We have found that a lecture on over-the-counter (OTC) medicines including television commercials and case studies that we have been giving to freshmen pharmacy students has been useful in enhancing the professionalism of students as well as their motivation to learn about OTC medicines.In this study,we modified the lecture by adding audience-friendly figures and explanations,and gave it to members of the public to see whether it was effective in enhancing their awareness of the proper use of OTC medicines.It was given to 166 local residents and high-school students who were asked to complete a questionnaire before and after the lecture,and responses were analyzed for 133 people who fully completed the questionnaires.
Of the 133 respondents,122 had used OTC medicines previously,and before the lecture,46 of 65 local residents (70.8 %) and 17 of 57 high-school students (29.8%) had considered a pharmacist’s advice in selecting OTC medicines.Further,the number of respondents who desired a pharmacist’s advice in selecting OTC medicines increased to 59 (90.8%) for the local residents and 54 (94.7%) for the high-school students after the lecture.While eight of 65 local residents (12.3%) and 11 of 57 high-school students (19.3%) had not read package inserts before using OTC medicines,after the lecture,all respondents said that package inserts should be read.The results showed that the lecture had increased people’s interest in OTC medicines.
These findings suggest that the lecture was useful for increasing the general public’s awareness of the importance of a pharmacist’s advice on the proper use of OTC medicines.

View full abstract

Warfarin potassium (Wf) interacts with a wide range of drugs and occasionally causes severe bleeding.We report the case of a 60-year-old female patient on Wf therapy who received 5 courses of cancer chemotherapy with doxorubicin,paclitaxel,and cisplatin.The Wf dose had to be reduced immediately after the chemotherapy due to an increase in international normalized ratio (INR).We then steadily increased the Wf dose till it had reached the previous level,which took almost 11 days from the time of receiving the anti-cancer agents.Although we could not determine which agent was interacting with Wf to cause the rise in INR in this case,we feel that attention must be paid to Wf drug-interactions for chemotherapy agents that have not previously been reported to interact with Wf in order to avoid the risk of bleeding.Therefore,there is a need for pharmacists to check medicines prescribed to patientsundergoingcancerchemotherapybyothermedicaldepart-ments and other medical clinics,especially for outpatients.

View full abstract

We conducted an awareness survey of factors relating to“International Health Care Cooperation”among Japanese pharmaceutical students.One hundred and sixty-one of 200 first-year students at Daiichi College of Pharmaceutical Sciences who attended a lecture on this subject filled out a questionnaire concerning it.The proportion of students answering that “international collaboration is necessary”was 85.8% and more than 80% of them thought that“pharmacists need knowledge”in this regard.Nearly 70% of the students selected the response“I would like to obtain more knowledge”.While more than 70% of all students were positive about participating in International Health Care Cooperation in the future,female students were significantly more willing to learn about and participate in International Health Care Cooperation (p< 0.05)than male students.Among students planning to become hospital pharmacists,the number feeling that“pharmacists need knowledge”was significantly higher (p<0.05)than for students hoping to follow other pharmaceutical-related careers.Furthermore,students doing voluntary activities were significantly more willing to participate (p<0.01)than others.
In conclusion,the pharmaceutical students showed great interest in and willingness to participate in International Health Care Cooperation and our findings indicate the importance of including international health care in the pharmaceutical college curriculum.

View full abstract

We investigated the pediatric doses of drugs for children aged 2 years to less than 15 years for the following age groups : early childhood (2-5 years),childhood (6-11 years),and puberty (12-14 years).Pediatric dosages indicated in package inserts of renally excreted drugs (vancomycin,fosfomycin,arbekacin,norfloxacin,amoxicillin,and digoxin) were adjusted using three variables : body,body surface area (BSA),and glomerular filtration rate (GFR).It was found that Dose/GFR was a better factor for adjustment than Dose/Body and Dose/BSA because Dose/GFR showed little variation with age during childhood.Based on the ratio between childhood and adult GFR (GFR_C/GFR_A),we established a formula for calculating the pediatric dose (D_C=D_A·GFR_C/GFR_A) and derived linear approximation and second-order approximation equations stratified by gender for clinical application.Compared with the Augsberger equation,these approximation methods produced smaller variations from the dosages indicated in the package inserts for almost all the drugs examined and enhanced predictability.While the linear and second-order approximation equations produced similar results,the former was considered to be more useful in the clinical setting due to its simplicity.The linear equations proposed for males and females in this study are D_C ~= D_A·(0.054 Age+0.093)and D_C ~= D_A·(0.062 Age+0.12),respectively.
Our new method of estimating pediatric doses may be better than conventional methods (Augsberger,Young,Clark,and Crawford equations,and von Harnack conversion table) because of its compatibility with pharmacokinetic mechanism(s).Conventional methods do not consider drug metabolism/excretion pathways and their physiological variations.

