The usefulness and uniformity of division for three types of tablets (U19D9, U8D9 and U2D9) were investigated to design a novel film-coated scored tablet, which can be divided by pressure regardless of the side with the score and the presence of packaging, were evaluated by pharmacists, volunteers and elderly patients. The results obtained are as follows:
1. Though the usefulness of division, which deteriorated with the presence of packaging, was affected by the dividing method, the overall evaluations of U19D9 and U8D9 were superior to that of U2D9.
2. U19D9 showed a uniform division regardless of the subject, dividing method and presence of packaging when dividing one tablet. when dividing of one packaged sheet (10 tablets), the coefficient of variation of the divided tablet weight for U19D9 and U8D9 was smaller than that for U2D9.
3. From the above results, U19D9 was found to be a film-coated scored tablet that was easy to divide and also demonstrated a greater uniformity of division.

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A transdermal therapeutic system (TTS) for the delivery of theophylline would be useful for treating bronchial asthma, especially in the case of asthma attacks in outpatients. We prepared several new types of theophylline and aminophylline ointments using transdermal absorption enhancers and measured the in vivo transdermal absorption efficiency of theophylline in rats. Among the ointments tested, a washable ointment of theophylline with N-methyl-2-pyrrolidone as a solvent and isopropyl myristate as an absorption enhancer showed the best results. The highest absorption was obtained with a concentration of 2% theophylline and 57% isopropyl myristate. The ointment was quite stable for at least 56 days at room temperature. An aminophylline ointment prepared in the same way showed less absorption and the change in appearance started after 1 week at room temperature. The serum levels of theophylline in the rats applied with the new theophylline ointment reached 10μg/mL after 2 h and a maximum level of 20μg/mL after 6 h. There was no apparent time lag in the absorption. These results suggest that a transdermal therapeutic system for the delivery of theophylline can be useful, even in the case of asthma attack.

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It has recently been reported that therapeutic drug monitoring (TDM) plays an important role in the optimal individualization of drug dosage regimens. However, TDM is known to have some pitfalls including inappropriate blood sampling, and these pitfalls are considered to possibly result from a lack of TDM education by the medical staffs, especially doctors and nurses. In the present study, we thus tried to determine whether an improved knowledge about TDM by the medical staff would result in a better drug therapy (e.g. dosage design). The medical staff was thus taugth about TDM pharmacists regarding several points, including a blood sampling. After this TDM education, the incidence of a time difference between the enforcement time and the recording time of drug dripping and blood sampling significantly decreased. The incidence of inadequate blood sampling in outpatients was 90% before TDM education, while after such education, it was only 14.5%. TDM education improvements were observed in the dosage regimens, drug evaluation, and monitoring of side effect, drug interaction and compliance, and thus, effectiveness of drug therapy was a much higher, than that before TDM education. These results suggest that an improved educational program for TDM given by pharmacists for medical personnel may thus significantly improve the clinical effectiveness of drug therapy and also help to avoid errors drug administration.

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A sensitive and specific double-antibody enzyme immunoassay (EIA) for adrenocorticotropic hormone-like immunoreactive substances (ACTH-ISs) was developed. In competitive reactions, the ACTH (1-24)-antibody was incubated with both ACTH (1-24) standard (or sample) and 13-D-galactosidase labeled synthetic human ACTH (1-24) (delayed addition). The free and antibodybound enzyme haptens were separated by using an anti-rabbit IgG coated immunoplate. The activity of the enzyme on the plate was fluorometrically determined. The present immunoassay allows for the detection of 2 to 600 fmol/mL of ACTH (1-24). Using the proposed EIA, ACTH (1-24)-ISs in human plasma were thus determined. As a result, the levels of ACTH (1-24)-ISs in human plasma were found to be about 3.7 fmol/mL.

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The nifedipine capsule is frequently administered by the sublingual route to provide a rapid effect, especially in patients who require an immediate reduction of an elevated blood pressure. However, many problems have also been reported in association with dispensing nifedipine capsules for the rapid management of systemic hypertension. In this study, 2 procedures of nifedipine administration for immediate treatment were evaluated regarding the efficacy and usefulness in a clinical setting.
Nifedipine liquid (10 mg) was withdrawn from a capsule with a 1.0-mL syringe through an 18-gauge needle and then was administered sublingually to 7 patients. nifedipine granules (10mg) were administrated orally with a glass of water to 6 patients.
The oral administration of fine granules provided higher serum levels of nifedipine with a more rapid onset than the sublingual administration of liquid in the first 30 min. In addition, the former administration technique also provided prompt and significant reduction of the systolic blood pressure, especially in patients with >170 mmHg systolic blood pressure.
In conclusion, among the commercially available nifedipine products, nifedipine fine granules were found to be both easy to use and effective for immediate management of systemic hypertension with a rapid onset of action.

