it was found that they gave patients a better understanding of Kampo pharmacotherapy and made them more interested in it. In conclusion, our database system will help improve the drug information service and quality of pharmaceutical care for inpatients treated with Kampo formulae prepared from crude drugs.
  • 小曽戸 圭子, 大森 光治, 伊藤 好夫, 柴田 秀郎, 村上 康二, 高橋 克彦, 巽 伸一郎, 倉橋 正浩, 越川 千秋
    2007 年 33 巻 1 号 p. 23-29
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    Pharmacists became involved in the synthesis of 18F-FDG and its quality control after our hospital opened a PET center on April 1, 2005. This work involves the use of high-dose radioisotopes and has raised concerns regarding the possibility of pharmacists being exposed to radiation in the hot lab. We created a dose-rate distribution map for the hot lab and determined radiation exposure doses at various points to investigate ways of minimizing radiation exposure during work procedures. The map enabled us to know the locations in the hot lab where there is a strong possibility of being exposed to high dose radiation, giving us a good starting point for considering countermeasures.
  • 宮松 洋信, 菅野 芳雄, 関根 祐介, 小林 仁, 長谷川 知子, 小谷野 実香, 橋本 美希, 野口 雅久, 笹津 備規, 阿部 満子, ...
    2007 年 33 巻 1 号 p. 30-35
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    For the disinfection of the hands, a basic measure used in the prevention of nosocomial infections, the existing guidelines recommend the use of alcohol-based hand rub agents, such as those drawn up by CDC (USA). Since such agents have shortcomings, in recent years, gel-form disinfectants have been developed to overcome them and have started to be used for disinfection. However, some investigators have reported that the disinfection efficacy of gel-form agents is lower than that of liquid-based agents and so we conducted the present study to compare these two types of agent in this regard using the palm stamp method.
    Nine subjects used gel-form disinfectants (hand rub agents containing 76.9-81.4 v/v% ethanol) and another nine subjects used a liquid-form disinfectant (hand rub agents containing 0.2 v/v% benzalkonium chloride and 83 v/v% ethanol). In the gel agent group, the average bacterial count decreased from 383.0±433.9 (mean±SD) before disinfection to 19.1±16.0 after disinfection. In the liquid agent group, the average bacterial count decreased from 609.3±789.7 to 84.7±186.5. The bacterial removal rate was 91.6%±8.6 in the gel agent group and 85.4%±12.3 in the liquid agent group. After disinfection, no MRSA, enterococci or Gram-negative rods were evident in either group. These results demonstrate that gel agents achieve adequate bacterial removal from hands immediately after use and that their disinfecting effect is satisfactory from a clinical point of view. They also indicate that gel-form disinfectants are a promising means of disinfecting the hands of healthcare professionals in the clinical setting.
  • 篠原 悦子, 石田 里子, 関 好秀, 横井 妙子, 浅山 亨, 早川 達
    2007 年 33 巻 1 号 p. 36-49
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    We developed a pharmaceutical management system for community acquired pneumonia which uses a standard care plan and a worksheet based on pneumonia diagnosis, treatment and antibiotic use guidelines. The system was introduced in clinical practice and its effectiveness evaluated using the findings for twenty patients hospitalized for community acquired pneumonia at Toho University Medical Center Ohashi Hospital from January to December 2005. Written informed consent was obtained from all of them.
    There was an increase in the numbers of pharmaceutical problems noted and pharmacist interventions compared to before introducing the system and there was a significant increase in the frequency of providing pharmaceutical care. A particular finding was that monitoring a patient's subjective symptoms and clinical laboratory test results using the worksheet made it possible for pharmacists to switch from intravenous to oral antibiotics. This also enabled patients to learn how to use antibiotics properly. The increase in the frequency of pharmaceutical care provided also enabled the conditions of patients to be determined at an earlier stage and helped prevent adverse effects. Our pharmaceutical management system for community acquired pneumonia also allowed the selection criteria for antibiotics and the effects of treatment using them to be easily determined. The findings of this study suggest that our system would be a useful tool in promoting the proper use of antibiotics.
  • 緒方 憲太郎, 高松 泰, 鈴宮 淳司, 田村 和夫, 藤金 治雄, 内山 将伸, 原 周司, 二神 幸次郎
    2007 年 33 巻 1 号 p. 50-53
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    Imatinib mesilate (Glivec®), a selective inhibitor of Bcr-Abl tyrosine kinase, has shown significant efficacy in chronicphase chronic myeloid leukemia (CML) with minimal toxicity. However, some patients have to discontinue Imatinib due to adverse reactions.
