Chemotherapy-induced nausea and vomiting (CINV) is one of the most unpleasant non-haematological side effects that affects a patient's quality of life and leads to poor adherence to further chemotherapy. The current antiemetic guidelines recommend a three-drug combination of a 5-HT₃ receptor antagonist, dexamethasone, and aprepitant for patients undergoing highly emetogenic chemotherapy. However, the efficacy of aprepitant has not been well investigated in breast cancer patients receiving doxorubicin and cyclophosphamide (AC). We investigated the incidence of nausea and vomiting before and after the introduction of aprepitant therapy in breast cancer patients. In addition, we also attempted to identify the risk factors predisposing these patients to CINV development.

A total of 132 patients (n = 64 in non-aprepitant group and n = 68 in aprepitant group) with breast cancer were analyzed. The incidence of vomiting was more frequently detected in patients in the non-aprepitant group than in patients in the aprepitant group (37.5 vs 13.2％; P = 0.001). In contrast, a significant higher proportion of nausea was observed in the aprepitant group (92.6 vs 78.1％; P = 0.018). Multivariate analysis showed that aprepitant use (odds ratio [OR] 0.240; 95％ confidence interval [CI] 0.099-0.582) and Body Surface Area > 1.52 (OR 2.713; 95％CI 1.143-6.439) were significantly associated with the incidence of vomiting. Meanwhile, aprepitant use (OR 3.528; 95％ CI 1.190-10.457) only resulted in an increase in the incidence of nausea. These findings suggest that aprepitant might not be effective for the prevention of nausea although it is effective for the prevention of vomiting.

Details regarding trends in the prescription rates of antihypertensive drugs after 2011 are unclear. Therefore, we compared the prescription rates of antihypertensive drugs in 2009 with those in 2014 using claim records. Data were extracted from claims data provided from April-July 2009 and from April-July 2014 in Tohoku University Hospital, Sendai, Japan. Prescription rates were presented as the percentage of patients who were prescribed each drug. We compared the prescription rates in 2009 (n = 3,954, mean age 63.8 years, men 53.4％) with those in 2014 (n = 5,196, mean age 63.3 years, men 52.9％). The two most prescribed classes of antihypertensive drugs were angiotensin II receptor blockers and calcium channel blockers in both years (≥ 60％). No significant changes in the prescription rates for these two classes were observed between 2009 and 2014. The prescription rate for aldosterone blockers and αβ-blockers increased from 12.6％ and 8.4％ in 2009 to 16.9％ and 13.5％ in 2014 (P < 0.0001), respectively. In contrast, the prescription rate for angiotensin converting enzyme inhibitors and α-blockers decreased from 23.5％ and 10.4％ in 2009 to 15.6％ and 7.7％ in 2014 (P < 0.0001), respectively. The prescription rates for thiazide diuretics, non-thiazide diuretics other than aldosterone blockers, β-blockers, and other classes of antihypertensive did not differ significantly between 2009 and 2014. The prescription rates of antihypertensive drugs have changed based on new evidence regarding the drugs' mechanisms of action on hypertension or their adverse effects.

Hepatitis B arising from hepatitis B virus (HBV) reactivation following chemotherapy or hematopoietic stem cell transplantation has a high risk of mortality. In January 2013, we began checking the HBV screening results of all patients scheduled to undergo chemotherapy. Furthermore, it has been reported that hepatitis B following HBV reactivation may develop even after chemotherapy has been completed. As yet, pharmacists have not been involved in preventive measures against HBV reactivation after the completion of chemotherapy. To address this, we constructed a HBV test confirmation system. In November 2013, we began checking the intervals and results of HBV-DNA tests in the 12 months following the completion of chemotherapy in patients with resolved HBV (hepatitis B surface antigen (HBs-Ag) negative and hepatitis B surface antibody (HBs-Ab) positive and/or hepatitis B core antibody (HBc-Ab) positive). We compared the implementation rate of HBV marker testing before and after initiating our approach. The implementation rate of blood testing for HBs-Ab/HBc-Ab in all patients scheduled to undergo chemotherapy rose significantly to 91％/95％, respectively, from 27％/27％ (P < 0.001). In addition, the implementation rate of HBV-DNA testing after the completion of rituximab-steroid combination therapy in patients with resolved HBV rose significantly to 69％ from 27％ (P < 0.001). The rate after hematopoietic stem cell transplantation rose to 64％ from 25％. In conclusion, such an approach by pharmacists is useful as a preventive measure against hepatitis B arising from HBV reactivation.

