Careful dose adjustment in consideration of changes in clearance with growth is required for children but up till now very little information on the capacities of drug-metabolizing enzymes in young children has been available.The aim of this study was therefore to obtain basic data in this regard to ensure the safety of individualized medication in children. Firstly,we investigated changes in CYP3A activity after birth using urinary steroid metabolites,and differences in the function of 2 expressed enzymes,CYP3A4 and CYP3A7.Our results indicated that conversion from CYP3A7 to CYP3A4 occurs during the neonatal period,and that the substrate specificities differed between CYP3A4 and CYP3A7.We therefore considered that changes in drug metabolism activity during the neonatal period may be dependent on the kind of medicine. Secondly,using NONMEM software,we developed population pharmacokinetic parameters for busulfan in young children prior to hematopoietic stem cell transplantation.The combined use of the Bayesian estimation and population pharmacokinetic parameters enabled the target exposure to be achieved with minimum blood sampling. Finally,with the aim of avoiding pharmacokinetic interaction between granisetron,a potent 5-HT3 receptor antagonist,and anticancer drugs,we identified the major CYP isoform catalyzing the 7-hydroxylation of granisetron.Our results indicated that the isoform,CYP1A1,plays a major role in the metabolism of granisetron in human liver microsomes. In conclusion,the results obtained in the present study could aid the making of individualized drug dosage regimens for children as well as the prediction of drug interactions.
As part of the training program in community pharmacy practices for students in the school of pharmacy,we conducted training aimed at enhancing understanding of over-the-counter (OTC) drugs,and evaluated student learning as well as their satisfaction with the training. This was done through the use of a questionnaire consisting of 21 questions on learning and 1 concerning satisfaction,and responses were evaluated according to seven grades.The questionnaire was given to 127 students who participated in the training in 2007.Questions on learning were devised using the KJ-method based on reports made by 130 students who took the OTC drug training in 2006. The average degree of satisfaction was 6.24.Factor analysis on the responses of 124 students who answered all questions in the questionnaire revealed 3 important factors:“need for the pharmacist”,“need for knowledge and information”,and “pharmacist’s sense of worth and responsibility”.Then,covariance structure analysis showed that understanding of“need for knowledge and information”in the sale of OTC drugs to customers was connected to“need for the pharmacist”,and recognition of“need for the pharmacist”gave rise to“pharmacist’s sense of worth and responsibility”which influenced satisfaction.These findings suggest that improvement in acquiring skills and knowledge is necessary but this alone is not enough.In devising meaningful training for students,it is also extremely important to include case studies and role plays to enhance pharmacist’s sense of worth and responsibility.
The frequency of accidental falls in psychiatric patients is reported to be markedly higher (46.5%) than in patients in other medical departments (15.7%).In order to prevent accidental falls,we provided physicians and nurses with pharmaceutical information on the adverse effects of cold medicines and traditional Chinese medicines.We also investigated the annual number of falls among inpatients before and after beginning our pharmaceutical information service.To do this,a questionnaire concerning cold medicines and traditional Chinese medicines was sent to physicians and nurses 2 years after starting the service.Owing to the provision of information,there were reductions in the annual number of falls (212 to 143),number of falls in patients taking cold medicines (8 to 1),percentage of falls in patients taking cold medicines among all falls (3.8% to 0.7%),and frequency of prescribing cold medicines for the common cold (96% to 75%).The questionnaire results also showed that 68% of physicians and nurses observed dizziness as an adverse effect of cold medicines,and 71% of physicians exercised caution with respect to the risk of falls due to cold medicines. To analyze the causes of accidental falls,a self-organizing map (SOM) was applied to the clinical data.The results suggested that the administration of cold medicines together with comparatively low dosages of chlorpromazine,or an equivalent antipsychotic,and two or more kinds of medication for Parkinson's disease was likely to lead to accidental falls.Thus,for patients having a high risk of falls,the co-administration of cold medicines and psychotropic drugsmayfurtherincreasesuch risk.
