The morbidity of elderly patients with methicillin-resistant Staphylococcus aureus (MRSA) infections is high. In view of this, the purpose of the present study was to establish pharmaceutical health care for such patients having the aim of “proper use of antimicrobial agents for MRSA infection based on pharmacokinetics and pharmacodynamics ”. I Vancomycin (VCM) 1) VCM exhibited a clinical effect in elderly patients infected with MRSA at serum trough levels of >10 μg/mL or an area under the curve (AUC0-24) of >420 μg/mL·hr. 2) Univariate logistic regression analysis of pharmacokinetic parameters indicated that VCM clearance was significantly enhanced in patients with malignant tumors. 3) With the population pharmacokinetics parameter mean (PM) method, the correlation between the value of the creatinine clearance (CLCr) estimated by substituting Jaffe-converted serum creatinine in the Cockcroft-Gault equation and the actually measured CLCr was the closest. 4) Prediction using Bayesian-estimated patient-specific parameters was more accurate than prediction by the PM method. II Linezolid (LZD) 1) The findings suggested a causal relationship between high LZD levels and adverse effects and that careful monitoring of LZD is necessary in hemodialysis patients. 2) The platelet count and hemoglobin level decreased as the AUC0-24 of LZD increased in patients with renal dysfunction, and the correlations were significant with r=−0.593 and r=−0.783, respectively. 3) LZD is present mainly as the free drug in the cerebrospinal fluid (CSF). The free LZD concentration in the CSF can be estimated using the free serum concentration at the trough level. These findings suggest that we should apply pharmacokinetic analysis in order to ensure that anti-MRSA agents are used properly with emphasis placed on safety and efficacy.
In our hospital, the psychiatry team, which consists of psychiatrists, nurses and pharmacists, has been trying to enhance patient adherence to medication. To do this, we created “Patient Medication Notebook”, a notebook in questionnaire form to be used as a tool for sharing patient information among members of the psychiatry team. In the ambulatory setting, patients with psychiatric diseases monitor the effects and adverse reactions of drugs themselves using the notebook. Information obtained from patients obtained in this way and treatment recommendations made by pharmacists are then input to electronic medical records. In this study, we conducted questionnaire surveys of patients and doctors regarding the notebook. Questionnaire results showed that after 6 months of using the notebook, total scores for patient adherence were significantly higher than those before it started to be used. Most patients felt that the notebook was a useful tool for monitoring their health condition and all doctors thought that it was helpful in the clinical setting. These results suggest that our Patient Medication Notebook is a useful tool for sharing information about psychiatry patients and for improving medication adherence in ambulatory psychiatric practice.
We have developed the ‘Practical Training Management/Assessment Web System’, which uses a web browser, to enable the long-term practical training in the 6-year pharmaceutical education curriculum at Gifu Pharmaceutical University to be conducted more efficiently. It was used for the long-term practical training in 2010 and at the end of it, a questionnaire survey of students, pharmacists and university teachers (responding students: n=119, pharmacists: n=155, university teachers: n=32) was conducted. Questionnaire survey scores for the necessity of the web system and degree of satisfaction with it were significantly higher for university teachers than students and pharmacists (Chi-square test, p<0.001). Pharmacists highly evaluated the practical schedule editing period of 2.5 months. Also, those working in pharmacies gave higher evaluations than hospital pharmacists concerning many questions including those regarding the necessity of and degree of satisfaction with the web system. These findings suggest that pharmacists working in pharmacies found it very useful in providing support for the long - term practical training. Overall many students, pharmacists and university teachers thought that our web system for the long-term practical training was highly necessary and provided a high degree of satisfaction and we feel that its objectives were successfully achieved. As a problem that needs to be solved, some students were unable to easily print out the practical notes containing SBOs for their practical training on a daily basis.
The authors retrospectively studied the incidence and severity of adverse events in 16 in-patients with locally advanced and/ or metastatic transitional cell carcinoma of the urothelium who had received GC [gemcitabine (1000 mg/m2) on day 1, 8, and 15 and cisplatin (70 mg/m2) on day 2 of every 28-day cycle] chemotherapy at Iwate Prefectural ISAWA Hospital. Regarding hematotoxicity, the most common causes for postponement and dose adjustment on day 8 and 15 were leucopenia, neutropenia, and thrombocytopenia. The percentages of postponed administration and the average number of days of postponement were 31.3% and 14.8 days for day 8 and 36.4% and 6.5 days for day 15 during the first course. Rates for dosage reduction during the second course and the third course were 28.6% and 8.3% for GEM and 21.4% and 8.3% for CDDP. Very few of the patients were able to receive the chemotherapy on an outpatient basis on day 8 (7.1%) or 15 (14.3%). For patients with hematopenia, a positive correlation was observed between pre-treatment nadir levels and the lowest nadir levels. Regarding non-hematotoxicity, the frequencies of the subjective symptoms of anorexia (75.0%), nausea (43.8%), diarrhea (37.5%), and constipation (25.0%) of Grade 1 or 2 as defined in Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0) were high during the first course. Frequencies of abnormal liver and renal function were also relatively high. These results suggest that the adverse events for this GC chemotherapy regimen are not mild by any means, and great caution should be exercised to monitor for hematotoxicity and non - hematotoxicity that may occur during it.
