著者
小川 壮寛 松下 明 中島 利裕 守安 洋子 島田 憲一 江川 孝 五味田 裕 髙橋 正志 髙見 陽一郎
出版者
一般社団法人 日本プライマリ・ケア連合学会
雑誌
日本プライマリ・ケア連合学会誌 (ISSN:21852928)
巻号頁・発行日
vol.36, no.4, pp.302-307, 2013 (Released:2014-01-10)
参考文献数
12
被引用文献数
1 1

目的 : 共同薬物治療管理 (CDTM) を地域医療に導入するための方略の一つとして, 事前に処方医と事後報告を行うポジティブリストを作成し, 疑義照会を事後報告へ切り替えることによる効果を検証した.方法 : 事後報告に替えることのできる疑義照会をリソルブ疑義と定義した上で, ポジティブリストに基づく事後報告への切り替えを行い, その効果をリソルブ疑義の件数, 保険点数およびジェネリック医薬品使用率の変化を調査することにより評価した.結果 : 医師の治療計画を変更することなく, ポジティブリストにより178件 (疑義照会全体の22.7%) の疑義照会を事後報告に替えることができ, 疑義照会にかかる時間を大幅に短縮することができた. これにより保険点数は17,455点削減でき, ジェネリック医薬品使用率は46.6%まで上昇した.結論 : ポジティブリストに基づく薬剤師自身の判断で疑義照会を事後報告に切り替えることにより, 疑義照会実施件数および医療費削減とジェネリック医薬品使用率上昇を可能とした.
著者
北村 佳久 四宮 一昭 五味田 裕
出版者
公益社団法人 日本薬理学会
雑誌
日本薬理学雑誌 (ISSN:00155691)
巻号頁・発行日
vol.132, no.6, pp.329-333, 2008 (Released:2008-12-12)
参考文献数
16
被引用文献数
1 2

うつ病の治療は抗うつ薬を中心とした薬物療法が中心である.多くの患者は抗うつ薬の服用により自覚症状が改善し社会生活への復帰が可能となっている.しかしながら,十分な治療を行っても,うつ症状の改善を見ない治療抵抗性うつ病の存在が問題とされている.これまで,うつ病の動物モデルおよび抗うつ薬のスクリーニングモデルが報告され,新規抗うつ薬の開発に寄与している.その一方,治療抵抗性うつ病を反映した動物モデルはその病態像が明確でないこともあわせて報告がなかった.そこで,我々は治療抵抗性うつ病の病態像の解明および次世代の抗うつ薬の創薬研究に応用させるため,治療抵抗性うつ病の動物モデルの作製を行った.これまで,うつ病は中枢神経系の機能異常のみならず,視床下部-下垂体-副腎皮質(hypothalamic-pituitary-adrenal axis:HPA)系の機能異常を含む中枢神経系-内分泌系の機能異常が関与していることが知られていた.特に,既存の抗うつ薬に反応しない患者に対してグルココルチコイド受容体拮抗薬の有効性も明らかにされている.そこで,我々はHPA系の過活動モデルが治療抵抗性うつ病の病態像の一部を反映していると仮定し,adrenocorticotropic hormone(ACTH)反復投与によるHPA系過活動モデルの作製を試みた.治療抵抗性うつ病の動物モデルとしての有用性については抗うつ薬のスクリーニング系であるラット強制水泳法の不動時間を指標として検討を行った.その結果,ACTH反復投与ラットではいくつかの既存の抗うつ薬の抗うつ効果が消失し,薬物反応性の側面より治療抵抗性うつ病を反映していると考えられた.この抵抗性には自殺者の死後脳で増加が報告されている5-HT2A受容体の過活動の関与を認めている.さらに,ACTH反復投与ラットでは海馬歯状回における神経細胞の新生作用が抑制されていることより,この抑制作用が治療抵抗性の病態の一部とも考えられる.本稿ではこれらACTH反復投与によるHPA系過活動モデルの治療抵抗性うつ病の動物モデルとしての有効性を紹介する.
著者
日野 美波理 石井 雅人 藤原 聡子 松香 直行 定金 典明 森山 雅弘 二神 幸次郎 柴田 和彦 五味田 裕
出版者
日本医療薬学会
雑誌
医療薬学 (ISSN:1346342X)
巻号頁・発行日
vol.30, no.7, pp.457-467, 2004-07-10
被引用文献数
7 7