In February 2005,Meijo and Nagoya Universities concluded an agreement with Nagoya University Hospital under which a resident faculty is stationed at the hospital.Nine graduate students are assigned to the resident faculty under whose guidance they engage in a variety of activities which include inpatient and outpatient pharmaceutical services under pharmacists and clinical research in collaboration with doctors at Nagoya University Hospital. In addition,our universities conduct practical training for fourth-year students for four-week periods each year from May to July.In 2007,a total of 41 students participated in the practical training at Nagoya University Hospital.Under the guidance of the resident faculty,graduate students instructed the students in activities conducted in hospital wards and the outpatient asthma clinic (we call this“age-mixing”).After the four-week training programs,a questionnaire survey was conducted to determine the participants’views concerning the training schedule,content of the training and the“Age-mixing Method”.The trainees had a favorable impression of the training with many selecting the responses“Our training went very well thanks to the support of the resident faculty”,“We learned a lot form graduate students”,“The Age-mixing Method is very useful for trainees”and“We realized that‘teaching is learning’”.The introduction of the Age-mixing Method not only allowed trainees to learn from graduate students,it also enabled graduate students to review and reinforce their knowledge and skills through teaching.We therefore believe that the Age-mixing Method is useful for both student trainees and graduate students.
In consideration of the difference between the 2006 American Society of Clinical Oncology guideline on the use of hematopoietic colony-stimulating factors (CSF) and the Japanese medical insurance regulation,we studied the appearance of neutropenia and the use of G-CSF in breast cancer patients undergoing FEC100 therapy as neoadjuvant or adjuvant chemotherapy. All patients undergoing FEC100 therapy developed neutropenia of grade 3 or 4.As febrile neutropenia (FN) occurred in the first course in which the start of G-CSF administration was delayed,the timing of G-CSF administration during the course was adjusted.We found that administering G-CSF early on was more effective than administering it after the appearance of neutropenia to prevent FN and severe neutropenia.The use of G-CSF in this manner enabled FEC100 therapy to be accomplished without dose-reduction in the breast cancer patients. Our findings suggest that the preventive administration of G-CSF is very useful in FEC100 therapy and that if it is used in accordance with the Japanese medical insurance regulation,it may be difficult to prevent the appearance of serious neutropenia and to continue FEC100 therapy at optimum strength.
We investigated Japanese articles relating to pharmaceutics and hospital pharmacy published between 1991 and 2006,grouping them by publication data in 5 year increments.Between 1991 and 2006 there had been an approximately 1.6-fold increase in the number of articles in“Japanese Journal of Pharmaceutical Health Care and Sciences /Japanese Journal of Hospital Pharmacy ”,and“YAKUZAIGAKU /Journal of Pharmaceutical Science and Technology,Japan ”. The content of the articles was classified as medical pharmacy,physical pharmacy,biopharmaceutics,manufacturing pharmacy,analytics and clinical biochemistry and others,and we found that the number of articles on medical pharmacy published in 2006 had increased approximately 3-fold over those published in 1991. A study of key words used in articles revealed that the“investigation”(analysis of questionnaires,case studies,and so on) occurred in approximately 28% of all articles.Further,over 20 years,there had been an increase in articles concerning practical training in pharmacy and generic drugs.An increasing trend was also seen for cooperative studies among institutions,hospital pharmacies and medical departments or colleges of pharmacy,as compared with studies exclusively on hospital pharmacy. Our findings showed a clear change in medical pharmacy studies along with the expansion of pharmaceutical practice.
With the introduction of 6-year pharmacy educational program in 2006,a provision was made to assign pharmacist faculties having working experience as pharmacists in pharmacy schools.In October 2007,we conducted a survey to investigate the situation of pharmacist faculties. We sent a questionnaire to 247 pharmacist faculties in 66 pharmacy schools and the response rate was 84.9%.The faculties consisted of professors (43%),associate professors (23%) and lecturers (23%),and 77% of them had a Ph.D.degree.In a typical week,the major activities they engaged in were educational activities (20.6 hrs),research (12.2 hrs) and management (9.6 hrs).While the average time they were occupied by clinical practice was 3.5 hrs,67% of them did not do any.Half of the faculties did not conduct any research with students or graduate students in their own schools,and in 2007 only 55% applied for Grant-in-aid for Scientific Research from the Ministry of Education,Culture,Sports,Science and Technology of Japan.Twenty-six percent said they were very satisfied or satisfied with their work on a five-point scale,and 44% rated their degree of satisfaction as fair. In conclusion,our survey showed that most pharmacy faculties are not sufficiently engaged in clinical practice and do not spend much time in clinical research.We hope that its results will promote discussions among pharmacy personnel concerning the role of pharmacist faculties so that even better clinical pharmacy education may be provided to students in pharmacy schools.
