In January 2020, Fukuoka Tokushukai Hospital started Protocol Based Pharmacotherapy Management (PBPM), which allows pharmacists to order regular blood and urine tests for drugs that are recommended in the package insert, with the permission of the physician. The purpose of this initiative is to improve the quality of drug therapy for patients through the intervention of pharmacists, to reduce the burden on physicians, and to provide a solution to the three problems of drug therapy at our hospital. As a result, 204 PBPMs (203 blood tests and 1 urine test) were performed for a period of 8 months after the start of drug therapy. Most of them were additions to existing physician orders. All suggestions to the physician for tests were accepted, and 95％ (96/101) of these were ordered by the pharmacist. In 37.3％ (28/75) of the cases, the medication was changed after the test results.

In addition, the "compliance rate of vancomycin (VCM) trough concentration measurement," "compliance rate of hepatitis B virus DNA (HBV-DNA) monitoring in oral chemotherapy alone," and "compliance rate of serum P concentration measurement during Continuous hemodiafiltration (CHDF)" increased after the start of PBPM compared with before (81.3％ vs 91.7％, 82.6％ vs 93.9％, and 65％ vs 100％, respectively). We suggest that our PBPM is a useful tool for pharmacists to proactively promote appropriate drug therapy.

The self-medication tax deduction system came into effect on January 1, 2017, as part of the efforts to maintain and improve health and prevent illnesses. It is important for pharmacists to understand this deduction system correctly and make it widely known to the public. However, it is not yet clear how aware pharmacists are and what opinions they might have about the tax deduction system. Therefore, in this study, we conducted a questionnaire related to the self-medication tax deduction system. Respondents were 310 pharmacists that have been working in drug stores or pharmacies accepting insurance co-established with drug stores. The results indicated that, despite differences in the levels of understanding, more than 90％ of the respondents were aware of the self-medication tax deduction system. Furthermore, the level of understanding about this tax deduction system was higher among respondents who said that they attended lectures about the self-medication tax deduction system in the university and through practical training. Many of the respondents considered it necessary to have knowledge about the system and desired a “mobile phone application” that would gather the latest information about it. These results revealed that pharmacists understood the system better when they received education and training. Moreover, it is essential that information related to this system be delivered regularly.

We report a patient in whom the prothrombin time-international normalized ratio (PT-INR) fluctuated greatly with changes in transluminal nutrient preparations. The patient began treatment with warfarin due to the onset of atrial fibrillation after mandibular bone transection plus plate/abdomen direct dermal flap reconstruction for radiation osteomyelitis of the left lower jaw. The patient was administered medication by feeding tube and nutrients intravenously and by feeding tube. The PT-INR remained mostly within the therapeutic range at a warfarin dose of 0.50 mg/day, but suddenly fell below the normal limit when the transluminal nutrient preparation was changed from inthrow^® (800 kcal/day; vitamin K (VK) 4.8 μg) to CZ-Hi^® (700 kcal/day; VK 56 μg). PT-INR then rapidly increased when CZ-Hi^® was discontinued; this elevation was not due to either a drug-drug interaction or a change in clinical condition. The sudden change in VK intake, despite its small magnitude, suggested the possibility that the intubation nutrients interacted with warfarin, thus affecting the PT-INR. Our observations suggest that nutrient preparations may interact with drugs, even if the preparations are classified as foods. To promote interprofessional collaboration among medical staff, pharmacists should report all food and drug interactions to physicians and dietitians for safe and effective medication.

Apnea of prematurity is one of the most common problems in preterm and low birth weight infants, and it is reported to be more likely to occur in infants of lower gestational age and lower birth weight. The present study investigated the efficacy and safety of caffeine according to weight, based on birth weight. We defined preterm infants with birth weights of < 1,000 g, 1,000 g to < 1,500 g, and 1,500 g to < 2,500 g as the extremely low birth weight (ELBW), very low birth weight (VLBW), and low birth weight (LBW) groups, respectively. There was a significant difference among the three groups in the rate of improvement of apnea attacks from days 1 to 10 of administration. The percentage of cases that showed “improvement” on each day tended to be higher in the LBW group. The incidence of adverse events was 100％ in the ELBW group, 90.9％ in the VLBW group, and 64.7％ in the LBW group (P < 0.001). However, regarding adverse events that were suspected to have been caused by caffeine or events that required dose reduction or discontinuation of caffeine due to adverse events, there were no significant differences among the three groups in any of the items that were investigated. These results suggest that the greater the birth weight, the more likely effects of treatment will occur, and that although careful administration is required, the administration of caffeine to infants of lower birth weight may be feasible.

We experienced oral temozolomide treatment for total gastrectomy in a high-grade glioma patient. In this case, as there was concern about hydrolysis of temozolomide due to total gastrectomy, we measured the temozolomide concentration during the treatment period. Furthermore, the side effects of 18 non-total gastrectomy patients who had been treated with oral temozolomide therapy in the past were evaluated and compared with the side effects of this gastrectomy patient.

The concentration of temozolomide showed the highest peak value (3.59 µg/mL) at 1.0 hour after the start of dosing, and AUC_0-6 up to 6 hours after administration was 11.0 µg/mL · hr (trapezoidal method). In addition, the decrease of myelosuppression of the gastrectomy patient that occurred after the start of treatment was similar to that of non-total gastrectomy patients. The concentration profile of oral temozolomide showed similar values to the pharmacokinetic parameters of temozolomide (T_max, C_max and AUC) reported so far, and it was considered that there was no effect on the hydrolysis of temozolomide.

Therefore, it is suggested that oral temozolomide may be well absorbed even in patients with total gastrectomy.

We developed a flowchart for standardizing insomnia treatment to prevent falls associated with hypnotic drug dosing in Yamaguchi University Hospital, and implemented it from April 2019. The first recommended drug was suvorexant, followed by eszopiclone. In November 2019, we conducted a questionnaire survey involving doctors and nurses regarding the effectiveness and convenience of the flowchart. Eighty-one percent of the participants responded positively. We also investigated the incidence of falls within 24 h after dosing hypnotics. The fall rate before and after the introduction of the flowchart was no significant difference as determined by propensity score matching of the patient background. However, the fall rate for patients who received the recommended drugs was 3.1％ and that for patients who received the deprecated drugs was 5.7％. Therefore, the fall rate of patients receiving the recommended drugs was significantly lower than that of patients receiving the deprecated drugs. The introduction of this flowchart may thus help prevent patient falls.