Owing to the approval of reimbursement of fees for antineoplastic chemotherapy on an outpatient basis by the national health insurance scheme in April 2002, an antineoplastic chemotherapy room was set up in the ambulatory area of our hospital in August 2000. In order to ensure the effective use of the safety cabinet and other existing equipment and the safe administration of antineoplastic agents to patients, the authors assigned a mixing pharmacist and a coordinating pharmacist who was to be in charge of antineoplastic chemotherapy for outpatients. First, the mixing pharmacist prepared IV mixtures of the antineoplastic agents and auxiliary medicines in a sterile area and then the coordinating pharmacist audited the mixtures and carried them to the antineoplastic chemotherapy room. Other functions of the coordinating pharmacist included providing pharmaceutical care to patients and cooperating with doctors, nurses and other pharmacists involved in the chemotherapy. They also searched for information on individual medical charts or in patient statements and pointed out doubtful records or potential problems that might affect chemotherapy. Coordinating pharmacists notified 50 potential problems between August 2002 and April 2003. To evaluate our pharmaceutical practices in outpatient antineoplastic chemotherapy, we conducted a questionnaire survey of the patients. Their responses indicated that our pharmaceutical care program was working well and that they hoped we would continue it. However, the usefulness of our program was not entirely clear to all patients and we recognized the need to better inform patients concerning this.
著者
末丸 克矢 荒木 博陽 五味田 裕
出版者
公益社団法人 日本薬理学会
雑誌
日本薬理学雑誌 (ISSN:00155691)
巻号頁・発行日
vol.119, no.5, pp.295-300, 2002 (Released:2003-01-21)
参考文献数
32
被引用文献数
5 4

神経性ニコチン性アセチルコリン受容体(nAChR)は,αサブユニットとβサブユニットから構成される5量体のイオンチャネル型受容体であり,多くの神経伝達物質の放出を促進することによって精神機能にさまざまな影響を及ぼす.従来より,喫煙と各種精神病疾患の関係について多くの調査や研究が行われ,精神分裂病,うつ病および不安などの精神病疾患と喫煙の間に正の関連性があることが示されている.その喫煙動因として,ニコチンの中枢刺激作用により精神疾患の症状を自ら改善しようとする試み(self-medication),またはニコチン退薬症候に伴う症状の悪化をニコチン再摂取により軽減させていることが考えられている.近年,nAChRサブユニットのノックアウトマウスや各種精神疾患の動物モデルを用いて神経性nAChRの精神薬理作用の解明が進み,精神分裂病の注意障害や情報処理障害にはα7 nAChRが,またニコチン依存および退薬症候にはα4β2 nAChRが関与していることが示唆されている.
著者
二神 幸次郎 定金 典明 西原 茂樹 三牧 祐一 荒木 博陽 五味田 裕
出版者
一般社団法人日本医療薬学会
雑誌
医療薬学 (ISSN:1346342X)
巻号頁・発行日
vol.28, no.6, pp.630-636, 2002-12-10 (Released:2011-03-04)
参考文献数
5
被引用文献数
2 2

Our hospital established a Center for Clinical Research of New Drugs and Therapeutics in April 1999. The Center consists of 6 departments : i.e. departments which help to coordinate clinical research, which help to manage the investigated drugs, preview clinical research study protocols, coordinate clinical research, educate research staff and support clinical research at other medical institutions. Pharmacists are involved in all 6 departments of the Center and have been playing various roles. Under this situation, the Institutional Review Board (IRB) started to review investigator-initiated clinical research on drugs, regarding the study protocol, written information (IC) for trial subjects and other information about the drugs beginning in January 2000. All research was performed according to the new Good Clinical Practice, but studies were initiated without providing sufficient compensation in cases of severe adverse drug reactions. The IRB reviewed thirty-four clinical research protocols from January 2000 to December 2001 and an average of 1.5 cases were reviewed by the IRB per meeting. The average reviewing time was 28 minutes (max. 68 minutes). Sixteen, eight, eight and two protocols of clinical research involved Phase III, I/II and II trials and medical instruments, respectively. Considerable clinical research has been performed by such departments as Internal Medicine I, II and Urology, in particular.We recognized that considerable clinical research has been performed with unapproved drugs at our hospital. After the IRB review, pharmacists played various important roles, e.g. dispensing test drugs, preparing some manufactured drugs and confirming the written informed consent. However, up to now the clinical research coordinator (CRC) has not sufficiently supported these studies. The CRC should thus support this research by improving the quality of these studies and the safety performance for patients.
著者
小金 一恵 二神 幸次郎 岡崎 昌利 谷口 律子 荒木 博陽 五味田 裕
出版者
一般社団法人日本医療薬学会
雑誌
医療薬学 (ISSN:1346342X)
巻号頁・発行日
vol.28, no.6, pp.599-604, 2002-12-10 (Released:2011-03-04)
参考文献数
6
被引用文献数
2 1

