The influence of pharmacist-supported insulin therapy on the safety and efficacy of blood glucose management in steroid therapy for hematologic malignancies complicated by diabetes in collaborative drug therapy management was examined. At the same time, an insulin dose-predicting factor required for blood glucose control was investigated. Changes in the blood glucose level after steroid administration were significantly decreased on medication support by a pharmacist compared to those in blood glucose control performed by a physician alone: the median (range) blood glucose level before breakfast, 138.6 (99.00 - 189.0) mg/dL vs 156.4 (111.2 - 204.6) mg/dL (P = 0.13); before lunch, 198.5 (128.7 - 307.0) mg/dL vs 240.9 (157.7 - 410.5) mg/dL (P < 0.01); before supper, 232.9 (161.7 - 329.8) mg/dL vs 311.5 (157.4 - 387.9) mg/dL (P < 0.01); before sleep, 247.5 (164.9 - 338.7) mg/dL vs 293.3 (174.7 - 345.9) mg/dL (P < 0.01), respectively. An index of daily glycemia excursions, Schlichtkrull M120 value, was also significantly decreased: 30.27 (5.96 - 66.04) vs 58.63 (9.21 - 93.68) (P < 0.001), respectively. The insulin dose was inversely correlated with the prednisolone dose (correlation coefficient: -0.511. P = 0.021), but no correlation with any other factor (dexamethasone dose, age, body mass index, and HbA1c (JDS ) was noted. The findings suggest that meticulous dose control in consideration of a patient’s insulin sensitivity is essential for blood glucose control using insulin in steroid therapy, and cooperation between pharmacists and physicians facilitates precise blood glucose control, leading to safe and effective insulin therapy.
Gemcitabine plus cisplatin therapy (GC) is standard therapy for urothelial carcinoma. However, Gemcitabine plus carboplatin therapy (GCb) may be chosen for patients with impaired renal function. In this study, we retrospectively investigated hematotoxicity of GC and GCb. In addition, we experienced split-dose carboplatin regimen in GCb. Therefore, we investigated hematotoxicity of single-dose and split-dose carboplatin in GCb. Grade 4 thrombocytopenia occurred with high frequency in GCb compared with GC. Furthermore, the renal function was maintained by switching from GC to GCb. The respective percentages for grade 4 thrombocytopenia were 62.5％ (single-dose) and 12.5％ (split-dose) in GCb. In addition, relative dose intensity (RDI) of gemcitabine was 67.9％ and 87.5％ and RDI of carboplatin was 94.8％ and 95.8％ respectively. RDI was maintained highly in split-dose compared with single-dose, and split-dose treatment period of up to progressive disease was longer than single-dose treatment. These results suggest that split-dose carboplatin in GCb may become a regimen with tolerability in patients with impaired renal function.
Hokkaido Pharmaceutical University School of Pharmacy provides students with on-site learning of pharmacist services (OSL, hereafter) in which they learn about the roles of local medical institutions, and collaboration between such institutions and pharmacists. Our aim is to train students to become highly qualified pharmacists as desired by the community. We provided our 3rd-year students with OSL at seven local medical institutions in Yubari City. A collaboration agreement was established between Yubari Medical Center, one of the institutions, and our College. The aims of the OSL were to teach students about the roles of pharmacists in the community and to give them a better understanding of the different types of pharmacist jobs. The students were surveyed by questionnaire before and after the OSL to examine changes in their understanding as well as the extent of their knowledge. Almost all degrees of their understanding as well as recognition of the necessity for the content of the OSL were significantly improved after OSL as compared to before OSL. Although they had already understood the tasks of physicians, nurses and pharmacists very well, the OSL seems to have raised their awareness of pharmacists' services as a whole in the local community especially by offering OSL in local medical institutions, nursing homes for the elderly and welfare facilities. We think that educating pharmacy students about community-based team medical care can be helpful for training them to become pharmacists who are capable of providing appropriate services in collaboration with society.
Recently, six furanocoumarin derivatives isolated from grapefruit juice were found to be inhibitors of CYP3A4, suggesting that they may be clinically active and useful constituents. We succeeded in developing a sensitive and specific enzyme-linked immunosorbent assay (ELISA) for these furanocoumarin derivatives in grapefruit juice. In this study, we examined the correlation between immunoactivity as indicated by ELISA and CYP3A4 inhibitory effects, in order to determine whether ELISA is a useful method for analysis of the CYP3A4-inhibitory activity of furanocoumarin derivatives. Our results show a close correlation between the values. Therefore, our findings strongly indicate that ELISA is a useful method for analysis of these furanocoumarins. Using this ELISA, grapefruit-derived products (grapefruit juice, jam and marmalade) were examined for furanocoumarin derivatives. Immunoactivity analysis was used to determine the amount of 6',7'-dihydroxybergamottin conversion. The amount of 6',7'-dihydroxybergamottin conversion was 13.0 μg/g with grapefruit juice, 40.0 μg/g with grapefruit marmalade and 1.7 μg/g with grapefruit jam. In addition, it was found that the heat treatment of grapefruit juice decreases the immunoactivity as indicated by ELISA and the CYP3A4-inhibitory activity. Moreover, the decreasing rate of the CYP3A4-inhibitory activity was lower than that of the immunoactivity as indicated by ELISA. Therefore, when the heat-treating grapefruit-derived products were analyzed by the ELISA, it was suggested that the CYP3A4-inhibitory activity might be estimated low. These findings will become indexes of the drug interaction of grapefruit-derived products.
