病院薬学
Online ISSN : 2185-9477
Print ISSN : 0389-9098
ISSN-L : 0389-9098
26 巻, 2 号
選択された号の論文の14件中1~14を表示しています
  • NORIYASU FUKUOKA, TOYOHISA TSUKAMOTO, JUNJI UNO, MICHIO KIMURA, SHUSHI ...
    2000 年 26 巻 2 号 p. 135-144
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    We conducted a study to clarify the most suitable factors related to the carbamazepine daily dose (D) with the serum concentration (Ct).
    Therapeutic drug monitoring data obtained from epileptic patients who were chronically treated with single and repetitive oral administrations of carbamazepine (CBZ). The 119 steadystate data were used.
    First, when the extracellular water volume (VECW) was employed as a transforming factor, Ct/(D/VECW) ratio was found to be independent of the patient's age. In addition, a multiple regression analysis revealed that Ct was dependent on only D/VECW. From these findings, we concluded that Ct could only be related with D/VECW.
    Next, a l -compartment model including two assumptions that CBZ binds to plasma protein and the distribution volume of free-CBZ is proportional to VECW, was postulated for our analysis. At steady-state, Ct was expressed as follows:
    C1X (1+KaCbsKaX)/(1+αKaX) (X=D/VECW.α, Ka, Cbs: parameter)
    The parameter values were estimated by the nonlinear least squares method as α, Ka and Cbs were 0.013, 1.6 and 12.8, respectively.
    The plasma protein binding ratios were 92.3, 90.2 and 87.1 (%) when the serum CBZ concentrations were 6, 8 and 10 [μg/mL], respectively. These values closely corrected with those reported previously.
    As a result, VECW is considered to be a suitable transforming factor for the relation between Ct and D, and our model seems to be approriate.
  • 名徳 倫明, 下村 一徳, 土師 久幸, 西野 隆雄
    2000 年 26 巻 2 号 p. 145-156
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    One of the side effects of cancer chemotherapy is the occurrence of stomatitis. Many studies have shown the effectiveness of a 0.1% allopurinol gargle for treating such stomatitis. Allopurinol gargle develops crystalline deposition a few days after preparation, and therefore it should befreshly prepared each time before use.We developed a prescription that delays crystalline deposition by adding glycerin to allopurinol gargle.
    Sterile allopurinol gargle (sterile ALT) was prepared by crushing allopurinol tablets, and then glycerin was added at various concentrations.The dissolved amount after 30 days was 0.65±0.05 mg/mL in sterile ALT without glycerin (sterile G0-ALT), 0.75±0.01 mg/mL in sterile ALT containing 1% glycerin (sterile G1-ALT), 0.79±0.03 mg/mL in sterile ALT containing 3% glycerin (sterile G 3-ALT), 0.89±0.06 mg/mL in sterile ALT containing 5% glycerin (sterile G 5-ALT), and 0.98±0.01 mg/mL in sterile ALT containing 10% glycerin (sterile G 10-ALT). The dissolved amount increased with the glycerin concentration.Allopurinol crystal deposition was observed after 2 days in sterile G 0-ALT, after 3 days in sterile G 1-ALT, after 6 days in sterile G 3-ALT, and after 10 days in sterile G 5-ALT, but could not be detected even after 30 days in sterile G 10-ALT.
    In tests of the sensation tastes during use in normal subjects, similar results were obtained between sterile G 10-ALT and sterile G 0-ALT. The xanthine oxidase (XOD) inhibitory activity was also similar between the two gargles.
    These results show that sterile G 10-ALT can be preserved for 30 days at 25°C, and its effects and sensation during use are similar to those of a prescription not containing glycerin.
  • Observing Cases of Carbapenem Antibiotics and Histamine H2-Receptor Antagonists Administered during Renal Dysfunction
    MITSURU MACHIDA, KENICHI SAGAWA, SETSUKO MURASE, HAJIME KAGAYA, HARUKO ...