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Pursuant to the revision of the Pharmacists' Law in April, 1997, we pharmacists have the responsibility to provide information to patients about medications. However, it is uncertain as to wheter written information is effective enough for the elderly living in our community.
Our research focused on the results of providing written drug information to 161 elderly homecare recipients aged 65 and older. Medication use was observed by pharmacistconducted interviews during home visits. Compliance was estimated by comparing the prescribed regimens with medications actually being taken at home. Knowledge about medications was also analyzed. Our results showed that the elderly home-care recipients knew only 2.4% of the names, 34.2% of the purposes, 66.0% of the dosages, 2.0% of the side effects, and 0.06% of the interactions of their prescribed medications.
We found that written drug information significantly increased the patients' knowledge of the name of the diseases, the purposes of the drugs, and the side effects. However, such knowledge did not improve the compliance among the elderly. Medication knowledge was also not affected by written drug information when the elderly patient had a hearing or visual impaiment. Nevertheless, we found that there was significant inverse association between knowledge of the name of the drug and compliance among those elderly patients who had a visual impairment without any written drug information.
It is therefore crucial that pharmacists provide elderly home-care recipients with not only verbal but also written information about their medications.

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We have followed up a liver transplantation recipient (fifty six years old, female) from a living donor for pharmacotherapy including immunosuppressant, ciclosporin since February 1994.
Therapeutic drug monitoring (TDM) of the tacrolimus concentration in the whole blood also began in April 1996 for a kidney transplantation patient. In March 1997, a “Morning Conference of kidney transplantation (opening from eight am every Friday)” with Department of Urology, Department of Internal Medicine II and Division of Pharmacy, was jointly established. Clinical pharmacists also participate a “Clinical study meeting of kidney transplantation (Starting from four p.m. on the 1 st and 3 rd Wednesday severy month)” . We also made a practical videotape in English explaining TDM to foreign doctor trainees, in response to a request from a Romanian nephrologist who was receiving kidney transplantation training in April 1997. We also report some events that clinical pharmacists have participated in regarding kidney transplantation therapy.

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It is well known that the bioavailability of digoxin is dependent on the dosage forms and the ground tablets of digoxin are also more frequently ordered instead of the powdered form for prescriptions. In the present study, the weight loss of the drug, due to the dispensing process and adherence to either the package or the measuring cup, was studied. Three dosage forms of digoxin including ground tablets, powders and elixir, were used as the model forms. Simulative dispensing was carried out using the conventional methods.
For ground tablets and powders, a 2 to 3% weight loss in the dispensing process, and a 7 to 8% weight loss due to adherence to the package were observed. In the case of the elixir, a 0.3 to 0.4% weight loss in the dispensing process, and a 1.3 to 1.4% weight loss due to adherence to the measuring cup and the plastic bottle was observed.
We thus conclude that the elixir is the most suitable digoxin dosage form for children who have difficulty swallowing tablets due to its smaller weight loss.

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A questionnaire survey of patinets' views regarding pharmaceuticals was carried on 4264 drugadministered patients more than 16 years of age at 13 medical institutions, consisting 9 hospitals and 4 pharmacies in the suburbs of Niigata City.
The results were as follows:
1. The degree of patinet concern about pharmaceuticals was 33.7%(95% confidence interval 27.8-39.6). The score was significantly higher in young patients than in elderly patients (P<0.0001), in females than in males (P=0.0002), in inpatients than in outpatients (P< 0.0001) and in the 2 university hospitals than in the other 11 institutions (P< 0.0001).
2. Regarding the information which the patients wanted to know about the pharmaceuticals, 53.1 % wanted to know about the “effects of the drugs”, 44.7% about the “adverse effects of the drugs”, 27.2% about “drug interactions” and 21.2% about “name of drugs” . Therefore, a high percentage of patients wanted to know about both the “effects of the drugs” and the “adverse effects of the drugs” .
3. The degree of patient anxiety about any adverse effects of the drugs was 23.0%(95% confidence interval 19.7-26.3). This percentage was significantly higher in young patients than in aged patients (P< 0.0001), in females than in males (P<0.0001), in the 6 institutions providing no 300 drug information than in the 7 institutions providing drug information (P=0.0431) and in the 9hospitals than in the 4 pharmacies (P<0.0001).

