著者

宮津 大輔 立石 裕樹 與田 賢作 松浦 徹 山下 大貴 安部 由起子 後藤 貴央 秋吉 正貴 田中 博和 平川 雅章

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.47, no.7, pp.345-357, 2021-07-10 (Released:2022-07-10)

参考文献数

23

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In January 2020, Fukuoka Tokushukai Hospital started Protocol Based Pharmacotherapy Management (PBPM), which allows pharmacists to order regular blood and urine tests for drugs that are recommended in the package insert, with the permission of the physician. The purpose of this initiative is to improve the quality of drug therapy for patients through the intervention of pharmacists, to reduce the burden on physicians, and to provide a solution to the three problems of drug therapy at our hospital. As a result, 204 PBPMs (203 blood tests and 1 urine test) were performed for a period of 8 months after the start of drug therapy. Most of them were additions to existing physician orders. All suggestions to the physician for tests were accepted, and 95% (96/101) of these were ordered by the pharmacist. In 37.3% (28/75) of the cases, the medication was changed after the test results.In addition, the "compliance rate of vancomycin (VCM) trough concentration measurement," "compliance rate of hepatitis B virus DNA (HBV-DNA) monitoring in oral chemotherapy alone," and "compliance rate of serum P concentration measurement during Continuous hemodiafiltration (CHDF)" increased after the start of PBPM compared with before (81.3% vs 91.7%, 82.6% vs 93.9%, and 65% vs 100%, respectively). We suggest that our PBPM is a useful tool for pharmacists to proactively promote appropriate drug therapy.

著者

宮津 大輔 秋吉 正貴 山下 大貴 立石 裕樹 後藤 貴央 與田 賢作 安倍 ひろみ 田中 博和 平川 雅章 片岡 泰文 首藤 英樹

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.42, no.4, pp.271-277, 2016-04-10 (Released:2017-04-10)

参考文献数

17

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Fosphenytoin (FOS) is a phosphate ester prodrug developed as an alternative to intravenous phenytoin for acute treatment of seizures. Although both FOS and phenobarbital (PB) are used for status epilepticus as second-line drugs, there is no data on their comparative efficacy and safety. We retrospectively analyzed data from children treated with FOS or PB for convulsive status epilepticus and acute exacerbation of seizures. Our aim was to compare the efficacy and safety of intravenous FOS with those of intravenous PB for convulsive status epilepticus and acute exacerbation of seizures. Seventy-seven children were included in the study: 54 received FOS, and 23 received PB. The primary end point was recurrence of seizures and drug-related adverse events. The response rate, defined as no recurrence of seizures within 24 hours after termination of seizure, was 92% (50/54) and 95% (22/23) in FOS group and in PB group, respectively. Adverse events occurred in 27% (15/54) of patients in FOS group and in 95% (22/23) of patients in PB group (P < 0.01). Although no serious adverse events occurred in patients in both FOS group and PB group, the incidence of both sedation and disturbance of consciousness were significantly higher in PB group than FOS group. From these results, FOS is recommended as second-line drugs for status epilepticus and acute exacerbation of seizures. However, the optimal serum concentration achievement rate was significantly lower in FOS group than PB group. To maintain optimal serum phenytoin levels (10 - 20 µg/mL), higher doses of FOS might be required.