Accurate continuous intravenous injection via peristaltic finger infusion pump has been utilized at outpatient clinics, such as cancer treatment centers. However, the flow rate accuracy of the peristaltic finger infusion pump might be affected by various factors, such as the properties of drugs containing surfactants, choice of infusion set, and the technique for using the peristaltic finger infusion pump by medical staff. In our experience with outpatient chemotherapy, medication administration has occasionally been incomplete at the calculated input time when using peristaltic finger infusion pump. For this reason, we have investigated the cause of delay in administration time with peristaltic finger infusion pump under various conditions. Saline containing ethoxylated hydrogenated castor oil (cremophor^® EL), polyoxyethylene sorbitan monooleate (Tween 80), and ethanol did not adversely affect administration time accuracy. Conversely, when the infusion set tubing was stretched approximately 1-3 cm and was attached to the peristaltic finger infusion pump, the time required for complete administration of the solution was prolonged compared to the input time (P < 0.0001-0.05, Tukey-Kramer multiple comparison). Therefore, we suggest that the technique for using the peristaltic finger infusion pump by the medical staff adversely prolonged the time required for completion of administration. In our opinion, pharmacists should provide information concerning not only drugs, but also medical devices to physicians and nurses.

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Pneumocystis pneumonia (PCP) is an opportunistic infection in people with weakened immune systems, such as people with blood disorders, solid cancers, or acquired immunodeficiency syndrome or who are undergoing immunosuppressive drug therapy or treatment with biological medical products. Trimethoprim-sulfamethoxazole (TMP-SMX) is frequently used for prophylaxis of PCP. The dosage and timing of TMP-SMX administration is not clear, although National Comprehensive Cancer Network guidelines suggest the use of TMP-SMX for prophylaxis of PCP in high-risk cancer patients undergoing chemotherapy. We investigated whether the timing of TMP-SMX administration is related to prophylaxis of PCP in patients with malignant lymphoma. The incidence of PCP was 9.9％ (7/71 patients) in patients with malignant lymphoma, 7.5％ (4/53 patients) in patients with B-cell lymphoma, and 16.6％ (3/18 patients) in patients with T-cell lymphoma. Receiver operating characteristic analysis showed that the cut-off level of peripheral blood lymphocytes for TMP-SMX administration was 250 /μL. TMP-SMX administration in seven to eight tablets per week (e.g., one tablet per day or four tablets twice a week) would be appropriate prophylaxis of PCP in high-risk cancer patients undergoing chemotherapy. We suggest that monitoring of peripheral blood lymphocytes is important and that TMP-SMX administration must start before the peripheral blood lymphocyte level reaches < 250 /μL.

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To garner additional insights into the risk of gastrointestinal (GI) complications among users of low-dose aspirin (LDA) products, concomitant use of LDA products and anti-secretory drugs was investigated using the national database. The frequencies of gastrointestinal diseases among users of LDA products were also investigated. The main purpose of this study was to assess the differences in gastrointestinal damage risk between enteric-coated and buffered LDA product use.
LDA use in combination with histamine H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) was examined for the period January 2010 to December 2010. In addition, the frequencies of claim codes for gastrointestinal diseases among users of enteric-coated LDA and buffered LDA products were investigated for December 2010.
In 2010, 24.0％ of enteric-coated LDA users and 17.2％ of buffered LDA users concomitantly used PPIs. There were substantial differences between enteric-coated LDA and buffered LDA users with regard to the frequency of PPI use. H2RAs were concomitantly used by 21.5％ of enteric-coated LDA users and 20.8％ of buffered LDA users. During December 2010, the frequencies of hemorrhagic gastric ulcer and lower gastrointestinal hemorrhage among entericcoated LDA users were higher than among buffered LDA users (0.31％ vs 0.26％, and 0.085％ vs 0.062％, respectively).
These findings may imply that the risk of GI complications associated with buffered LDA use is lower than that with enteric-coated LDA use.

