Regular medication reviews have been recommended for elderly patients on multiple drug therapies. Pharmaceutical care, which includes medication reviews, is very important in community-based care wards with a large number of elderly inpatients. However, little information is available regarding pharmaceutical care in these wards. Therefore, we conducted a survey to evaluate the effectiveness of the pharmaceutical care intervention provided in the wards. A retrospective study was performed from April 2019 to March 2020. When pharmaceutical care was performed during a patient’s hospital stay, we categorized the problem, purpose of the intervention, intervention method and an evaluation of its effectiveness in each case. The effectiveness of pharmaceutical care was assessed by the ratio of cases in which the results of the intervention were judged to be effective in all intervention cases. There were 341patients in the study. We provided intervention to 107 patients (31％) in 196 instances. Intervention was shown to be effective in 95％ of all cases. The implementation of pharmaceutical care helped to optimize the pharmacotherapy provided and contribute to the maintenance and improvement of patients’ quality of life.

In case of difficulty in oral drug administration to patients with dysphagia, the simple suspension method is useful for administering a drug by a nasogastric tube, and is used in many medical institutions. However, information on the simultaneous application of multiple drugs by the simple suspension method is insufficient. In this study, we used aspirin, clopidogrel sulfate, lansoprazole, atorvastatin calcium, and amlodipine besylate, which are commonly used in patients with cerebrovascular disease, to evaluate the suspensibility, nasogastric tube passability, and stability of the active ingredient in the simultaneous multiple suspension method. Under the conditions of four agents (excluding amlodipine besylate) and five agents, the entire suspension can be passed through the nasogastric tube by changing the nasogastric tube diameter or changing the suspending procedure, with no decreases in recovery of the active ingredient after passing through the nasogastric tube.

However, under the conditions for a combination of aspirin and clopidogrel, and for aspirin alone, the recovery rate of aspirin after passing through the nasogastric tube was low, suggesting that the simple suspension method should be applied carefully under a particular set of conditions. In the combination tested in this study, changes in formulation resulted in no decreases in the content of drugs, and the recovery rate after passing through the nasogastric tube was increased with an increase in the number of combined preparations. This information obtained by the present study might be useful for applying multiple drugs by the simultaneous suspension method.

Reports of opioid induction with Fentos^® tape (FT) 0.5 mg potency are limited and the appropriate patient-selection-method isn't clear. We report on a retrospective study of the efficacy and safety of opioid induction at FT0.5 mg in our hospital. Patients with cancer who started FT1 mg as a half pasting (0.5 mg potency) during one year from February 2018 to January 2019 and who started FT0.5 mg during one year from February 2019 to January 2020 (Period B) were included in the study. In this study, appropriate cases were defined as those that could be continued for more than 3 days at FT0.5 mg and the number of opioid rescues was < 2 per day. A total of 49 applicable patients in both periods were included, of which 78％ (38/49) used FT for opioid induction. In Period B, 30 patients used FT 0.5 mg for opioid induction. Among them, 20 patients were able to continue using the tape for more than 3 days and had opioid rescues < 2 per day. Therefore 67％ (20/30) were appropriate cases. The age of appropriate cases was significantly younger (late 70s) than that of inappropriate cases (P = 0.029). Adverse events occurred in 23％ (7/30) of cases, none of which were serious. The induction of opioids in the FT0.5 mg potency was safe with no serious adverse events. However, in terms of efficacy, opioid induction at FT may not be appropriate for patients over 80 years old, and careful patient selection is required.

Water intoxication is a group of symptoms that can lead to death. Therefore, it is important to detect the onset of water intoxication at an early stage and to respond promptly and appropriately. The Pharmaceuticals and Medical Devices Agency (PMDA) publishes information reported by the Pharmaceuticals and Medical Devices Safety Information Reporting System. In this study, to contribute to the early detection of the onset of water intoxication, we attempted to detect drugs that can induce water intoxication using PMDA’s database of Japanese Adverse Drug Event Report (JADER). We focused on reports referring to suspected drugs from JADER database of PMDA for about 15 years from April 2004 to March 2019. Adverse drug events were analyzed based on the number of reports. As a result, we detected 34 drugs that are likely to be the causative agents of water intoxication. Among these, “water intoxication” was not stated in 27 drug package inserts. It is important to pay attention to the onset of water intoxication when administering the 27 drugs we detected.

