Low-dose aspirin,an antiplatelet agent,acts by irreversibly acetylating internal cyclooxygenase-1 (COX-citation=1)on platelets,and is effective in the secondary prevention of cardiovascular events.However,as loxoprofen sodium also inhibits COX-1reversibly,its coadministration with aspirin may suppress the latter’s antiplatelet effect.We performed single- and multipledaily-dose studies in healthy volunteers to investigate the antiplatelet effect of aspirin when given with loxoprofen sodiumand determined a method for avoiding any interaction between the 2 drugs.We administered aspirin and loxoprofen sodium in the following manner in the single-daily-dose study : aspirin and loxoprofensodium administered at the same time or with a two-hour interval between them.In the multiple-daily-dose study,drugs were taken for four days as follows : aspirin (after breakfast),loxoprofen sodium (after every meal),both drugs givenat the same time in the morning,and taking aspirin before loxoprofen sodium in the morning.We measured platelet aggregationand serum thromboxane B2,and calculated the platelet aggregation threshold index (PATI) as the index of aggregationactivity,which was defined as the putative stimulus-concentration giving 50% aggregation.In the multiple-daily-dose study,when both drugs were taken at the same time,the PATI was 2.20±0.43μg/mL,suggestingthat the antiplatelet effect of aspirin had been decreased due to weak platelet COX-1 inhibition.On the other hand,when aspirin was taken before loxoprofen sodium the PATI was 5.29±0.59μg/mL,similar to that for aspirin only (5.51±0.59μg/mL).Therefore,though the antiplatelet effect of aspirin was suppressed by loxoprofen sodium,this interactioncould be avoided by taking aspirin 2 hours before loxoprofen sodium in the morning.
The advanced objective structured clinical examination (advanced OSCE) trial was conducted in a hospital pharmacy forfifth-year students who had completed the pharmaceutical common achievement test,and the results were evaluated.Theitems students were tested on were“blood pressure measurement skill”with a mercury manometer and“physical assessmentability”(regarding diarrhea,brain hypertension,or chronic obstructive pulmonary disease) using a Physiko?? device.In thedetailed overall evaluation,the mean achievement rates for both items tested were high,ranging from 95.6 to 98.5%.However,there was a significant difference in the mean achievement rate between“blood pressure measurement skill”and“physical assessment ability (regarding diarrhea)”,showing that there was a difference in level of difficulty between these 2items.As there had been high levels of achievement in the detailed overall evaluation,we feel that the students had beenable to acquire the required skill in blood pressure measurement technique and ability to conduct basic physical assessmentsin the advanced OSCE trial.Implementation of the advanced OSCE trial will help pharmacy students acquire the ability to check vital signs and conductphysical assessments effectively and we hope that this study will contribute to pharmacist education in the Faculty ofPharmacy in the future.
With the increasing demand for the preparation of sterile admixtures of anticancer drugs by pharmacists,it is importantthat their preparation can be done efficiently and safely,even by unskilled persons.In 2008,a drug transfer device whichaids the preparation of anticancer drugs (Chemo Mini-Spike?? ; CMS) was launched in Japan.Although this transfer device is said to be advantageous in that it makes drug preparation more rapid and reduces the riskof contamination and incidence of coring during preparation,there is no evidence to support this.Therefore,in this study,we compared CMS with a method using an 18 gauge injection needle (IN) regarding preparation time and incidence ofspillage and coring when used by 15 unskilled pharmacists.The total preparation time using CMS was significantly shorterthan that using IN (150.0±13.8 vs.175.3±23.7 s ; p<0.001).In particular,the time for aspiration of the solution from thevial was 2.5 times shorter for CMS (37.2±6.0 vs.90.5±15.7 s ; p<0.001).Though the incidence of spillage for CMS wasless than half of that for IN,this was not significant.There was only 1 case of coring among 45 preparations and this waswith the IN method.Our results suggest that CMS is a more efficient method for admixture preparation by unskilled pharmacists.
In Japan,many new pharmacy graduates currently look for positions in large chain community pharmacies.We conducteda cross-sectional study to obtain information that could be used in career design for pharmacy students by investigatingthe attitude of pharmacists working in such pharmacies toward their work,especially with regard to job satisfaction,andtheir future work plans,through a self-administered survey.We had the headquarters of 4 pharmacy chains distribute thesurvey to 2,071 pharmacists working in their pharmacies.The proportion of usable data was 76.5%.More than 60% of the surveyed pharmacists were working as communitypharmacists in order to put their license to good use or because they wished to work in the health care field.Though 90%of the pharmacists were satisfied with their jobs,only 7.6% of them could see themselves remaining in their current jobsuntil retirement.Therefore,job satisfaction among pharmacists was considerably higher than it was for college graduates,expert workers and technicians in general.It was felt that pharmacists' future work plans was affected by age,job satisfaction,years employed and gender.The results of our survey suggest that pharmacists working in large chain community pharmacies are dedicated professionalswho are highly motivated,have a tendency to change jobs,and mostly female.It seems that generally speaking,pharmacists are more interested in their field of expertise than their workplace as compared with workers in other professions.
