著者

國津 侑貴 磯野 哲一郎 平 大樹 寺田 智祐

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.139, no.11, pp.1457-1462, 2019-11-01 (Released:2019-11-01)

参考文献数

16

被引用文献数

1 4

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Recently, there have been reports that the combination of renin angiotensin inhibitors, diuretics, and non-steroidal anti-inflammatory drugs increases the risk of acute kidney injury (AKI). This combination has been dubbed the “Triple Whammy”. However, there have been no reports about its chronic effects on the kidney. In this study, we investigated the chronic effects of the “Triple Whammy” on kidney function. There were 203 outpatients who were prescribed this combination in our hospital for 5 years. We excluded patients who could also confirm the combination in the previous year and patients for whom laboratory data were unavailable, thus, leaving a target patient group of 95 patients. The average estimated glomerular filtration rate (eGFR) decreased significantly from 62.6 to 58.9 mL/min/1.73 m2 immediately after administering the combination (p<0.01). Although no patients were diagnosed with AKI within 90 days after being administered the combination, 7.4% of patients exhibited a ≥25% reduction in eGFR compared with that before commencing the combination. Correlation analysis of gender, age, past renal function, and renal function change demonstrated that eGFR before administration of the combination negatively correlated with changes in eGFR (p<0.01). Considering the effects of individual differences, eGFR changes before and after administering the combination were compared using a case-crossover design and eGFR after administering the combination was found to be significantly reduced (p<0.01). Therefore, it appears that the “Triple Whammy” may cause not only AKI but also chronic renal degeneration.

著者

炭 昌樹 長谷川 千晶 森井 博朗 星野 伸夫 奥貫 裕美 金本 賢枝 堀江 美弥 岡本 陽香 藪田 直希 松田 雅史 神谷 貴樹 須藤 正朝 増田 恭子 岩下 由梨 松田 佳織 本岡 芳子 平 大樹 森田 真也 寺田 智祐

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.138, no.5, pp.715-722, 2018 (Released:2018-05-01)

参考文献数

10

被引用文献数

1

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The importance of community-based care systems has increased due to the highly aging population and diversity of disease. To enhance the cooperation among healthcare professionals in community-based care systems, a two-day on-site training program for community pharmacists based on a multidisciplinary team approach was conducted at the Medical Science Hospital of Shiga University from April 2015 to March 2017. There were two professional courses in this training program: the palliative care course and nutrition support course. Both courses consisted of common pharmaceutical care training as follows: regional cooperation among healthcare professionals, pharmacist's clinical activities in the ward, pressure ulcer care, infection control, and aseptic technique for parenteral solutions. Each course was limited to 2 participants. A questionnaire was given to participants in the training program. Seventy-five pharmacists participated in the training and all of them answered the questionnaire. According to the questionnaire, 86% of participants felt that 2 days was an appropriate term for the training program. Positive answers regarding the content of each program and overall satisfaction were given by 100% and 99% of the participants, respectively. In the categorical classification of free comments regarding the expected change in pharmacy practice after the training, both “support for patients under nutritional treatment” and “cooperation with other medical staff” were answered by 24 participants. These results suggested that the 2-day on-site training for community pharmacists facilitated cooperation among healthcare professionals in the community.

著者

川上 恵 北田 徳昭 米澤 淳 岡村 みや子 尾崎 淳子 池見 泰明 中川 俊作 今井 哲司 中川 貴之 土井 恵太郎 秋月 修治 武藤 学 寺田 智祐

出版者

一般社団法人 日本医薬品情報学会

雑誌

医薬品情報学 (ISSN:13451464)

巻号頁・発行日

vol.25, no.2, pp.83-90, 2023-08-31 (Released:2023-09-15)

参考文献数

18

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Objective: In patients with specific backgrounds, comprehensive identification of health problems and proactive pharmacist intervention are crucial to providing safe and effective medical care. However, there are insufficient reports on chemotherapy regimen selection and supportive care management in patients taking immunosuppressants. In this study, to circumvent adverse events, pharmacists intervened with a patient administering tacrolimus (TAC) using known information, focusing on multiple factors attributable to the patient in addition to drug interactions.Methods: The patient was a male in their 70s who received palliative chemotherapy for gastric cancer during their dermatomyositis treatment with TAC. Pharmaceutical support for cancer chemotherapy was provided using the following four procedures: (1) Patient information was collected from interviews and electronic medical records to identify patient-specific problems; (2) Basic pharmacological information was collected from tertiary sources, focusing on the interaction between TAC and aprepitant (APR). Furthermore, clinical reports were collected, and the pharmacokinetic drug interaction significance classification system was used for quantitative predictions; (3) The information obtained in steps 1) and 2) was evaluated, and comprehensive proposals linked to the patient information were presented; (4) Adverse events, TAC blood level, and patient outcomes were monitored after treatment initiation.Results: A chemotherapy regimen consisting of S-1/oxaliplatin therapy without APR was selected. The adverse effects were controllable, and the treatment was completed without many adverse events. Meanwhile, TAC adherence was unaffected by cancer chemotherapy, and the TAC blood concentration or dose ratios were controlled within the same range as previously reported.Conclusion: In cancer chemotherapy, for cases with limited evidence or information, comprehensive pharmaceutical support was provided using known patient information, considering multiple patient factors. This report is beneficial as an example of supportive care management by a pharmacist and contributes to providing optimal service in cases with specific backgrounds.

