著者

鈴木 彩夏 半谷 眞七子 亀井 浩行

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.45, no.12, pp.688-697, 2019-12-10 (Released:2020-12-11)

参考文献数

22

被引用文献数

3

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The medical system has been changing from medical institutions to home medical care with an increase in the number of elderly persons. Home medical care is a type of interprofessional team care, requiring pharmacists' participation. However, insufficient cooperation with other occupations makes participation difficult under some circumstances. In this study, we interviewed 5 pharmacists who had participated in home medical care in Aichi Prefecture with respect to the involvement of pharmacists in home medical care and opinions regarding multi-occupational cooperation (semi-structured interview), and qualitatively analyzed their responses using the Grounded theory approach. Concerning the involvement of pharmacists in home medical care, two characteristics were extracted: “pharmacists' viewpoint required for home medical care” and “relationship with other occupations”. In the field of home medical care, the number of requests for the management of terminal-stage patients has increased, and pharmacists must perform “viewpoint of medical staff”-based management, such as sterile preparation and emergency management. On the other hand, pharmacists' “viewpoint of living people” to support patients' feelings or lifestyle and “view of life and death” were required for the management of terminal-stage patients. With respect to the relationship with other occupations, the results showed that pharmacists' low-level recognition of the contents of home service affected cooperative work, suggesting the necessity of presenting the pharmacists' position to contribute to other occupations and establishing a face-to-face relationship.

著者

土屋 雅美 河添 仁 江面 美緒 橋口 宏司 飯原 大稔 橋本 浩伸

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.46, no.11, pp.664-671, 2020-11-10 (Released:2021-11-10)

参考文献数

18

被引用文献数

2

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We developed an international journal club, using an online meeting tool, as an evidence-based medicine training program intended for healthcare professionals and students. This study aimed to evaluate the outcome of the journal club via a questionnaire survey. We administered the questionnaire to 53 healthcare professionals and students who participated in the journal club between February 2019 and April 2020. Respondents showed positive improvement scores after participating in the journal club, compared with those before, as conveyed through the use of a seven-point Likert scale. The median scores of critical thinking skills, discussion skills in English, evidence-based practice skills, and the sense of freedom to ask questions and make comments after participating in the journal club were significantly improved from 4 (interquartile range [IQR]: 2 - 5) to 5 (IQR: 4 - 6); 3 (IQR: 2 - 4) to 3 (IQR: 2 - 5); 3 (IQR: 2 - 5) to 4 (IQR: 3 - 6); and 3 (IQR: 1 - 5) to 3 (IQR: 2 - 6), respectively. Moreover, they expressed interest in the opportunity to share articles on topics of interest with other professionals from different disciplines, to exchange clinical practice ideas concerning topics of interest, and to explore differences in clinical settings between Asia and the MD Anderson Cancer Center. They also expressed great appreciation for the online meeting format, novelty, and overall qualities of the journal club. These findings suggest that an international journal club for healthcare professionals and students could be useful in an evidence-based medicine training program and communication in English.

著者

岡田 浩司 薄井 健介 大内 竜介 金野 太亮 鈴木 裕之 西川 陽介 紫桃 裕造 布施 克浩 齋藤 裕子 星野 淳 渡辺 善照

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.46, no.12, pp.739-746, 2020-12-10 (Released:2021-12-10)

参考文献数

10

被引用文献数

1 1

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The COVID-19 pandemic has significantly affected every aspect of social life. Even in the education field, flexible measures were required beyond conventional wisdom. We provided remote practical hospital pharmacy training (remote training) using online systems such as Zoom and Moodle. We conducted a questionnaire survey with 38 subjects and 34 respondents, who were students that underwent remote training. The students self-evaluated their achievement level regarding specific behavioral objectives (SBOs), from the 2013 revised edition of pharmaceutical clinical practice related to hospital pharmacy practical training, in four stages. In addition, we analyzed the words used in the free comments using a text mining method for their characteristics. The SBO classifications exceeding the overall average were “clinical attitude”, "acknowledgement of patient information”, “prescription and question inquiry”, and so forth. The SBO classifications falling below the overall average were “team medical care at medical institutions”, “preparation of drugs based on prescription”, “safety management”, and so forth. The analysis of the positive aspects of remote training suggest that it was useful in sharing information about Subjective, Objective, Assessment, Plan (SOAP) records in case analysis, and evaluating the effects and side effects of drug treatment. Conversely, the analysis of the required improvements in remote training showed concerns regarding the considerable amount of homework and issues within the communication environment. We consider that remote training has a certain educational effect and can be expected to complement clinical training.

