Topical medicinal substances (or drugs) in liquid formulations are conventionally applied using cotton, gauze or other applicators made of cellulose materials. The adsorption of drugs by these cellulose materials is known to reduce the availability and, therefore, the efficacy of such drugs for patient treatment. In our previous studies, cellulose fibers were found to be negatively charged. A substantial degree of adsorption of positively charged or cationic drugs, such as disinfectants, due to electrostatic interaction was also observed in these studies. The objective of this study was thus to determine the effect of coating cottonwith positively charged chitosan on cationic drug adsorption. The results of this study indicate that coating cotton with chitosan reduces the adsorption of cationic drugs in the application of topical formulations.

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In order to evaluate the dividing properties of scored sulfonylurea (SU) tablets, and to also elucidate the usefulness of powder prepared by pulverizing SU tablets, we examined the content uniformity and weight variation in five kinds of divided SU tablets and in each kind of powder prepared by pulverizing the SU tablets with either EFC lactose, powdered lactose or a mixture of powdered lactose and potato starch. All tablets were divided by hand, while the 3 different powders were divided and packed into machines used for dividing and packing powdered medicine.
As a result, large variations in both the weight and SU content of the two halves were observed following the division. However, the divided tablets showed a good correlation between the variation of the divided tablet weight and that of to SU content. On the other hand, some differences in the dividing property were observed among the various kinds of powders. When the powders were divided and packed by the machine eqquipped with a linear vibrator to feed powders into the division holes using an alternating motion (Tosho, OMP-90 A), packing errors in dividing weight frequently occured for all powders. In addition, those of EFC lactose caused a low dispersibility of the SU constituent into the divided powders. However, by using two machines, one which automatically feeds the powders on a revolving disk (Takasono, HP-93 UT) or manually feeds them into the division holes (Yuyama, CP-D-42), such disadvantages as OMP-90 A improved in all the powders.
These findings suggest that dividing the SU tablets is not an accurate method of drug dispensing and it is thus necessary to carefully select powder's excipient and machine used for dividing and packing the powders when by pulverizing the SU tablets.

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The povidone-iodine contents in liquid and ointment were determined using high-performance liquid chromatography (HPLC). The chromatograph equipped reversed phase ODS column and detector was set at 355 nm. The flow rate of the mobile phase of methanol: water (7: 3) containing 1% KI was 1.0ml/min.
The retention time of povidone-iodine was 3.9 min. When this HPLC was applied to the povidone-iodine preparations (gurgle and solution) on the commercial market, the povidoneiodinecontents were found to comprise more than 95%. In the povidone-iodine sugar ointment, which was prepared in the hospital pharmacy, admixed with lysozyme chloride ointment, the iodine contents by this HPLC had a good correlation with the available iodine contents by titration (r=0.9999). Furthermore, this method could also be applied to povidoneiodine in the organic solution after extracting the povidone-iodine sugar ointment admixed with lysozyme chloride ointment.

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It is well known that tobacco smoke causes the health risks not only for smokers but for non-smoker as well. We thus evaluated the urinary cotinine, content, which is a major metabolite of nicotine, by high-performance liquid chromatography (HPLC). Such a determination is considered to provide a useful objective assessment of exposre to tobacco smoke. Using the Previously described method, non-smokers in a typical company were thus found to appareutly demonstrate cotinine concentrations due to passive smoking, Furthermore we also determined the urinary cotinine in an asthma patient who could not stop smoking. The results indicated that the measurement of the urinary cotinine level by HPLC could be effective as a strong motivating factor to stop smoking and also to form a system of nosmoking support groups. In the future, such continuous study will enable us to approximate the effect of passive-smoking on a disease based on the measurement of the urinary cotinine level.

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We evaluated a one-to-one education program carried out by pharmacists to NIDDM outpatients treated with oral antidiabetic drugs. The subjects consisted of 73 outpatients without any complications who had glycosylated hemoglobin (HbAlc) levels of over 7%. They consisted of 32 men and 41 women, all under 70 years of age (average, 56.9±7.2yr).
We provided the one-to-one education program to patients in a medication counseling room. The outcome was later evaluated by a postal qestionnaire survey to evaluate patient satisfaction based on improvements in both the fasting plasma glucose (FPG) and HbAlc. The patients initially had a low level of understanding regarding oral medicinal treatment, with an average score of 2.9±1.6 out of 6 items. A survey of our education program showed that 87.1% of respondents were satisfied with our program. The FPG levels significantly decreased both 2 months and 4 months after education, from 194.3±44.8 to 181.8±40.3, 178.0±45.8 mg/dl, respectively.
The HbaAlc levels significantly increased before education, but there after significantly decreased 2 months and 4 months after education, from 8.8±1.3 to 8.5±1.3, 8.3±1.1%, respectively. These results suggest that a one-to-one education program given by pharmacists to NIDDM outpatients receiving oral antidiabetic drugs may be useful for improving diabetic control, by promoting a better understanding of the oral medicinal treatments, and may therefore also lead to greater awareness of diabetic therapies.

