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Purpose: Problem-based learning (PBL) has been adopted to foster active and self-directed learning and enhance critical thinking and problem-solving skills in many health-care academic disciplines in Korea. Interest in PBL has rapidly grown with a 6 year pharmacy degree program in Korea. The objective of this study was to evaluate feasibility of PBL, student satisfaction and academic performance with a self-assessment survey questionnaire. Method: Sixty students participated in the PBL for pharmacotherapy course. Average scores from student self-assessment on participation, satisfaction, and academic performance were 3.85±0.55, 2.94±1.04, 3.09±0.91 out of 5 point lickert scale (1-do not agree at all, 5-agree completely), respectively. Results & Conclusion: The level of participation was positively correlated with improvement of communication skill in academic performance (correlation coefficient 0.27, p=0.037). In the quality analysis of the cases provided for PBL, students who participated more in the PBL greatly agreed the cases given were appropriate to learn fundamental knowledge for each disease state. The students disagreed that PBL was fun. The studentsstated that PBL was good to experience self-directed learning and clinical context beforehand but too time-consumingto devote and too demanding to commit. Lack of facilitator and insight on active learning should be rectifiedfor successful launch of PBL in Korean pharmacy education.

Background: 6-year College of Pharmacy curriculum had started in Korea, and the students in college of pharmacy aresupposed to have student practice in the hospital pharmacy, community pharmacy, pharmaceutical company and administrationto experience the role of pharmacists in advance. However, despite Korean Association of Pharmacy Educationprovided its own teaching plan, most Pharmacy Schools and the hospital pharmacy have difficulty in performingthe desirable student practice program because they seldom experienced it. So, we reported the student practice programin the hospital pharmacy conducted by Yonsei University College of Pharmacy prior to the other numerous universitiesand the evaluation of survey on the student pharmacy practice program. Method: Severance Hospital,Gangnam Severance Hospital and National Health Insurance Service Ilsan Hospital took part in the student pharmacypractice program of Yonsei University. Students took 8-week pharmacy practice in Severance Hospital or GangnamSeverance Hospital plus 4 -week pharmacy practice in National Health Insurance Service Ilsan Hospital. Also, studentshad once-a-week presentation class at school. A survey was conducted to evaluate the student practice program. Results: The presentation class was considerably helpful to share their own experiences at different practice sites in differenthospitals, but there were some disadvantages that students could not experience the specific pharmacy practicesite on the day of once-a-week presentation at school and so on. The results of the survey on the student practice programreported that students were satisfied with the overall practice program and presentation class at school. Also, theyanswered that the student practice program in the hospital pharmacy was significantly helpful for planning of the futurecareer. Conclusion: Through the performance of the student practice program in Yonsei University, the adjustment ofthe student practice program in the hospital is planned to provide better experience of practice to the students and theresults will be helpful for the student practice in the hospital of the other colleges of pharmacy.

Objective: Colistimethate was first became available in 1950s and used until the early 1980s to treat infections causedby gram-negative bacteria and was abandoned due to its nephrotoxicity and neurotoxicity. However, it was recently reintroducedinto the clinical practices due to emergence of multidrug-resistance gram-negative bacteria, particularlyPseudomonas aeruginosa and Acinetobacter baumanii. Therefore, it is increasingly used in the intensive care unit settingsas a salvage therapy. This study was designed to investigate the incidence rates and risk factors of acute kidneyinjury associated with colistimethate by using the standardized definition in critically ill patients. Methods: This studyretrospectively reviewed the electronic medical records of 71 adult patients above 18 years old receiving intravenouscolistimethate at least 48 hours at intensive care unit, university-affiliated hospital from Nov 2012 to Aug 2013 andexcluded patients with end-stage renal disease (ESRD) and required renal replacement therapy before initiation of thecolistimethate therapy. Acute kidney injury (AKI) was determined by using the standardized RIFLE criteria, classifiedwith risk, injury, failure, loss and ESRD according to serum creatinine (Scr) levels. Results: Among the 71 patientsincluded in the analysis, AKI developed in 40 patients (56.3%) and 6 patients (8.4%) had irreversible kidney injury. AKIoccurred within 5 days in 20 patients (50.0%). Maximum Scr level showed a significant increase in the patients with AKI(1.92±0.86 mg/dL vs. 1.12±0.46 mg/dL p=0.001), maximum BUN also increased (64.2±28.7 mg/dL vs. 48.4±24.9 mg/dLp=0.017) and minimum creatinine clearance (CLcr) was significantly decreased in the patients with AKI than non-AKI(34.5±18.6 ml/min vs. 64.4±33.7 ml/min p=0.185). The patients with AKI had significantly longer duration of colistimethatetherapy (21.1±17.0 days vs. 13.0±11.5 days, p=0.020) and larger cumulative doses of colistimethate (6465.9±4717.0 mg vs. 4438.1±3426.7 mg, p=0.040). Conclusion: The incidence and severity of AKI associated with colistimethatein critically ill patients was high and serious. Drug monitoring program should be performed to shorten durationof therapy and reduce cumulative dose from initiation of colistimethate therapy for minimizing AKI of colistimethate.