    2000 年 26 巻 2 号 p. 157-163
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    The Ministry of Health and Welfare has issued a warning against carbapenem antibiotics regarding, their relationship to central convulsions and renal function, and also against histamine H2-receptor antagonists as well, regarding their relationship to renal dysfunction, hematological disorders, and other problems. Therefore, the careful administration of such drugs to prevent renal dysfunction is considered particularly important and strict guidelines for use of there drug have been developed but there has so far been no reports of institutional standardization of these guidelines. The Committee on the Promotion of the Appropriate Use of Medicines, which consists of physicians of various departments in our hospital, prepared unified drug administration guidelines for our hospital, and also examined their usefulness. As a result, these guidelines have proved to be useful, and were found to help reduce the overall health care costs.
  • MOEMI SAITO, MACHIKO WATANABE, MASAHIRO HOSHI, TAKEHIKO MIKAWA, HIROHI ...
    2000 年 26 巻 2 号 p. 164-170
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    For the purpose of determining the shelf life of 1% Methylene Blue (MB) injection, its stability was investigated under 4 storage conditions for 30 weeks. The content of MB in 1% MB injection started to decrease at 5°C in the dark 4 weeks after preparation, but no significant differences were observed under three other storage conditions (at room temperature (22.0±0.5°C) and at 40°C in the dark and at room temperature (22.0±0.5°C) in 1000 Lux fluorescent light) for 30 weeks. According to these results, we changed the shelf life of 1% MB injection from 2 to 6 months and the frequency of preparation from six times to twice/year. The unit cost before and after the change of shelf life was compared. One unit cost calculated according to materials costs and labor costs was ¥2, 738.6 during the 1993-1995 period (six times preparations/year), while it was ¥1, 545.9 during the 1996-1998 period (twice preparations/year). A cost savings of ¥1, 192.7/ampule (43.6%) was produced by changing the frequency of preparation from six times to twice/year. In addition, the discard cost for 1% MB injection past its shelf life was estimated. A discard cost saving of ¥85, 766.8/year (75.2%) was achieved by changing the frequency of preparation from six times to twice/year. Furthermore, the working hours were reduced by 9.58 hours/man/year and it allowed pharmacists to utilize the extra time gained by changing the frequency to other work.
  • 三牧 祐渉, 川上 賢哉, 今中 智恵子, 末丸 克矢, 谷口 律子, 渡辺 和英, 荒木 博陽, 五味田 裕
    2000 年 26 巻 2 号 p. 171-176
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    The influences of both the mixing ratios of Witepsol as a lipophilic base and the temperature on the drug release from the zonisamide suppositories was investigated. Mixed types of zonisamide suppositories consisting of Witepsol H-15 (H) and Witepsol S-55 (S) as a lipophilic base were prepared and the release of zonisamide from a suppository was determined using the dissolution apparatus in Paddle method of JPX III. The release rate of zonisamide from the Witepsol (H: S=4: 1) suppository and Witepsol (H: S=3: 1) suppository at 4 hours after start of the release test were 66.6% and 56.5%, respectively. The former was significantly higher (p<0.05) than that of the latter. The release volume and mean dissolution time (MDT) of zonisamide from a suppository increased and decreased, respectively, according to the high mixing ratio of Witepsol H 15.
    The effect of low temperature (32 and 34°C) on drug release from the zonisamide suppositories was also studied using artificial membranes. The drug release properties were changed according to the mixing ratios of the two lipophilic bases and the temperature of the fluid tested. At a low temperature, the amount of released zonisamide correlated with the ratio of Witepsol S 55 in the suppository. However, the amount of the drug released from the zonisamide suppositories decreased at temperatures lower than normal body temperature. These results indicate that the ratio of Witepsol H 15 and Witepsol S 55 in suppositories was important while the temperature also influence drug absorption from the rectum with zonisamide suppositories.