    A 67-year-old Japanese man with CML was started on 400 mg/day of Imatinib. On day 13 of treatment, he developed a generalized skin rash and was treated with an oral steroid. As the skin rash was aggravated and serum liver transaminase levels increased, Imatinib was discontinued on day 20. Three weeks later, the skin rash had abated and serum liver transaminase levels had returned to the normal range. Based on the pharmacist's recommendation, desensitization to Imatinib was attempted. To do this, its administration was restarted at a dose of 1 mg/day and then the dose was gradually increased at 2-day intervals - to 2, 5, 10, 25, 50 and then 100 mg/day, taking adequate care while doing so. Subsequently, the patient was able to take 400 mg/day of Imatinib with no recurrence of the rash or liver dysfunction. These findings suggest that desensitization therapy should be attempted for patients exhibiting adverse reactions to Imatinib.
  • 小嶋 文良, 武田 直子, 武田 真美子, 櫻井 可奈子, 半田 貢康, 相原 由香, 峯田 純, 新田 幸男, 伊藤 順子, 岡嵜 千賀子 ...
    2007 年 33 巻 1 号 p. 54-59
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    Medication notebooks are useful for preventing prescription duplication and/or drug interactions for patients who are visiting several medical institutions and/or consulting many medical practitioners, and can thus help ensure that medicines are used properly. However, such notebooks will not be useful if doctors are unaware of them or do not know how to use them properly. With this issue in mind, we sent a questionnaire on awareness of medication notebooks, their distribution, utilization and problems to members of Yamagata City Medical Association. Responses were obtained from 222 doctors (recovery rate 42.1%). Approximately 80% of them were familiar with medication notebooks, and more than 50% had actually found them to be useful in preventing prescription duplication and/or drug interactions. More than 30% of the responding doctors recorded information in notebooks such as that concerning diabetes mellitus and blood pressure, while some doctors had never seen a medication notebook. Almost 75% of the respondents considered medication notebooks to be useful, and some doctors themselves provided them to patients. Since medication notebooks help ensure that drugs are used properly and that doctors and pharmacists have the same information on patients, efforts should be made to raise awareness of them, among both patients and doctors.
  • 武田 光加, 小林 政彦, 河崎 育代, 淡野 芳久, 若杉 博子, 大野 明洋, 矢野 育子, 岡田 俊, 林 拓二, 乾 賢一
    2007 年 33 巻 1 号 p. 60-65
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    Many studies have reported that the polypharmacy of conventional antipsychotics at high doses is still common in the majority of Japanese patients with schizophrenia. However, most of them targeted prescriptions for inpatients in psychiatric hospitals and very few have been done on prescriptions for outpatients at university hospitals. We conducted our prescription survey in the psychiatric outpatient unit of Kyoto University in June 2001, after risperidone was introduced, and June 2004, when quetiapine, perospirone, and olanzapine were also available. From it, we collected data on use of antipsychotics and concomitant medications. The numbers of patients with schizophrenia in 2001 and 2004 were 262 and 203, respectively. The proportion of patients receiving novel-antipsychotic medications and novel-antipsychotic monotherapy increased from 30.9% to 70.0% and from 17.2% to 35.0%, respectively, in the two periods. Thus, most patients receiving novelantipsychotic medications were also given conventional antipsychotics. Further, though the percentage of patients prescribed antiparkisonian medicines decreased from 83.6% to 69.0%, biperiden-equivalent dosages did not change significantly. This resulted from the fact that high-dose antiparkisonian medicines were administered to patients receiving polypharmacy of conventional and novel antipsychotics and indicates that the benefit of administering novel psychotics for extrapyramidal symptoms was not realized because they were co-administered with conventional antipsychotics. Further studies are needed to examine the factors inhibiting the change to novel-antipsychotic monotherapy in schizophrenia.
  • 佐々木 紀彰, 緒方 憲太郎, 桝屋 愛, 鈴木 恵子, 高松 泰, 鈴宮 淳司, 田村 和夫, 二神 幸次郎, 原 周司
    2007 年 33 巻 1 号 p. 66-69
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    Tretinoin (All-trans retinoic acid : ATRA) is the drug of choice for the remission induction treatment of acute promyelocytic leukemia (APL). Its action against APL cells involves the degradation of promyelocytic leukemia-retinoic acid receptor α (PML-RARα) protein which represses their cellular differentiation.
    We treated a 44-year-old Japanese male patient with APL using orally administered ATRA. He had previously undergone multiple resections of the bowels due to Crohn’s disease and his residual intestine length was only 120 cm. In order to investigate the pharmacokinetics of ATRA in this patient, we measured the plasma concentrations. On the 11th day of orally administering ATRA twice a day, the maximum concentration (Cmax) and the area under the plasma concentration versus time curve (AUC0-12) of ATRA were 51.9μg/L and 460μg·h/L, respectively. These data are comparable with those for patients without gastrointestinal complications, indicating that ATRA was sufficiently absorbed in spite of the patient having such a short intestine. Complete remission was achieved by the course of ATRA treatment.