View full abstract

A recent meta-analysis has shown that the serum cystatin-C concentration is a superior marker to serum creatinine for estimating the glomerular filtration rate (GFR).In this study,we investigated the relationship between serum vancomycin (VCM) and cystatin-C concentrations to establish a simple method of setting initial doses for VCM therapy.
We conducted a non-parametric analysis in which data from 140 patients treated with VCM for Methicillin-resistant Staphylococcus aureus (MRSA) infection were divided into 2 groups (a once-a-day group (n=54)and a twice-a-day group (n=86)).The GFR was estimated using the equation of Hoek based on the serum cystatin-C concentration.
In the once-a-day group,VCM dose/serum VCM trough concentration (D/C) ratios were significantly different among 4 -subgroups established on the basis of GFR.The subgroups were GFR<20,20-40,40-50 and 50>mL/min and the average D/C ratios in them were 28.4,57.2,87.9 and 170.3,respectively.In the twice-a-day group,D/C ratios varied signifi-cantly among 3 subgroups based on GFR,which were GFR<50,50-80 and >80 mL/min,and the average D/C ratios in them were 75.0,149.9 and 264.0,respectively.
Based on these findings,we simply established the following initial dosage regimens for VCM using GFRs estimated from serum cystatin-C concentrations : 500 mg q.o.d for GFR<20,500 mg s.i.d for GFR of 20-40,1000 mg s.i.d for GFR -of 40-50,1500 mg b.i.d for GFR of 50-80 and 2000 mg b.i.d for GFR>80.In conclusion,we consider that serum cystatin-C concentrations are a useful basis for setting initial doses of VCM,in particular for patients with a GFR<80.

View full abstract

Palliative care screening is important in ensuring that palliative treatment is timely and appropriate.Thinking that the Seirei Mikatahara Hospital’s Support Team Assessment Schedule (STAS),which is mainly used for evaluating physical discomfort,could be useful in palliative care screening,we surveyed the need for palliative care at Toyama University Hospital to verify the usefulness of the STAS for this purpose.Our subjects were cancer patients in the gastroenterological surgery,gastroenterology/hematology and respiratory medicine departments and the Outpatient Chemotherapy Center at Toyama University Hospital who had not undergone any surgery within the previous two weeks.In our study which was conducted in May and June 2008,patients were scored using STAS twice,with a week between the scorings.Patients for whom the score in both STAS screenings were 2 or more were considered as positive.There were 15 positive patients (18.3 %) among 82 hospitalized patients and 6 (31.6%) among 19 outpatients.Among the positive patients,46.7% (7/15)of those hospitalized and 50.0% (3/6)of those being treated as outpatients required referral for other palliative treatment.Our palliative care team has had 2.1 patients per month on average since 2007,but this study showed that there are many more patients with a potential need for palliative care.
In conclusion,we found that 21 of (20.8%) of 101 patients were positive in the screenings and 47.6% (10/21 cases) of them needed other treatments,demonstrating the usefulness of Seirei Mikatahara Hospital’s STAS as a palliative care screening system.

View full abstract

A questionnaire was conducted among pharmacists working for 193 pharmacies regarding the present situation and their recognition of palliative treatment and narcotic analgesics.Responses to the questionnaire were collected from 171 pharmacists at 81 pharmacies,revealing that 70.2% of the pharmacists had experience of dispensing narcotic analgesics,46.8% of the pharmacies had a regular stock of narcotic analgesics,the mean number of narcotic items in stock was 6.5,and 25.3% of the pharmacies practiced home-visit treatment.The level of understanding palliative treatment and the proper use of narcotic analgesics was higher in pharmacists working for pharmacies dealing with narcotic analgesics,and engaged in homevisit activities than in those working in other situations.While many pharmacists gave instructions regarding adverse reactions to narcotic analgesics and precautions for their use to patients notified of their condition,they often only gave information on common indications and side effectsto patients yet to be notified or unaware of their condition.In the future,we should hold study meetings in communities to improve their expertise in palliative treatment.

View full abstract

As a preventive measure against allergic/hypersensitivity reactions due to paclitaxel (PTX),the administration of premedication composed of three components,dexamethasone sodium phosphate injection,diphenhydramine hydrochloride tablet,and ranitidine hydrochloride injection solution (or injectable famotidine),is stipulated in the package insert.In the present study,we used d -chlorpheniramine maleate injection instead of diphenhydramine hydrochloride tablet and examined its effectiveness against PTX-related allergic reactions in 101 patients.
When d -chlorpheniramine maleate injection was given as premedication,the frequency of allergic reactions was 13.9% (14/101),and for those of greater than Grade 3,which are considered to be severe,it was 2.0% (2/101).In addition,the frequencies of allergic reactions in patients with and without an allergic past were 37.5% (6/16)and 9.4% (8/85),respectively,a significant difference (p=0.0087).Although none of the patients with an allergic past had severe allergic reactions (greater than Grade 3),there were severe reactions in 2 (2.4%) patients with no allergic past.Seven of the 101 patients (6.9 %) experienced PTX-related allergic reactions in the first treatment,whereas 1 patient (1.0%) had an allergic reaction in the second treatment.In the 3rd and later treatments,PTX-related allergic reactions occurred in 6 patients (0.6%),though PTX had been administered 992 times to 91 patients.
In conclusion,when d -chlorpheniramine maleate injection was used as premedication,it was equivalent to the conventional premedication as regards preventing allergic/hypersensitivity reactions.However,in patients with no allergic past and those under long-term treatment who had been treated 3 or more times,we consider that d -chlorpheniramine maleate injection was particularly effective in preventing PTX-related allergic reactions.

View full abstract