  • 新迫 恵子, 石塚 良子, 若杉 博子, 高柳 和伸, 橋田 亨, 二見 高弘, 石津 雅弘, 乾 賢一
    2000 年 26 巻 2 号 p. 177-182
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    Sufficient drug informations should be provided to patients who place themselves under medical care regarding the proper use of drugs. Various reports have been published regarding what kind of drug information should be provided to outpatients. In our hospital, we meet these requirements by distributing of notebooks on the patients' medication history and medication cards. We have developed a system to prepare medication cards for a clinical consultation of inpatients using the database for outpatients, in order to efficiently individualize the medication cards according to each patients' disease. The accumulation and reproduction of individualized medication cards allows us to efficiently inform and educate inpatients about proper drug usage.
  • 森井 恵, 上野 和行, 高田 充隆, 日野 裕, 笹子 佳門, 柴川 雅彦
    2000 年 26 巻 2 号 p. 183-187
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    A 56-year-old woman inpatient that had been administrated warfarin, digoxin, verapamil and disopyramide after undergoing surgery for a mitral and aortic valve replacement associated with artrial fibrillation received a 300mg daily dose of disopyramide therapy before and after the operation. Although the serum disopyramide concentration was within the normal therapeutic range, dry mouth appeared as a side effect. Disopyramide was thus changed to pirmenol. The trough level of pirmenol was 2.1μg/mL at seven days after starting pirmenol therapy at the dose of 300 mg/day, and the dose was there after decreased to 200mg/day. About two weeks after pirmenol therapy was started, liver injury was observed. At approximately 30 days after pirmenol administration was stopped, the liver function returned to a normal level.
    On the other hand, according to recent reports pirmenol was suggested to show a high level in the liver. The reported levels of pirmenol were also similar to for amiodarone and aprindine, which are both well known to induce side effect in the liver. Therefore, one of the reasons that pimenol induced liver injury may be due to its high levels in the liver.
  • 大坪 泰昭, 石光 淳, 坪根 香織, 吉田 久博, 神谷 晃
    2000 年 26 巻 2 号 p. 188-197
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    Various pharmaceutical preparations are prepared in hospital pharmacies on a daily basis. The Product Liability (PL) Law has been in effect since July 1995 in Japan. To clarity the influence of the PL Law on the pharmacy service for hospital preparations, the frequency of preparation requests, preparation quantities, and the total preparation time of each hospital preparation were investigated retrospectively for 5 fiscal years (April to next March) from April 1993 to March 1998 at Yamaguchi University Hospital. Hospital preparations were classified into three categories based on the raw materials used. The category I preparations were prepared from the medicines listed in the National Health Insurance price standard for medicine, and were used according to the Pharmaceutical Affairs Law. The category 2 preparations were prepared from the medicine listed on the standard price lists and were used outside the jurisdiction of the Pharmaceutical Affairs Law. The category 3 preparations were prepared from chemical agents not listed in the standard price lists. It is necessary to get the approval of the Institutional Review Board at our hospital before category 2 and 3 preparations can be used. The request frequency and preparation quantity of category 1 preparations gradually decreased during the investigation period, while category 2 preparations remained almost constant. On the other hand, those of category 3 preparations steadily increased from 1993 to 1997. In addition, the total preparation time of the hospital preparations gradually increased year by year, and the preparation times for 1997 reached 110 percent of that for 1993. These results indicate that the pharmacists in our hospital have adequately understood the importance of the hospital preparations and have been adhering to the special preparation orders from each physician. As a result, it appears that the PL Law has not substantially affected the pharmacy service for pharmaceutical preparations in our hospital.