著者

髙武 嘉道 川俣 洋生 大石 裕樹 福石 和久 髙島 伸也

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.46, no.11, pp.655-663, 2020-11-10 (Released:2021-11-10)

参考文献数

7

被引用文献数

3

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Evaluating the awareness and experience with regard to clinical research and understanding the current challenges are important in promoting the engagement of hospital pharmacists in clinical research. Therefore, we conducted a questionnaire survey on 337 pharmacists working at 28 National Hospital Organization Kyushu Group facilities and 5 National Hansen's Sanatoriums, regarding their experience and awareness of clinical research. The survey was conducted via mail from June 2019 to July 2019. Overall, 335 (99.4%) questionnaires were collected, 280 (83.1%) of which were valid responses and could be analyzed. The survey showed that 48.2% of the responding pharmacists had delivered conference presentations and only 15.4% had published articles. The necessity for hospital pharmacists to plan and conduct clinical research was considered “necessary” or “slightly necessary” by 86.0% of the respondents; the most frequent reason was "for medical development." However, concerns about planning and conducting a clinical study were expressed by 94.6% of the pharmacists; “statistical analysis” was the most frequent issue. The results of this survey indicate that the majority of pharmacists are interested in clinical research; however, writing a dissertation was a difficult task for hospital pharmacists. Hence, we believe that it is important to include the topics of research planning and statistical analysis in the basic education of pharmacists.

著者

今西 孝至 岩竹 柚樹 岡村 美代子 矢野 義孝 楠本 正明

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.1, pp.25-32, 2021-01-10 (Released:2022-01-10)

参考文献数

9

被引用文献数

1

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In order to prevent a crisis due to the increasing elderly population in 2025, home medical care should be enforced and promoted. Therefore, pharmacists are expected to play their roles in home medical care. However, pharmacists’ involvement in home medical care remains inadequate in Japan. In this study, a nationwide questionnaire survey was conducted on the awareness of visiting nurses about the roles of pharmacists in home medical care, and data were analyzed using the text mining method. A request letter was posted to 47 prefectural branches of the Japanese Nursing Association and 28 prefectural branches of The National Association for Visiting Nurse Service. Only members of these associations who agreed to participate in this survey responded. As a result, a total of 103 visiting nurses completed the questionnaires. “Distribution of medicines to the medication calendar” was one of the main medicine-related jobs performed by visiting nurses during home medical care. The majority of them (95% of visiting nurses replied “it is necessary”) indicated that pharmacists’ activity was required for home medical care. According to visiting nurses, the job expected from pharmacists in home medical care was the “centralized unitary management of medicines in collaboration with medical doctors.” In summary, our survey results suggest that an active intervention to polypharmacy by pharmacists in collaboration with home medical doctors is important for home medical care.

著者

本田 勝亮 稲垣 啓太 大貫 よし子 釋 悦子 中村 みどり 志智 大介

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 = Japanese journal of pharmaceutical health care and sciences (ISSN:1346342X)

巻号頁・発行日

vol.34, no.12, pp.1120-1126, 2008-12-10

参考文献数

16

被引用文献数

1 1

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We established a reporting system for the use of antimicrobial agents for methicillin resistant Staphylococcus aureus (MRSA) infections in January 2003 to help ensure they are used properly.Then,in October 2005,we set up an infection control team (ICT) to monitor the use of four agents for MRSA infections : vancomycin,teicoplanin,arbekacin and linezolid.Changes in the antimicrobial use densities of the agents,the number of patients receiving them and the therapeutic drug monitoring (TDM) execution rate were investigated for three periods : I : before the reporting system (2002),II : while reporting system was in use (2004),III : during ICT monitoring (2006).<br>There was no significant change in the antimicrobial use densities of the agents for MRSA infection,while the number of patients receiving them decreased significantly in period III (p<0.05).Also in period III,the antimicrobial use density of teicoplanin increased significantly (p<0.05),there was a marked decrease in the number of patients receiving vancomycin (p<0.01)and the TDM execution rate increased significantly (p<0.01).<br>The systematic activities performed by the ICT were effective in ensuring the proper use of antimicrobial agents for MRSA infection.Further,by enabling us to share information with other medical staff and conduct rapid interventions,they have been playing an important role in infection control in our hospital.

