著者

鹿村 恵明 高橋 淳一 大山 明子 根岸 健一 伊集院 一成 上村 直樹 青山 隆夫

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.131, no.10, pp.1509-1518, 2011 (Released:2011-10-01)

参考文献数

9

被引用文献数

2 4

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Community pharmacists can provide effective pharmaceutical care by questioning the physicians about their prescriptions. The regulatory authority (Ministry of Health, Labour and Welfare or the like) has been issuing instructions/advice to health insurance-covered pharmacies about the nature of questions to be asked to physicians under the national health insurance system. However, this practice has been facing similar kind of problems almost every year. To identify the reasons for repetition of the problems and facilitate proper application of drug therapy at hospitals, we recently examined the nature of questions asked to physicians by conducting a survey of 165 health insurance-covered pharmacies belonging to 8 district branches of the Japan Pharmaceutical Association. When the pharmacists were asked to express their view whether each of the 18 sample questions included in the past surveys was actually necessary, the most frequent answer from the respondents (n=1980) was “neutral” (42.9%), followed by “unnecessary” (29.0%) and “necessary” (26.6%). Further, 55.5% respondents answered that it is necessary to refer to publications of the concerned fields (guidelines, etc.) when questioning the prescriptions. However, the responses about the possible reasons for judging the necessity of the questions suggested that sometimes the pharmacists failed to understand the details of such publications. The results from this study suggest that a high percentage of community pharmacists believed that there was little need to ask questions about prescriptions if the suggestions made by the regulatory authority about the relevant questions were taken into account. Further, our study findings suggested that pharmacists working at clinics cannot present a clear-cut rationale for their judgment about the necessity of asking questions about prescriptions under the current circumstances where sufficient information collection and the evaluation of need for asking questions about prescriptions are not possible.

著者

赤木 祐貴 荒井 碧 下村 斉 山本 康次郎 青山 隆夫

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.41, no.6, pp.404-414, 2015-06-10 (Released:2016-06-10)

参考文献数

37

被引用文献数

1 1

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Low-dose aspirin inhibits cyclooxygenase-1 (COX-1) on platelets irreversibly, suppressing platelet aggregation.Nonsteroidal anti-inflammatory drugs (NSAIDs) also inhibit COX-1 reversibly by forming a salt bridge. However, there is little information on the antiplatelet effects of the chronic use of NSAIDs (other than aspirin). We performed pharmacokinetics/pharmacodynamics (PK/PD) analysis using in vitro experimental data obtained when NSAIDs were added to human blank blood, and estimated the antiplatelet effects of continuous NSAID administration.Ibuprofen, diclofenac, indomethacin and loxoprofen were studied in a one-compartment model, and etodolac was studied in a two-compartment model. Platelet aggregation was measured after adding NSAIDs to platelet-rich plasma at a range of concentrations containing the maximum plasma concentrations of one clinical dose. We calculated the platelet-aggregation threshold index (PATI) as an index of aggregation activity, which was defined as the putative stimulus concentration giving 50% aggregation, and performed PD analysis according to the sigmoidal Emax model. Simulated time-PATI curves of NSAIDs were compared to that of low-dose aspirin.Simulated values of increase in PATI for the maximum plasma concentration of each NSAID were lower than 3.9 µg/mL, which is the same as that of low-dose aspirin. Increases in PATI around the trough concentration were nearly zero for all NSAIDs except ibuprofen, thus suggesting that the antiplatelet effects of continuous NSAID administration are weaker and less persistent than those of low-dose aspirin. The simulation results indicate that continuous NSAID administration is less effective at preventing thrombosis and embolism than low-dose aspirin, and postoperative NSAID treatment needs to be careful of the occurrence of bleeding.