  • 吉田 直弘, 新井 克明, 幸田 幸直
    2000 年 26 巻 2 号 p. 198-201
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    The stability of chloral hydrate (CH) in aqueous solutions for rectal use was studied. The CH solution (5%) was stored in glass containers at the volume of 4 mL for 90 days at 25°C (under 480 lux and in the dark) and 4°C (in the dark). To observe the stability in daily use, the CH solution
    was also stored in glass or polypropylene bottles for dispensing at the volume of 100 mL for 90 days at 4°C in the dark. The stability was evaluated by pH variation and the amount of CH in the solution.
    In both CH solutions stored in glass containers at the volume of 4 mL and glass bottles at the volume of 100 mL for dispensing at 4°C in the dark for 30 days, there was very little pH change the solution. Under other conditions, a significant decrease in the pH was observed at the CH solutions stored for 30 days. However, the CH amounts in the solutions remained more than 95% at least 90 days under all tested conditions.
    We therefore conclude that 5% CH solution is applicable for rectal use for at least 30 days, if is stored in glass bottles for dispensing at 4°C in the dark.
  • 根岸 悦子, 中島 裕子, 遠藤 理夏, 山田 安彦, 中村 均, 佐藤 均, 伊賀 立二
    2000 年 26 巻 2 号 p. 202-206
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    An investigation of package inserts was performed for 794 oral prescription drugs, in order to assess the package inserts as an information resource regarding the timing of drug intake which is important for rational usage of medicine. As a result, the number of package inserts which described the proper timing of drug intake was only 157 (20%). The timings of drug intake could be classified into five categories, i.e., before a meal, immediately before a meal, immediately after a meal, after a meal and between meals (at a hunger state). Evidence for the timing of drug intake is written in only 9% of the package inserts. However, such evidence could be provided from interview forms and original articles for 24% and 44% of the drugs, respectively. Furthermore, most of the evidence for the timing of drug intake (94%) was shown to be meant for either the appropriate onset of therapeutic actions (58%) or the prevention of adverse reactions (36%). On the other hand, there was a clear tendency that more evidence is provided for drugs which were put on market more recently. From these results, the information only from package inserts was found to be insufficient for the rational usage of medicine and that the timing of drug intake should thus be explained to patients based on additional investigation from interview forms and original articles as described in this study in order to achieve an improved efficacy and safety of drug administration.
  • 五土嵐 正博, 黒岩 朝子, 林 昌洋, 灰田 美知子, 峯村 信嘉, 高木 英爾, 西山 信一郎, 百村 伸一
    2000 年 26 巻 2 号 p. 207-211
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    We experienced a serious interaction between miconazole gel and warfarin. The patient had just undergone an aortic and mitral value replacement and thus was medicated with warfarin at a dosage according to the International Normalized Ratio (INR) of about 2.0-2.5. He was prescribed miconazole gel 400 mg/day for thrush induced by steroid for asthma. About two weeks later, he showed bleeding in the mouth and underwent a medical examination. His INR was higher than the upper of measurement limit and so he was immediately hospitalized. Vitamin K was given, miconazole gel and warfarin ware stopped. Two weeks later, his INR was less than 3.0 and thus the warfarin was restarted. But his warfarin dose was less than one third of dosethat had been given before hospitalization.
    The interaction between miconazole gel and warfarin that we experienced by our patient while was as serious as the reports from abroad.
  • 外間 惟夫, 芳原 準男, 酒井 将之, 亀谷 浩昌, 大城 進, 坂梨 又郎
    2000 年 26 巻 2 号 p. 212-218
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    Colestimide is a new anion exchange resin synthesized from 2-metyl imidazole and epichlorohydrin, and shows a specific affinity to bile acids among physiological anions. The drug interaction of colestimide with sodium valproate, phenobarbital and carvedilol in the gastrointestinal absorption in male rats was examined.
