Though Health literacy (HL) is considered crucial to patients’decision making concerning medical treatment,it is notclear how patients utilize counseling services provided by community pharmacists to improve their HL. Among 101 outpatients at Saga Medical School Hospital who completed a questionnaire,those who were aware of their HLproblems were identified,and factors associated with these patients were analyzed by logistic regression.The resultsshowed that 52.5% of the patients were aware of their HL problems,40.4% of whom (OR=6.6,95% CI=1.55-28.47)had received explanations concerning prescription drugs at pharmacies but not concerning their illness or treatment.Factorssignificantly correlated with the patients who were aware of their HL problems were“no particular pharmacy used regularly”(OR=3.9,95% CI=1.09-14.00),“underlying cancer”(OR=3.8,95% CI=1.15-12.83),“unsatisfactory explanationby community pharmacist”(OR=5.8,95% CI=1.02-32.8citation=1)and“strong wish to receive medical information from pharmacies”(OR=3.5,95% CI=1.05-11.54).They also had a significantly great desire be provided with“information supplementalto physician’s explanation”and“cautions and advice for everyday life”,as well as information on“selection and use ofmedical institutions”,and“care and welfare services available”.Taken together,these findings indicate that patients who areaware of their HL problems are not fully utilizing community pharmacists’counseling services and not satisfied with theservices provided. Therefore,the role of community pharmacists should not be limited to dispensing ; it is also important for them to contributeto patients’HL and everyday medical treatment by providing medical and welfare information,enhancing patients’understanding of such information,and providing guidance on appropriate services.
Some food thickeners and deglutition aid jellies have been reported to be associated with drug-food interactions becausethey contain a lot of saccharides and dietary fiber. Acetaminophen was used as a model drug and administered to healthy volunteers as one of 3 forms:“drug alone”,“THICKENER”(mixed with 4% solution of a commercially available food thickener) and“JELLY”(mixed with commerciallyavailable deglutition aid jelly).We then monitored their acetaminophen plasma levels.There were no significant differencesin acetaminophen levels between the drug alone and JELLY forms,whereas the THICKENER form brought abouta significant increase in Tmax (0.75 to 1.5 hr). Next,we tested the effect of the JELLY form on the plasma levels of 3 other drugs (sodium valproate,carbamazepine,and theophylline) in patients and observed comparable plasma concentration-time curves for all of them. Finally,a dissolution test was performed to further evaluate the effect of the THICKENER form on drug plasma levels.As compared with the drug alone and the JELLY form,the THICKENER form significantly delayed dissolution for alldrugs tested other than a theophylline sustained release preparation.We observed an increase in T80 (time for release of 80% of the total content) for acetaminophen from 2.5 to 25.5 min,in T85 for valproate from 9.8 to 42.8 min,and in T75 forcarbamazepine from 12.0 to 33.8 min. These results suggest that commercially available food thickeners are likely to be associated with changes in the pharmacokineticprofiles of clinically important drugs,and they therefore need to be carefully used in certain clinical situations.
To quantitatively investigate the history of medical pharmacy research in Japan,we analyzed the titles of articles in theJapanese Journal of Pharmaceutical Health Care and Sciences and the Japanese Journal of Hospital Pharmacy,the principalmedical pharmacy journals in Japan,by text-mining.All article titles (2884 articles) between 1975 and 2009 were collectedfrom article databases,and the text of titles was analyzed using the KH Coder,free software for quantitative textanalysis of the Japanese language.This software produces basic information on text data such as the rate of occurrence ofcertain words.Nine research categories were identified through multivariate analysis of frequently appearing words.Also,coding rules were created to assign article titles to these research categories,and the categorization results were analyzed quantitatively. Pharmaceutical investigation was the principal category in the 1970 s and 80 s,with the quality evaluation of drugs asthe major area of research.Articles assigned to this category accounted for 41.4% of all articles published during the period1980-1984.Articles assigned to the drug therapy category began to gradually increase in the 1990 s,and since 2000,drugtherapy has been the major area of medical pharmacy research in Japan.In addition,there has been an increase in investigationsassociated with the education of pharmacists and pharmacy students in recent years Our findings suggest that there has been a shift in the dominant research area of medical pharmacy in Japan from qualityevaluation of drugs to patient care.
Oxybutynin hydrochloride (OB) is often used in intravesical instillation therapy for spastic neurogenetic bladder.The purposeof this study was to determine the expiration date and administration device for intravesically administered OB solutionscontaining sodium hyaluronate (HYA) as a pharmaceutical additive to enhance the muco-adhesiveness of the solution.The stability of OB in containers made of glass,polystyrene (PS),polypropylene (PP) and polyethylene (PE) was investigatedunder various temperature and light exposure conditions.Sorption of OB was observed in PP and PE containers andfor the latter,it was enhanced at higher temperatures and pHs.Based on these results,the optimal expiration date and storageconditions of OB solution were determined to be 84 days in a cool place (4°C),in a PP container.