We investigated the pharmaceutical factors affecting the functional independence measure (FIM) of adult patients in our convalescent rehabilitation ward.

The subjects were 294 patients who were discharged from April 2018 to December 2019. The outcomes were motor FIM gain and motor FIM efficiency. From univariate analysis and decision tree analysis, age, renal function, cognitive function, sex, hypertension, number of drugs prescribed at discharge, hypnotics and anticholinergic drugs were related factors.

Since it was found from the decision tree analysis that cognitive impairment had the greatest effect on motor FIM gain and motor FIM efficiency, multiple regression analysis was performed according to the presence or absence of cognitive dysfunction. In 82 patients with cognitive impairment, motor FIM gain was affected by the number of drugs prescribed at discharge (P = 0.001, β = -0.376), renal function (P = 0.010, β = -0.307). The use of hypnotics (P = 0.004, β = 0.327) and the number of drugs prescribed at discharge (P = 0.045, β = -0.236) affected the motor FIM efficiency, whereas in 212 patients without cognitive impairment, renal function affected both motor FIM gain and motor FIM efficiency (P = 0.046, β = -0.149)(P < 0.001, β = -0.286).

Renal function was evaluated by standardized eGFR, but other parameters should be examined. In patients with cognitive impairment, both motor FIM gain and efficiency decreased as the number of drugs prescribed at discharge increased, and it was expected that the use of hypnotics suitable for individual patients increases motor FIM efficiency.

To cope with the aging population of Japan, medical care needs to be more accessible and efficient. Furthermore, resulting from the measures put in place against COVID-19, the use of information and communication technology (ICT) is expected to be promoted; telemedicine and telepharmacy need to be improved and extended to meet the new demands. To evaluate the implementation of telepharmacy and explore the future agenda, we conducted questionnaire surveys of 5 patients, 5 pharmacists from 4 pharmacies, and 3 physicians who participated in the demonstration project in the National Strategic Special Zone. The survey results confirmed that the quality of medication instruction improved, helping patients to be more relaxed at home; pharmacists were able to check the remaining medicines and medication-storage conditions. Although the introduction of telepharmacy required time and effort from pharmacists, telepharmacy facilitated making appointments, allowing for advance arrangements for medication shortage, and better preparation of medication instructions. Both patients and physicians rated telepharmacy highly, especially for the reduction in travel time and enabling comfortable, private conversation in the absence of other patients. It is suggested that telepharmacy may be an appropriate complement to in-person medication instruction for patients with stable chronic diseases, and it is expected to play an important role in the future, including supporting measures against COVID-19.

In patients being fed with a nasogastric tube (NGT) or gastrostomy tube, over secretion of saliva can cause aspiration pneumonia. Tricyclic antidepressants (TCA), which has an anti-cholinergic effect, is used at our hospital for patients with hypersalivation. The efficacy and safety in the suppression of saliva secretion with the use of tricyclic antidepressants, such as amitriptyline (AMT), were examined. From January 2018 to May 2019, patients who had hypersalivation, were suffering from aspiration pneumonia and who were supported by the nutrition support team (NST), were administered AMT. Comparison of the frequency of saliva suctioning and the course of disease, before and after AMT use, was carried out in 6 patients. A significant decrease in the frequency of suctioning was observed in all 6 patients after 1 week of AMT administration. Four patients had NGT and 3 of them were able to have gastrostomy with continuous AMT use. Four patients were discharged from the hospital to their home or a nursing home. Aspiration pneumonia occurred in only 1 patient and AMT dosage was decreased in 1 patient due to dry mouth. Medical accidents, such as self-removal of NGT or IV tubing, due to delirium caused by antidepressants are of deep concern. Initial and continuous use of TCA must be taken into careful consideration. Adverse reactions to TCA are relatively mild in most cases. Early detection and treatment and evaluation of the balance between a patient’s physical burden and the effectiveness of inhibiting saliva secretion are very important.