    The plasma valproate concentrations in the treatment with colestimide were significantly lower than those in the control at 15 min-1 hr, and the drug pharmacokinetic parameters, Cmax and AUC0-∞ were 40 and 25% decreased after oral administration of 100 mg/kg sodium valproate with 1.05 g/kg colestimide. The plasma phenobarbital concentrations were significantly lower than the control at 30 min-1 hr, and tmax was 3.0 times delayed after oral administration of 80 mg/kg phenobarbital with 1.05 g/kg colestimide. On the other hand, the administration of 20 mg/kg carvedilol with 1.05 g/kg colemide did not change the time dependent profiles of the plasma concentration and pharmacokinetic parameters of carvedilol.
    These result suggested that the absorption of sodium valproate was decreased and the absorption of phenobarbital was delayed by the coadministrated colestimide, but no significant effect on the bioavailability of carvedilol was observed.
  • 浅井 和範, 勝田 栄男, 森下 真莉子, 高山 幸三, 永井 恒司
    2000 年 26 巻 2 号 p. 219-226
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    A new method for the analysis of pheytoin (DPH) and carbamazepine (CBZ) in human serum described. The method involves extraction of DPH and CBZ from serum by re-used solidphase extraction (SPE) column prior to a semi-micro high-performance liquid chromatographic analysis. The chromatography for the analysis of DPH at a level of 20μg/mL was complete in 5 using a semi-micro column (C 18, 2.0mm i.d.×15cm). The sensitivity of the analysis was 3.97-fold higher than that for conventional HPLC. DPH and CBZ were extracted from serum using commercially available SPE column (Isolute C 18), and analytical recovery rate of DPH and CBZ which were added to the serum (50μL) at 2.0, 5.0, 10.0, 20.0 and 40.0μg/mL, ranged from 83.5 to 94.0% and from 86.7 to 117.1%, respectively. Excellent recovery rates of DPH and CBZ in the serum were also obtained when the same SPE column was re-used over 30-times, protein and/or albumin hardly remained in the solid-phase of the re-used SPE column. There results indicate that this new method could reduce both the time need to perform each analysis the amount of sample needed due to high sensitivity. In addition, the method also demonstrated a good cost performance. Thus, the method might be highly useful to support drug monitoring and pharmacokinetic studies.
  • 森川 正子, 高崎 彩子, 大山 良治, 阿部 和史, 平島 由香, 向井 峰代, 辻野 元祥, 西田 賢司
    2000 年 26 巻 2 号 p. 227-233
    発行日: 2000年
    公開日: 2011/08/11
    ジャーナル フリー
    ported that oral antidiabetic agents may sometimes induce hepatic injury. We therefore investigated the influence of α-glucosidase inhibitor (α-GI) on the liver functions, both retrospectively and prospectively.
    1. From January, 1996 to July, 1998, 222 patients received Voglibose (VOG: 132) or Acarbose (ACA: 90) at an outpetient Clinic of the Internal Medicine Department for Endocrine Diseases of Tokyo Metropolitan Futyu Hospital.
    2. VOG was found to be induce the hepatic injury in 3 patients within 1 month from the start of administration, and in 3 patients within 3 months. The rise in the ALT level was higher than that of the AST level, but it wes slight and transitory.
    3. One patient administered VOG (0.9 mg/day) showed significant changes in his hepatic functions, and at 84 days the following levels were seen: AST rose 801 IU/L, ALT 1104 IU/L, LDL 907, IU/L.
    4. In a literature review, hepatic injury was reported in 14 ACA-treated patients, and appeared in 10 of them within 3 months. In 0.6 mg/day VOG-treated patients, one patientshowed hepatic injury within 1 month, and one patient within 3 months. In Pharmaceuticals and Medical Devices Safety Information, hepatic injury was reported in 57 ACA-treated patients, and appeared in 44 of them within 6 months. In VOG-treated patients, hepatic injury was reported in 20 patients, and appeared in 17 of them within 3 months.
    The incidence of α-GI-induced hepatic injury is low but unpredictable, however, if it does occur the condition often serious. As a result, periodical hepatic function tests should be performed at least monthly, for at least 6 months after the administration ACA and for 3 months after VOG.
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