The ward pharmacist received a report from ward nursing staff that an aggregation formed when lansoprazole OD tablets and ground levofloxacin tablets were suspended simultaneously in water. In this study, we elucidated the factors of aggregation focusing on additives, the main drug, and pH in suspension, and also considered ways of preventing the aggregation. To elucidate the contribution of additives in levofloxacin tablets, drugs containing similar additives to those of levofloxacin tablets were suspended with lansoprazole OD tablets in water, but no aggregation was observed. Levofloxacin hydrate intravenous drip infusion (pH 4.8) did not form an aggregation with lansoprazole OD tablets, meanwhile levofloxacin hydrate intravenous drip infusion adjusted to pH 7.3 and levofloxacin hydrate solution adjusted to pH 7.3 formed an aggregation with lansoprazole OD tablets. When lansoprazole OD tablets and ground levofloxacin tablets were suspended in a buffer solution of pH 5.0, pH 6.0, and pH 7.0, no aggregation was observed in a buffer solution of pH 5.0. When generic lansoprazole OD tablets and generic lansoprazole capsules were suspended with levofloxacin tablets in water, aggregation was also observed. On the other hand, the aggregation of lansoprazole OD tablets was not observed when lansoprazole OD tablets and levofloxacin tablets were suspended in apple juice. According to the above results, factors related to the formation of the aggregation were involved in the preparation of lansoprazole, levofloxacin hydrate, and around pH 6.0, and the suspending of lansoprazole OD tablets and levofloxacin tablets simultaneously in acidic drinks such as apple juice is means of avoiding the aggregation.

In April 2014, legal and regulatory changes in Japan allowed self-blood tests to be performed at community pharmacies designated as “Bioanalytical Labs”. However, the number of new applications from pharmacies seeking to become Bioanalytical Labs is decreasing. We previously examined the disincentives to continuation of operation as a Bioanalytical Lab. In this study, we aimed to reveal the disincentives to the spread of Bioanalytical Labs among Japanese pharmacies. We conducted a questionnaire survey of 993 randomly selected pharmacies that had not been designated as Bioanalytical Labs. We received 336 responses, of which 315 were valid. Almost half of the respondents indicated a lack of knowledge of Bioanalytical Labs. Therefore, to accelerate their spread, it seems important to raise awareness of Bioanalytical Labs among pharmacists. Additionally, more than 80％ of the respondents were willing to encourage users to seek a medical consultation after a self-blood test when needed. The spread of Bioanalytical Labs could contribute to increased visits to medical institutions and earlier detection of diseases. Many pharmacies cited a shortage of space, lack of personnel, or the cost of equipment as a reason why they had not yet applied to become a Bioanalytical Lab. Our previous study found that burdens such as a shortage of space and the cost of equipment significantly decreased after beginning operation as a Bioanalytical Lab. The dissemination of this finding could lessen the disincentives found in the present study.

Team medical care by numerous job categories has been emphasized in recent years. It is necessary to develop pharmacy specialists who have rich knowledge and perform important roles in the clinical setting. However, young pharmacists have fewer opportunities associated with various specialized fields, and they worry about how to proceed into specialized fields in their career path. In Nagasaki University Hospital Pharmacy, we have been holding early-exposure training to introduce the basic knowledge of different specialized fields for young pharmacists.

In 2014, we held early-exposure training in 7 fields (oncology, palliative care, nutrition support, infection control, diabetes care, emergency / intensive care, and HIV infection control). To estimate the effect of the training, we questioned participants before and after each training, and investigated the intelligibility and their interest in the pharmacy specialist’s activity, the aim as a pharmacist, the value of the work, and the will to work in specialized fields.

After the training, the intelligibility rose significantly in 6 fields, and the interest rose significantly in 2 fields. The aim and the value of doing the work did not change, but slightly more participants expressed a wish to become involved in specialized fields early on.

Young pharmacists need to have a high level of interest to decide to become professional pharmacists. We should maintain an environment in which young pharmacists consider pharmacy as their career path.

Hypertensive emergency is a situation in which uncontrolled hypertension is associated with acute end-organ damage. Nicardipine hydrochloride is a calcium channel blocker indicated for the treatment of hypertensive emergencies. However, nicardipine infusion-related phlebitis is a common and significant problem in clinical practice. The aim of this study was to survey the incidence of nicardipine infusion-related phlebitis and to identify associated risk factors for phlebitis. We conducted a retrospective observational study at Fukuoka Tokushukai medical center. A total of 79 patients who received precision continuous infusion of nicardipine were enrolled in this study. Nicardipine infusion-related phlebitis occurred in 34 (25.7％) of 132 peripheral intravenous catheters. On multivariate logistic analysis, “the dosing period over 24 hours” and “no co-infusion of saline” were significantly associated with an increased risk of nicardipine infusionrelated phlebitis. The odds ratio (OR) and 95％ confidence interval (95％ CI) for the occurrence of phlebitis with respect to “the dosing period over 24 hours” and “no co-infusion of saline” were 5.04 (2.012 - 12.657) and 3.36 (1.190 - 9.514), respectively. In addition, the optimal cut-off level of the dilution rate of saline was determined to be 4.23 times (sensitivity 73.5％, specificity 58.8％) based on receiver operating characteristic (ROC) analysis for predicting the occurrence of phlebitis. To minimize the risk of peripheral phlebitis, we propose that medical professionals should consider changing the infusion site every 24 hours at least and co-infusing saline diluted more than 4-5 times.