  • 増田 寛樹, 丸山 精一, 小林 義和, 笹原 一久, 外山 聡, 佐藤 博, 菊池 朗, 高桑 好一, 田中 憲一
    2007 年 33 巻 1 号 p. 70-77
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    Drug counseling during pregnancy plays an important role in eliminating anxiety concerning the adverse effects of drugs on fetuses and explaining the importance of drug administration during pregnancy. In the Outpatient Department of Obstetrics and Gynecology at the Niigata University Medical and Dental Hospital, together with obstetricians, pharmacists have provided information on the adverse effects of drugs administered during pregnancy on fetuses (teratogenicity) since March 22, 1995. Up to March 31, 2006, 269 patients had received such counseling.
    In this study, we investigated the timing of a decrease in the work of searching for information on drugs, and evaluated strategies for the development of drug counseling.
    According to the order in which drug counseling was requested by obstetricians, 250 patients were first divided into groups of 50 patients each, and then the quantity of drugs with general names as a percentage of the total number of drugs with trade names was determined. For 247 patients (3 excluded because they were women who had received counseling on drugs prescribed to their husbands), the percentage of drugs with general names of the total of those with trade names was 37.4% (413/1,103).
    Our results suggested that there would need to be about 650 drugs with general names in the database of information on the adverse effects of drugs taken during pregnancy on the fetus to provide effective drug counseling in the future. They also suggested that the work of searching for information on drugs decreased after counseling 100 patients.
  • 丸山 知恵美, 杉浦 宗敏, 長瀬 幸恵, 清野 敏一, 中島 克佳, 樋坂 章博, 鈴木 洋史, 伊賀 立二
    2007 年 33 巻 1 号 p. 78-86
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    The services pharmacists need to provide have been increasing and becoming more complex in recent years. In order to ensure a high level of competence among pharmacists who have just graduated from university, it is important that they undergo training that is both heterogeneous and experience-based. In this study, we developed training materials which make use of numerous prescriptions with queries to physicians raised by experienced pharmacists and used them in training for new pharmacists. We also evaluated the effectiveness of the materials by having the new pharmacists fill out a questionnaire. The system was developed over the five year period from April 1999 to June 2004 when 11000 prescriptions with queries were recorded. On analyzing 481 prescriptions collected from April to June in 2004, it was found that there were queries regarding dosage or dosage form in 280 prescriptions (58.2%), adverse effects or drug interactions in 50 prescriptions (10.4%), off-label drug use in 6 prescriptions (1.2%), and other problems in 62 prescriptions (12.9%).
    When twelve new pharmacists with less than 3 years experience studied the training materials by themselves and then filled out the questionnaire, they felt that they had learned the real risks of malpractice from the materials and said they often used the knowledge gained from them in daily dispensary inspections.
    We conclude that our training materials are useful for the training of new and inexperienced pharmacists.
  • 丸山 徹, 古川 真一, 吉田 健二, 荒平 光利, 佐藤 弘希, 岡山 善郎, 山崎 啓之, 森内 宏志, 甲佐 貴光, 石塚 洋一, 入 ...
    2007 年 33 巻 1 号 p. 87-92
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    A medication envelope functions not only as a drug container but also as a means of providing basic information on the usage and dosage of a drug. We made a prototype medication envelope based on Universal Design (UD) with which administration instructions can be obtained through the senses of sight, hearing and touch. In addition to conventional printed information, the UD medication envelope is equipped with an audio playback device to provide prerecorded spoken instructions on administration. It also has Braille labels so that administration instructions may be checked using the sense of touch.
    We performed a questionnaire survey of the usefulness of the UD medication envelope after it had been used by visually impaired patients, elderly patients as well as the families of patients, caregivers, nurses, and other individuals assisting patients in taking their drugs in the home health care setting. The results showed that the use of the UD medication envelope enabled the majority of patients to understand administration instructions better, which reduced mistakes in administration. They suggest that the UD medication envelope would help ensure that patients take drugs properly, thereby strengthening safety management, and would be useful in today's society in which there are large numbers or elderly and other types of patient having special needs with regard to understanding administration instructions.
  • 高野 三男, 戸井田 真弓, 内山 明子, 田中 千恵子, 馬場 浩介, 西村 博行, 成井 浩二, 野口 雅久, 笹津 備規
    2007 年 33 巻 1 号 p. 93-97
    発行日: 2007年
    公開日: 2008/01/22
    ジャーナル フリー
    Fourteen patients in a healthcare center for the elderly (100 beds) at Hokushin General Hospital contracted influenza due to influenza virus A in February 2006. To prevent the spread of the disease, the preventive administration of oseltamivir was conducted for 44 non-infected patients at a daily dose of 1 capsule daily for a period of 1 to 3 days. There were no new cases of influenza during the 1 week period from the start of the administering oseltamivir suggesting that this method of preventing influenza was more successful than influenza vaccination.
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