著者

鹿村 恵明 大山 明子 高橋 淳一 赤木 祐貴 根岸 健一 伊集院 一成 上村 直樹 青山 隆夫

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.132, no.6, pp.753-761, 2012-06-01 (Released:2012-06-01)

参考文献数

18

被引用文献数

13 8

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This study examined the impact of pharmaceutical inquiries regarding prescriptions on drug costs by surveying the actual condition of inquiries at 13 pharmacies. The study also investigated the significance of inquiries from a medical economics perspective by calculating the medical cost savings realized by preventing adverse drug reactions (ADRs). As a result, the total change in drug costs for the 13 pharmacies after pharmaceutical inquiries represented an increase of ¥9,018/month. However, upon recalculating the cost of drugs by assuming that those with an “Incomplete entry in the prescription (compared with previous prescription, etc.)” should in fact have been prescribed, and excluding them, the total drug costs for the 13 pharmacies is decreased to ¥154,743/month, translating to a cost-savings of ¥7.2/prescription. The study then undertook a comprehensive assessment based on the Diagnosis Procedure Combination (DPC) system to determine the total medical cost-savings for 5 patients in whom ADRs could have occurred if the prescriptions had not been modified as a result of pharmaceutical inquiries. The obtained figure of ¥1,188,830 suggests that pharmaceutical inquiries contribute to reduced medical costs. The findings of this study indicate that pharmaceutical inquiries regarding prescriptions by staff pharmacists not only ensure the proper delivery of drug therapy to patients, but are also effective from a medical economics perspective.

著者

下村 斉 青山 隆夫

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.12, pp.781-794, 2016-12-10 (Released:2017-12-10)

参考文献数

53

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The incidence of pulmonary Mycobacterium avium complex (MAC) disease is increasing worldwide. Currently, clarithromycin is the key drug for treatment of pulmonary MAC disease, and multidrug therapy with rifampicin and ethambutol is recommended. However, the efficacy of this therapy is reported to be approximately 60-80%. Therefore, this disease is often difficult to treat, and there are some problems concerning this form of chemotherapy. Firstly, rifampicin decreases the serum clarithromycin concentration owing to CYP3A4-related interactions. Although this therapy needs to be administered for more than one year, to our knowledge, no study has investigated the long-term relationship between serum clarithromycin and rifampicin concentrations and CYP3A4 activity, together with treatment efficacy. Secondly, an alternative treatment to the recommended therapy of clarithromycin, rifampicin, and ethambutol has not been established. Therefore, fluoroquinolones are often used when the clinical efficacy of the recommended regimen is insufficient. However, very few previous studies have investigated the clinical efficacy of the combination of clarithromycin and fluoroquinolones, especially levofloxacin.Our recent study demonstrated that serum clarithromycin concentrations in patients with pulmonary MAC disease were continuously low because of rifampicin-mediated CYP3A4 induction, which may be responsible for the unsatisfactory clinical outcomes observed. We also investigated the clinical outcomes achieved with the currently recommended dose of clarithromycin and levofloxacin, and suggested the possibility that combined administration of clarithromycin and levofloxacin did not improve clinical outcomes for the treatment of pulmonary MAC disease. In this mini-review, we summarize the findings of our clinical studies concerning chemotherapy for pulmonary MAC disease.

著者

朝倉 佑実 河野 洋平 佐藤 将嗣 青山 隆夫

雑誌

日本薬学会第140年会(京都)