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We evaluated the stability of various compositions after the plastic exterior bag of the TPN kit leaked out and the kit's partition broke.
PN-twin-2 and Aminotripa 2 leaked out of the plastic exterior bag in the double chambered type TPN kit, after being stored at room temperature for 14 days, a slight degree of coloration was noticed on the amino acid layer, while the A350 level (index for tryptophan degradation) was increasing.
Coloration was evident after the kit's partition broke, and the residual rate of glucose and amino acids were over 95%.
As for Unicaliq N, the residual glucose and amino acid rates were also over 95%.

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The drug interaction between sodium valproate (VPA), an anticonvulsant, and faropenem sodium (FRPM), a new penem antibiotic drug, was studied in rats. No significant change was observed in the plasma VPA concentration when compared with the control after the administration of VPA (TOO mg/kg per oral) simultaneously with FRPM (600 mg/kg per oral).

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To ensure the quality of sterilized IVH preparations, we attempted to predict the pH of the admixture using Shoji's method (a method of for predicting incompatibility when admixing injections for infusion) and Iseki's method (a method for multiple admixture based on the acid-base equilibrium theory).
Furthermore, we also carefully measured the endotoxin levels in IVH.
A significant correration between the estimated pH and the measured pH (n=19) was observed in both Shoji's (r=0.9761) and Iseki's method (r=0.9849). In addition, the injected levels were determined by dilution with any sterile water and evaluated after recovering any added endotoxin in IVH. As a result, we recovered more than 80% of the endotoxin from the diluted IVH solution.

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Recently, the administration of traditional Chinese herbal medicines (Kampo medicine) has increased especially, in the form of Kampo extrast granules, as a medical treatment in dentistry and oral surgery. We surveyed the use of Kampo medicine in our hospital from April 1995 to March 1996. A total of 53, 884 prescriptions were issued during this period, including 3, 373 prescriptions (6.26%) for Kampo medicine. The following Kampo medicines were the most frequently prescribed: Bakumondo-to (14.7%), Juzentaiho-to (14.6%), Kami-shoyosan (10.2%), and Sho-saiko-to (9.9%). These accounted for almost half of all the Kampo medicine used in our hospital. The main indications for Kampo medicine were due to the following chronic diseases; glossodynia (22.1%), xerostomia (19.4%), oral cancer (16.8%), and atypical facial pain (16.2%) etc. These indications mainly determined by the Department of Oral Surgery and the Department of Anesthesiology. Regarding patient age, the largest group consisted of patients in their seventies (31%), almost 60% of all patients prescribed Kampo medicine were above 60 years old. The ratio among men and women was 3 to 7. This survey suggests that a lot of Kampo medicine has been recently introduced for certain indications in dentistry and oral surgery.

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We conducted three-month clinical pharmacy training program for third-year undergraduates studying at Nagasaki University. The students received training at the School of Pharmaceutical Sciences, the Department of Hospital Pharmacy, the School of Medicine, and at fourty-three community pharmacies. We taught communication skills at the School of Pharmaceutical Sciences. The results of a questionnaire survey given to the students after the communication skills program showed that 75% of them considered this program to be effective for the teaching of basic knowledge about clinical pharmacy.

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It is important that hospital pharmaceutical manufacturing (HPM) is used rationally for both prescription and non-prescription drugs. However, at Fukushima Medical University Hospital, the rational use of HPM was not considered to be sufficient. A new system for regulation of the HPM is thus needed because HPM has to be used under strict controls as well as investigating drugs. As a result, an institutional review board for HPM was established at our hospital and the pharmaceutical quality control of HPM regarding factors as assurance or microbial control, was improved. Furthermore, for the rational use of HPM, we prepared information leaflets for patients, package inserts for doctors, and also developed a format for the clinical evaluation of HPM. 35 kinds of HPM are now being used under this new system.
At the end of this chapter we proposed a system for the rational use of HPM at our hospital.

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