Earticle

Objective: Currently, rivaroxaban is widely used clinically for thromboprophylaxis after surgery. However, thereare concerns on effectiveness and safety of rivaroxaban for its proper use. We aimed to evaluate the effectivenessand safety of rivaroxaban in orthopaedic patients after total hip replacement surgery in a large medicalcentre after the preferred formulary was switched from enoxaparin to rivaroxaban. Methods: The study wasconducted on the patients who underwent hip arthroplasty surgery at the department of Orthopaedic Surgery atSeoul St. Mary’s Hospital, South Korea. Electronic medical records were retrospectively reviewed to identifypatients treated with rivaroxaban following total hip replacement between February 2011 and March 2012. Evaluation criteria included indications for use, dose, initiation and duration of therapy, drug interactions,adverse reactions, and status of health care reimbursement. The patients who were on enoxaparin were alsoreviewed as a reference. Results: We identified 57 patients who received rivaroxaban and 50 who receivedenoxaparin. All patients were prescribed the drugs for Korean Food and Drug Administration–approved indications. No thromboembolic or bleeding events were observed in either group. However, only 5.3% of rivaroxaban-treated patients had an appropriate length of prophylaxis and only 3.5% began rivaroxaban treatment at therecommended time. Surprisingly, 47.4% of rivaroxaban-treated patients received rivaroxaban despite being ineligiblefor reimbursement benefits. Conclusion: Rivaroxaban was generally well tolerated clinically. However, theduration of treatment, the time of initiation and patient eligibility for reimbursement require improvements,emphasising the need for education which indicates the area of pharmacists’ involvement.

Background: It is known to reduce the mortality when glutamine is supplied to patients during the surgery or in intensivecare unit through intravenous nutrition supply. The purpose of this study is to establish the appropriate basis foruse of glutamine and guidelines of nutrition supply for critically ill patients in the hospital by examining the clinicaleffects of administration of glutamine with subjects of elderly critically ill patients receiving intravenous nutrition in onehospital in Korea. Method: Among elderly patients with age of 60 or more hospitalized in Yeuido St. Mary’s Hospitalfrom August 2012 to July 2013, those who stayed in the intensive care unit for more than a week and received TPN(Total Parenteral Nutrition) for more than 3 days during staying in the intensive care unit were classified to a test groupusing glutamine and a control group without glutamine. Duration of use of mechanical ventilator, duration of hospitalization,occurrence of infectious disease and death were compared between two groups. We would like to identify theclinical test figures affected by the use of glutamine by examining changes in SCr, Total Protein, Albumin, AST, ALT,TB, DB and GFR at the time of admission and discharge. Results: At the time of admission to intensive care unit,gender, physical measurement information and clinical test figures did not show any significant difference between 72subjects in a test group and 24 subjects in a control group. Thus, two groups began in the same condition. There wereno significant difference in duration of hospitalization, duration of intensive care unit, use of mechanical ventilator,occurrence of infectious disease and death. As the results of statistical analysis of the average changes of clinical testfigures at the time of admission and discharge of intensive care unit, SCr and GFR were significantly changed in thetest group. GFR was significantly changed in a control group. As the result of analysis of the clinical test figures at thetime of discharge with reflection of average changes after clinical test figures were corrected at the time of admissionof intensive care unit, TB and GFR were significantly increased in a test group compared with those in a control group. Other clinical test figures were not significantly changed. Conclusion: If glutamine is administered to critically illpatients over age 60 receiving TPN and careful monitoring for total bilirubin is made in the future, it is expected togive the positive effect on renal function andminimize the side effect of arise in total bilirubin.

