Proper Use Of Drugs Research Articles

Policy Making: How the Advisory Committee on Immunization Practices Reached Recent Decisions

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

個別化に対応した薬剤管理指導用「お薬説明書」作成システムの構築

Sufficient drug informations should be provided to patients who place themselves under medical care regarding the proper use of drugs. Various reports have been published regarding what kind of drug information should be provided to outpatients. In our hospital, we meet these requirements by distributing of notebooks on the patients' medication history and medication cards. We have developed a system to prepare medication cards for a clinical consultation of inpatients using the database for outpatients, in order to efficiently individualize the medication cards according to each patients' disease. The accumulation and reproduction of individualized medication cards allows us to efficiently inform and educate inpatients about proper drug usage.

処方せんデータベースを活用した高尿酸血症治療薬の処方実態調査 薬剤の適正使用に関する考察

In order to study the proper use of urate-lowering drugs, we searched and analyzed a recently established database of 151, 804 community pharmacy records for the one-year period ending in August 1997. A total of 5, 312 prescriptions for typical urate-lowering drugs, allopurinol and benzbromarone, were searched. The number of male patients was found to be approximately 6.5 times that of females (578 and 89, respectively). The average age was 59.8 years (range 15 to 90 years). Of the 5, 312 prescriptions examined 81.4% were for allopurinol, 17.1% for benzbromarone and 1.5% for both. The number of prescriptions for allopurinol was approximately 4.5 times greater than that for benzbromarone. Hyperuricemia is classified into three types. The first type, includes patients who under-excrete uric acid, occurs in approximately 55% of patients. Uricosuric drugs such as benzbromarone are considered to be the drugs of choice. The second type, consists of over-producers of uric acid, occurs in approximately 10% of patients. The third type, comprising a mixed category, accounts for the remaining 30%. Allopurinol is recommended for the latter group of both under-excreters and over-producers. Given this classification, benzbromarone should thus be prescribed on a relatively frequent basis.The average number of drugs per prescription was 5.9 (range 1 to 25 drugs) thus indicating that patients with hyperuricemia tend to be prescribed multiple-drug regimens. From the analysis of concomitant drugs, it was found that the most frequently prescribed drug was furosemide (22.4%), followed by nifedipine sustained-release preparations (15.7%), pravastatin sodium (11.7%) and aspirin diaulminate for children (10.7%). The most frequently prescribed drug group was vasodilators (60.2%) including calcium antagonists and nitrates, followed by peptic ulcer agents (44.4%), anti-arteriosclerotic agents (27.1%), anticoagulants (25.1%), diuretics (24.2%) and ACE inhibitors (20.7%). These finding suggest that patients with hyperuricamia tend to have multiple complications such as hypertension, hypercholesterolemia, and ischemic cardiopathies.Inappropriate drug use and combinations are as follows: Alkalinizing agents, which prevent urate stone formation and are recommended for hyperuricemia, appear to be under-utilized (only 11.8%). Diuretics, trichlormethiazide (2.5%) and furosemide (22.4%) commonly cause hyperuricemia and thus should be avoided. When allopurinol and captopril are administered concomitantly (2.9%), a dangerous hypersensitivity reaction can also sometimes occur.These results indicate that doctors and pharmacists need to obtain a greater awareness of inappropriate drug use and dangerous drug combinations.

How to Explain Vaccines to Children and other Inquisitive People

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunopro-phylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

Short-term and long-term treatment for bipolar patients: beyond the guidelines

This clinical review considers the different symptomatic forms of bipolar disorders and the influence of the clinical subtype on treatment. Therapy is required both to manage the various types of acute episodes of mania or depression and to prevent recurrence. For the latter purpose, continuous long-term or even lifetime prophylaxis may be required, continuing on after control of the acute episode. In this context, the roles and potential side-effects of lithium, divalproex sodium and carbamazepine, alone and in combination, are summarized, along with the proper use of antipsychotic drugs. The selection of mood-stabilizing agent or drug combination depends on the clinical manifestations of bipolar disorder, family history and previous treatment history of the patient. Particular caution must be exercised in those with a history of antidepressant-induced switches; many such patients appear prone to course aggravation and even rapid-cycling and will often need combined mood-stabilizer combinations.

