Drug responses and adverse side effects vary widely among individuals. Researchers have focused on genetic polymorphisms that encode drug-metabolizing enzymes, drug transporters, and drug receptors, as the chief causes of the variations in drug responses. Personalized drug therapy involves analysis of genetic polymorphisms associated with drug responses before drug administration and the selection of drugs and doses according to individual genetic backgrounds. Establishment of personalized drug therapy is expected to contribute to medical economy through avoidance of wasteful drug administration. For the promotion of such medical practice, the use of simple genetic testing that is clinically convenient is necessary. Currently, genetic testing using real-time polymerase chain reaction is frequently employed in laboratories and its clinical application is expected. Regarding the many genes involved in drug responses, to date, the application of patient genetic information to personalized drug therapy has been achieved at a practical level. Information on pharmacogenomics will be critical in medical practice in the near future.

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We investigated the effectiveness of using a “Sports Pharmacist” to prevent the occurrence of doping in sports.
During the first step, we individually interviewed 17 high school softball team athletes and determined their regular and/or occasional use of prescription and OTC medications, herbal agents, vitamins and supplements. A total of 76％ of these players were either taking or had access to medications for occasional use that contained prohibited substances. Athletes determined to be using a prohibited compound were sent a written notice that recommended they avoid carelessly taking these banned substances.
In the subsequent step, we gave an educational lecture to the entire team on how to avoid doping in sports. Before and after the presentation, we evaluated the effectiveness of the lecture by examining the athletes’ knowledge and awareness of anti-doping in sports. The results indicated a significant difference after the lecture with regard to appropriate knowledge and awareness of anti-doping in sports. This specific awareness continued for at least a month.
In summary, medication reviews and one-on-one consultation with athletes in conjunction with a follow-up educational lecture to the team as a group resulted in successfully educating and helping team members avoid doping. In addition, these findings demonstrated the effectiveness of the “Sports Pharmacist” profession in working with athletes to help prevent doping in the future.

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Although meta-analysis is ranked among the highest-quality study designs, objective assessment criteria specific to meta-analysis have not been reported. As meta-analysis is complex in structure, we developed the Quality Score, which assesses the quality and format of meta-analysis. In this study, we attempted to assess the structure and quality of meta-analysis articles on type 2 diabetes.
We searched and extracted meta-analysis articles on the treatment of type 2 diabetes from PubMed and the Cochrane Library. We then assessed the structure (PRISMA statement) and quality (the Quality Score) of the articles found by assigning scores. We further extracted articles above a certain level, and analyzed and organized the data with statistically significant differences.
The initial search for meta-analysis articles identified 217 articles from PubMed and 25 from the Cochrane Library. Eight of the 25 articles from the Cochrane Library were also found among the articles from PubMed. Of the resultant 234 articles retrieved by the search formula, 44 were studied. The assessment score (0 - 100) for the structure (PRISMA statement) of meta-analysis was 60.2 ± 22.0％ (Mean ± SD), while the Quality Score was 53.0 ± 18.9％.
This study showed that the assessment of the quality of meta-analysis articles is linked to the assessment of the structure of the articles. In order to produce the great effect expected from diabetes medications, healthcare professionals are required to go beyond medication management and offer a wide range of therapeutic management. To do this, management priority should be given to items with secured evidence.

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Generic medicines are often put on the market with shapes and PTP packaging similar to those of the original drugs, which may cause preparation and medication errors. However, there has been no comparative study on the visual resemblance between original and generic drugs. We extracted eight items related to the similarity in appearance from their interview forms, and compared them using the cluster analysis method.
According to the results, most generic drugs converged in the same group as their originals, while a few of them were classified into different groups.
In addition, there was no relationship between the result of the cluster analysis and their therapeutic classes, and no apparent intention of manufacturers to give a similar appearance to their generic products.
Our findings demonstrate the effectiveness and applicability of cluster analysis for drug classification by resemblance.