Background: Elderly patients with gastrointestinal (GI) and cardiovascular (CV) risk factors may be more easilyexposed to NSAID-related side effects (SEs). Based on the ACG guideline of year 2009, the aim of the study is toevaluate proper use of NSAIDs and gastroprotective drugs according to the degree of GI and CV risk strengths in thepatients. Methods: Retrospectively surveyed 410 elderly patients with NSAIDs for more than 30 days at a general hospitalin Korea. GI risk factor includes age, ulcer history, high-dose NSIADs, concurrent aspirin use, steroids or anticoagulants. CV risk factor includes angina, myocardial infarction, cerebral infarction, atrial fibrillation or coronaryintervention requiring low-dose aspirin. These factors were classified as high/low cardiovascular groups and high/moderate/low GI groups. Results: There were 14 patients in high CV risk group and high GI risk group. The group was recommendednot to use NSAIDs as it is not adequate. There were 101 patients in high CV risk group and moderate GIrisk group. This group was recommended to use naproxen and PPI/misoprostol. But all patients except one were notadequate. There were 9 patients in low CV risk group and high GI risk group. This group was recommended to useselective COX-2 inhibitor and PPI/misoprostol. 5 cases were proper while 4 cases did not. There were 285 patients inlow CV risk and moderate GI risk group who were recommended to use non selective NSAIDs and PPI/misoprostol orselective COX-2 inhibitor only. 103 patients were proper while 182 patients not adequate. Overall, the SEs were higherin those cases for inadequate use of drugs comparing to the adequate. CV SEs were statistically significant. However,SEs for each risk groups were different. For the case of low CV risk group and high/moderate GI risk group, the inadequateuse of drugs makes the SE high and the other groups are not. Also, it was not statistically significant. Conclusions:In elderly patients, the inappropriate use of NSAIDs can increase the risk of the disease. Therefore, GI and CVrisk must be considered simultaneously, and the proper use of NSAIDs and gastroprotective drugs for each risk groupsshould be reconsidered.

Purpose: The aim of this study was to investigate drug prescription patterns for the treatment of asthma and chronicobstructive pulmonary disease (COPD) patients in Korea. Methods: Ambulatory adult patients who were diagnosed andreceived treatment for the asthma (ICD-10 code J45) or COPD (ICD-10 code J44) from January 2009 to September2011 in two independent secondary hospitals in Korea were enrolled in this study. Prescribed drug lists were generatedbased on the evidence-based guidelines and prescribed drug dosage forms were identified from the patient medicalrecords and computerized drug prescription databases of the study centers. Results: Total numbers of asthma andCOPD patient enrolled in this study were 2,432 and 2,615, respectively. Individual prescription-based accumulated numbersof patient were 12,021 for asthma and 16,584 for COPD. The most commonly prescribed three drugs were oralpredisolone, oral formoterol and oral montelukast for asthma and oral formoterol, oral doxofylline and inhaled tiotropiumfor COPD. Frequencies of oral drugs were 83.4% and 63.3% while inhalers were 16.4% and 30.2%, for asthmaand COPD, respectively. Conclusion: The oral treatment was prescribed more in asthma and COPD patients than inhalers. To enhance the compliance of evidence-based guidelines for these chronic airway diseases, more realistic and specificstrategies to increase the use of inhalers recommended as primary treatment options for asthma and COPD wouldbe required.

Background: Diabetes is accompanied by complications. One of the chronic complications, diabetic retinopathy is themost common cause of the loss of eyesight and thus has enormous impacts on the quality of life to the patients. It hasbeen reported that thorough glucose regulation can prevent or postpone the outset of diabetic retinopathy in diabeticpatients and that the patients who received anti-diabetic manage & care education would be capable of more thoroughglucose-level regulation than those who did not. Method: This study set out to investigate the current state of educationon anti-diabetic manage & care in South Korea and connections between anti-diabetic manage & care educationand occurrence of diabetic retinopathy in diabetic patients based on the Korea National Health and Nutrition ExaminationSurvey of 2011. Results: Of the 410 diabetes patients, 74 received anti-diabetic manage & care education, whichmeans that only 15% of diabetic patients benefited from the education in the nation. The occurrence rate of diabetic retinopathywas 28% in the education group and 24% in the non-education group with no significant differences betweenthem. The anti-diabetic manage & care education group recorded a higher occurrence rate of diabetic retinopathy, oneof the chronic diabetic complications, than the non-education group contrary to the hypothesis. One of the reasons wasthat the educated group had a significantly longer duration of diabetes and significantly higher HbA1c than the noneducatedgroup, which indicates that anti-diabetic manage & care education is provided to those who have progressedfarther along the course of diabetes instead of the early stage and cannot regulate their glucose-level well in the nation. Conclusion: Those findings raise a need for active educational policies in order to provide anti-diabetic manage & careeducation under the goals of preventing complications through anti-diabetic education for many patients in early stagesof diabetes.

