To evaluate the quality and stability of limaprost-alfadex generics,we carried out a comparative study on 5 generics and 2 branded products.
The limaprost contents were higher in 2 of the generics than in the 2 branded products,and 1 generic had a higher level of 17S,10-dimethyl-trans -δ²-PGA₁(11-deoxy congener),the major degradation product of limaprost,than the specification for the branded products (</=5.0%).To compare the stability of the tablets in the PTPs,they were removed from the aluminum pillow and stored under the conditions of 25°C and 57.5% relative humidity (RH),25°C and 75.0% RH and 40 °C and 75.0% RH.At 25°C and 57.5% RH,though the limaprost contents of the generics were similar to those of the branded products after 3 months,the 11-deoxy congener levels in 2 of the generics had increased to over 5.0%.Moreover,the percentage degradation of limaprost and 11-deoxy congener levels were particularly marked in some of the generics under the more humid conditions of 25°C and 75.0% RH and 40°C and 75.0% RH.On comparing the stability in cellophane paper at 25°C and 57.5% RH for 3 months,the limaprost content only remained above 90% in the branded products.These results indicate that the limaprost-alfadex generics could be less stable than the branded products in a PTP and one-dose package made of cellophane paper.Therefore,when deciding to use generics or not,it is necessary to evaluate them on the results of stability tests as well as those of bioequivalence and dissolution tests.

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New regulations that came into force in June 2009 prohibit the sales of some over-the-counter (OTC) drugs via the Internet,by telephone,or via catalogues.However,the appropriateness of this regulation is now being widely discussed from the viewpoints of safety and convenience.The purpose of this study was to survey the attitudes of residents living on a remote island (island with 97 residents having pharmacies,drug stores,and licensed pharmacists) toward purchasing OTC drugs via the Internet.
The results showed that approximately 80% of the respondents had purchased items other than OTC drugs via the Internet but none responded that they usually used the Internet for OTC drug purchases.Further,approximately 90% of them answered that they never felt that Internet OTC drug sales were a necessity.
The results of the survey suggest that,compared with people living in urban areas,purchasing medicinal products via the Internet is disadvantageous for residents of a remote island in terms of the amount of time and money they have to spend to receive them.In view of this,a fact-finding survey on the purchase of OTC medicines by residents of remote islands where there are no pharmacies,drug stores,or licensed pharmacists needs to be conducted in order to establish an optimum system for supplying medicinal products to remote islands.

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To increase the number of surgical operations and reduce the work of anesthesiologists involved in anesthetic management,a pharmacist started providing pharmaceutical services in the operating theater of Kyoto University Hospital in July 2007.We evaluated the changes in the workload of anesthesiologists and number of surgical operations performed due to the services as well as the medicoeconomic effects.
Improvement of narcotic management and the provision of anesthetic sets by the pharmacist reduced the workload of anesthesiologists by approximately 173 hours per month.We found that assigning the pharmacist to the operating theater increased the number of daily operations to 22.3,from 20.3 beforehand.Furthermore,doing this achieved annual savings of \2 million by preventing omissions in the reimbursement of medical fees,saved \10 million by providing drug sets designed for use in surgery for individual patients and \5 million by improving drug inventory management.Thus the total annual medicoeconomic benefit was \17 million.
The results of the present study suggest that that the stationing of pharmacists in operating theaters not only helps reduce the workload of anesthesiologists and improves drug management but also increases the number of surgical operations and produces medicoeconomic benefits.

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To clarify the difficulties in dealing with adverse events in oropharyngeal and hypopharyngeal cancer patients receiving concurrent chemoradiotherapy (CCRT),we retrospectively investigated items in clinical and pharmaceutical records which included incidence of adverse reactions,frequency of supportive treatment,and problems encountered by medical staff.The concomitant chemotherapy these patients received consisted of cisplatin or carboplatin plus 5-fluorouracil.
We noted high incidences of neutropenia,leukocytopenia,pharyngeal mucositis,xerostomia,taste disturbances and eating disorders.Many patients had discontinued supportive therapy drugs in the course of treatment,and about half of the patients felt anxiety concerning medications for pain such as acetaminophen or opioids,or refused them.We worked out solutions to these problems and based on them,prepared an explanatory brochure on supportive therapy for patients.
Though CCRT has been established as a standard treatment for pharyngeal cancer,we are concerned about the severity of complications due to adverse reactions to the concomitant use of radiotherapy and chemotherapy.We still do not have sufficient experience in providing pharmaceutical care for CCRT but hope that our efforts will contribute to improving pharmaceutical care and patient’s quality of life.

