Little research has been published on the influence of deferasirox (DFX) (an iron chelating agent), or its use concomitantly with other drugs and acute renal dysfunction. We used signal detection to determine the risk of acute renal failure associated with DFX and concomitant drug use using the Japanese Adverse Drug Event Report database (JADER). When using the proportional reporting ratio (PRR) as an evaluation index, the following concomitant drugs were found by signal detection: DFX-cyclosporin A (CyA) (risk ratio associated with concomitant use: 2.53); DFX-loxoprofen sodium (risk ratio associated with concomitant use: 2.48); DFX-diclofenac sodium (risk ratio associated with concomitant use: 3.31); DFX-amphotericin B (risk ratio associated with concomitant use: 2.88); DFX-anti-human thymocyte immunoglobulin (risk ratio associated with concomitant use: 2.13). When we used the reporting odds ratio (ROR) as an evaluation index, we found the concomitant usage risk of DFX-CyA (adjusted ROR: 24.9, 95% confidence interval (CI): 14.8-42.0).
We found concomitant drugs using signal detection and evaluated them by performing a case-control study. We investigated cases that occurred between June 2008 and December 2014 at Tosei General Hospital in Aichi, Japan (701 beds). Of 29 total cases where DFX was administered, there were a higher number of cases where cyclosporine was administered concomitantly in the acute renal failure group compared with the group with no onset of acute renal failure (odds ratio: 16.00, 95% CI: 1.58-162.10).
Our study suggests the possibility that the concomitant use of DFX and CyA might be associated with an increased risk of acute renal failure.
The merit of outpatient chemotherapy is that patients can continue their daily lives at home and at work, while the demerit is that patients have to manage their side effects. As side effects reduce the quality of life, it is important that side effect manifested circumstances are understood, and appropriate guidance and suggestions on side effect measures are given. Therefore, we investigated the impact of counseling before examination by the hospital pharmacist on the QOL of breast cancer outpatient chemotherapy. Subjects were 37 breast cancer patients receiving first outpatient chemotherapy in Gifu Municipal Hospital between December 2013 and November 2015. We performed a questionnaire survey on the quality of life (EQ-5D), and the responses before the 2nd and 3rd courses were compared with those before the 1st course. We defined the period up to the introduction of the personal counseling before the medical examination by a hospital pharmacist as the non-intervention group, and the period after introduction as the intervention group. No significant mean difference in either group before the 2nd course was observed (P = 0.112), but a significant mean difference in the intervention group before the 3rd course was observed. (P = 0.042) The hospital pharmacist performed a hearing, symptom evaluation and causative analysis of side effects in counseling before the medical examinations in the intervention group and reflected the results in patient guidance and supportive therapy suggestions to the doctor regarding side effect manifestation after that at a minimum, and influence was exerted on patient QOL improvement.
In previous studies, standardized or drug-specific laboratory data have been listed on prescriptions. However, drug-specific laboratory data used as selection criteria differ between facilities, and no previous study has determined whether the way laboratory data are listed improves the quality of prescription audits. Here, selection criteria based on drug-specific laboratory data were created specifically for contraindications and drugs that require careful use in patients with renal insufficiency to determine whether listing drug-specific laboratory data on prescriptions improves the quality of prescription audits. The selection criteria used in this study were primarily those listed in package inserts in the Warnings, Contraindications, and Relative Contraindications sections. Simple, clear criteria were selected. These criteria were incorporated into in-hospital prescriptions, and the number of prescription changes due to prescription inquiries related to laboratory data was recorded. Based on the new selection criteria, drug-specific laboratory values revealed 505 contraindications in 287 of the drugs handled at our hospital, and 75 drugs required caution when used in patients with renal insufficiency. The number of prescription changes due to laboratory value-related prescription inquiries for drugs with changes in the contraindications increased significantly from 0 to 20 over the 6-month period after the change in the laboratory data listings. When laboratory data related to renal function were changed from standardized data to drug-specific data, prescription changes due to prescription inquiries significantly increased from 14 to 42 over the 3-month period. These results show that listing drug-specific laboratory data on prescriptions improves the quality of prescription audits.