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For patients receiving prescriptions of inhaled steroids, gargling after completing inhalation is necessary to prevent adverse drug reactions, including oral problems (stomatitis caused by oral candidiasis, hoarseness, and pharyngolaryngeal irritation). However, it has been reported that many patients experience oral problems despite gargling considered to be appropriate after inhalation. A possible cause of these problems is dry mouth, which is one of the adverse drug reactions to anti-allergic drugs and leukotriene receptor antagonists frequently administered concomitantly. This study evaluated the relationship between the onset of oral problems and salivary secretion. In 531 patients receiving treatment for asthma, we conducted a questionnaire survey, measured salivary secretion, and examined prognostic factors for the onset of oral problems using simple and multiple regression analyses. The results revealed significant prognostic factors before adjustment to be the number of concomitant drugs other than anti-asthma drugs and decreased salivary secretion. Furthermore, independent significant prognostic factors after adjustment were age and decreased salivary secretion.
These results suggested that oral care focusing on improvement of dry mouth and thorough instructions to younger patients would be effective for the prevention of oral problems. Based on the verification results obtained in this study, re-establishment of the current instructions for inhalation is considered to be necessary to support better treatment for asthma in the future.

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Medications account for about 20％ of all medical costs, so it is important to reduce the cost of drugs. Most anticancer agents are very expensive, and it is reported to be more cost-effective to use these agents in a cost-minimizing combination when several different doses are available at a hospital. Injectable drugs are mainly entered directly into the Electronic Medical Record (EMR), but anticancer injections are entered into the regimen-ordering system for safety. When prescribing anticancer injections, selecting the lowest-cost combination is complicated for both doctors and pharmacists. Some computer programs that can suggest suitable combinations have already been reported, but are not yet available for either the EMR or the regimen-ordering system. Therefore, we attempted to develop a program that would automatically select the lowest-cost combination with the regimen-ordering system, and we evaluated the utility of this program.
When we investigated the prescriptions (57.2％ of all anticancer injection prescriptions) entered without this program from July to September 2010, 5.9％ of anticancer injection combinations were unsuitable and the pharmaceutical price difference was 329,795 yen. We also confirmed the speed of selecting the lowest-cost combination for some model prescriptions and found that it was fast enough for practical use.
In conclusion, we developed a cost-minimizing program that reduced medication costs and ensured safe prescribing. This program works with the regimen-ordering system.

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Tablet-splitting is an important practice for pharmacists in hospitals and pharmacies. We investigated the variation of line tablet containing splitting score using 4 splitting methods (scissors, automatically, knife and spoon). We evaluated variation using the coefficient of variation. As a result, scissors and automatically showed small variation, but knife showed big variation. Furthermore, as individual difference using a warfarin tablet was investigated, the scissors showed small variation compared with other methods. As the splitting methods and individual difference results, the tablet scissors method was the most useful division method. We investigated the variation of line tablet non-containing splitting score using scissors and crushing tablet on/off diluting agent. As a result, crushing tablet on a diluting agent showed small variation. Using a score line tablet divided by the tablet scissors method, the non-score line tablet divided by crushing tablet on the diluting agent was small variation.

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Breastfeeding is important in infant rearing. To support safe breastfeeding in a patient using lamotrigine, the transfer of lamotrigine to the infant via breast milk was evaluated in two couples of Japanese mother and infant. The infants took their mothers' milk expressed a day ahead. The plasma and breast milk concentrations of lamotrigine at 4 (or 5) and 89 (or 90) days after the birth were measured by HPLC. The lamotrigine concentrations of the two mothers were 12.63 and 6.21 µg/mL in plasma, 11.50 and 4.13 µg/mL in milk at Day 4. Milk/Plasma ratios (M/P) were 0.91 and 0.67, and the estimated Relative Infant Dose (RID, at Day 5) was calculated to be 12-29％. At 89 and 90 days after birth, the milk concentrations and RID, respectively, were similar to those at 4 days, which indicates that the transfer of lamotrigine into milk is high in Japanese mothers. The infant plasma concentrations of lamotrigine at 5 and 90 days were between 2.8 and 6.7 µg/mL, which was within the therapeutic range in children with epilepsy. Typical adverse effects were not observed in these infants under meticulous surveillance. In conclusion, pharmaceutical healthcare is necessary for lactating mothers using lamotrigine and their infants.

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