- 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
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
- 立石 裕樹 宮津 大輔 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.8, pp.397-404, 2021-08-10 (Released:2022-08-10)
- 参考文献数
- 26
A drug-drug interaction (DDI) caused by a drug combination may cause clinical problems. This study evaluated the frequency and details of potential DDI (pDDI) in the discharge prescription and the relationship between pDDI and number of drugs used. The study included patients who were discharged from the rehabilitation ward for a duration of two years between 2018 and 2019. Lexicomp Drug Interactions, a DDI screening program, was used to detect pDDI. Clinically important pDDI was detected in 22.8% (59/259) of patients. The DDI mechanisms were based on pharmacodynamic interactions in 63.6% of cases and on pharmacokinetic interactions in 29.9%. Central nervous system depressant related pDDI was the most frequent type of pDDI detected. Use of hypnotics, antidiabetic drugs, antidepressants and antipsychotics was significantly higher amongst patients with detected pDDI. The incidence and frequency of pDDI increased with the number of drugs used. It is necessary for pharmacists to correctly evaluate the pDDI detected by the DDI screening program and contribute to the optimization of prescriptions and patient treatment.
- 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
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.
1 0 0 0 OA 注射用バイアルのゴム栓に関する品質評価
- 著者
- 平川 雅章 立石 真理 牧野 和隆 千堂 年昭 伊藤 善規 大石 了三
- 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.29, no.1, pp.20-27, 2003-02-10 (Released:2011-03-04)
- 参考文献数
- 10
Although the standards for the quality of rubber closures on injectable glass vials were specified in USP 24 in the U.S. and BP 2001 in the U.K., no such guidelines for quality control exist in Japan. In the present study, we investigated the quality of rubber closures on glass vials of frequently-used anti-biotic and anti-viral injections in our hospital, according to the quality control method of rubber closures for aqueous infusion that was standardized in JP14. Sufficiently washed rubber closures were immersed in distilled water, and test solutions were prepared after gently shaking them for 5 min or heating them at 121°C under high-pressure steam for 60 min. The optic transmittance in the resultant solutions was measured at 430nm and 650nm, and the findings were compared with those for the standard values in JP14 for rubber closures on aqueous infusions. Of 23 different rubber closures tested, only one showed a lower transmittance at 430nm when the solution was prepared by gentle shaking. Under the condition of heating with high-pressure steam, 15 products did not reach the criteria at both wavelengths, 3 did not meet the standards set at either of the wavelengths, but 5 had no qualitative problems. We also checked the materials stuffed in 0. 45μm membranes after filtration with an injection by microscopic observations using scanning electron microscopy and by an element analysis with an X-ray energy dispersive microanalyzer. A number of micro-particles were observed and they were found to be composed of silicon, aluminium and titanium.These results indicate that the quality of rubber closures of injectable glass vials varies among products. Therefore, the standards and guidelines for the quality control of rubber closures of injectable glass vials should be established in JP.
- 著者
- 宮津 大輔 江田 陽一 今給 黎修 桑名 寿幸 松浦 徹 竹下 龍次 與田 賢作 秋吉 正貴 手嶋 由加 田中 博和 長郷 あかね 平川 雅章 首藤 英樹 片岡 泰文
- 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.1, pp.45-52, 2017-01-10 (Released:2018-01-10)
- 参考文献数
- 14
- 被引用文献数
- 2
Hypertensive emergency is a situation in which uncontrolled hypertension is associated with acute end-organ damage. Nicardipine hydrochloride is a calcium channel blocker indicated for the treatment of hypertensive emergencies. However, nicardipine infusion-related phlebitis is a common and significant problem in clinical practice. The aim of this study was to survey the incidence of nicardipine infusion-related phlebitis and to identify associated risk factors for phlebitis. We conducted a retrospective observational study at Fukuoka Tokushukai medical center. A total of 79 patients who received precision continuous infusion of nicardipine were enrolled in this study. Nicardipine infusion-related phlebitis occurred in 34 (25.7%) of 132 peripheral intravenous catheters. On multivariate logistic analysis, “the dosing period over 24 hours” and “no co-infusion of saline” were significantly associated with an increased risk of nicardipine infusionrelated phlebitis. The odds ratio (OR) and 95% confidence interval (95% CI) for the occurrence of phlebitis with respect to “the dosing period over 24 hours” and “no co-infusion of saline” were 5.04 (2.012 - 12.657) and 3.36 (1.190 - 9.514), respectively. In addition, the optimal cut-off level of the dilution rate of saline was determined to be 4.23 times (sensitivity 73.5%, specificity 58.8%) based on receiver operating characteristic (ROC) analysis for predicting the occurrence of phlebitis. To minimize the risk of peripheral phlebitis, we propose that medical professionals should consider changing the infusion site every 24 hours at least and co-infusing saline diluted more than 4-5 times.
1 0 0 0 OA 粉砕不可とされている錠剤・カプセル剤の調剤方法に関する検討
- 著者
- 吉田 実 平川 雅章 堤 千秋 立石 真理 中島 和博 岡部 昌之 末安 正典 吉川 学 中尾 泰史 伊藤 善規 大石 了三
- 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.29, no.2, pp.189-195, 2003-04-10 (Released:2011-03-04)
- 参考文献数
- 11
- 被引用文献数
- 1 1
We examined the procedures for dispensing tablets or capsules that are not approved for crushing after checking the basis for such non-approval regarding 108 medicines introduced in our hospital. The problems are summarized as 1) a reduction in the pharmacological efficacy, 2) lowering the compliance due to a bitter taste or unpleasant odor, 3) dispersing hazardous powder, and 4) a disappearance of the efficacy of improved formulation such as for enteric coating.The taste of the ground tablets or capsules that are indicated to not be crushed was examined and compared with various concentrations of quinine hydrochloride powder in 8 healthy volunteers who showed a normal response to a bitter taste. Thirty-one out of 43 drugs were found to be tolerable to the taste, in which 13 drugs were less bitter than 0.5% quinine hydrochloride powder. However the other drugs either induced numbness or had a pungent taste and unpleasant odor, which were also considered to become the major reasons for nonapproval for crushing. Therefore, we found that several tablets have no serious problems, when they are dispensed after grinding. On the other hand, a number of hygroscopic medicines and anticancer agents tended to easily disintegrate in water. As a result, they can be prescribed by suspending them in water immediately before taking them. Our findings suggest that several tablets or capsules that are non-approved for crushing may thus be dispensed without any serious problems after crushing or disintegrating them in water. Therefore, our present findings may offer some useful information on the countermeasures for dispensing tablets and capsules that are not approved for crushing.