巻号頁・発行日

2020-02-01

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【目的】慢性裂肛には、ニトログリセリン等を含むクリームを患部に塗布し、肛門静止圧を低下させる治療が行われている。しかし、副作用や高い再発率が問題であり、有用な新規薬剤が求められている。芍薬甘草湯は内服で筋弛緩作用を示すことが知られており、外用薬としての有用性が期待できると考えられる。本研究ではラットを用いた肛門内圧測定法を構築するとともに、芍薬甘草湯クリームによる内肛門括約筋の弛緩効果を評価した。【方法】芍薬甘草湯クリームは、精製水に懸濁した市販エキス細粒2.5 gに、添加剤の流動パラフィンとグリセリン、および基剤の親水軟膏を加え、全量を7.0 gとした。肛門内圧測定用のプローブは、カテーテル(6 Fr)の先端にポリエチレン製のバルーンを装着して作成した。プローブにかかる圧力は、血圧トランスデューサと圧力用増幅器を用いて測定し、解析にはPowerLabを用いた。肛門内圧測定精度の検証では、クリープメータを用いてプローブにかけた一定の荷重と圧力測定値間の相関性を評価した。SD系雄性ラットを無作為に芍薬甘草湯群または対照群に振り分けた2剤2期のクロスオーバー試験では、吸入麻酔下でクリーム塗布前と塗布(0.1 g/kg)後3 hに肛門内圧を測定し、算出した肛門内圧変化率で効果を評価した。【結果・考察】プローブに一定の荷重(0.01–0.1 N)をかけて圧力を測定した結果、荷重と圧力の間に良好な相関が認められ(R2=0.996)、本測定法の定量性が確認された。肛門内圧変化率は、芍薬甘草湯群の塗布後3 hで78.8±13.5%(n=10, mean±S.D.)となり、対照群に比して有意に低下した(p<0.05)。以上のことから、芍薬甘草湯クリームは慢性裂肛の治療薬として有用である可能性が示された。

著者

山本 晃之 根岸 健一 木下 果鈴 福井 絢子 上村 直樹 青山 隆夫

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.21, no.1, pp.20-26, 2019-05-31 (Released:2019-06-21)

参考文献数

7

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Objective: It has been recognized that most medical institutions preferred the printed medium for their information sheets for patient education of inhaler usage. However, some questions have arisen. In a case where patients are not sufficiently informed of drug administration guidance due to limited information with only pictures and text, they might not be able to obtain a proper understanding. Contrarily, it is assumed that video medium, with audio and visual elements, is a format for education conveying a larger amount of information. We conducted comparative research regarding patient’s degree of understanding of inhalation guidance, comparing two groups of print- and video-medium-based instructions for inhaler usage and examined how effective two types of media explanations were on patients.Methods: Research participants were thirty persons visiting Jinjo Pharmacy, who were randomly assigned to the print medium group and the video medium group. After one group read and saw an explanation sheet of an inhaler where the maker wrote inhalation instructions and the other group watched an instruction video, the two groups practiced inhaler usage. Evaluation was performed with specified items and comprehensive assessment, and in addition, the time required for inhalation was measured.Results: Score of the evaluation score was statistically significantly higher in the video medium group than in the print medium group in score of specified items and score of comprehensive assessment, and was also significantly shorter in the operation time of the inhaler.Conclusion: This study clarified that the video medium group had fewer improper inhalation occurrences and shorter operation time and, therefore, showed the effectiveness of the video medium. It is recommended that the video medium should be actively utilized,which could improve patient medication adherence. Accessibility is required for patient education to achieve inhaler techniques by watching video-based instruction.

著者

青山 隆夫 松元 美香 中山 紀美子 中島 克佳 渋谷 文則 小滝 一 澤田 康文 伊賀 立二

出版者

一般社団法人 日本医療薬学会

雑誌

病院薬学 (ISSN:03899098)

巻号頁・発行日

vol.23, no.2, pp.108-114, 1997-04-10 (Released:2011-08-11)

