- 著者
- 竹馬 章悟 小川 竜一 越前 宏俊
- 出版者
- Japanese Society of Drug Informatics
- 雑誌
- 医薬品情報学 (ISSN:13451464)
- 巻号頁・発行日
- vol.17, no.4, pp.175-184, 2016 (Released:2016-03-19)
- 参考文献数
- 72
Objective: To evaluate the validity of dosage adjustment of renally eliminated drugs using Giusti and Hayton method in patients with renal dysfunction by reviewing the pharmacokinetic data of the drugs.Design: A systematic literature review.Methods: Drugs with the following characteristics: ≥70% of the drug excreted in urine is the unchanged form and ≥20% of the drug in plasma is the unbound drug, were retrieved from Goodman and Gilman’s the Pharmacological Basis of Therapeutics, 12th edition. For the drugs identified, the area under the concentration-time curves (AUC) obtained from pharmacokinetic studies in healthy subjects and patients with renal dysfunction were extracted from package inserts, interview forms, summary basis of approval, and by systematic review of the MEDLINE database. Pharmacokinetic studies in children, patients with end-stage renal disease, patients on hemodialysis, and kidney transplanted patients were excluded from this review. The observed AUC ratio (AUCRobserved) of a drug was calculated by dividing mean AUC of patients by that of healthy subjects, and stratified by creatinine clearance (CLcr) into three categories: 50 to 79 mL/min, 30 to 49 mL/min, and 10 to 29 mL/min. Theoretical AUC ratios (AUCRpredicted) of drugs for the respective CLcr categories were calculated using Giusti and Hayton method.Results: Twenty-six drugs met our study criteria, and 43 data sets were obtained from the data sources. The AUCRobserved deviated from the AUCRpredicted by more than ±50% in 3 of 35 (9%) data sets for CLcr 50 to 79 mL/min, 4 of 39 (10%) data sets for CLcr 30 to 49 mL/min, and 7 of 29 (24%) data sets for CLcr 10 to 29 mL/min.Conclusion: Since AUCRpredicted calculated by Giusti and Hayton method erratically over- or under-estimates the maintenance doses in patients with reduced renal function, the use of AUCRobserved is preferred for dose adjustment in these patients.
- 著者
- 小川 竜一
- 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.637-644, 2018-05-01 (Released:2018-05-01)
- 参考文献数
- 20
- 被引用文献数
- 1
Training pharmacy students to become future clinical pharmacists is an important mission in the 6-year school of pharmacy curriculum in Japan. Since 2014, we have conducted an on-campus practical training program to develop basic skills in clinical pharmacy for third-year pharmacy students at Meiji Pharmaceutical University. This training program includes searching for and retrieving drug information; interpretation of laboratory findings, vital signs, and physical examinations; literature appraisal; and professional writing. These training sections are arranged in the above-mentioned order to facilitate effective understanding of each. In the literature appraisal section, each student group is assigned a report on a prospective controlled study of a given drug published in English and reads it critically according to the literature appraisal worksheet. Then the group writes a monograph on the drug described in the report based on the literature and other information. Thereafter, all students are reshuffled into new groups so that students who were assigned different drugs are placed together, in the so-called jigsaw learning method. Students then discuss which two or three drugs in a specific pharmacological class should be adopted in the hospital formulary according to the knowledge gained through this training program series. The themes were novel oral anticoagulants in the 2014 academic year, dipeptidyl peptidase 4 inhibitors in 2015, and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors in 2016. Although there are some problems that need to be resolved in the future, this approach appears effective in helping students build drug information skills as a basic competence of clinical pharmacists.