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The National Cardiovascular Center (NCVC) is a“Special Function Hospital”that specializes in cardiovascular disease,and has 640 beds.The Department of Pharmacy of the NCVC is responsible for overseeing“preavoids”(adverse effect evasion case reports advocated by the Japanese Society of Hospital Pharmacists) and drug safety information.Serious cases are reported to the Japanese Society of Hospital Pharmacists or the Ministry of Health,Labour and Welfare.In April 2006,resident pharmacists were assigned to 2 floors and 4 wards,and there are now resident pharmacists on 5 floors and in 10 wards.We report on the contributions made to the proper use of medication and safety of medical treatment by preavoid reports and provision of drug safety information by resident pharmacists.
Our findings showed that having resident pharmacists increased the number of preavoid reports regarding existing patient medications,clinical records,and medication history,and contributed to the proper use of drugs and avoidance of negative interactions.Drug safety information reports noted cases of adverse effects that were impossible to avoid and appeared later even though pharmacists were stationed in wards.However,there was a decrease in the number of reports of serious adverse effects.In conclusion,the provision of dependable drug information by resident pharmacists in wards contributes to achieving proper drug use and better pharmaceutical management,which results in safer medical treatment and avoidance of serious adverse effects.

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In 1997,PTP sheets containing tables were changed so that they could not be separated into individual doses since there had been several cases in which medicines had been swallowed in the PTP.As there are still cases of this happening,we felt the need to clarify the causes and devise a way of preventing them.
Through interviewing 8 patients who had swallowed medicines in the PTP sheet and had them removed at Matsudo City Hospital in last 5 years,the causes of such accidents were being distracted when taking medication and separating medicines into individual doses for convenience.Armed with this knowledge,we questioned a large number of patients visiting community pharmacies on how they kept their medicines at home.Our findings showed that elderly patients and those prescribed multiple drugs tended to separate their medicines,accounting for 45.7% of 368 patients interviewed.There has also been an increase in the number of elderly patients with dementia who have swallowed medicines in the PTP sheet and have not been aware of this until they have had to undergo emergency surgery to remove the PTP when it has caused perforation of the gastrointestinal tract.
To decrease the risk of swallowing the PTP sheet,we propose increasing its size so that patients are physically unable to swallow it,and print a pharmaceutical code and expiration date on each sheet.

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The blister package of once-weekly oral bisphosphonates is designed to avoid confusing them with once-daily oral bisphosphonates,and instructions that help ensure proper use are printed on the package.However,as there have been few studies on the form and size of packages,amount of information,and package design aspects such as color,fonts,pictograms and layout,in Japan,we investigated the utility of once-weekly bisphosphonate blister packages by questioning senior citizens not taking any oral bisphosphonates concerning the products of 4 different manufacturers.
They had a good understanding of the drug information printed on all of the packages,indicating that it would be effective in informing patients about proper drug use.Regarding blister package utility,card-type packages made of stiff,thick paper received higher ratings than book-type packages (also called wallet packs) which can be folded and closed.Acceptance of blister packages was satisfactory as 72% of the respondents said they would use medication in such packages.
In this study,we evaluated blister packaging from the user viewpoint and our results suggest that it would be useful to patients needing to take medication for osteoporosis.

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In this study,we developed a postgraduate education program designed to cultivate pharmacists who can contribute to the proper use of non-prescription drugs.In the program,which comprises several workshops,4 cases of a patient wishing to buy a cold medicine are presented and the response to the patient is discussed in small groups (small group discussion,SGD).This was a comparative study of thirty-one pharmacists working in 4 community pharmacies in the Tokyo area,who were assigned to an intervention group who took the program and a control group who did not take it,with 16 persons in the former and 15 in the latter.The program was conducted from March 17 to 25,2009.
To evaluate the program’s effectiveness,1 week after it had finished,we conducted a test with simulated patients (SP),comprising 21 items related to obtaining information on patient symptoms and histories.For obtaining these 2 categories of information,the intervention group achieved 8.1±2.9 items,while those in the control group achieved 3.3±1.8 items (mean ±SD),showing that members of the intervention group collected significantly more drug information (p <0.01).We also found that the items discussed in the SGD in the intervention program had a higher rate of implementation in the simulated patient test (p <0.01,r =0.828).In conclusion,the program proved useful for pharmacists working in community pharmacies by improving the support they could give regarding the proper use of non-prescription drugs.

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