At Fukuoka University Hospital,the Chemotherapy Protocol Review Committee evaluates the appropriateness and safetyof investigator-initiated clinical study regimens involving anticancer drugs,and the Department of Pharmacy prepares thesedrugs.Before clinical studies,physicians produce regimens based on clinical study protocols,and submit these regimenswith written requests for review to the pharmacy.The Department of Pharmacy then checks regimens for any deviationsfrom protocols as well as the pharmaceutical characteristics of the drugs,makes sure that there are no problems regardingmixing procedures,and directs inquiries,if any,to the physicians concerned.We investigated the contents of inquiries addressed to physicians after submission of regimens,and evaluated the contributionof pharmacists to their production and registration.Between December 2007 and November 2009,there were 19 applicationsfor clinical studies,and the total number of submitted regimens was 56.There were 72 inquiries about regimens,of which 18.1% concerned“suspected deviations from study protocols”,and 30.6%“addition of cautionary items”.As a resultof the inquiries,all regimens were revised.These results suggest that at the stage of producing regimens,pharmacistscan help make sure that clinical studies on anticancer drugs are conducted properly.In addition,their interventions at thetime of regimen registration should help ensure the quality of clinical studies.
The purpose of this study was to investigate the anxiety of pregnant and lactating women about taking drugs to determinea relationship between the nature of the anxiety and its degree.To do this,we conducted a survey of postpartum lactatingwomen and mothers with children in the GCUs of BFH-certified hospitals.The questions mainly involved the degreeof anxiety about drug use during pregnancy and lactating,and the nature of the anxiety (subject’s own description).Descriptionsof anxiety were analyzed by text mining,and then correspondence analysis was conducted to determine a relationshipbetween the nature of the anxiety and its degree.The results of text mining revealed that there was anxiety concerning the effect of drug use on fetuses,babies,and breastmilk.They also showed that the numbers of respondents who were anxious about drugs prescribed by physicians and thosewho had no anxiety were about the same.Correspondence analysis indicated that there was a connection between the natureof anxiety during pregnancy and lactating and the degree of anxiety.High-anxiety respondents frequently used the words“fetus”and“baby”,while low-anxiety respondents frequently used the word“doctor”in their responses.The above results suggest that the anxiety of pregnant and lactating women concerning drug use stems directly from theeffect drugs might have on the fetus or baby.They also showed that doctors were a factor in relieving such anxiety.Therefore,pharmacists must determine the degree of women’s anxiety concerning drug use and attempt to relieve it by providinginformation on the effects of drug use on the fetus or baby in cooperation with doctors,and in on-demand consultations.
Metronidazole (MNZ),an inexpensive and highly active drug,is the first choice in many countries worldwide for eradicationof Clostridium difficile,which causes antibiotic-associated diarrhea (C.difficile-associated diarrhea or CDAD).However,MNZ has not been approved for the treatment of CDAD in Japan,and vancomycin (VCM) is often used instead.In recent years,there has been much concern regarding the spread of VCM-resistant bacteria,and careful use of VCM isnow advocated.In order to ensure the proper and consistent use of MNZ in the treatment of CDAD,we determined criteriafor drug selection,contraindications,dosage,administration,discontinuance,and modification.We also created a flow chartto simplify treatment.After the introduction of the flowchart,as a result of pharmacist intervention,the quantity of VCMused decreased from 78.4% to 35.1%,and the quantity of MNZ used increased from 21.6% to 64.9%.This reduced drugcosts by 37.4%.However,there was no significant difference between MNZ and VCM in terms of improvement of CDADand its rate of recurrence,and adverse effects due to MNZ caused were only mild.Our flow chart enabled appropriate drug selection for patients with CDAD as well as prompt determination of dosage andadministration details.Following its procedures should help standardize the use of MNZ.
The FOLFOX regimen is recommended for the treatment of advanced colorectal cancer in combination with Becacizumab.In some cases,granulocyte-colony stimulating factor (G-CSF) is given within 24 hours of the FOLFOX regimen in orderto satisfy its administration criteria but it has been said that administering G-CSF within the 24 hours before or aftercancer chemotherapy should be avoided because of the possibility of severe myelosuppression developing.In this study,we investigated the effects of using G-CSF during a 24 hour period before or after the FOLFOX 4 regimen.Patients were divided into 2 groups : one was called the“within 24 hours group”and one the“Other group”.For the“within24 hours group”,G-CSF was given during the 24 hours before or after the FOLFOX 4 regimen,while for the“Othergroup”it was administered 24 hours after treatment.Leukopenia and neutropenia of Grade 3 or greater tended to be more common in the“within 24 hours group”,but no differenceswere found in compliance rate or total number of courses administered.These findings showed that administering aG-CSF within 24 hours of conducting the FOLFOX 4 regimen causes the development of serious leukopenia and neutropeniaand does not improve the treatment schedule.