Calcium channel blockers (CCBs) decrease lower esophageal sphincter pressure,which may result in gastrointestinal disease.In a previous study,we observed an increased risk of gastrointestinal disease following treatment with CCBs in elderly patients.However,there have been few epidemiological studies in non-elderly patients to determine whether CCBs increase the risk of gastrointestinal disease. We hypothesized that there would be greater use of antisecretory drugs,such as H2-receptor antagonists and proton pump inhibitors (PPIs),among patients prescribed CCBs and to test this hypothesis,performed a dynamic retrospective cohort study from September 2005 to August 2008 at six community pharmacies in Nagasaki Prefecture,targeting patients aged< 55 y.Correlations between initiation of treatment with antisecretory drugs and maintenance therapy with PPIs were determined by the Cox proportional hazards model.The study included 86 patients on CCBs and 93 controls not on them.During the study period,12 patients on CCBs and 6 controls started to use antisecretory drugs,for which the hazard ratio was 4.02 (95% confidence interval 1.82-10.10,P <0.001).Maintenance therapy with PPIs was commenced for 7 patients taking CCBs and 3 controls,for which the hazard ratio was 1.99 (95% confidence interval 0.52-9.42,P =0.31).These results suggest that the risk of gastrointestinal diseases could be increased by long-term treatment with CCBs in non-elderly patients.
The psychiatry team in our hospital consists of psychiatrists,nurses and pharmacists,and holds meetings with inpatients with psychiatric disease to increase patient adherence to medication.The role of pharmacists in the team is to provide medication information and drug counseling using illustrations.In this study,we conducted questionnaire surveys with regard to medication adherence and drug counseling using illustrations after discharge from hospital.All of the subjects with psychiatric disease targeted (n=citation=50)answered the questions.The total score for patient adherence at 1 month after discharge from hospital was significantly higher than that before hospitalization,and the improvement was maintained for 8 months.Most of the patients felt that drug counseling using illustrations aided understanding of their medication.These results suggest that drug counseling using illustrations is useful in improving medication adherence in patients with psychiatric disease.
We developed a simple and sensitive method using reversed-phase high-performance liquid chromatography (HPLC) for determining lamotrigine (LTG) plasma concentrations in infant patients with epilepsy undergoing polypharmacy.It involves a simple protein precipitation procedure that uses no solid-phase or liquid-liquid extraction.HPLC was carried out on a Cadenza CD-C 18 column (3μm,4.6 mm×150 mm) with phosphate buffer (pH 4.6;25 mM) containing a methanolacetonitrile mixture (4:3,v/v) as the mobile phase,by gradient elution at a 1.0 mL/min flow rate.LTG was detected using a UV detector at 215 nm.The quantification limit was 0.10μg/mL for 100μL of plasma sample.The intra- and interassay coefficients of variation were 1.18-6.87% and 1.65-7.07%,respectively.A specificity and selectivity study showed that there were no interfering peaks.In addition,correlation analysis conducted on LTG concentrations by the new method and a commercial HPLC method produced a correlation coefficient (r ) of 0.9974.
Niigata Cancer Center Hospital has made efforts to standardize the use of antiemetics and the present study was performed to investigate adverse events occurring after their use.In 373 patients who received treatment regimens with a high risk of vomiting during the period from April 2008 to March 2009,we investigated the occurrence of nausea and vomiting and other adverse events.The incidence of delayed nausea was high (63.3%).Other adverse events were : constipation (40.5%),blood pressure elevation (42.4%),and fatigue (43.4%).The number of delayed nausea patients in whom constipation occurred increased after receiving chemotherapy regimens containing cisplatin.Also in an analysis of factors influencing the cause of delayed nausea,the following were identified as significant factors : onset of constipation after chemotherapy (odds ratio,3.303 ; 95% confidence interval,1.990-5.48citation=4)and regimens containing cisplatin (odds ratio,3.505 ; 95% confidence interval,2.046-6.003). When both a 5-HT 3 receptor antagonist and high-dose steroid are prescribed for patients receiving regimens with a high risk of vomiting,we should pay careful attention to adverse events such as delayed nausea,constipation,blood pressure elevation,and fatigue.In addition,since constipation following chemotherapy and the use of regimens containing cisplatin are risk factors for delayed nausea,it is essential to take appropriate actions based on an evaluation of clinical symptoms relevant to the use of antiemetics.