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The adsorption characteristics of various adsorbates by spherical charcoal (Kremezin ^®) were studied in vitro and then compared with those of powdered medical charcoal. Medical charcoal adsorbs substances with molecular weights ranging from several hundred daltons to several thousand daltons. Kremezin, however, adsorbs only low molecular weight substances with molecular weights of up to several hundred daltons. Therefore, the adsorption selectivity of Kremezin, which is related to the molecular weight of adsorbate, seemed to contribute to the specific pharmacological action of this drug under clinical conditions. In batch adsorption tests for various amines, amino acids and organic acids with molecular weightsof from 45 to 251, both adsorbents showed similar behaviors. An increase in the size of the adsorbate molecule enhanced the degree of adsorption, especially in compounds that are analogs. The molecular structure also seemed to be an important factor in the adsorption phenomena; an aromatic ring tended to increase the adsobability while the amino group, carboxyl group and hydroxyl group all showed a decrease in adsorbability.

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By comparing the usual method of measuring medication dosage in medical cups in our hospital (A packages) with newly developed one dose packages (B, C packages) the stability of the ingredients, the sterility of the material, and the accuracy of the correctness of the measuring the samples, we assessed the usefulness of one dose packages of preservativefree 0.125% tyloxapol solutions for the administration of oral medications. The results were as follows: 1) pH tended to rise in A as the strage temperature increased but was stable in both B and C. No changes in the external appearance were detectable in any of them. 2) No microbial contamination was found in any of the packages, A, B or C. 3) The measuring accuracy was better in B and C than in A. Thus, the one dose packages appeared to be more useful than the usual method of measuring drugs using medical cups as a method by which 0.125% tyloxapol solutions for inhalations can be used safely and conveniently even when supplied to patients.

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To elcidate the factors leading to hindrance for the rationalization of dosage regimen of vancomycin (VCM), its therapeutic drug monitoring (TDM) data obtained from 64 patients were reviewed, and the utility of a nomogram method to determine the daily dosage of VCM (Nomogram_Dose) described in the package insert of VCM injection was examined in comparison with another nomogram method to determine the dosing interval (Nomogram_Int) which was reported by Matzke et al. Before starting the dosage regimen, the serum peak and trough levels of VCM in the almost patients deviated from their therapeutic ranges (peak, 25-40μg/ml; trough, ≤10μg/ml), because the uniform dosage based on the descriptions in the package insert were performed for the patients with various degrees of renal functions. The after dosage regimen by using Nomogram_Int., the serum peak and trough levels of VCM in the subjects were controlled within their therapeutic ranges as a result of the uniform dosing interval of 8 or 12 hours in the early step of dosing were corrected to 18-56 hours according to the values of creatinine clearance (CLcr) in the patients. On the other hand, the serum level of VCM was poorly controlled within its therapeutic ranges after starting the dosage regimen by using a Nomogram Dose, because the nomogram provided only the daily dose but not the optimum dosing interval. To aleat all physicians to the problem of the dosage regimen of VCM, a letter including these results was thus distributed to all wards in our hospital. Thereafter, the percentage of well controlled subjects, in the early dosage step increased to about 10-fold which was about as much as that before the information was disseminated.
Based on the present results we strongly recommend the package descriptions inside VCM package should thus be revised for adoption in clinical practice.

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A fact-finding study of the inhalation techniques for pressurized aerosol metered-dose inhaler (MDI) use was carried out on 130 asthmatic patients who used the MDI From April 1993 to October 1993. Furthermore, the relationship between the degree of practice and the comprehension of the correct inhalation technique was also evaluated. Eight maneuvers to inhale correctly were considered and consisted of:(1) Removing the cap and shaking the MDI, (2) Holding the MDI upright and 4 cm in front of the open mouth, (3) Tilting the head back and breathing out, (4) Activating the MDI and then inhaling slowly for 5-6 seconds, (5) Holding the breath for 10 seconds, (6) Breathing out slowly, (7) Gargling in the thrioat, (8) Waiting 3 minutes and then chang hands before taking another puff.
The questionnaires were collected in 80 of 130 patients (61.5%) and there was a wide range in the percentages of patients correctly performing the individual maneuvers, as follows:(1) 88.8%, (2) 27.5%, (3) 42.5%, (4) 30.3%, (5) 47.5%, (6) 63.8%, (7) 17.5%, and (8) 33.8%. Three patterns were observed in the relationship between the degree of practice and the comprehension of the correct inhalation technique. One is that maneuvers (1), (5), and (6) could be easily carried out because of good comprehension. Second is that the maneuvers, such as (2), (3), (4), and (8), could not be carried out because of poor comprehension. Third is that maneuvers (7) could not be carried out in spite of good comprehension.
These results suggest that it is important to provide proper drug information and to educate patients on the correct inhalation techniques of MDI, in order to improve the clinical effectiveness and avoid any adverse effects of MDI based on improper application techniques.