It is extremely important for physicians to obtain accurate information on patient medication histories on hospitalization.At the National Hospital Organization Kobe Medical Center,we have been asking all newly hospitalized patients abouttheir medication history and providing information on this to other medical staff through the electronic medical records systemsince October 1,2007,in order to enhance safety and reduce medication costs by using medicines brought by patients.However,it is often more difficult to ask patients about their medication histories when they are hospitalized in an emergencythan it is in the case of scheduled hospitalization.To examine the importance of and problems in the management ofmedication histories for emergency hospitalization,we investigated the status of medication history management as well aspharmaceutical care management and usage of medicines brought by patients,and compared the findings with the case ofscheduled hospitalization.We also evaluated the new system for this purpose through a questionnaire survey of all physiciansin our hospital.No difference was found in the proportion of patients with medication history between an emergency hospitalization andscheduled hospitalization group.However,for the former,the number of patients bringing medicines to hospital and havingprescription histories at our hospital was significantly lower.Also,use of antiplatelet and anticoagulant agents tended togreater,though the difference was not significant.The questionnaire results revealed that prompt information was needed,especially for patients hospitalized in an emergency.These findings suggested that medication management is more important for patients hospitalized in an emergency.Theyalso suggested that it is necessary to increase our efforts to ask such patients about their medication history.kn-abstract=
It is well known that psychotropic drugs,such as hypnotics and anxiolytics,increase the risk of falls for patients (includingfalls from high places).The present study was undertaken to evaluate the risk of falls following the taking of suchdrugs,with the focus on the benzodiazepine (BZ) family of hypnotics and anti-anxiety drugs previously reported to have ahigh risk of causing falls.When drugs of the BZ family were classified according to tmax,the mean frequency of falls differedbetween short tmax drugs and the long tmax drugs (P <0.05).This suggests that we should avoid combining shorttmax drugs (flunitrazepam,brotizolam,and triazolam) with other medication as well as the combined use of short tmaxhypnotics and drugs having potent muscle relaxant activity (bromazepam,diazepam,etizolam etc.) unless there is good justificationfor doing this.Our study showed that quazepam and rilmazafone hydrochloride are relatively safe hypnotics so far as the risk of falls isconcerned,in view of their relatively long tmax and less potent muscle relaxing activity.In some cases,the t1/2 of the drugswas correlated with the frequency of falls,suggesting that t1/2 may be a useful indicator for identifying patients requiringspecial attention and care from nurses,for instance when they are on night patrols of wards.
There are hopes that the amounts of residual anticancer agents contaminating the biological safety cabinet (BSC) andpreparation room can be reduced.Degradation solutions such as sodium hydroxide solution have been recommended forwiping away residual anticancer agents in the BSC.However,the effectiveness of such solutions in degrading anticanceragents has not been sufficient.In this study,we attempted to reduce the contamination due to anticancer agents in the BSC using a photocatalyst consistingof titanium dioxide (TiOcitation=2)that produces free-radicals when irradiated with near-ultraviolet light (near-UV).We dropped several concentrations of cyclophosphamide on a stainless steel plate coated with TiO2 in the BSC and irradiatedwith near-UV for 12 hours.As another method,we sprayed on the photocatalyst.Solutions containing TiO2 (0.1%w/v and 0.3% w/v) were sprayed on to an uncoated stainless plate,cyclophosphamide was dropped on to it and the platewas irradiated with near-UV in the BSC.Following irradiation,the plates were wiped,the wiped off cyclophosphamide wasextracted and its amount measured using high-performance liquid chromatography.We found that 1 mg,0.1 mg and 0.05mg of cyclophosphamide dropped on to the photocatalyst coated plate were degraded by 44%,89%,and>93% (belowquantification limit) respectively.At 0.1% w/v the photocatalyst spray degraded 4 mg and 1 mg of cyclophosphamide by63% and 60%,respectively,while at 0.3% w/v,the photocatalyst spray degraded 4 mg and 1 mg of cyclophosphamide by39% and 83%,respectively.In conclusion,the photocatalyst was useful in the degradation of residual anticancer agents in the BSC.
Recently,hemodialysis patients have been steadily increasing and for such patients,it is very important to control serumphosphate levels in order to decrease cardiovascular risks.Currently,a variety of therapeutic drugs,such as calcium carbonate,lanthanum carbonate and sevelamer hydrochloride,are administered to hemodialysis patients to enhance phosphateclearance from the body.Several anion-exchange resins,among them colestimide and colestyramine,have also been consideredfor the treatment of hyperphosphatemia.However,the relative effectiveness of these drugs in interacting with phosphatehas not been examined.In the present study,we compared the phosphate-binding capacities of therapeutic agents for hyperphosphatemia using aconventional centrifugation method.After mixing drug suspensions and a phosphate solution together,the pH of the mixturewas adjusted to between 1.2 and 8.0.It was then gently shaken for 30 min and subjected to high-speed centrifugation.By determining the phosphate concentration in the resultant supernatant fluid by the molybdenum blue method,the amountsof phosphate bound to each drug were estimated.The phosphate-binding capacity in descending order was as follows :sevelamer hydrochloride (614 mg/g)>lanthanum carbonate (557 mg/g)>calcium carbonate (535 mg/g)>colestimide (256mg/g)>cholestyramine (98 mg/g)=colestipol (93 mg/g),indicating that sevelamer hydrochloride was most potent in bindingphosphate.However,the interaction between sevelamer hydrochloride and phosphate was pH-dependent,as it was forcalcium carbonate and colestimide,and became weaker as the medium pH increased.In contrast,lanthanum carbonate hydrateexhibited potent binding that was independent of pH.The present results therefore suggest that lanthanum carbonatewould be most effective therapeutic agent for inhibiting phosphate absorption in hemodialysis patients.