The Importance of Up-to-Date Vaccine Information Statements

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunopro-phylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

Vaccines and Antibodies in Relation to Pregnancy and Lactation

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunopro-phylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

Pandemic Influenza: Planning Now to Prevent Another Tragedy

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

Are Vaccines Safe? Risk Communication Applied to Vaccination

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunopro-phylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

Overcoming Immunization Disparities Based on Race or Ethnicity

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunopro-phylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

How to Interpret Immunization Schedules and Records

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunopro-phylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

Immunization and Organ Transplantation

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunopro-phylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

Illicit Prescription Drug Use among Pharmacists

On average, pharmacists spend six years in college studying the intricacies of prescription medicines and their effects on the human body. Upon graduation, they embark on a career where their expertise and familiarity with the proper use and dangers of prescription drugs continuously grows. Despite this wealth of experience, some pharmacists become prescription drug abusers. The present analysis uses interview data obtained from 50 recovering drug dependent pharmacists to understand the process by which these professionals come to abuse the tools of their trade. Ironically, the data show several ways in which the individuals' knowledge and expertise may actually contribute to progressive prescription drug abuse. The authors argue that being and becoming a pharmacist presents a paradox of familiarity wherein technical knowledge and opportunity, in the absence of proper appreciation of the risks of substance abuse, can delude pharmacists into believing that they are immune to prescription drug abuse.

Targeting Vaccines to Specific Clusters of People

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunopro-phylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.

製薬企業の行うPMSとその方法論

Post-marketing surveillance (PMS) of ethical drugs has been institutionalized in Japan. The framework of the PMS consists of : 1) collection of information related to the drug, 2) evaluation and analysis of that information, and determining the correspondence, 3) reporting the information and filing of applications of Reexamination/Reevaluation to the Ministry of Health and Welfare (the Koseisho), and finally 4) dissemination of information to medical and pharmaceutical professionals. Although a sphere of strict regulations is imposed for conducting these tasks, pharmaceutical companies comply with these regulations and execute post-marketing surveillance with an aim toward the true objective of the PMS, which is to “secure the proper use of ethical drugs”. In order to accomplish this objective, nothing is more important than for medical representatives (MR) to collect as much accurate information as possible, and for post-marketing surveillance management to conduct a precise evaluation and analysis of the collected information and then to feed back the pertinent information to medical and pharmaceutical professionals. With this in mind, pharmaceutical companies can be considered as conducting post-marketing surveillance systematically.

Evaluation of the timing of flecainide administration and ischemia-induced ventricular arrhythmias in rats

Ischemia-induced arrhythmias are major complications of acute myocardial infarction; therefore, understanding the proper use of antiarrhythmic drugs in this situation is important. The goal of the present study was to determine how the timing of flecainide administration influenced ischemia-induced arrhythmias in an isolated rat heart model. Ischemia-induced arrhythmia was produced by ligating the left coronary artery. The effect of flecainide (10 −6 M) on ischemia-induced arrhythmia varied depending on the time of drug administration in relation to the time of coronary artery ligation. Drug administration both before and after (group 5) coronary artery ligation was most effective, followed by administration before (group 4) and then by administration after (group 3). At the end of each experiment, the left and right ventricular walls of each heart were separated, and drug concentration in each part was measured. Drug concentration in the left ventricular wall differed significantly between the group in which coronary artery ligation was not performed (group 1) and group 3 or 4. No correlation between drug concentration in the right ventricular wall and antiarrhythmic effect was observed. These differences in antiarrhythmic effect depending on the timing of drug administration may be caused by the difference in drug concentration in the ischemic zone and the effect of coronary artery occlusion on the speed of drug dispersion within this zone. This myocardial infarction model is useful for studying the correlation between antiarrhythmic effect and regional drug distribution.

臨床薬理学の教育と啓発 医薬品の臨床試験と適正使用―行政の立場から

臨床薬理学の教育と啓発 医薬品の臨床試験と適正使用―行政の立場から

Self-Medication of Dyspepsia: How Appropriate Is It?