著者

磯野 哲一郎 國津 侑貴 増田 恭子 平 大樹 荒木 久澄 荒木 信一 宇津 貴 寺田 智祐

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.43, no.11, pp.601-609, 2017-11-10 (Released:2018-11-10)

参考文献数

29

被引用文献数

1 2

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The proper use of drugs with renal excretion and nephrotoxicity is an urgent problem due to the increase in CKD patients. We have been sharing renal function data on CKD patients among medical staff, including community pharmacists, using the CKD sticker since March, 2012 in Shiga. The CKD sticker is affixed to the medication log book of CKD patients. We performed questionnaire surveys of all community pharmacies in Shiga for five years from 2012 to 2016, and examined the utility of the CKD sticker. The CKD sticker was recognized at 98.6% of pharmacies in 2016. Pharmacies attended by patients with the CKD sticker increased to 68.8% in 2016. In addition, there were no local differences among 9 branches in the Shiga Pharmacist Society in 2016. The number of pharmacies that performed questionable inquiries based on the CKD sticker increased from 7.7% in 2012 to 24.7% in 2016. Pharmacies that inquired about patients with CKD stickers greatly increased in 2016, and the number of prescription changes increased. The spread of CKD stickers was observed throughout the prefecture, and this study demonstrated that the CKD sticker was a useful tool for questionable inquiries. The CKD sticker helped to avoid the use of drugs in cases with nephrotoxicity and to reduce the quantity of drugs in cases with renal excretion, allowing for safe medication of CKD patients.

著者

平 大樹 角本 幹夫 岡野 友信 寺田 智祐

出版者

日本耳鼻咽喉科感染症・エアロゾル学会

雑誌

日本耳鼻咽喉科感染症・エアロゾル学会会誌 (ISSN:21880077)

巻号頁・発行日

vol.7, no.2, pp.51-54, 2019-05-20 (Released:2019-05-20)

参考文献数

14

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エアロゾル吸入療法は喘息や慢性閉塞性肺疾患(COPD, chronic obstructive pulmonary disease)の治療の第一選択となる.しかし,患者の吸入動作により薬物が治療部位に送達される必要があるため,患者が適切に使用することが十分な治療効果と低い副作用発現の両立に必要不可欠となる.吸入器は大きく分けて,粉末吸入剤(DPIs, dry powder inhalers),加圧式定量噴霧式吸入器(pMDIs, pressurized metered dose inhalers),ソフトミスト吸入器(SMIs, soft mist inhalers)およびネブライザーの4種類に分類される.最適な吸入方法は各々の吸入器によって異なるので,医療者による適切な吸入指導(吸入支援)が非常に重要となる.本稿では,各々の吸入器について,その特徴と吸入支援方法を概説すると共に,吸入支援に関する地域連携事例を紹介する.

著者

寺田 智祐 乾 賢一

出版者

一般社団法人 日本臨床化学会

雑誌

臨床化学 (ISSN:03705633)

巻号頁・発行日

vol.34, no.1, pp.20-26, 2005-03-31 (Released:2012-11-27)

参考文献数

31

著者

辻 大樹 斎藤 嘉朗 莚田 泰誠 三浦 昌朋 平 大樹 寺田 智祐

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.46, no.2, pp.66-76, 2020-02-10 (Released:2021-02-10)

参考文献数

12

被引用文献数

1 2

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Given that the cancer gene panel test was approved in June 2019, precision medicine based on the information about somatic mutation is expected to be widely available. Similarly, pharmacogenomics (PGx) associated with germline genes, such as drug-metabolizing enzymes, could also be effective tools. However, its clinical implementation has been delayed.To address this issue, we conducted a survey regarding pharmacists’ involvement in “cancer genomic medicine (CGM)” and actual use of PGx and therapeutic drug monitoring (TDM). The response rate of the survey was 96.8% (121/125).According to this survey, genetic polymorphism analysis for irinotecan (UGT1A1), which is approved for genetic testing, was most commonly used. Among the tests not covered by insurance, tacrolimus (CYP3A5) and voriconazole (CYP2C19) were commonly used. Only a few facilities conducted PGx tests. Unlike PGx, many drugs are covered by insurance for TDM, which was commonly used. Vancomycin was most commonly used, followed by teicoplanin and cyclosporine. Regarding CGM, it was found that the pharmacists were most commonly involved in dose adjustment support, followed by support for selection of anti-cancer agents. Pharmacists’ participation in the expert panel was 21.3%.This survey revealed that PGx testing is less common compared with TDM. PGx of drug-metabolizing enzymes could potentially influence adverse reactions and efficacy. It might be possible to provide individualized pharmacotherapy if PGx testing could be performed at the same time as gene panel tests. Insurance-covered PGx testing may increase in the future if more high-quality clinical trials are conducted and its usefulness is validated.