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Although the efficacy and safety of ophthalmic solutions are known to be related to their use, so far little has been published on the patients use of ophthalmic solutions. In an attempt to facilitate the counseling for the patients prescribed with ophthalmic solutions, a fact-finding study on the rational use of ophthalmic solutions was carried out on ophthalmic outpatients from February 1994 to May 1994. Questionnaires were made a consisting of 22 items concerning the rational use of ophthalmic solutions, including the number of instilled drops per eye for each treatment, the treatment after the instillation of drops, the administration order for ophthalmic solutions, the administration intervals of other ophthalmic solutions, and adverse reactions. Completed questionnaires were collected from 287 patients. The mean age of these patients was 54.4 years and their mean period for eye disease was 5 years. The ophthalmic solutions exhibiting such systemic actions as ophthalmic ±-lockers were used in 53% of the patients. The inappropriate use of ophthalmic solutions was reported in 47% of the patients regarding the number of instilled drops, in 48% regarding the treatment after the instillation of drops, in 65% related to the administration order of the ophthalmic solutions, and in 78% related to the administration intervals of the other ophthalmic solutions. The directions for the use of ophthalmic solutions were under stood by the physicians and pharmacists in 45% of the patients regarding the number of instilled drops, in 35% regarding the administration order of the ophthalmic solutions, in 64% regarding the administration intervals of the other ophthalmic solutions. Three percent of the patients experienced systemic adverse reactions after the administration of ophthalmic solutions.
Based on these results, in order to improve the clinical effectiveness and avoid any systemic adverse effects of ophthalmic solutions based on unsuitable use, it is thus important to provide the proper drug information and to educate patients on the correct administration techniques of ophthalmic solution.

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We invesigated patients who consulted multiple clinics. The patients who had their prescription filled at 4 pharmacies (Bohsei Pharmacy, Bohsei Oiso Pharmacy, Bohsei Yoyogi Pharmacy, and Bohsei Tukiji Pharmacy) during the month of April in 1994. We determined the frequency of the duplicated prescription of the same drug and the relative risk of drug interactions. The patients who consulted multiple clinics were noted in 11.6% of 38, 027 general patients. The females (12.0%) slightly outnumbered the males (11.2%). Since 50.1% of the patients who consulted multiple clinics were over 65 years of age and 20.9% of all patients aged over 65 years consulted multiple clinics.
The investigation on visits to of multiple clinics showed that the departments of of internal medicine and ophthalmology has such multiple consultations in 19.7% of all patients, the departments of internal medicine and surgery in 10.7%, departments of internal medicine and dermatology in 8.7%, the departments of internal medicine and urology in 7.3%, the departments of internal medicine and otorhinolarynology in 6.9% the departments of internal medicine and psychiatry in 3.4%, and the departments of internal medicine and obsterics/gynecology in 1.9%. In addition other combinations were noted in 31.1%. Drug prescription duplication was noted in 1.8% of patients who consulted multiple clinics. The risk of drug interaction in patients who consulted multiple clinics simultaneously was thus found to be twice as high as in general patients.

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To provide information on nutrition therapy by pharmacists, we constructed a calculation form for TPN components using commercially available calculation software. The calculation form was developed to support the prescription of TPN solution. We evaluated the number of questions regarding TPN prescriptions as well as the usefulness of the received information on TPN components by means of a questionnaire sent to doctors. The information was thus utilized in 61 % of the questions regarding prescriptions using TPN solution. As a result, almost all doctors (88%) answered that the information was useful.

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We studied the effect of advising outpatients on the rational use of ophthalmic solutions and compliance by a questionnaire (n=158), in order to establish the optimal consultation method. A total of 41.8% of the patients answered the questionnaire. In compairing the actual use of ophthalmic solutions before and after consultation, the rates of rational use increased for all items except for “applications per day”, which decreased slightly from 93.4% before the consultation to 90.2% after that. In particular, “eyelid closure” and “nasolacrimal occlusion” after instillation, and “the 5 min interval of instillation in the case of plural medication”, considerably increased from 34.8% before the consultation to 60.6% after that, from 9.5% to 50.8% and from 45.9% to 73.8%, respectively. The compliance remarkably improved in glaucoma patients after consultation regarding “the 5min interval of instillation” .
Based on these results, our consultation method for the rational use on ophthalmic solutions was thus evaluated. However, since some patients who still did not appreciate the need for the rational use of such medication still presented, further improvements in the consultation method requires for the rational use.

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