著者

入口 慎史 今井 徹 吉田 善一 折井 孝男

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.135, no.5, pp.745-751, 2015 (Released:2015-05-01)

参考文献数

32

被引用文献数

2 6

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Therapeutic drug monitoring (TDM) of vancomycin (VCM) is recommended to minimize its nephrotoxicity and maximize efficacy. Recently, the concept of systemic inflammatory response syndrome (SIRS) has been introduced to describe a clinical state resulting from the actions of complex intrinsic mediators in an acute-phase systemic response. However, there are few reports on the pharmacokinetics of VCM in patients with SIRS. This study investigated the effect of SIRS on the pharmacokinetics of VCM by analyzing the predictability of TDM and pharmacokinetic parameters in 31 non-SIRS patients and 52 SIRS patients, with stratification by SIRS score. The mean prediction error (ME) and mean absolute prediction error in SIRS score 2 and 3 patients differed from those in non-SIRS patients. The ME in the score 4 group showed a negative value. In the comparison of pharmacokinetic parameters by SIRS score, a significantly lower CLvcm value was observed at score 4 compared with scores 2 and 3, a higher Vd value was observed at score 4 compared with non-SIRS and at score 3, and a longer T1/2 was observed at score 2. In the comparison of patient characteristics by SIRS score, albumin, aspartate aminotransferase, and alanine aminotransferase levels showed differences among the scores. However, no correlation was observed between VCM pharmacokinetics and these three laboratory parameters. These findings suggest that the pharmacokinetics of VCM may be affected by the pathology of SIRS rather than by patient characteristics.

著者

入口 慎史 今井 徹 田中 昌代 田沼 道也 折井 孝男 加藤 敏明

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.9, pp.1117-1127, 2017 (Released:2017-09-01)

参考文献数

32

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We conducted a meta-analysis to investigate the influence of antifungal spectrum on the effectiveness and adverse events of empirical antifungal therapy for febrile neutropenia. We searched PubMed and Cochrane Central Register of Controlled Trials (Central), and identified randomized controlled trials reporting mortality, efficacy, adverse events, and hepatic and renal dysfunction. Five trials assessed the efficacy and adverse events of agents with antifungal spectrum covering and those not covering Aspergillus. There were no differences in mortality [risk ratio (RR); 0.79, 95% confidence interval (Cl); 0.60-1.02], efficacy ratio (RR; 1.01, 95%Cl; 0.91-1.12), adverse event ratio (RR; 0.23, 95%Cl; 0.04-1.23), and hepatic dysfunction ratio (RR; 0.81, 95%Cl; 0.59-1.12) between two groups. Antifungals with no activity against Aspergillus were associated with lower renal dysfunction ratio (RR; 0.27, 95%Cl; 0.10-0.71). Five trials compared agents with antifungal spectrum covering versus those not covering Mucor. There were no difference in mortality (RR; 1.24, 95%Cl; 0.98-1.57), efficacy ratio (RR; 1.09, 95%Cl; 0.91-1.30), and hepatic dysfunction ratio (RR; 0.98, 95%Cl; 0.66-1.45) between two groups. Antifungals with no activity against Mucor were associated with lower adverse event ratio (RR; 0.60, 95%Cl; 0.47-0.77) and renal dysfunction ratio (RR; 0.25, 95%Cl; 0.13-0.49). Presence or absence of activity against Aspergillus or Mucor is not associated with mortality or efficacy ratio. Amphotericin B with activity against Aspergillus and Mucor has a higher adverse event ratio. Depending on the case, selection of antifungal drugs considering efficacy and side effects is necessary.

著者

清水 幸雄 柚原 亜美 矢野 勝子 北川 佳奈子 飯田 純一 五十嵐 信智 伊藤 清美 落合 和 折井 孝男 杉山 清

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.36, no.1, pp.31-36, 2010 (Released:2011-12-24)

参考文献数

17

被引用文献数

6 4

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There is concern about the possibility of degradation of the active substance as a result of pH changes when making suspensions of several drugs together by the simple suspension method.However,this has been investigated by few researchers.In the present study,we focused our attention on aspirin since it is known to be hydrolyzed at high temperatures or with elevation in pH.In this study,a Bufferin® 81 mg Tablet was suspended alone or together with alkaline drugs by the simple suspension method,and its stability evaluated.When in the suspension alone,the Bufferin® 81 mg Tablet was stable for 5 hours and the amount of salicylic acid (hydrolyte of aspirin) produced was negligible.On the other hand,when it was suspended together with alkaline agents (magnesium oxide tablet/powder,or lithium carbonate tablet),the residual content of aspirin decreased to 77-84% in ten minutes.The pH of the suspensions containing both the Bufferin® 81 mg Tablet and alkaline agents ranged from about 9 to 10 showing that alkalinity had been enhanced as compared with the suspension of Bufferin alone whose pH was 4.It has been reported that in low-dose aspirin therapy,platelet aggregation inhibition is unstable if the daily aspirin dosage is reduced to less than 75 mg.However for Bufferin® 81 mg Tablet,the results of the present study suggested that the beneficial effect of low-dose aspirin therapy might not be fully achieved it were suspended together with alkaline agents by the simple suspension method.