著者

湯元 良子 田川 茉希 永井 純也 酒井 正彦 桑田 直治 木平 健治 石野 岳志 平川 勝洋 高野 幹久

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.34, no.10, pp.951-955, 2008 (Released:2010-02-07)

参考文献数

19

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Burow’s solution,a hospital preparation,exhibits antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) and other microorganisms that are commonly observed in chronic supprative otitis media.However,it takes several days to prepare Burow’s solution by the method commonly employed in Japan and it is difficult to ensure constant quality.With this in mind,we examined the pharmaceutical and pharmacological characteristics of Burow’s solution and developed a new prescription for it (Neo-Burow’s solution) having an aluminum acetate base.The new prescription takes only a few hours to prepare,is convenient,and ensures a solution of constant quality.In this study,we examined the clinical effects of Neo-Burow’s solution in external and internal otitis.We prepared NeoBurow’s solution in the Department of Pharmacy and used it for 13 patients in whom commercially available antibiotics had had no effect,in the Department of Otorhinolaryngology of Hiroshima University Hospital.Nine of the patients completely recovered after treatment with Neo-Burow’s solution,and it had some effect in 1 patient but was completely ineffective in the remaining 3 patients.No adverse reactions were observed.Our results indicated that Neo-Burow’s solution was effective and safe in the treatment of chronic suppurative otitis,even that accompanied by MRSA.We have received a lot of inquiries about Neo-Burow’s solution from pharmacies and other hospital facilities,most of them relating to its preparation and preservation.Our manuscript includes a summary of the inquiries and the answers given to them.

著者

森 良江 濱 宏仁 西村 亮 中浴 伸二 森本 茂文

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.46, no.4, pp.222-229, 2020-04-10 (Released:2021-04-10)

参考文献数

14

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This study clarifies the storage situation of drugs that require light-protection at patients’ homes, and reveals the proper storage conditions of these drugs.We interviewed inpatients about the storage situation of drugs for light-protection. In addition, we measured light illuminance on the desktop (J), inside of a storage case (C) of the pill-shelf, inside medicine envelopes: white-color (YW), pink-color (YP) and black inside (YB), and lightproof plastic bags (S) at our prescription department.Eighty-four percent of patients were not consciously protecting the drugs from light at home. As for the storage form of those patients, “storage in medicine envelopes / storage in non-lightproof plastic bags with a sealer or pill case / storage from medicine envelopes as is” were respectively 43, 41, and 17 percent. The illuminance of J was 696-811 lx. The illuminance of C, YW, YP, YB and S decreased to values corresponding to 6-13, 21-22, 15, 0.9, and 0.3-0.4 percent against J, respectively. We found that many patients have problems with drug storage situations.As a result of the illuminance measurement, it was clear that storage in C and each medicine envelope have certain light protection effects. It was considered that YB might be useful as a storage condition for drugs that require light-protection, because a shielding effect of 99 percent was observed under 800 lx. These results were one indicator of the effects of exposure to light depending on the storage condition of the drug.

著者

三島 江津子 岡戸 洋 加藤 さおり 櫛原 秀之 黒田 純子 榊原 隆志 首代 みどり 鈴木 厚志 松岡 加恵 宮坂 朋恵 渡辺 法男 横田 学 板倉 由縁 鈴木 照美 斉藤 寛子

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.6, pp.403-408, 2009 (Released:2010-08-19)

参考文献数

11

被引用文献数

1 1

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When pharmacists provide drug guidance to in-patients,they are often asked about health foods such patients are regularly taking in expectation of anti-cancer effects.However,pharmacists cannot always answer these questions based on scientific evidence.To further evaluate the efficacy of health foods for this purpose,we did a survey of the literature concerning 5 frequently used health foods said to have anticancer effects using the PubMed and Ichushi search services,obtaining 1,300 papers from the former and 1,142 papers from the latter.However among them,we could not find any providing data from randomized controlled trials and thus there was no clear scientific evidence,though some of the papers noted an improvement in the quality of life of patients.In conclusion,when pharmacists provide guidance on health foods to patients and their families,it is important for them to collect detailed information and evaluate them on a scientific basis.

