A drug-drug interaction (DDI) caused by a drug combination may cause clinical problems. This study evaluated the frequency and details of potential DDI (pDDI) in the discharge prescription and the relationship between pDDI and number of drugs used. The study included patients who were discharged from the rehabilitation ward for a duration of two years between 2018 and 2019. Lexicomp Drug Interactions, a DDI screening program, was used to detect pDDI. Clinically important pDDI was detected in 22.8％ (59/259) of patients. The DDI mechanisms were based on pharmacodynamic interactions in 63.6％ of cases and on pharmacokinetic interactions in 29.9％. Central nervous system depressant related pDDI was the most frequent type of pDDI detected. Use of hypnotics, antidiabetic drugs, antidepressants and antipsychotics was significantly higher amongst patients with detected pDDI. The incidence and frequency of pDDI increased with the number of drugs used. It is necessary for pharmacists to correctly evaluate the pDDI detected by the DDI screening program and contribute to the optimization of prescriptions and patient treatment.

At Hiroshima City Hospital, there was a large number of cases in which patients with pyelonephritis who were hospitalized continued to receive intravenous antibiotics administered empirically that were then changed to oral levofloxacin. Therefore, the intervention was performed with the aim of reducing inappropriate use of oral broad-spectrum antibacterial agents and optimizing administration when switching to oral medications. For 29 patients who were hospitalized for pyelonephritis at our urology department from June 2019 to February 2020, we proposed to doctors a drug change to oral antibiotics and the administration period. There were 24 cases of proposal to change to oral antibiotics, and all proposals were adopted. Of the 24 cases proposed, 20 were able to switch to narrow-range oral antibiotics. In addition, 23 cases were able to comply with the 14-day administration period, and one case was less than 14 days. By having the pharmacist confirm the susceptibility results of the detected bacteria and make suggestions before the doctor’s prescription, the number of easy oral broad-spectrum antibacterial drug prescriptions was reduced, and an appropriate prescription could be selected.

Naldemedine is a drug used to prevent opioid-induced constipation (OIC); however, the use of naldemedine leads to the frequent occurrence of diarrhea. As diarrhea is associated with peripheral opioid withdrawal symptoms, the duration of opioid administration before the initiation of naldemedine administration may be an important factor for preventing diarrhea. To determine the appropriate time for the initiation of naldemedine administration, we examined the opioid administration period before starting the naldemedine administration. This study was a retrospective case-control study. The participants were patients who had received opioids, and were newly administered with naldemedine from October 2019 to January 2020 at Yamagata University Hospital. The initiation of naldemedine was decided by the attending physician. The opioid administration period before the initiation of naldemedine administration was analyzed using the Mann-Whitney U-test. To determine the cut-off value of the opioid administration period before starting the naldemedine administration to prevent the occurrence of diarrhea, receiver operating characteristic (ROC) analysis was performed. The study enrolled 38 patients, with 12 in the diarrhea and 26 in the non-diarrhea group. The opioid administration period before starting the naldemedine administration in the diarrhea group (53.5 [8.3 - 124.8] days) was significantly longer than that in non-diarrhea group (5 [1.0 - 34.8] days). The ROC analysis showed the initiation of naldemedine administration to be less than 4 days after starting opioid administration for the reducing risk of diarrhea. The results provide new insights into the prevention of diarrhea incidence and may promote the appropriate use of naldemedine for patients with OIC.

It is important for patients to maintain medication adherence, for which an understanding of patient psychology by pharmacists is essential. However, as most pharmacy students do not have a chronic illness, it is difficult for them to recognize the problems associated with taking medication, such as the burden of regularly taking medicines. At our university, we conducted a simulated medication experience to help students understand the factors that reduce adherence and patient psychology in relation to medication. A questionnaire survey about medication adherence was conducted before and after the experience. Based on the survey results, students learned about the difficulty of regularly taking medication and the reasons that patients forget to take it through experience. Furthermore, students with support from family members during the simulation demonstrated high medication compliance. Moreover, as students who had taken medication for a certain period had significantly higher medication compliance in the simulation, the experience of regularly taking medication is important. Using a text mining approach to assess free descriptions of impressions after medication simulation, we found that students learned the causes of forgetting to take medication and factors that reduce adherence. Furthermore, the students learned about the influence of patient psychology on medication adherence, such as the presence of symptoms and the significance of medication.