Cancer chemotherapy is currently being shifted to outpatient services. At the same time, the number of patients receiving chemotherapy and visiting pharmacies is increasing. In this study, as a survey revealed that pharmacists considered their knowledge of chemotherapy and information for patients were insufficient, a workshop was held for pharmacists working at pharmacies to increase their knowledge in these areas. The pharmacists were highly motivated to participate in the workshop, and it may be possible to improve pharmacy staff's knowledge of chemotherapy on a community-wide basis by holding such workshops continuously. In the study, a system for liaison with neighboring medical institutions was also developed based on the results of the awareness survey. The system is expected to facilitate patient-related information collection, and improve the quality of guidance provided by pharmacists for appropriate care.
In the School of Pharmaceutical Sciences of Kyushu University of Health and Welfare, an Advanced Objective Structured Clinical Examination (advanced OSCE) utilizing a simulator has been performed since the 2010 school year for physical assessments. In 2014, we newly implemented the advanced OSCE (Ver 4) presenting patient characteristics and prescriptions. In the advanced OSCE, we created an issue table presenting patient characteristics and prescriptions and subsequently performed practical tests investigating pulse, blood pressure, heart sounds, lung sounds, and intestinal sounds. After the students viewed an issue table along with the package inserts of medicines shown in this table, they received the advanced OSCE. The mean scores of all of the detailed evaluations performed in the new advanced OSCE were slightly increased compared to the OSCE scores of the previous year. Higher achievement rates were also noted for each of the practical tests of the new advanced OSCE for which significant differences were observed (pulse measurement and listening to heart sounds) compared to the results of the previous year. This could be because students could not only determine these abnormal sounds but also predict patient symptoms based on information from patient characteristics and prescriptions. Another reason is that students could predict the effects and adverse effects of the medicines from the package inserts.
The maintenance and improvement of medication compliance is important, and the medication counseling offered to dementia patients by pharmacists also plays an important role in providing effective dementia treatment. However, there have been no reports on pharmacists educating dementia patients continuously via an outpatient department to date. To achieve maintenance of taking medicine instruction and medicine compliance at Oita University hospital after August 2015 and in the outpatient memory care department of our hospital, where dementia patients undergo their medical examinations, a pharmacist delivered the new drug management instructions (hereafter, pharmacist outpatient department). Eighteen patients received instructions from a pharmacist from August 2015 through May 2016. We investigated the reasons why doctors requested these specific instructions, the intervention contents used by the pharmacist, and the outcome using a Mini-Mental State Examination (MMSE) before and after the instructions began and patients began the new medicine regimen. The results of the study found that the instructions by pharmacists increased their medicine use continuation rate, but MMSE had not changed. It is considered that the instructions given by pharmacists in dementia outpatient departments are connected to the maintenance of anti-dementia medicine regimens by improving patients' medicine-taking compliance.
Nicardipine hydrochloride injection often induces venous irritation despite infusion at the recommended concentrations in the intensive care unit (ICU) at Kyushu University Hospital. We retrospectively investigated the incidence and risk factors of venous irritation in ICU patients, and previously reported that administration time and infusion rate are risk factors for nicardipine injection-induced venous irritation. Based on this result, we carried out compliance with the package insert, setting of the infusion rate (45 mL/h or less) and enhancement of monitoring (if the administration time exceeds 20 h), as efforts to prevent nicardipine injection-induced venous irritation in ICU. Moreover, we arranged the replacement of the catheter within 96 h in ICU, and pharmacists were alerted about it. In this study, we evaluated the effects of these efforts. After the efforts, the incidence of venous irritation induced by nicardipine injection was significantly decreased (P = 0.0172). In addition, 3 patients experinced severe vascular damage before the efforts, while no patients experienced severe vascular damage after the efforts. These results suggest that this approach is useful in the prevention of venous irritation.