Questionnaires on pharmacists working in community pharmacies were sent out by mail to investigate their opinions on oral rehydration therapy (ORT), which was recommended as a safe and effective therapy for mild to moderate dehydration in children and elderly people. The recovery rate in this study was 46％. Pharmacists who knew either very well or reasonably well concerning ORT were 68％. Pharmacists working more than 5 years in the pharmacy, and engaged actively in giving advice on health or nursing for customers and patients knew about ORT significantly. Furthermore, it is speculated that pharmacists working in the pharmacy handling many healthcare items, such as ‘the first kind of over-the-counter drug,’ ‘Pharmaceutical preparation in pharmacy,’ ‘Food with nutrient functions,’ with prescription medicines are involved in self-medication. The most common trigger to start obtaining information on ORT was consultation by customers or patients. The results obtained in this study suggest that the pharmacists participating in self-medication understand ORT very well. Therefore, the initiative of the pharmacist in community pharmacy participating in self-medication is key to the spread of the understanding of ORT.
There have been few reports on efficacy of aprepitant for the prevention of chemotherapy-induced nausea and vomiting in pediatric cancer patients. In this study, we evaluated the efficacy of aprepitant in patients aged 7-16 years. Between June 2011 and June 2012, 9 patients with hematologic malignancy and osteosarcoma who had received highly and moderately emetogenic chemotherapy with methotrexate (≥1000 mg/m2), cytarabine (≥2000 mg/m2), cyclophosphamide (≥200 mg/m2), or ifosfamide (≥800 mg/m2) at Iwate Medical University Hospital were enrolled in this study. We retrospectively analyzed the number of emetic episodes within 7 days from the start of chemotherapy in 7 patients treated with a combination of granisetron and aprepitant (aprepitant group, a total of 21 cycles) and in 8 patients treated with granisetron without aprepitant (control group, a total of 20 cycles). The rate of complete response (defined as no emetic episodes and no use of rescue medication) was significantly higher in the aprepitant group (71％) than in the control group (15％). The percentage of patients with no emetic episodes during the acute and delayed periods was significantly higher in the aprepitant group than in the control group (acute period, 75％ vs 100％ and delayed period, 15％ vs 76％). No adverse events associated with aprepitant or granisetron were observed. Aprepitant was considered a useful drug, because it showed superior antiemetic effects in children aged 7-16 years. The results of this study could provide important information for the development of antiemetic therapy for pediatric cancer patients undergoing chemotherapy.
Incidents involving cancer chemotherapies may result in a critical situation. We analyzed the incident reports involving enforcement of cancer chemotherapies in terms of frequency and risk. Thereafter, we implemented practical training based on the analysis for preventing incidents. The incidence of “medication error” was the highest in frequency at 43％, followed by “line management error” 30％ and “inspected error” 27％. After training, the number of incident reports in 2009 involving enforcement of cancer chemotherapies decreased by 45％, from 40 to 22 cases. The incidence per ward nurse involving enforcement of cancer chemotherapies was significantly higher in the non-participants (17/124, 0.137) than in the participants (5/125, 0.040) of the training. The results of questionnaires gathered from the participants indicated that a lack of knowledge about the antineoplastic was the chief cause of these incidents. Our findings suggest that practical training in consideration of the frequency and risk is effective for preventing incidents.
External surface contamination of cytotoxic drugs has been reported. In Japan, a report on the contamination of cyclophosphamide (CP) vials has already been published. Here, we verified the contamination of other vials containing 5-FU. Furthermore, the outer package contamination and removal effectiveness of 5-FU by water washing were also verified. Wipe samples were taken from 180 vials containing 5-FU. Wiping samples were taken from one vial or from a bundle of ten vials. After vials coated with 5-FU were washed, wipe samples were taken. Then, the surface of the 5-FU outer package was wiped using the same method and the samples were analyzed. In wipe samples from each vial, 35-82 ng was detected in 3 of 90 samples and the contamination rate was 3 percent. In a bundle with ten vials, 50-112 ng was detected in 6 of 19 samples and the contamination rate was 32 percent. The removal effectiveness of contamination by washing the 5-FU vials was 99.9-100 percent. It was confirmed that the external surface of the 5-FU vials was contaminated. This demonstrates that the handling and touching of 5-FU vials without protection can be hazardous. It is improbable that handling of the 5-FU outer package caused occupational exposure. Washing was effective for decontaminating the vials. It is impossible to use the same verification for all cytotoxic drug products. Therefore, healthcare workers should handle such products on the premise that all vials are contaminated.