Thus, our study indicates that a simulated medication experience is a useful program for pre-clinical education to improve pharmacy students’ understanding of the factors that lower adherence and patient psychology regarding medication.

The use of closed-system drug-transfer devices (CSTD) is recommended for occupational exposure to injectable anti-cancer drugs. We evaluated the usability by users who actually use CSTD, the economy, and the impact on operational efficiency. In a questionnaire survey of pharmacists and nurses regarding the usability of each CSTD product, the evaluation of ChemosafeLock^TM was significantly high in both occupations in items “ease of connection between devices” and “ease of remembering operations.” It was found that expanding the use of CSTD for the preparation and administration of all injectable anti-cancer drugs would increase the facility burden by 18 to 37 million yen per year. The CSTD to be adopted was selected based on the results of the questionnaire and the trial calculation of operating costs. Next, when the preparation time of cyclophosphamide and bendamustine was compared before and after the change of adoption of CSTD, the preparation time was significantly shortened when both drugs were prepared with the changed CSTD. The fact that the method of connecting and disconnecting devices, which is a common task for pharmacists and nurses, is simpler than that of other products is considered to be a factor in the evaluation of the questionnaire and shortened the preparation times. Medical devices have been devised to improve not only performance but also usability. These results suggest that a change of adoption to appropriate CSTD could improve the usability by pharmacists and nurses and the efficiency of preparation and administration operations.

Thyroid dysfunction, occurring as a side effect of treatment with molecular targeted antineoplastic drugs, should be monitored in patients. This study evaluated the occurrence of thyroid dysfunction as a result of treatment with 16 such drugs, using the Japanese Adverse Drug Event Report database. The reporting odds ratios indicated that thyroid dysfunction was associated with the use of the drugs sunitinib (SUN), ipilimumab (Ipi), nivolumab (Nivo), and pembrolizumab (Pembro). The median time to onset of hypothyroidism/hyperthyroidism from the beginning of treatment with SUN, Ipi, Nivo, and Pembro was 15/22.5, 34/36, 85/29, and 75.5/28 days, respectively. In the cases of Nivo and Pembro, hyperthyroidism occurred much earlier than hypothyroidism did. The Weibull distribution for SUN exhibited a profile for early failure, suggesting a high incidence of hypothyroidism, early in the course of treatment. Keeping these characteristics in mind, it is important to monitor thyroid function from the start of treatment with SUN. The maximum time for onset of thyroid dysfunction, from the end of therapy with SUN, Ipi, Nivo, and Pembro, was 1311, 295, 272, and 121 days, respectively. Thyroid dysfunction that developed during the course of treatment was surmised to occur as a result of the drug main effect and the immune response it elicited.

Thyroid dysfunction, caused by the therapeutic administration of molecular targeted antineoplastic drugs, is associated with various developmental situations. Therefore, thyroid function should be closely monitored, keeping in mind the properties of the drug and the profile of the patient.

A female patient in her 30s developed intractable trigeminal neuralgia on the left side of her face due to a metastatic tumor in the left middle cranial fossa. Despite being treated with carbamazepine, gabapentin, pregabalin, baclofen, tramadol, lidocaine, Neurotropin, and nerve block, the trigeminal neuralgia was not resolved. After a joint discussion between pharmacists and neurosurgeons, the patient was suspected of having trigeminal neuralgia with facial numbness due to a tumor. We, therefore, administered traditional the Japanese herbal medicine Goshajinkigan, a formulation approved for pain and numbness. An MRI revealed a tumor with edema around the left trigeminal nerve, and the traditional Japanese herbal medicine Saireito was also administered to reduce edema. Her neuralgia improved markedly after Goshajinkigan and Saireito administration, i.e., the pain was confined to a narrow area on her left lower eyelid, temple, and lower jaw. Furthermore, her breakthrough pain scale score decreased from numerical rating scale (NRS) 10 to NRS 3, and her continuous pain scale score decreased from NRS 10 to NRS 0. The findings from this case suggest that Goshajinkigan and Saireito may benefit patients with intractable trigeminal neuralgia.