Only a few studies have been done on mixing methods with mortars and pestles since many factors influence the mixing degree. Near-Infrared Spectroscopy (NIRS) is used to determine the composition of food and drugs in the U.S.A., Europe, and Japan. In order to evaluate its utility in establishing mortar and pestle mixing methods, we examined the effects of the number of mixings and filling factor on the mixing degree of ethenzamide and lactose, using NIRS and High Performance Liquid Chromatography (HPLC). Keeping the mixing ratio constant at 1:1 and varying the filling factor from 5% to 50%, and the number of mixings from 20-80, a relationship between the filling factor and the number of mixings, and the coefficient of variation as an index of mixing was examined. A filling factor of 50% was found to be the optimum condition for mortar and pestle mixing methods. As the number of mixings increased, the coefficient of variation tended to decrease. NIRS was a more rapid and simple method of evaluation than HPLC, and there was no difference between NIRS and HPLC regarding ethenzamide concentration. These results suggested that measurement by NIRS is applicable in establishing optimum conditions for mixing pharmaceutical powders with mortars and pestles.
It has been reported that cardiopulmonary bypass (CPB) surgery influences the pharmacokinetics of various drugs. In this study, we investigated serum concentrations of amiodarone (AMD) and desethyl-amiodarone (DEA), the amiodarone metabolite, in the vicinity of CPB. Our patient was taking amiodarone tablets because other antiarrhythmic agents had been ineffective against premature ventricular contraction and nonsustained ventricular tachycardia. The patient underwent aortic valve replacement under CPB for aortic stenosis, and serum concentrations of AMD and DEA were measured in the vicinity of the CPB surgery before and after it. There was no change in the serum concentrations (before CPB surgery; AMD : 0.71 μg/mL, DEA : 0.47 μg/mL, after CPB surgery; AMD : 0.85 μg/mL, DEA : 0.46 μg/mL). During and after surgery, no atrial or ventricular tachyarrhythmia was observed. We considered that serum concentrations of AMD and DEA were not influenced by CPB because of amiodarone's high protein binding ratio and large distribution volume, which are characteristics of this drug.
Chemotherapy induced nausea and vomiting (CINV) is one of the most frequent adverse events in cancer patients receiving chemotherapy. Thus, preventing CINV is the key to maintaining the QOL of patients. As aprepitant, a powerful oral prophylactic for CINV, has been recommended for this purpose since it came on to the market, we retrospectively examined the adverse events induced by this drug in 36 patients (Control group 20, aprepitant group 16) with gastric cancer who received combination chemotherapy with S-1 and CDDP between November 2009 and October 2010 at Osaka Medical Center for Cancer and cardiovascular Diseases. We examined the different types of adverse events, including emesis and hiccups, all of which were presumably induced by chemotherapy, and evaluated each of them using CTCAE v3.0 JCOG/JSCO. This confirmed the effectiveness of aprepitant against CINV both in the acute phase and delayed phase. Our results suggested that QOL was mostly improved by it, though the incidence of hiccups was higher than before. Therefore when aprepitant is given with CDDP and DEX, measures such as administering metoclopramide should be taken against hiccups.
We developed a software package using Microsoft Excel to support tasks related to cancer chemotherapy. The software facilitates the management of dosage schedules of anticancer agents, accurate counting of the anticancer agents to be used and creation of worksheets for various purposes, such as selecting the most cost-effective vials and ampoules, and calculating the quantities of medicinal solutions to be prepared. Using it, we were able to create worksheets in 15% of the usual time required when doing this manually, and the time required for determining the counts of the anticancer agent to be used was also reduced. In addition, even if the number of prescriptions were increased, the results of our evaluation suggest that the time required for determining the count of the anticancer agent to be used would remain the same. In conclusion, we believe that our support software would be extremely useful in the efficient and safe management of cancer chemotherapy-related tasks.