著者

森田 真樹子 米澤 淳 森 美奈子 田﨑 嘉一 長屋 健 千石 一雄 松原 和夫

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.39, no.8, pp.504-509, 2013-08-10 (Released:2014-08-10)

参考文献数

16

被引用文献数

1 1

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Breastfeeding is important in infant rearing. To support safe breastfeeding in a patient using lamotrigine, the transfer of lamotrigine to the infant via breast milk was evaluated in two couples of Japanese mother and infant. The infants took their mothers' milk expressed a day ahead. The plasma and breast milk concentrations of lamotrigine at 4 (or 5) and 89 (or 90) days after the birth were measured by HPLC. The lamotrigine concentrations of the two mothers were 12.63 and 6.21 µg/mL in plasma, 11.50 and 4.13 µg/mL in milk at Day 4. Milk/Plasma ratios (M/P) were 0.91 and 0.67, and the estimated Relative Infant Dose (RID, at Day 5) was calculated to be 12-29%. At 89 and 90 days after birth, the milk concentrations and RID, respectively, were similar to those at 4 days, which indicates that the transfer of lamotrigine into milk is high in Japanese mothers. The infant plasma concentrations of lamotrigine at 5 and 90 days were between 2.8 and 6.7 µg/mL, which was within the therapeutic range in children with epilepsy. Typical adverse effects were not observed in these infants under meticulous surveillance. In conclusion, pharmaceutical healthcare is necessary for lactating mothers using lamotrigine and their infants.

著者

雪田 拓 樋浦 一哉 渕上 俊介 安土 菜美 陶山 明菜 稲垣 貴裕 今井 隆人 渡辺 浩明

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.40, no.10, pp.618-624, 2014-10-10 (Released:2015-10-10)

参考文献数

16

被引用文献数

1 1

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Upper gastrointestinal symptoms, a common adverse effect of dabigatran, influence the continuation of medication. It has been speculated that this adverse effect can be reduced by changing the method of taking dabigatran: that is, to instruct patients to swallow dabigatran capsules whole with a glassful of water. However, there is no evidence to support this conclusion. Therefore, we changed our patient compliance instruction of dabigatran to the method mentioned above from September 2013 and investigated the effect of that change on the onset of adverse events and patient quality of life (QOL). Among 42 patients treated with dabigatran, 17 patients were categorized into the instruction change group and 25 were categorized into the no instruction change group. The Izumo scale was used to assess patient QOL. A total of 20 patients experienced side effects in the upper gastrointestinal tract (6 in the instruction change group, and 14 in the no instruction change group), and 18 patients in the lower gastrointestinal tract (3 in the instruction change group, and 15 in the no instruction change group). Izumo scale scores were significantly lower in the instruction change group than in the no instruction change group. Furthermore, in the no instruction change group, 5 patients showed a remarkable decrease in patient QOL by the adverse effects of gastrointestinal symptoms; however, in the instruction change group, this did not occur in any patients. The results indicate that patient QOL can be maintained by altering the method of taking dabigatran.

著者

猪川 和朗

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.5, pp.305-316, 2016-05-10 (Released:2017-05-10)

参考文献数

54

被引用文献数

1

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So-called pharmacometrics were used for information creation and decision-making in the drug development and drug approval process. However, for individualized drug therapy in clinical settings, pharmacometrics were not fully utilized. Therefore, our research group has defined, as “clinical pharmacometrics”, clinical contribution to decision-making in individualized drug therapy, especially with dosage optimization support and adverse effects management, by pharmacist-led quantitative analysis, evaluation and prediction using mathematical statistical methods. We show here some examples of practicing clinical pharmacometrics. In the case of supporting meropenem dosage optimization, we developed a population pharmacokinetic model and then performed random simulation to predict the efficacy of dosages (the drug exposure time above the minimum inhibitory concentration) by employing a probabilistic approach considering the variation of the patient and bacteria. The optimized meropenem dosage achieved favorable outcome. In the case of managing adverse effects of voriconazole, we developed a population pharmacogenomic-pharmacokinetic model and a logistic pharmacodynamic model, and then performed simulation to predict the safety of dosages (the hepatotoxic effects). These results optimized the voriconazole dosage according to the body weight and CYP2C19 genotype of the patient, considering the hepatotoxicity probability. As in these examples, for optimal drug therapy in individual patients, pharmacists need to practice clinical pharmacometrics by repeating the cycle of processes: clinical data measurement in the medical setting, acquisition of quantitative pharmaceutical knowledge, and provision of therapeutic benefits to patients.