参考文献数

16

被引用文献数

1 1

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The pyrogenic activity of 10% inulin injections prepared at a hospital pharmacy was measured using the Pyrogen test in Japanese Pharmacopeia (JP), while the endotoxin concentration in the injections was determined by the, Limulus test, which were JP Endotoxin test and a turbidmetric kinetic assay. After the intravenous administration of 30 ml of inulin injections to a rabbit, the rectal temperature rose to 1.5° compared with that before administration. As a result, the endotoxin was found in all lots of the inulin injections tested, and their values were markedly beyond the limit of Water For Injections prescribed in JP (0.25 EU/ml). In addition, the endotoxin content varied between the various lots of inulin powder, and also between the manufacturers. The endotoxin in inulin injection was removed (less than the quantitative limit of 0.031 EU/ml) by adding activated carbon black to the injection or the filtration using a Posidyne® Nylon 66 filter. No pyrogenic activity was observed in the inulin injections after the removal of endotoxin.Based on these results, the adverse effects induced by inulin injections may thus be caused by endotoxin derived from inulin. This method using either adsorption or filtration is thus considered to be useful for the removal of endotoxin when preparing inulin injections.

著者

青山 隆夫

出版者

東北大学大学院国際文化研究科

雑誌

国際文化研究科論集 (ISSN:13410857)

巻号頁・発行日

vol.1, pp.109-126, 1994-03-30

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Der unvollendete Teil von "Heinrich von Ofterdingen" mit dem Gedicht "Das Lied der Toten" hat nicht nur der Struktur nach viele Reminiszenzen an das japanische Maskenspiel No bzw. das Traumspiel (Mugen-No), wie z.B. die Poesie bei Novalis, das Ideale durch die wohlklingende Sprache in zusammenhanglosen Dingen symbolisch zusammenzufassen, entspricht also dem Element von "Yugen" bei Seami, das UnfaBbare hinter dem FaBbaren zu offenbaren. Die Zeit-Struktur der No-Dramaturgie, in der die Vergangenheit in die Gegenwart durchdringt, ist wiederum im zweiten Teil des "Ofterdingen" zu bemerken. Man konnte den zweiten Teil und "Das Lied der Toten" nach dem zweiaktigen No-Spiel rekonstruieren bzw. interpretieren. Die Nebenrolle Waki, der Pilger Heinrich, tritt mit der Begleiterin Wakizure bzw. dem Hirtenmadchen Cyane auf. Die Hauptrolle Shite im ersten Akt, der alte Arzt Sylvester, wartet auf die beiden hinter dem Tor und fuhrt ein Gesprach mit dem Pilger uber die Moral und die menschliche Erziehung und verschwindet schlieBlich ins Kloster. Der Alte, der uber Zeit und Raum existiert, ist eigentlich einer der Totengeister im Kloster. Im zweiten Akt erscheint die Hauptdarstellerin Mathilde vor Heinrich. Sie lobt und singt die Herrlichkeit des Totenreiches, das ein erhohtes Lebensreich bedeutet. Der Chor, die Klosterbruder, singt auf der Buhnenecke mit, wahrend die Shite-Figur auf der Buhne nach dem No-Stil tanzt und singt. Drei Strophen im Gedicht, von der 7. bis zur 9., werden dem Inhalt nach, der als Theater im Theater den Kern des ganzen Gedichts ausmacht, rezitativ und schlieBlich mit Chor dargeboten. DaB die Shite-Figuren im ersten und im zweiten Akt verschieden sind, widerspricht struktuell auch nicht der doppelten Rolle einer Person bei Novalis, die eventuell als eine Art Metempsychose verstanden wird. Diese ambivalente Wirkung der Figuren kann man doch als Allegorie annehmen. DaB das Totenreich noch kein endgultiges Ziel, sondern nur eine Zwischenstufe auf dem Weg zur Erfullung ist, zeigt der Anruf der Shite an das irdische Wesen als dramatischer Hohepunkt des ganzen Spiels, damit der Pilger mit erneuertem Mut weiter in die unbekannte, offene Ferne wandern kann. Mit Hilfe der Dramaturgie von No interpretiert man anschaulicher die Zeit- und Figurenstruktur von dem zweiten Teil "Ofterdingen" mit dem "Lied der Toten".