Purpose: Atorvastatin, a HMG-CoA reductase inhibitor is widely prescribed in hyperlipidemic patients and telmisartan,an angiotensin receptor blocker is frequently used in the treatment of hypertension. Both drugs are substrates of organicanion transporting polypeptide (OATP) expressed in basolateral membrane in the liver, and undergo high first passmetabolism. Therefore, OATP-mediated hepatic uptake is important for disposition and metabolism of these drugs. Thepresent study was designed to investigate the pharmacokinetic interactions between atorvastatin and telmisartan in rats. Method: Young adult SD rats were divided into three groups (n=6, each) and atorvastatin (10 mg/kg) and telmisartan(4 mg/kg) were orally given alone and together. Heparinized blood was serially taken and plasma concentrations of bothdrugs were measured using HPLC-MS/MS. Pharmacokinetic parameters of two drugs were calculated. Results: No significantpharmacokinetic change was found except a delay of time to peak of telmisartan when administered with atorvastatin. Each drug at the present dosage seemed to be insufficient to alter the pharmacokinetic parameters of itscounterpart drug. Conclusion: Conclusively, co-administration of atorvastatin and telmisartan may lead to negligibleclinical consequences.

Purpose: Telmisartan, an angiotensin receptor blocker has been known to be a potent blocker of both CYP2J2 and Pglycoprotein(P-gp) in vitro. This study aims to investigate the drug-drug interactions between telmisartan and ebastine,a CYP2J2 and P-gp substrate in rats. Method: Ebastine (10 mg/kg) was orally given in the presence and absence oftelmisartan (4 mg/kg, p.o.). Heparinized blood was serially taken and the plasma concentrations of ebastine and its threemetabolites (hydroxyebastine, carebastine and desalkylebastine) were determined using LC-MS/MS, and their pharmacokineticparameters were compared. Results: Peak concentrations (Cmax) and AUC of ebastine were significantly (p<0.05)increased in the presence of telmisartan by 2.1 and 1.9 times, respectively. While Cmax of hydroxyebastine was significantlyincreased by 1.9 times, the half-life of hydroxyebasteine was decreased significantly with telmisartan (p<0.05). There was no change in the pharmacokinetic parameters of carebastine, the active metabolite of ebastine, and desalkylebastinewas not detected in plasma. The systemic exposure of ebastine was significantly augmented by telmisartan, indicatingthat telmisartan may enhance the absorption of ebastine by blocking P -gp. Conclusion: Although telmisartanmay also partially contribute to inhibit the biotransformation to hydroxyebastine, the inhibitory action seemed to beoverridden by the enhancement of absorption, because the generation of hydroxyebastine was not diminished. In spiteof such interactions between telmisartan and ebastine, no clinical consequence could be expected due to no significantchange of the active metabolite, carebastine.

Background: Antihistamine and anti-allergy medications are widely used during pregnancy. Reading label information isone of the easiest ways to get safety information. But there are content gaps among countries. Objective: To compare therisk level and the recommendation level of antihistamine/anti-allergy drug’s label information in pregnant women amongKorea, the USA, the UK, and Japan. Method: Study drugs of antihistamine/anti-allergy medications were selected accordingto Korea drug classification codes. Based on the label information of selected product, risk level was classified into 5categories as follows: ‘Definite’, ‘Probable’, ‘Possible’, and ‘Unlikely’, ‘Unclassified’ according to the level of evidence. Recommendation level was classified into 4 categories as follows: ‘Contraindicated’, ‘Cautious’, ‘Compatible’, and‘Unclassified’. Frequency and proportion were presented according to the each category. To estimate agreement of eachcategory among 4 countries, percent agreement and kappa (k) coefficient were calculated. Results: Total 13 drug ingredientswere selected for antihistamine/anti-allergy medications. In risk level, Korea (46%) and Japan (69%) were mostly classifiedin the category of ‘Unclassified’, but ‘Unlikely’ category was more frequent in the UK (62%) and the USA (46%). In recommendation level, the proportion of ‘Contraindicated’ was highest in Korea (46%) compared to other countries. Incontrast, the category of ‘Cautious’ was 77%-85% in the USA, the UK, and Japan. The percent agreement for risk levelwas highest in the USA-UK (54%). The recommendation level of Korea-USA showed lowest agreement for percent agreement(46%) and kappa coefficient (k=0.02). Conclusion: We confirmed the differences among safety information providedby four different countries. ‘Contraindicated’ was more likely in Korea compared with other countries.

