著者

今浦 将治 山谷 武司 上原 望 眞野 匠智 永瀬 怜司 木村 耕二 菅野 浩 山田 安彦

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.137, no.6, pp.767-774, 2017 (Released:2017-06-01)

参考文献数

15

被引用文献数

4

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We evaluated the effects of pharmacist intervention for adverse drug reaction detection and exacerbation avoidance, as well as the severity and outcome of reactions based on analyses of pharmacist involvement in a collaborative approach to medicine. Of 5436 cases with pharmacist involvement, adverse drug reaction prevention was seen in 440, accounting for 8.1%, and exacerbation avoidance in 213, accounting for 3.9%. We concluded that pharmacist involvement contributes to detect adverse drug reactions and avoid exacerbation, and improves pharmacotherapy safety. We also analyzed 131 cases in which the course after intervention was followed. When categorized by adverse drug reaction severity, Grade 1 and 2 were the same at 45.8%, Grade 3 at 8.4%, respectively. Those findings suggested that pharmacist intervention contributes to early detection of an adverse drug reaction. Also, the relationship between clues for detecting adverse drug reactions by a pharmacist and their severity showed that objective evaluations such as clinical laboratory test results, physical assessments and medication history were important for detecting reactions that became more serious. Patients recovered or recovering from an adverse reaction comprised 76.4%, indicating that pharmacist intervention contributed to exacerbation avoidance and improvement. Our findings revealed the effects of pharmacist intervention for adverse drug reaction detection and exacerbation avoidance, and for safety improvement of pharmacotherapy. Additionally, we considered it necessary for the future pharmacist intervention to improve skills of assessing an adverse drug reaction objectively.

著者

今浦 将治

出版者

日本外科代謝栄養学会

雑誌

外科と代謝・栄養 (ISSN:03895564)

巻号頁・発行日

vol.55, no.5, pp.179-184, 2021 (Released:2021-11-15)

参考文献数

37

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医療技術の進歩は手術の低侵襲化を実現し, 高侵襲手術が困難な患者に対しても手術を可能にした. これにより, 高齢患者の手術件数は増加している. 一方で, 高齢患者は, 加齢に伴う臓器機能の低下, 併存疾患の存在, 栄養不良などから術後に予期せぬ合併症を発症することがある. そのため, 術前の呼吸機能訓練や栄養療法など, 手術に向けた準備が重要となる.まさに,本特集のテーマである「術前環境の適正化」が求められる. 薬はどうか.高齢患者に限らず,さまざまな疾患を合併している患者は,服用している薬剤数も多くなり,周術期の適切な薬剤管理が求められる.抗血栓薬の術前休薬は,代表例である.これは手術を安全に行うために重要だが,不用意な休薬は血栓塞栓症を発症させるリスクを高めてしまう. β遮断薬の急な中断は反跳性高血圧, 虚血症状, 不整脈などの中断症状を引き起こすことがあり, 継続が望ましい. 術前に薬を休止するのか, 継続するのかは患者側と手術側のリスク・ベネフィットを考慮した判断が求められる.