著者

大塚 亮子 青山 隆夫 高柳 理早 清野 敏一 清水 秀行 中村 幸一 小滝 一 澤田 康文 伊賀 立二

出版者

一般社団法人 日本医療薬学会

雑誌

病院薬学 (ISSN:03899098)

巻号頁・発行日

vol.23, no.3, pp.269-277, 1997-06-10 (Released:2011-08-11)

参考文献数

15

被引用文献数

1 2

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We studied the effect of advising outpatients on the rational use of ophthalmic solutions and compliance by a questionnaire (n=158), in order to establish the optimal consultation method. A total of 41.8% of the patients answered the questionnaire. In compairing the actual use of ophthalmic solutions before and after consultation, the rates of rational use increased for all items except for “applications per day”, which decreased slightly from 93.4% before the consultation to 90.2% after that. In particular, “eyelid closure” and “nasolacrimal occlusion” after instillation, and “the 5 min interval of instillation in the case of plural medication”, considerably increased from 34.8% before the consultation to 60.6% after that, from 9.5% to 50.8% and from 45.9% to 73.8%, respectively. The compliance remarkably improved in glaucoma patients after consultation regarding “the 5min interval of instillation” .Based on these results, our consultation method for the rational use on ophthalmic solutions was thus evaluated. However, since some patients who still did not appreciate the need for the rational use of such medication still presented, further improvements in the consultation method requires for the rational use.

著者

下村 斉 青山 隆夫

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学

巻号頁・発行日

vol.42, no.12, pp.781-794, 2016

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<p>The incidence of pulmonary <i>Mycobacterium avium</i> complex (MAC) disease is increasing worldwide. Currently, clarithromycin is the key drug for treatment of pulmonary MAC disease, and multidrug therapy with rifampicin and ethambutol is recommended. However, the efficacy of this therapy is reported to be approximately 60-80%. Therefore, this disease is often difficult to treat, and there are some problems concerning this form of chemotherapy. Firstly, rifampicin decreases the serum clarithromycin concentration owing to CYP3A4-related interactions. Although this therapy needs to be administered for more than one year, to our knowledge, no study has investigated the long-term relationship between serum clarithromycin and rifampicin concentrations and CYP3A4 activity, together with treatment efficacy. Secondly, an alternative treatment to the recommended therapy of clarithromycin, rifampicin, and ethambutol has not been established. Therefore, fluoroquinolones are often used when the clinical efficacy of the recommended regimen is insufficient. However, very few previous studies have investigated the clinical efficacy of the combination of clarithromycin and fluoroquinolones, especially levofloxacin.</p><p>Our recent study demonstrated that serum clarithromycin concentrations in patients with pulmonary MAC disease were continuously low because of rifampicin-mediated CYP3A4 induction, which may be responsible for the unsatisfactory clinical outcomes observed. We also investigated the clinical outcomes achieved with the currently recommended dose of clarithromycin and levofloxacin, and suggested the possibility that combined administration of clarithromycin and levofloxacin did not improve clinical outcomes for the treatment of pulmonary MAC disease. In this mini-review, we summarize the findings of our clinical studies concerning chemotherapy for pulmonary MAC disease.</p>

著者

吉村 浩太郎 青山 隆夫 岡崎 睦 北野 幸恵

出版者

東京大学

雑誌

基盤研究(B)

巻号頁・発行日

2000

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メラノサイトのメラニン産生に対するall-trans retinoic acid(atRA)、ハイドロキノン、ハイドロコーチゾンの影響を三次元培養皮膚、単層培養を用いて調べた。三次元培養皮膚における総メラニン量、単層培養における総メラニン量、チロジナーゼ活性などを測定した。細胞数(蛋白量)をもとに相対値で比較した。ハイドロキノンでは強いメラニン産生抑制効果、細胞毒性が見られたが、レチノイン酸では明らかではなかった。ハイドロコーチゾン、ハイドロキノンとの相乗効果は特に観察されなかった。AtRAのケラチノサイトに対するHB-EGFmRNA誘導能を単層培養を用いて調べた。MRNA量はreal-time PCRを用いて、GAPDHとの相対値で比較、検討した。AtRA刺激12時間後で正常にくらべて10-30倍のHB-EGFmRNA増加が見られた。この変化は未分化なケラチノサイトよりも分化誘導されたケラチノサイトでより著明であった。他の天然および合成レチノイドとの比較では、Ch55においてレチノイン酸よりも強い誘導能が観察された。13cisRAおよび9cisRAではatRAとほぼ同程度の誘導能が観察された。他の天然および合成レチノイドではさらに誘導能は弱かったが、濃度を40-100倍にあげることにより、レチノール、レチナールではatRAとほぼ同程度のHB・EGFmRNA誘導能が観察された。