We have recently instituted an audit system with the goal of maintaining and improving quality in pharmaceutical management and counseling services, i.e., pharmaceutical care practices. This system was created to improve the quality of record keeping for counseling services. The audit system is composed of 5 supervising pharmacists. A meeting is held once a month, and an audit is carried out concerning the patient compliance instruction documents, medication history and practice records of 2 clinical departments. In addition, methods for improving business efficiency are also discussed. We herein report on the specific guidance given to the supervising pharmacists of each clinical department, based on a total of 12 audit conferences. As a result, four problems were identified : (1) fundamental description issues, (2) record keeping modes, (3) insurance demands, (4) pharmaceutical perspective. The following improvements were instituted after notifying the relevant pharmacists and all other pharmacy staff of these problems : a reduction in the leakage of specific items, corrections of the records explaining the pharmacological effects, establishment of a drug interaction checklist, simplification of laboratory data records, simplification of the format, utilization of a problem list field, and other issues. The role of this audit system in maintaining and improving the quality of pharmaceutical management and counseling services has become increasingly important because as the counseling services for patients continue to expand.
著者
二神 幸次郎 西原 茂樹 定金 典明 谷口 律子 荒木 博陽 川崎 博巳 五味田 裕
出版者
一般社団法人日本医療薬学会
雑誌
医療薬学 (ISSN:1346342X)
巻号頁・発行日
vol.27, no.6, pp.589-593, 2001-12-10 (Released:2011-03-04)
参考文献数
4
被引用文献数
5 5

During a three-week long practical training program for pharmacy students at our hospital, senior pharmacy students had a one-day observation of pharmacists performing new drug investigations. Using a questionnaire survey we investigated whether the observation of the work of clinical research coordinator (CRC) influenced the student's understanding of the new drug investigation procedures. The observation of CRC's work consisted of counseling/interviewing prior to the doctor's consultation and visiting a clinical laboratory to observe new drug investigations. The items evaluated were impressions of the clinical investigation of new drugs, precautions for preparing investigational drugs, understanding the new Good Clinical Practice (GCP) guidelines and other important aspects in the clinical investigation. Each group consisted of 26 students. Only 10 out of 26 students observed counseling/interviewing before the doctor's consultation with CRC. The impression of the clinical investigation procedure in group I, which observed the CRC's work was more favorable than in group II, which did not observe it. The understanding of the important aspects of the clinical investigation procedures in group I was markedly better than in group II. We thus consider that the observation of the CRC work is very useful for students not only to learn new drug investigation procedures, but also to understand the meaning of the new GCP guidelines.
著者
塩尻 容子 黒崎 勇二 川崎 博巳 柳澤 一恵 荒木 博陽 五味田 裕 小田 慈 竹田 芳弘 平木 祥夫
出版者
一般社団法人 日本医療薬学会
雑誌
病院薬学 (ISSN:03899098)
巻号頁・発行日
vol.24, no.6, pp.677-682, 1998-12-10 (Released:2011-08-11)
参考文献数
14
被引用文献数
1 3

Improving the patient's QOL is an important matter for guaranteeing proper pharmacotherapy. Lugol's solution (LS, iodine content: I2 3.4%, KI 6.6%) for internal use is a useful drug for the inhibition of radioiodine uptake to the thyroid gland. However, it is difficult for patients, especially children to take this agent or ally due to its unpleasant taste, terrible smell, and peculiar color. The present study was conducted to improve both the taste and the smell of LS, by using soft drinks containing ascorbic acid. Iodine (I2) molecules in LS are reduced to iodide (F) by ascorbic acid, and the peculiar color of LS thus vanished. The amount of L (+)-ascorbic acid (VC) required to remove the color was in good agreement with the rational value. The improvement in the taste, smell, stimulation on the tongue, and the overall ease in taking the following four LS preparations, i.e., the control LS (LS-I), added by Simple Syrup solution (LS-II), by VC solution (LS-III), and by POCARISWEAT® (LS-IV), were then evaluated in the ten healthy adult volunteers. LS-II, -III and -IV, significantly improved all the elements compared with LSI, and eight volunteers selected LS-IV as the easiest preparation. The inhibitory effect of LS-IV to the radioiodine uptake to the thyroid gland was also confirmed in a patient with neuroblastoma based on a clinical diagnosis using 131I-metaiodobenzyl-guanidine scintigraphy. These results suggest that the medication method for taking LS with soft drinks containing VC improves the compliance and QOL of these patients.
著者
北村 佳久 荒木 博陽 五味田 裕
出版者
公益社団法人 日本薬理学会
雑誌
日本薬理学雑誌 (ISSN:00155691)
巻号頁・発行日
vol.119, no.6, pp.319-325, 2002 (Released:2003-01-21)
参考文献数
42
被引用文献数
4 4