Purpose: To investigate adverse drug reactions (ADR) and causative drugs in the elderly 65 years of age or older,using Korean spontaneous reporting adverse events reporting database from June 2009 to December 2010. Methods: We estimated the association between ADRs and implicated medications by calculating a proportional reportingratio (PRR), reporting odds ratio (ROR), and information component (IC). We reexamined the most frequentlyimplicated medications and ADRs, and the seriousness of ADRs. Then, we assessed reports and concordant rate ofADRs due to medications designated as “high-risk” in elderly by 2012 healthcare effectiveness data and information set(HEDIS) or “potentially inappropriate” by 2012 American Geriatrics Society updated Beers criteria for potentially inappropriatemedications (PIMs). Results: Among 15,484 elderly reports, data-mining analysis by PRR, ROR and ICshowed that 421 drug-ADR pairs were detected as signals (3,189). The most frequently reported ADR and causativedrug were urticaria (470) and contrast media agents (647), respectively. One hundred eighty nine ADR cases weregraded as serious. Twenty-two kinds of high-risk medications were shown to be implicated in only 0.9% of ADRs. Only thirty-nine cases were consistent with 2012 Beers criteria or HEDIS. Conclusion: These results suggest that managementof the other medications including contrast media agents as well as close monitoring of PIMs are necessary forreducing ADRs in the elderly.

Objective: To evaluate the clinical manifestations and causative drugs of the outpatient adverse drug reactions (ADRs)reported by community pharmacy. Methods: From April 2013 to September 2013, all outpatient ADRs reported bycommunity pharmacy to Regional Pharmacovigilance Center of Korean Pharmaceutical Association were included. Thecausality of ADRs was assessed by the criteria of WHO-Uppsala Monitoring Centre. The clinical features and theoffending drugs were analyzed using the WHO-Adverse Reaction Terminology and the classification of American HospitalFormulary Service Drug Information, respectively. Results: 2,826 (97.0%) of the total 2,912 ADRs had causalrelationship. The 1,923 patients with mean age of 55.1 years and female fraction of 66.5% were included in the ADRs. Gastrointestinal (33.6%), nervous system (14.9%), and skin (13.5%) symptoms were common in ADRs. Analgesicdrugs (19.7%), gastrointestinal drugs (17.7%), and central nervous system drugs (11.0%) were prevalent offendingdrugs. The leading causative generic drug was the complex of acetaminophen and tramadol. Among 203 ADRs by thenonprescription drugs, the most common clinical features were skin (37.4%) and gastrointestinal (23.6%) symptoms andthe most prevalent offending drugs were analgesic drugs (40.0%) and mucocutaneous system drugs (16.3%). The combinationof acetaminophen and chlorzoxazone was the leading causative generic in nonprescription drugs. Conclusion:In this study, gastrointestinal symptom was the most common manifestation and analgesic drug was the most commoncausative drug in outpatient ADRs reported by community pharmacy.

Background: The use of health functional food (HFF) is increasing and will continue to rise worldwide. Concerns about HFF-drug interactions are increasing as HFF are becoming more widely used. Therefore,awareness of consumers’ perceptions and behaviors associated with HFF use may help health care providersimprove their communications with patients. Purpose: The aim of this study was to assess the characteristics,perceptions, and behaviors associated with HFF use in South Korea. Method: The online surveywas conducted from September 21th to October 7th, 2013. With the aid of Social Network Service (SNS)and google, the questionnaire was posted online on internet website targeting people aged 15 years or olderso that self-reported data covering 4 domains were collected from 257 Koreans. Results: A total of 257people responded the questionnaire. Among them, 81.3% reported experiences of HFF use. Female weremore likely than male to use HFFs. There were no differences in demographic characteristics between HFFusers and non-users in relation to age, education, and household income. Higher level of education wasassociated with high-level perception of HFF function (OR 3.9, 95% CI 1.48, 10.1) and a positive relationshipwas observed between the maximum number of HFFs used concurrently and age of the respondents. Amongthe HFF users, 42.6% reported concurrent HFF-medication use. However 73.3% of them did not disclosetheir use to physician or pharmacist and only 30.2% were informed about potential drug-HFF interactions. Pharmacy was most commonly reported as the source from which the respondents were informed aboutpotential interactions. Conclusion: Many people had used HFF and medications concurrently while not beinginformed about potential HFF-drug interactions. Pharmacists and physicians should be vigilant for risk ofthe interactions and actively determine whether the patient is using an HFF before prescribing and administratingmedications.