著者

飯塚 俊介 葉山 達也 内池 明博 堤 大輔 小田桐 功武 中山 敏光 早坂 正敏 村松 高 橋本 修 吉田 善一

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.3, pp.145-153, 2017-03-10 (Released:2018-03-10)

参考文献数

21

被引用文献数

1

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The absorption of gefitinib is dependent on gastric pH. However, an increase in gastric pH via the use of antacids such as proton pump inhibitors (PPI) and histamine H2 receptor antagonists may reduce the bioavailability and efficacy of gefitinib.In this study, we report the influence of the concurrent use of antacids with gefitinib on the efficacy in epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC). Our subjects were 68 patients with NSCLC who were treated with gefitinib at our hospital between 2008 and 2015.In the study, we compared time to treatment failure (TTF), overall survival (OS), response rate, disease control rate and adverse effect rates in patients receiving antacids in combination as well as (AC; n = 29) with those only receiving gefitinib (no AC; n = 34).The patients in the AC group exhibited a significant difference in TTF (409 days (95%CI: 1.00-4.22) vs 901 days (95%CI: 0.24-0.99), P = 0.0492) as compared to the no AC group. But then the OS, response rate, disease control rate and adverse effects rate were not significant between each group. Therefore, this study suggests that, as long as the combination of gefitinib with antacids is avoided, the combination with antacids should not impair the clinical efficacy of gefitinib. From the results of the sub-analysis, this study suggests that, in particular men, less than 75 years old, PS≧2, pulmonary metastasis, it is preferable to avoid the combination of gefitinib and antacids.

著者

成重 友莉 尾川 理恵 辰島 瑶子 福井 史織 江頭 伸昭 光安 正平 坂井 真樹 桑城 貴弘 井無田 麻衣子 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.38, no.9, pp.541-546, 2012-09-10 (Released:2013-09-12)

参考文献数

14

被引用文献数

5 6

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Nicardipine hydrochloride injection, a dihydropyridine calcium channel blocker, is an acidic drug. The package insert recommends that nicardipine injection should be administered at the concentrations of 0.01-0.02%. However, the drug often induces venous irritation despite infusion at the recommended concentrations in the intensive care unit (ICU) at Kyushu University Hospital. Therefore, we retrospectively investigated the incidence and risk factors of venous irritation in ICU patients. Univariate and multivariate analyses revealed that the administration time and infusion rate of the drug were significantly related to venous irritation (P<0.05). Patients who were infused with nicardipine injection (administration time: more than 24 h, infusion rate: more than 45 mL/h) developed the venous irritation frequently (7 of 9, 77.8%). In the case of infusion of nicardipine injection for more than 96 h, the patients experience severe vascular damage and needed for treatment with medicine such as topical steroids. These results suggest that the administration time and infusion rate are involved in nicardipine injection-induced venous irritation, and it is necessary to pay attention to these factors as well as observing the instructions in the package insert.

著者

辻 大樹 斎藤 嘉朗 莚田 泰誠 三浦 昌朋 平 大樹 寺田 智祐

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.46, no.2, pp.66-76, 2020-02-10 (Released:2021-02-10)