Background: The scope of self-medication is increasing in many countries, and drugs for dyspepsia are a popular group for deregulative activities. This study investigated what kind of upper gastrointestinal symptoms people self-medicate and how appropriate this self-medication is. Methods: An anonymous questionnaire was given to 50 consecutive customers buying antacids, alginates, or sucralfates in 10 pharmacies in the capital area in Finland in 1995. In half of the pharmacies the questionnaire was returned by mail, and in the other half the questionnaire was filled out at the pharmacy. The response rate was 53% (n = 292). Results: The commonest reasons for self-medication were heartburn (88%), gastrointestinal pain (31%), and acid regurgitation (32%). Seventy-five per cent of respondents had used dyspepsia drugs for more than a year. The commonest way to self-medicate was to interchange regular and occasional use. Knowledge about the proper use of dyspepsia drugs was poor, and 6% of respondents had symptoms contraindicating self-medication but had not visited a physician during the past year. Patients more than 60 years old were especially at risk of potential inappropriate use. Conclusions: Over-the-counter (OTC) drugs for dyspepsia are likely to be used improperly. A physician's advice on the use of OTC dyspepsia drugs, in addition to detailed printed information about drug action and proper administration, would be important means to guarantee appropriate use of these drugs.

Prescribed medication and nutrition of social care patients in Crete, Greece

The aim of this study was to make a systematic registration of a group of 354 social care indigent patients in relation to: their pharmaceutical needs: the conditions for which it was prescribed, its cost, and details of prescriptions. In addition patients' eating patterns relating to and knowledge of how to use their medication was assessed. They were compared to a control group of 153 Social Security patients. The Social Care indigent patients were of low income, consisting of groups as unmarried mothers with their children and Greeks emigrants coming back home from other countries (Albania, Russia, Georgia, Ukraine, Romania etc.). The socio-demographic profiles of this group reveal an unemployment rate of 74% and an illiteracy rate of 18%. As regards marital status, 20% are bachelors and 12% divorcees. The results of the study indicated no significant difference between the two groups in the mean cost of prescription (40 ECU for Social Care patients vs 32 ECU for Social Security patients), in the mean number of medication per prescription (2.6 vs 2.6 respectively), in the percentages of the Daily Defined Doses and the cost of the various categories of drugs. For both groups, the most common drugs were those of the Cardiovascular system (30% vs 26%), Gastrointestinal system (17% vs 27%) and Nervous system (16% vs 18%). The most common diagnosis was Hypertension (10% vs 8%) and the most common drugs were Ranitidine (3% vs 2%), Diclofenac (3% vs 3%), Salbutamol (3% vs 3%) and Paracetamol (2% vs 2%). Significant differences between Social Care patients to Social Security patients respectively were found regarding: knowing how to take their medication correctly (47% vs 77%), knowing for how long treatment needed to be taken (21% vs 43%), requesting information from the pharmacist (39% vs 68%) knowledge of dietary instructions regarding medication (17% vs 41%) and in smoking more than 20 cigarettes per day (15% vs 3%). The results indicated that the Social Care patients, in comparison with the patients of the Social Security, need more education and more help in the area of the proper use of drugs and in the personal contact that this procedure involves.

Failure of clotrimazole-betamethasone dipropionate cream in treatment of Microsporum canis infections

The use of antifungal-steroid combination topical medications carries a theoretic advantage of rapid symptomatic relief. At the same time, these drugs possess several potential disadvantages, including steroid-related adverse effects (such as atrophy, telangiectasia, and acneiform eruptions) and steroid impairment of natural defenses facilitating infection and thereby interfering with the expected efficacy of the antifungal component. Although steroid-related complications would most likely result from prolonged use or abuse of combination agents, treatment failures could theoretically appear even with proper drug use. The latter actually appears to be relatively rare. As documented in a review, the use of proprietary clotrimazole-betamethasone dipropionate offers similar mycologic and clinical cure rates when compared with a variety of single-agent antifungal drugs in the management of tinea pedis, tinea cruris, and tinea corp0ris.l We report a small series of therapeutic failures associated with use of a steroid-antifungal medication. Of particular interest, all cases treated were caused by Microsporum canis.