Postoperative nausea and vomiting (PONV) are common and unpleasant postoperative complications. Although guidelines recommend preventative measures according to PONV risk, anesthesiologists do not always follow the guidelines. In this study, we investigated whether the pharmacists’ proposal of a PONV prevention method to anesthesiologists in accordance with the guidelines affected the decision-making of anesthesiologists and subsequent PONV development. Two hundred and five patients who underwent gynecological surgery at Keiyu Hospital were included in this study, and the number of preventative measures selected by an anesthesiologist and frequency of PONV complications before and after the pharmacists’ intervention were determined. After the intervention, the number of preventative measures implemented by the anesthesiologist increased in the PONV moderate- and high-risk groups (P < 0.01) and incidence of PONV in patients decreased [odds ratio 0.362 (95％ confidence interval 0.174 - 0.726) (P < 0.01)]. It is the intention of anesthesiologists for pharmacists to evaluate PONV risk and propose preventative measures that comply with guidelines to anesthesiologists. The results of this study show that the proposal of pharmacists on PONV prophylaxis affects anesthesiologists’ decision-making and is effective in preventing PONV.

In the previous study, we prepared phosphatidylcholine (PC) liposomes and phosphatidylserine (PS)-containing PC/PS liposomes, and investigated the uptake characteristics of lipophilic organic cations. The uptake of bisoprolol into PC/PS liposomes was significantly greater than that into PC liposomes. In the present study, we prepared the 5-component liposomes containing PC, PS, phosphatidylethanolamine, sphingomyelin, and cholesterol, and compared the uptake characteristics of lipophilic organic cations into the liposomes with that into porcine kidney LLC-PK₁ cells. The uptake of flecainide was significantly inhibited by lipophilic diphenhydramine (DPH) both in 5-component liposomes and in LLC-PK₁ cells, but not by hydrophilic tetraethylammonium. The 50％ inhibitory concentration (IC₅₀ value) for the DPH-sensitive uptake of flecainide was 1.08 mM and 657 µM in the 5-component liposomes and LLC-PK₁ cells, respectively. In addition, the uptake of the various 11 cationic compounds both into the 5-component liposomes and into LLC-PK₁ cells was significantly correlated with their lipophilicity (Log D) values and their polar surface area (Log PSA) values. Collectively, the uptake characteristics of lipophilic cations in the 5-component liposomes was considerably similar to that of the postulated H⁺/lipophilic cation antiport system in LLC-PK₁ cells.

The antimicrobial stewardship team (AST) plays an important role in assisting with the treatment of infectious diseases. In August 2018, we started a program to dedicate a pharmacist to the AST and performed consultations focusing on patients before receiving intravenous antibiotics and all patients receiving intravenous antibiotics. In this study, we investigated the impact of full-time pharmacist interventions on antimicrobial stewardship pre- (August 2017 - July 2018) and post- (August 2018 - July 2019) intervention.

The total number of consultations with the full-time pharmacist increased significantly at 71 and 252 consultations pre- and post-intervention, respectively. There was no significant difference in the intervention, and a total of 69 (pass rate 85.5％) and 230 (83.5％) prescription improvement proposals were made pre- and post-intervention, respectively (P = 0.852).

There was no difference in 30-day mortality pre- and post-intervention.

Additionally, as compared to the period from August 2017 to July 2018, that is, before the intervention, Antimicrobial Use Density (AUD) / Days of Therapy (DOT) for carbapenem antibiotics decreased from 0.73 to 0.58 during the intervention period (P = 0.004).

Based on these results, we suggest that the implementation of aggressive consultations and interventions by the full-time pharmacist is useful for promoting the appropriate treatment.

There are no reports on the appropriateness of disposal methods for anticancer drugs and the management of the associated contamination from disposal containers in Japan. We performed a quantitative survey of the contamination from anticancer drugs from disposal containers and aimed to optimize the storage and management of containers to prevent occupational exposure to anticancer drugs. The containment performance of polyethylene bags and disposal containers was measured for cyclophosphamide and 5-fluorouracil. Although cyclophosphamide was detected on the surface of the polyethylene bags after 3 h, neither drug was detected at 72 h at the body-lid junction of the sealed disposal containers, suggesting that following the disposal of cyclophosphamide and anticancer drugs with properties similar to cyclophosphamide, the inside of the disposal containers was exposed to these drugs for a definite period. Furthermore, we olfactorily and visually assessed the spread of the anticancer drugs from the disposal containers. Sensitivity to the smell following the opening of an upward-opening disposal container was significantly higher than these of slide-opening disposal containers. In addition, white vapors of the dry ice stored inside the containers were observed to displace upward following the opening of an upward-opening disposal container. These suggest that if a disposal container had been exposed to anticancer drugs, there was the possibility of unintentional exposure and the contamination spreading to the surrounding area via inhalation. Therefore, in order to reduce the risk of occupational exposure to anticancer drugs, setting specific restrictions for the handling of disposal containers is recommended.

In the simple suspension method, the intended medicine is suspended in hot water when administered to a patient by tube. Suspension of the laxative, magnesium oxide is reported to hydrolyze ester-type drugs. Because several angiotensin converting enzyme (ACE) inhibitors have ester bonds in their structure, magnesium oxide may cause incompatibility when suspended with an ACE inhibitor. The purpose of this study was to clarify the effect of magnesium oxide on the stability of eight kinds of ACE inhibitors in the simple suspension method.

When suspended together with magnesium oxide in hot water (55℃), temocapril, delapril, captopril, and benazepril showed a significant decrease in concentration compared to when suspended alone. Enalapril, trandolapril, quinapril, and imidapril, however, showed no significant decrease. When temocapril was suspended with magnesium oxide, the concentration of its hydrolysis product temocaprilat was increased in a time-dependent manner. In addition, when temocapril was suspended in a carbonate-sodium bicarbonate buffer (pH 10.6), temocapril degradation was slower than with magnesium oxide, suggesting that the temocapril decomposition is not a simple hydrolysis caused only by pH but one requiring the presence of magnesium oxide as a catalyst.

Ester structures in ACE inhibitors are intended to improve gastrointestinal absorption. Therefore, the condition of several ACE inhibitors kept in suspension with magnesium oxide causes degradation of these drugs, inhibiting their absorption and pharmacological effects. It may be necessary for pharmacists to suggest to physicians that their prescriptions be changed to non-degradable ACE inhibitors and/or laxatives other than magnesium oxide.

Docetaxel and paclitaxel (PTX) are key drugs in human epidermal growth factor receptor type 2 (HER2) positive metastatic/recurrent breast cancer. However, there is little information on the recommended doses for liver dysfunction. We performed trastuzumab/pertuzumab/PTX combination therapy (50％ dose of PTX) for patients with HER2-positive breast cancer who had Child-Pugh C liver dysfunction due to multiple liver metastases. After the chemotherapy, the patient’s liver function improved rapidly, so the dose of PTX was increased to 75％. However, since febrile neutropenia (FN) occurred, PTX was continued at a dose of 50％ thereafter. As a result, the patient was able to continue chemotherapy without FN. This case will help us consider the administration method of PTX in the case of severe liver dysfunction.