参考文献数

12

被引用文献数

1 2

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Given that the cancer gene panel test was approved in June 2019, precision medicine based on the information about somatic mutation is expected to be widely available. Similarly, pharmacogenomics (PGx) associated with germline genes, such as drug-metabolizing enzymes, could also be effective tools. However, its clinical implementation has been delayed.To address this issue, we conducted a survey regarding pharmacists’ involvement in “cancer genomic medicine (CGM)” and actual use of PGx and therapeutic drug monitoring (TDM). The response rate of the survey was 96.8% (121/125).According to this survey, genetic polymorphism analysis for irinotecan (UGT1A1), which is approved for genetic testing, was most commonly used. Among the tests not covered by insurance, tacrolimus (CYP3A5) and voriconazole (CYP2C19) were commonly used. Only a few facilities conducted PGx tests. Unlike PGx, many drugs are covered by insurance for TDM, which was commonly used. Vancomycin was most commonly used, followed by teicoplanin and cyclosporine. Regarding CGM, it was found that the pharmacists were most commonly involved in dose adjustment support, followed by support for selection of anti-cancer agents. Pharmacists’ participation in the expert panel was 21.3%.This survey revealed that PGx testing is less common compared with TDM. PGx of drug-metabolizing enzymes could potentially influence adverse reactions and efficacy. It might be possible to provide individualized pharmacotherapy if PGx testing could be performed at the same time as gene panel tests. Insurance-covered PGx testing may increase in the future if more high-quality clinical trials are conducted and its usefulness is validated.

著者

古野 孝明 半田 寛 今井 圭介

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.5, pp.260-266, 2017-05-10 (Released:2018-05-11)

参考文献数

8

被引用文献数

1 1

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The phosphorus content of the drug was reported in the United States, and attention was paid to pharmaceutical additives. However, papers surveying the phosphorus content of drugs in Japan have not been reported. We calculated the phosphorous content in dibasic calcium phosphate hydrate (DCPH) or dibasic calcium phosphate (DCP) in amlodipine (AML) and compared the phosphorus content for each formulation. DCPH or DCP was found in all the 104 AML tablets and in 15 of the 78 AML OD tablets. On request, the pharmaceutical company revealed the amounts of DCPH or DCP in 78 of the 104 AML tablets (75.0%) and 9 of the 15 AML OD tablets (60%). The phosphorus content in AML tablets varied among the pharmaceutical companies and it tended to increase with an increase in dose. On the other hand, 63 of the 78 AML OD tablets did not contain DCPH or DCP. Furthermore, the phosphorus content in 9 of the 15 AML OD tablets containing DCPH or DCP was lower than that in AML tablets. Therefore, unnecessary phosphorus load can be avoided in dialysis patients by opting for AML OD tablets rather than AML tablets or opting for low phosphorus content AML tablets.

著者

片田 佳希 中川 俊作 田上 裕美 津田 真弘 都築 徹教 端 幸代 小高 瑞穂 米澤 淳 萱野 勇一郎 矢野 育子 南方 謙二 坂田 隆造 松原 和夫

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.1, pp.14-22, 2016-01-10 (Released:2017-01-10)

参考文献数

14

被引用文献数

4 7

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Vancomycin (VCM) is a first-line antibiotic used for methicillin-resistant Staphylococcus aureus (MRSA), and therapeutic drug monitoring (TDM) is recommended to minimize the risk of nephrotoxicity and ensure successful therapeutic outcomes. In Kyoto University Hospital, we have developed a new approach of pharmacist intervention in the medication with VCM, which is named “Protocol-Based Pharmacotherapy Management (PBPM).” PBPM is based on a protocol approved in a hospital committee, which mentioned that pharmacists could order TDM and propose the most appropriate treatment plans with VCM to surgeons. From April 2011 to September 2014 in Kyoto University Hospital, a total of 54 patients hospitalized for cardiovascular surgeries received VCM without the treatment of hemodialysis. Twenty-nine patients before introducing PBPM were the control group. The VCM treatment according to PBPM was applied to 25 patients (protocol group). The incidence of acute kidney injury (AKI) due to VCM therapy, the retention rates of VCM blood concentration maintained in the therapeutic range (10-20 µg/mL) and in the toxic range (over 20 µg/mL) were retrospectively surveyed. The incidence of AKI was significantly lower in the protocol group than that in the control group (8.0% vs 31.0%, P < 0.05). The retention rates maintained in the therapeutic blood concentration range and in the toxic blood concentration range were significantly different between the control group and the protocol group. These results demonstrate that pharmaceutical intervention based on PBPM for MRSA treatment is effective for maintaining VCM blood concentration in the therapeutic range, resulting in a reduction of adverse drug reactions.