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We investigated the awareness of the “Yakuzai-kanri Summary” (a pharmaceutical management summary) at community pharmacies in Japan that were prescribing drugs under the health insurance system. In addition, we assessed the pharmacy needs regarding receipt of the Summary. A cross-sectional survey was conducted by self-administered questionnaire between December 8 and December 30, 2011. Subjects were supervising pharmacists at 217 community pharmacies belonging to the Qol Group. The questionnaire comprised questions on the following: 1) awareness of the Yakuzai-kanri Summary; 2) Summary receipt rate; 3) pharmacy needs regarding receipt of the Summary; and 4) pharmacy needs regarding information on patient pharmaceutical care. Among the 178 community pharmacies that returned the self-administered questionnaire (response rate, 82.0％), 73 (41.0％) knew about the Yakuzai-kanri Summary and 6 (3.4％) had previously received it. A total of 155 community pharmacies (87.1％) were willing to receive the Yakuzai-kanri Summary to gain information on patient pharmaceutical care, especially information relating to discharge prescriptions, diagnosis, and treatment strategy. The results showed that the receipt rate of the Yakuzai-kanri Summary remains low, although community pharmacies are keen to receive it.

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The simple suspension method is a method of administering drugs via a feeding or gastrostomy tube, and it involves allowing tablets or capsules to be disintegrated and suspended in warm water at 55℃ without crushing. The present study evaluated the stability of two prodrugs suspended alone or in combination with an alkaline agent according to the simple suspension method. The study used two ester-prodrugs, acemetacin (AMT) and cefpodoxime proxetil (CPP), which are hydrolyzed at higher pH. Drug concentrations in the suspension were measured by high-performance liquid chromatography. AMT and CPP were not hydrolyzed when suspended alone, but decomposed under alkaline conditions with the addition of magnesium oxide (MgO). The AMT concentration decreased to 55.5％ and 38.9％ at 30 min and 60 min, respectively, whereas its active metabolite, indomethacin (IMT), increased from 0 to 90.7 µg/mL and 122.7 µg/mL at 30 and 60 min, respectively. The CPP concentrations with MgO were decreased to 47.9, 28.5, 20.8 and 12.7％ at 30, 60, 90, and 120 min, respectively. Therefore, AMT and CPP should not be administered in the simple suspension method in combination with an alkaline drug that increases the suspension pH.

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Dacarbazine (DTIC) produces adverse reactions including local venous pain during the intravenous injection. DTIC is reported to be photolyzed to produce certain kinds of pain producing substances. 5-diazoimidazole-4-carboxamide (Diazo-IC) is considered to be a causative photolyte of venous pain. A newly designed cover shield has been used at Osaka University Hospital when DTIC is administered for the last 4 years. This shield comprises black cotton and covers both the infusion bag and route of infusion. We evaluated the effectiveness of this new shield against photodegradation of DTIC by determining the concentration of Diazo-IC. DTIC was dissolved with an injection solvent and mixed with 5％ dextrose in water. Prepared samples were divided into 3 groups (without shield, infusion bag covered with shield, and infusion bag and infusion route covered with shield) and exposed under natural light conditions indoors. Prepared solutions ran down through the route and those samples were taken before and after passing the route pipe. Diazo-IC in the samples was measured by HPLC. Production of Diazo-IC in the non-covered bag was significantly increased in comparison with that in covered infusion bags. Diazo-IC production in samples after passing through the route was significantly increased compared with that in samples taken before passing through the route of the non-covered shield and covered infusion bag only. For the covered infusion bag and infusion route, the samples taken before and after passing through the route did not show significant differences. These data suggest that the new shield, which almost perfectly covers both the infusion bag and route of infusion, is effective in preventing DTIC photodegradation.

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Rheumatoid arthritis (RA) is an autoimmune disease that causes joint destruction and greatly reduces a patient's QOL (quality of life). The clinical response and safety in many clinical trials in RA patients using biological medication have been reported. However, there are few reports on the influence of concomitant drugs on patients using biological medication. We investigated the change in the concomitant drug with the start of biological medication (etanercept, tocilizumab, abatacept, adalimumab, infliximab) and the concomitant drug for 12 months. We found a difference with each biological in terms of age, average methotrexate dose, steroid dose, and non-steroidal anti-inflammatory drug. Furthermore, as a result of investigating the change in the concomitant drug for 12 months, the average methotrexate dose did not change except for that of tocilizumab. However, the average steroid dose and non-steroidal anti-inflammatory drug decreased or stopped. It was shown that biological medication may influence not only a good clinical response but a concomitant drug.

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[in Japanese]

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