著者

影山 恵美子 古岩 清子 木村 りつ子 折井 孝男 伊賀 立二

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.28, no.5, pp.435-442, 2002-10-10 (Released:2011-03-04)

参考文献数

3

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The Ministry of Health and Welfare (the present, Ministry of Health, Labour and Welfare) has begun to report the recall information of medical supplies (in short, recall information) on the home page of the pharmaceutical information provision by the Organization for Pharmaceutical Safety and Research since April 1 st, 2001. However, all recall information on the home page appears the day after the official publication. In case of medical devices in comparison to pharmaceuticals, it takes a longer time to be reported on the home page. However, such recall information is valuable, because it is the only information source, which medical institutions can obtain up-to-date information spontaneously.At Uwajima City Hospital, from May 2001, the pharmacists have participated in a safety management program regarding new medical devices or medical materials.In order to keep all medical materials safe, pharmacists check the recall information regularly and provide them to the clinical site for risk management. Not only the medical institutions but also the dealers have begun to make practical use of such recall information. However, no system for using such information has yet been established among them. According to the regulations of recall information, a contact system from the maker to the dealer has been established. However, the first information of medical devices is always obtained through the home page. The way to obtain the information has been changing.Needless to say, the “Internet” is nowadays the main media for the communications all over the world. Accurate information must be speedy and reliable. The rational use of such information on the Internet is therefore urgently needed.

著者

福岡 恵理子 鎌田 志乃ぶ 中島 克佳 折井 孝男 中村 均 佐藤 均 伊賀 立二

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.27, no.5, pp.523-530, 2001-10-10 (Released:2011-03-04)

参考文献数

2

被引用文献数

1 1

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In the University of Tokyo Hospital, the reentry of data, the re-output of documents, the transfer of data by hand writing, etc. has to be routinely carried out in each department, because there is no compatibility in the related work between the systems and generated information.In this study, we developed a medication management system to share drug-requesting information generated inside the hospital with medical wholesalers who introduced the Value Added Network (VAN) -ordering system, and evaluated the usefulness of this system by sending questionnaires to those who are working in the wholesale, clinical wards, and office work sections.The developed medication management system unified a series of information on the request-to-order processing of medicine between the hospital and wholesalers, the warehousing processing in the pharmacy department, the supply processing for the clinical wards, and the expenditure processing of purchased medical supplies. In addition, the system was designed to work with the LAN of our hospital information system under the environment of Windows NT®.In the investigation on the introduction situation of the computer for the drug wholesalers, 14 out of 16 companies (88%) introduced a computerized system to receive orders. Moreover, 12 out of 14 companies (86%) replied with “it is useful” regarding the usefulness of the system. On the other hand, in clinical wards, 41 out of 55 (75%) replied with “the requesting process has become more convenient by using this system”. In office sections, the time needed to process orders was drastically shortened from approximately 20 to 5 minutes on average.By utilizing this newly developed medication management system, it became possible to share the drug-requesting information originally generated in the clinical wards with the pharmacy department and office work section in the hospital and the medical wholesalers ; therefore, we find this system to be a useful supporting system for the proper management not only for hospitals but for medical wholesalers as well.

著者

木村 友美 小出 大介 折井 孝男

出版者

一般社団法人 日本薬剤疫学会

雑誌

薬剤疫学 (ISSN:13420445)

巻号頁・発行日

vol.17, no.2, pp.135-144, 2013-02-20 (Released:2013-04-10)

参考文献数

37

被引用文献数

5

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IT 技術の発展とともに,日々の診療や病院経営,その他の一次目的のために電子的に蓄積される医療情報は飛躍的に増加している.日常診療下での薬剤の使用実態や有用性・安全性を対象とする薬剤疫学研究において,データベースはもはや欠かせないツールであり,その二次利用は規制当局,企業,アカデミアのいずれにおいてもようやく一般的に認められるようになってきた.医療情報データベースを薬剤疫学研究に活用するためには,まず医療システムやデータソースならびにその限界点をよく理解する必要がある.本稿では 2012 年 10 月現在,筆者らが把握している範囲で,本邦で薬剤疫学研究に利用可能なデータベースを,各データベース保有者の確認および許可を得て,その特徴や活用事例と共に紹介する.(薬剤疫学 2012; 17(2): 135-144)

著者

保坂 恵玲 高柳 理早 鈴木 あやな 折井 孝男 清野 敏一 清水 秀行 山村 喜一 中村 幸一 小滝 一 澤田 康文 伊賀 立二

出版者

日本医療薬学会

雑誌

病院薬学 (ISSN:03899098)

巻号頁・発行日

vol.23, no.4, pp.342-347, 1997-08-10

被引用文献数

8

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We conducted a survey to evaluate a system adopted by the Pharmacy Department of Tokyo University Hospital to address the problem of drug compliance under this system, patients are provided with a "Drug History Handbook", or drug notebook. This survey attempted to determine the extent to which a "Drug History Handbook" helped patients understand the drug they were taking, and the extent to which it was utilized during visits to other institutions. Based on the results of the survey we evaluated the efficacy of "Drug History Handbook" as a means to enable patients themselves to perform comprehensive drug information management. Out of 288 patients respondmg to the survey 149 (52%) had a "Drug History Hand-book"149out of 286 respondents or 40% had been diagnosed at other institutions. The respondents who said they had shown their "Drug History Handbook" to phamacists or physicians at other pharmacies, hospitals, or medical institutions were numbered 7 1 out of 149 (48%), including duplicate responses. At community pharmacies conducted at the same time, responses were obtained from 48 pharmacies. Of the 48 responding pharmacies, 21 (44%) said that patients had presented either "Drug History Handbook"or "prescription cards" From these results, it is clear that the patients thus realized the importance of keeping a complete record of the drugs they had taken, and that presenting information about drug history can be a very valuable aid in both prescribing and preparing appropriate medications. From thus survey, it was found that the use of a "Drug History Handbook" can help prevent the dispersal of information about purchase of over the counter drugs as well as prescription drugs. As a means of patient education, it can also be extremely effective for avoiding the duplicated administration of medications and drug-drug interactions.