著者

山下 大輔 和田 恭一 吉牟田 剛 森 英人 中蔵 伊知郎 堀部 明美 岡田 博 佐田 誠 岡島 年也 塘 義明 野々木 宏 小原 延章

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.36, no.5, pp.323-327, 2010 (Released:2012-03-09)

参考文献数

13

被引用文献数

1

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The purposes of this study were to demonstrate how the interaction between rifampicin and voriconazole can be managed clinically and to characterize the changes in voriconazole concentration levels after discontinuation of rifampicin.The concomitant administration of voriconazole and rifampicin is contraindicated because the interaction between these drugs results in a subtherapeutic concentration of voriconazole.In this regard,voriconazole is known to be metabolized by CYP2C19,2C9,3A4,and rifampicin is a potent inducer of CYP3A4.The interaction between rifampicin and voriconazole was investigated in a 70 year old male patient with severe infection in a prosthetic graft,necessitating simultaneous treatment with vancomycin and rifampicin.Rifampicin therapy was discontinued to start antifungal treatment with voriconazole.Interaction between the 2 drugs was evaluated by measuring voriconazole trough levels 4,7,11,18,and 29 days after starting therapy with it,performing the assays by high-performance liquid chromatography.Four days after starting voriconazole,we observed a significant decrease in its serum concentration,to 0.24μg/mL.After 7 days,it had increased to 0.84μg/mL and to 1.24μg/mL after 11 days,and thereafter,continued to gradually increase.Thus,after discontinuing rifampicin,CYP induction continued to be strong for the first 11 days and then became more moderate over the course of a month.In conclusion,it is essential that patients being treated with both rifampicin and voriconazole have their voriconazole concentrations monitored when rifampicin therapy is discontinued.

著者

辻本 高志 和田 吉生 阿知波 一人 結城 祥充 後藤 仁和 福澤 信之 原田 浩

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.8, pp.407-416, 2017-08-10 (Released:2018-08-10)

参考文献数

22

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Although some have reported that Astragali Radix, which has a diuretic effect and is contained in herbal preparations for kidney disorders, suppresses the progress of renal dysfunction, its effects on chronic-phase patients after renal transplantation have not been verified. Therefore, the effect of Astragali Radix on improving the creatinine levels of patients with chronic kidney allograft dysfunction (CKAD) and the possibility of its interaction with immunosuppressants were studied. The subjects were 13 patients who had received living-donor kidney transplantation at our hospital for stage 4/5 chronic kidney diseases (CKD) and agreed to cooperate in the study. Their serum creatinine (sCr) level, which was 3.6 ± 0.8 mg/dL before Astragali Radix administration, decreased significantly by 1 month later and was 3.0 ± 0.7 mg/dL after 3 months, resulting in a significantly increased estimated glomerular filtration rate (eGFR). In all cases, the 1/sCr level after Astragali Radix administration exceeded the value estimated from the approximate line obtained by plotting the pre-administration 1/sCr levels on the administration period. The area under the curve (AUC) of blood concentration standardized by dose for 12 hours after immunosuppressant administration increased by approximately 20% for tacrolimus (TAC) after Astragali Radix administration, but did not change significantly for mycophenolic acid (MPA), which is an active metabolite of mycophenolate mofetil (MMF). Astragali Radix reduced sCr significantly and suppressed the progress of CKAD. Since the blood TAC level increase caused by Astragali Radix was not clinically significant, it was considered safe for use in combination with TAC or MMF.

著者

山本 勇樹 森元 慶三 北村 諭思 米谷 智樹 古川 壮彦

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.37, no.10, pp.567-571, 2011 (Released:2012-10-11)

参考文献数

12

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The hepatitis B virus (HBV) is a serious concern for people at high risk of exposure to blood in their work because it is very infectious. While infection can be prevented by acquiring antibodies from hepatitis B vaccine, there are low responders and non-responders to the vaccine.We examined 2 possible methods of overcoming this problem: performing an additional vaccination with a different type of vaccine and carrying out 2 additional vaccinations at monthly intervals. Regarding the former method, an additional vaccination with a different vaccine type was carried out for a subject who could acquire no antibodies after undergoing 2 series of 6 vaccinations and who had not had any antibodies to hepatitis B for about 10 years. One month later, the passive hemagglutination test (PHA test) showed that the subject had obtained a 512-fold increase in the number of antibodies. As for the latter method, 3 of 5 non-responders acquired antibodies. Also, 5 of 6 subjects who were less responsive to the vaccine acquired antibodies and maintained them for at least 3 years.We intend to improve immunization coverage by using the methods examined in this study.