In 2006 the Faculty of Pharmacy of Meijo University introduced an early exposure program into the first-year curriculum of the 6-year pharmacy course,with the aim of increasing motivation towards pharmaceutical education.The approaches of “student-directed education”,“small group learning (SGL)”,and“age-mixing”are used in the program. The results of questionnaire surveys conducted just after the training programs in 2006 and 2007 verified that students had a good understanding of the purpose of the program and recognized the effectiveness of SGL.They also indicated that the first-year students were very satisfied with our program as means of enhancing motivation towards the 6-year pharmacy course. To evaluate the influence of the early exposure program on students with regard to deciding on a career path or changing to another one,a factor indicating motivation towards pharmaceutical education,we also conducted recall questionnaire surveys 2 or 3 years after students had taken the program.The results clearly indicated that the early exposure program did affect first-year students with respect to deciding on a career path or changing one.Unfortunately,the results indicated that the program did not increase motivation towards basic pharmacy subjects very much. To maintain the high motivation due to the early exposure program,it is very important to teach the students that the importance of the basic pharmacy subjects since clinical pharmacy is founded upon them.
Giving patients access to drug information can play an important role in pharmacotherapy.This study was on provision of drug information via an internet-based system accessed by cell phone using the quick response (QR) codes printed on drug packaging such as PTP sheets and powder formulation packages.By providing drug information in a timely manner,the system should be useful in promoting proper drug use by patients. In the study,we performed a questionnaire survey to determine the usefulness of drug information websites accessed using QR codes.The subjects were first- and second-year,and the fourth- and fifth-year pharmacy students at the University of Shizuoka,outpatients treated with amlodipine,and families of pediatric patients treated with antibiotics at Jikei University Daisan Hospital,who accessed drug information websites for information on amlodipine and cefcapene.When asked whether the information websites for amlodipine and cefcapene were easy to view,use,and understand,more than 80% of the students and patients responded positively,saying“Yes”or“Yes,to some extent”.Regarding usefulness,convenience,ease of use,and speed,nearly all subjects gave positive evaluations.To the question“Would you like to access similar websites for other drugs besides amlodipne and cefcapene?”,more than 90% of all subjects responded positively.The present results therefore verify that access to websites in this system is a useful and fast means of gaining drug information,not only for patients,but also students with pharmaceutical knowledge.
The effects of hypnotics are one of the many causes of falls.However few studies have been done on a relationship between falls and hypnotics use in Japan. We studied 109 patients who had experienced falls in hospital.The male to female ratio was 6:4,mean age was 67 years,22% of them had hepatic dysfunction,and 12% had renal dysfunction.Among them,38.5% were on hypnotics,and other frequently prescribed drugs were diuretics,analgesic antipyretics and laxatives.The incidence of falls for hypnotics was higher in subjects on the ultra-short-acting type (1.6 to 6.2%) than in those on the short-acting type (5.0 to 6.8%).For ultra-short-acting hypnotics,the incidences were similar in the daytime and nighttime,but for short-acting hypnotics,the incidence was higher in the daytime than in the nighttime,suggesting a persistent diurnal effect. A questionnaire survey of physicians revealed that they selected hypnotics mainly based on the types of insomnia,duration of the hypnotic’s effect and the age of patients.They paid only a little attention to hepatic or renal function or metabolic pathways in patients.In order to prevent falls,we posted a recommendation in our electronic medical records system that physicians prescribe ultra-short-acting hypnotics whenever possible.Afterwards,the number of patients prescribed ultrashort-acting hypnotics increased by 75% and the number of patients who experienced falls during treatment with hypnotics decreased from 42 to 25 over a 4-month observation period. Our findings suggest that it is important to select hypnotics for elderly patients in consideration of hepatic function,which may influence the lingering effects of hypnotics.
Measurement of the serum level of theophylline (TP) is essential for its appropriate use.It has been reported that the metabolic capacity of individual patients can be estimated from simultaneously measuring the serum levels of TP and these metabolites.In this study,we measured the serum TP and metabolite levels in patients treated with 2 types of sustainedrelease TP preparation,and investigated the influence of the pharmacokinetics of TP by employing different forms. The subjects were asthma patients who visited the outpatient clinic of Respiratory Medicine,St.Luke’s International Hospital,between April and October 2003,and were medicated with sustained-release TP tablets (Theodur® or Uniphyl® tablets).Blood samples were collected from patients who gave written consent.They were also interviewed and their medical records were investigated to confirm their backgrounds.The serum TP and metabolite levels were measured by HPLC. In 52 patients treated with Theodur® tablets,there was a strong correlation between the serum TP and 1,3-dimethyluric acid (DMU) levels (r=0.670).However,there was a weak correlation in 30 patients treated with Uniphyl® tablets (r= 0.249).In the two groups,the DMU/TP was within the range of the mean±SD regardless of blood collection points in all patients.The values markedly differed from this range in patients with factors influencing TP metabolism. The results suggest that,in patients receiving Theodur® tablets,their TP-metabolizing capacity can be predicted by simultaneously measuring the serum TP and metabolite levels and calculating the DMU/TP.However,such a prediction is difficult in those receiving Uniphyl® tablets.