The taking of vital signs and medical emergency procedures are taught as a part of bedside practice at the Department of Pharmacy of Kyushu University of Health and Welfare to aid pharmacists in providing medication for patients.Conducting a survey on the attitudes of hospital pharmacists and pharmacy students regarding their involvement in checking vital signs and medical emergency procedures produced the following results.Both hospital pharmacists and pharmacy students at our university were very interested in learning how to take vital signs and medical emergency procedures,in order to expand their role in treating patients.Hospital pharmacists were more aware of the need to have injection sets for pharmacists and instruction in emergency procedures than students. The taking of vital signs enables pharmacists to understand the conditions of patients better and helps them to evaluate drug efficacy and adverse effects.It also allows pharmacists to be more active members of the medical team and optimizes their role in patient-centered care.
Though the use of residual anticancer-agents in vials reduces drug costs,the vials may be subject to bacterial contamination.With this in mind,we examined the extent of bacterial contamination in reused vials and estimated the resulting reduction in drug costs.The anticancer agent vial formulations studied were those of Etoposide(ETP),Paclitaxel(PTX),Irinotecan (CPT-11),Vinorelbine(VNR),Cisplatin(CDDP),and Carboplatin(CBDCA). Vials containing residual anticancer agents were placed in sterilized ointment containers in a safety cabinet and then stored at room temperature for 14 days outside a safety cabinet.We then performed sterility tests based on the methods specified in the Japanese Pharmacopoeia to test for the presence of bacterial contamination.Furthermore,in order to simulate actual contamination,we added E.coli,P.aeruginosa,S.aureus,A.niger ,and C.albicans to the vials,and performed preservative efficacy tests. All vials tested negative in the sterility tests,and no bacterial contamination was observed.In the antimicrobial preservative efficacy tests,except for CPT-11 when C.albicans was added and VNR when A.niger was added,viable bacteria counts decreased to zero or were reduced to less than 1/1000 of the inoculated level.Most of the tested anticancer agents were therefore considered to possess antimicrobial properties. Between January and December 2007,for 2,313 preparations of ETP,PTX,CDDP and CBDCA,we estimated the extent of the reduction in medical costs when they were used as residual drugs,and found there was a saving of 2,549 yen per preparation.These agents were selected as they are considered to be appropriate for residual drug use due to their preservative properties. The results of this study indicate that residual drug use is possible for ETP,PTX,CDDP and CBDCA if stored under specific conditions,and that such use will reduce drug costs.
We gave a lecture on over-the-counter (OTC) medicines to freshmen pharmacy students as early as possible to enhance their professional sense and their learning motivation.The impact of the lecture was reinforced through the use of television commercials and a case conference.In addition,questionnaires were given to the 182 students who attended the lecture before and after it,and the responses of the 170 students who fully completed the questionnaires were analyzed.The following results were obtained. For the students who had bought OTC medicines in the past,the package was the most important factor in selecting the medicine.As a result of the lecture,the number of students who wanted help from a pharmacist in selection increased.Of the 166 students who had used OTC medicines in the past,152 had read package inserts.After the lecture,all students said that the package insert should be read before using OTC medicines.Attending the lecture also increased the number of students who considered it important to read the major items of the package insert,such as“Ingredient and amount”and“Drug characteristics”.The lecture also increased students’interest in the pharmacist dealing with OTC medicines about 1.8-fold.In addition,most students were satisfied with the lecture and it stimulated their interest in learning more about OTC medicines. In conclusion,we felt that the lecture had been useful in enhancing professional sense among freshmen pharmacy students as well as their motivation to learn about OTC medicines.