著者

北澤 文章 寺田 智祐 高橋 一栄 松本 繁巳 乾 賢一

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.35, no.5, pp.337-342, 2009 (Released:2010-07-31)

参考文献数

19

被引用文献数

3 2

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The aim of this study was to clarify the influence of renin-angiotensin (RA) system blockers on the anti-cancer effect of chemotherapy with bevacizumab and its adverse effects.Twenty-six patients treated for metastatic colorectal cancer at Kyoto University Hospital between August 2007 and July 2008 were assessed.All of the patients received bevacizumab plus mFOLFOX 6 or FOLFIRI,and were divided into a control group (23 patients) and an RA system blocker group (3 patients).Regarding background factors,which included chemotherapy doses,the only significant difference between the groups was with respect to age.However,hypertension grades in the RA system blocker group were significantly higher than those in the control group,and RA system blockers had no significant antihypertensive effect.There was no severe proteinuria in either group.As for anti-cancer effects,in the control group,6 patients exhibited a partial response and in 16 patients,the disease was stable.In only one patient was the disease progressive.On the other hand,the disease was progressive in all patients in the RA system blocker group.These findings indicate that anti-hypertensive agents which provide better hypertension control than RA system blockers may be necessary as first line medication for the management of bevacizumab-induced hypertension.Although RA system blockers are useful antihypertension agents,they might not be able to control bevacizumab-induced hypertension and proteinuria,and could reduce the anti-cancer effect of bevacizumab.

著者

寺田 智祐

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.140, no.5, pp.663-666, 2020-05-01 (Released:2020-05-01)

参考文献数

3

被引用文献数

1

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The development of cancer genomic medicine has been embraced as an important new policy issue in “The 3rd Basic Plan to Promote Cancer Control Programs” formulated by the Japanese government. Cancer-associated gene panel testing has been recognized by the public health insurance system since July 2019, and is a critical component of the clinical implementation of genomic science. Because of this dynamic change in cancer medicine, pharmacists are now expected to acquire knowledge about genomic science, and to apply it to individualized and appropriate pharmacotherapies. This review outlines the roles of pharmacists in cancer genomic medicine.

著者

寺田智祐

出版者

医薬ジャーナル社

雑誌

医薬ジャーナル (ISSN:02874741)

巻号頁・発行日

vol.54, no.6, pp.1383-1385, 2018-06-01

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2017年のノーベル経済学賞は,行動経済学に関する業績であった。実は,行動経済学が脚光を浴びたのは,2002年のノーベル経済学賞まで遡る。当時の受賞理由は,「不確実性下における人間の判断や意思決定に関して,心理学の研究成果を経済学の考え方に統合したこと」とある。それまでの伝統的な経済学では,「ホモ・エコノミカス」と呼ばれる,非常に合理的で,完全な情報と計算能力を持っていて,常に自分の満足度を最大化するように行動する人間像を想定していたが,行動経済学は従来の説に対する強烈なアンチテーゼでもあった。振り返って,医療界はどうであろうか?例えば,患者は常に病気の治療に前向きに取り組み,医師の指示には100%従い,治療中の様子を医療者へくまなく報告する者ばかりであろうか?実際そうでないことは,誰でも知っている。本稿では行動経済学が示唆してくれる,行動科学の知見について紹介したい。

著者

寺田 智祐

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.136, no.11, pp.1469-1476, 2016-11-01 (Released:2016-11-01)

参考文献数

47

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After the year 2000, the treatment of cancer remarkably changed, including the development of outpatient cancer chemotherapy. Meanwhile, we have encountered many clinical problems related to cancer patient pharmacy services. To resolve these problems, I have tried to establish the individualized and optimal cancer pharmacotherapy utilizing the findings of basic research. In this review, three topics of my research will be introduced. 1) In 2005, information regarding the genetic polymorphism of UGT1A1*28 was described in the package insert of the drug irinotecan in the United States. At that time, however, there was little similar information for Japanese patients. Through clinical research, we demonstrated that UGT1A1*6 was a significant factor for neutropenia, as induced by irinotecan. 2) Tyrosine kinase inhibitors are mainly used at a fixed dose, but wide interpatient variability has been observed relative to their pharmacokinetics and/or pharmacodynamics. To overcome these variations, clinical and basic pharmacological research on erlotinib, sorafenib and sunitinib was carried out. Especially, in sunitinib therapy, we demonstrated that the breast cancer resistant protein in the intestine functions as a limiting factor for oral absorption, and that therapeutic drug monitoring could be helpful for avoiding severe toxicities, resulting in prolonged progression-free survival. 3) We quantitatively assessed side effect management by pharmacist intervention for outpatient chemotherapy. We calculated the improvement ratio between before and after pharmacist intervention, and found that 135 suggestions (50.8%) led to significant improvements, indicating that pharmacist intervention could be useful for attenuating the side effects of cancer chemotherapies.

著者

寺田 智祐

出版者

京都大学 (Kyoto University)

巻号頁・発行日

1999-03-23

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新制・課程博士