従来よりうつ病の発症機序についてはモノアミン欠乏説,受容体感受性亢進説などが提唱されてきた.しかし,これらの仮説には矛盾する点も多く,現在においても明確な発症機序についての結論はない.一方,うつ病は中枢神経系の異常のみならず視床下部-下垂体-副腎(hypothalamic-pituitary-adrenal:HPA)系の機能異常を含む中枢神経系-内分泌系の機能異常が深く関与しているといわれている.本稿では抗うつ薬の作用機序およびうつ病の病態に深く関与しているserotonin(5-HT)-HPA系の相互作用とうつ病との関連性について紹介する.動物に反復のストレス負荷およびHPA系の活性化により5-HT2受容体機能は亢進し,うつ病の病態との類似性が考えられる.ACTH反復投与によるHPA系過活動モデルではイミプラミン反復投与による5-HT2受容体ダウンレギュレーションが消失し,さらに抗うつ薬スクリーニングモデルである強制水泳法におけるイミプラミンの不動時間短縮作用も抑制される.つまり,HPA系過活動モデルは三環系抗うつ薬治療抵抗性うつ病の動物モデルとしての可能性が考えられる.これまでコルチコイド受容体や5-HT受容体サブタイプの神経化学的および分子生物学的研究は進んでいるが,今後トランスジェニックマウスまたはノックアウトマウスなどを応用し,行動薬理学的研究および神経科学的研究によりうつ病の病態メカニズムおよび抗うつ薬作用機序の解明などの重要性が増すと思われる.
著者
川上 英治 二神 幸次郎 定金 典明 西原 茂樹 荒木 博陽 川崎 博己 五味田 裕
出版者
一般社団法人 日本医療薬学会
雑誌
病院薬学 (ISSN:03899098)
巻号頁・発行日
vol.25, no.1, pp.69-75, 1999-02-10 (Released:2011-08-11)
参考文献数
7

Pharmacists need to have a clear policy for managing investigational drugs under circumstances that are consistent with Good Clinical Practice. We studied the management and support system for the clinical research of investigational drugs based on the management of investigational drugs. We experienced 126 cases of pharmaceutical consultations in 650 prescriptions for investigational drugs from April 1997 to March 1998. Seven cases which might induce a patient to drop out, were included in pharmaceutical consultations. We found it was important to communicate with all investigators regarding giving adequate prior information to having a clearly defined protocol. Our pharmaceutical program for the clinical research of investigational drugs was thus found to be useful in the management of investigational drugs.
著者
松山 賢治 山下 親正 野田 敦子 後藤 茂 野田 浩司 市丸 保幸 五味田 裕
出版者
公益社団法人日本薬学会
雑誌
Chemical and Pharmaceutical Bulletin (ISSN:00092363)
巻号頁・発行日
vol.32, no.10, pp.4089-4095, 1984-10-25 (Released:2008-03-31)
参考文献数
29
被引用文献数
16 26 23

Isonicotinoyl-γ-aminobutyric acid (GABA) (IG) and nicotinoyl-GABA (NG), candidate prodrugs of GABA, were assessed by measuring various pharmacological responses such as anticonvulsant effect, prolongation of pentobarbital sleeping time and depressive effect on rearing or ambulation in general behavior, in relation to the GABA level in the mouse brain. The GABA level after the intraperitoneal administration of IG at a dose of 1000 mg/kg increased significantly from 2.30±0.02μmol/g wet wt. in the control to 2.93±0.05μmol/g wet wt., while NG caused only a slight increase in GABA level. IG showed a stronger anticonvulsant effect, greater prolongation of pentobarbital sleeping time and greater depressive effect on rearing in general behavior than NG did. The pharmacological effect of IG or NG corresponded well to the GABA level in the brain.
著者
川上 英治 二神 幸次郎 定金 典明 西原 茂樹 荒木 博陽 川崎 博巳 五味田 裕
出版者
日本医療薬学会
雑誌
病院薬学 = Journal of the Nippon Hospital Pharmacists Association (ISSN:03899098)
巻号頁・発行日
vol.25, no.1, pp.69-75, 1999-02-10
被引用文献数
8

Pharmacists need to have a clear policy for managing investigational drugs under circumstances that are consistent with Good Clinical Practice. We studied the management and support system for the clinical research of investigational drugs based on the management of investigational drugs. We experienced 126 cases of pharmaceutical consultations in 650 prescriptions for investigational drugs from April 1997 to March 1998. Seven cases which might induce a patient to drop out, were included in pharmaceutical consultations. We found it was important to communicate with all investigators regarding giving adequate prior information to having a clearly defined protocol. Our pharmaceutical program for the clinical research of investigational drugs was thus found to be useful in the management of investigational drugs.