Purpose: This study aims to investigate consumers’ demand of and perspective on drug information domestically availableand uncover hurdles that they faced while utilizing information. Methods: We conducted a survey of 101 consumers,face-to-face after obtaining informed consent. Chi-squared, or Fisher’s exact tests, and multivariate logistic modelswere used to investigate the association between participants’ perceptions and characteristics. Results: As results, participantsshowed the highest demand for “Adverse effects >90%”; “Drug interactions/Dosage/Drug-food interactions/ Indication>80%”, and utilized package inserts (52%), doctors (41%) and pharmacists (36%) most often as informationsources. Generally, the most common difficulty consumers suffered with was that “it is hard to understand (51%)”. With public sources of drug information, sixty one percent of participants were “unaware of the provision of information”,resulting in strikingly low usage rates (5~11%). Subgroup analyses indicated that the older (≥ 50 years) and thedisadvantaged might have been placed in the blind spot of information mostly developed online (p<0.05).Conclusion:In conclusion, public sources of drug information that have been developed online might fail to meet consumers’demand. Greater efforts should be made to balance the development of the information sources between online andoffline, and to increase accessibility of the established information sources.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immune-complex-mediatedhypersensitivity reactions that predominantly involve skin and mucous membranes. Despite the low incidence, both areconsidered medical emergencies as the mortality rate has been estimated at 30-50%. Although as many as half of casesare idiopathic, several drugs have been implicated as main cause of SJS/TEN. This review therefore aimed to identifydrugs that were potentially associated with SJS/TEN and compare the relative risk of the medications. Method: A comprehensivesearch was performed using MEDLINE, EMBASE and 5 Korean databases. We defined study drugs as nonsteroidalanti- inflammatory drugs (NSAIDs), antibiotics, antiepileptics, and allopurinol. Only epidemiologic studiesinvestigating associations between the above drugs and drug-induced SJS/TEN were included. Two reviewers independentlyselected and evaluated candidate papers and extracted odds ratios or incidence rates. Meta-analysis was performedonly for drugs that were reported from 4 or more studies. Results: We found 8 case-control studies, 3 cohortstudies and 1 RCT. The ranges of adjusted ORs were 0.6-34.0 for NSAIDs, 1.6-302.0 for antiepileptics, 0.3- 10.0 forantibiotics and 1.0-187.0 for allopurinol. The drug with the highest incidence of SJS/TEN was carbamazepine (40 persons/1,000 DDD). Conclusion: Finally, the risk was highest in first 8 weeks after onset of treatment in all drugs.

Background: Malnutrition of inpatients has been associated with higher morbidity, mortality, cost, and longer hospitalstay. Total parenteral nutrition (TPN) therapy plays an important role in decreasing morbidity and mortality among criticalinpatients in hospitals, and has been commonly used to improve clinical outcomes. However, only a few studieswere conducted regarding patients` nutritional improvement by TPN. Method: This study therefore evaluated thechanges in nutritional parameters by TPN therapy for early malnourished inpatients. Data from early malnourished inpatientswho were treated with TPN therapy between January 2012 and June 2013 at the ○○ university Hospital werestudied retrospectively. Information regarding sex, age, underlying diseases, division, TPN (peripheral and central), andchanges in nutritional parameters were collected by reviewing electronic medical records. The criteria for evaluation ofthe changes in nutritional parameters were included physical marker, body mass index (BMI), and biochemical markers,including albumin (Alb), total lymphocyte count (TLC), and cholesterol. Nutritional parameters were collected threetimes: pre-TPN, mid-TPN and end-TPN. A total of 149 patients (peripheral, 97; central, 52) was evaluated. Results: In allpatients, the malnutrition number was significantly decreased following the complete TPN therapy (peripheral patients, pre-TPN: 3.33±0.12, mid-TPN : 3.06±0.17, and end-TPN: 2.85± 0.21 (p < 0.05); central patients, pre-TPN: 3.38±0.11, mid-TPN: 3.06±0.13, and end-TPN: 2.75 ±0.21 (p < 0.05). The malnutrition number means number of nutrition parametersbelow normal range of malnutrition. In addition, all of the four nutritional parameters (BMI, Alb, TLC and cholesterol)were increased with duration of TPN periods for all patients, and the changes in the early stage were larger than in thelate stage (p < 0.05). The nutritional parameters of non -cancer patients were increased to a greater extent compared tocancer patients with longer TPN therapy, but it was not significant. The nutritional parameters of younger patients (50-60 years) were also increased more than of older patients (70-80 years), but it was not significant. Conclusion: In conclusion,the TPN therapy decreases malnutritional status and improves nutritional parameters in malnourished patients,thereby decreasing morbidity and mortality. The combined evaluation of all four nutritional parameters is more accuratefor nutritional assessment than a single one.