著者

矢野 育子 井関 健 東海林 徹 青山 隆夫 木津 純子 中村 均 藤井 俊志 渡邊 美智留 野田 幸裕 脇屋 義文 森田 邦彦 手嶋 大輔 二神 幸次郎

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.1, pp.43-49, 2009 (Released:2010-02-07)

参考文献数

8

被引用文献数

1 1

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With the introduction of 6-year pharmacy educational program in 2006,a provision was made to assign pharmacist faculties having working experience as pharmacists in pharmacy schools.In October 2007,we conducted a survey to investigate the situation of pharmacist faculties.We sent a questionnaire to 247 pharmacist faculties in 66 pharmacy schools and the response rate was 84.9%.The faculties consisted of professors (43%),associate professors (23%) and lecturers (23%),and 77% of them had a Ph.D.degree.In a typical week,the major activities they engaged in were educational activities (20.6 hrs),research (12.2 hrs) and management (9.6 hrs).While the average time they were occupied by clinical practice was 3.5 hrs,67% of them did not do any.Half of the faculties did not conduct any research with students or graduate students in their own schools,and in 2007 only 55% applied for Grant-in-aid for Scientific Research from the Ministry of Education,Culture,Sports,Science and Technology of Japan.Twenty-six percent said they were very satisfied or satisfied with their work on a five-point scale,and 44% rated their degree of satisfaction as fair.In conclusion,our survey showed that most pharmacy faculties are not sufficiently engaged in clinical practice and do not spend much time in clinical research.We hope that its results will promote discussions among pharmacy personnel concerning the role of pharmacist faculties so that even better clinical pharmacy education may be provided to students in pharmacy schools.

著者

倉本 加代 青山 隆夫 中島 克佳 中村 幸一 小滝 一 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.6, pp.491-496, 1997-12-10

被引用文献数

2

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We studied the effects of various infusion containers materials on the fluid volumes, different infusion fluids and fluid concentrations of nartograstim (NT), a recombinant human granulocyte colony stimulating factor, on the adsorption of NT to containers, after adding NT preparations (Neu-up^&ltss;[O!R}> for injection 100) into infusion fluids. The NT concentrations in the infusion fluids after adding NT to containers were determined by a high-performance liquid chromatographic method or bioassay. When 1000 ng of NT was added to 500 ml physiological saline in glass containers (final concentration : 200 ng/ml), the residual rates in the fluids was to 89.5% immediately after addition, and thereafter decreased 73.3% at 6 hr and 59.1% at 24 hr. Similarly, when NT was added to the same solution in polypropylene containers, the residual rates was 74.2% immediately after adding, and 37.5% at 6 hr, and 27.8% at 24 hr. The results in the ethylenvinyl acetate and polyethylene containers were also similar to those in the polypropylene containers. No influence of the volumes (100 and 250 ml) or the kinds of fluids (physiological saline, 5% glucose solution and ringer lactate solution) on the residual rates of NT in fluids was observed. As the fluid concentrations of NT were higher, the residual rates were found to be larger within the range of 100- 1200 ng/ml. These decreases in the NT concentrations in the infusion fluids could be prevented almost completely by adding commercially available total-vitamin injections containing polysorbate surfactants.