Earticle

Background: There exist some different perceptions on clinical pharmacy between Korean and western societies. Since the pharmacists who received the 6-year pharmacy education join the pharmacy profession soon, it appears imperative to know whether the western-style clinical pharmacy is adaptable to Korean-style pharmacy education and profession. Methods: The authors surveyed 54 professors in the membership directory of the Korean College of Clinical Pharmacy (KCCP) on their perceptions on clinical pharmacy and clinical pharmacists, and their willingness for adapting clinical pharmaceutical care (CPC) and clinical pharmaceutical sciences (CPS) into clinical pharmacy education. The survey consists of 47 questions including dichotomized and Likert scale questionnaires in the areas of respondent demographics, clinical pharmacy, clinical pharmacists, CPC and CPS. Results: Of the 54 KCCP members surveyed, 29 completed the questionnaires in full and one in part. It appears that most KCCP members acknowledge the existence and importance of the two major fields of clinical pharmacy, CPC and CPS. Twenty-eight (96.6%) and seventeen members (68.0%) agreed to introduce CPC and CPS into the clinical pharmacy education in Korea, respectively. Seventeen (63.0%) answered CPC would be successfully adapted in Korea. Twenty (74.1%) agreed that it is desirable for clinical pharmacists to perform CPC and CPS simultaneously. Conclusion: Based on this survey, the authors suggest that pharmacyschools provide their students with the education opportunities on CPC to nurture clinical pharmacists through a master’s program and CPS to foster clinical pharmaceutical scientists through a Ph.D. program.

Purpose: This study was aimed to identify the status of utilization of healthcare services and self-care behaviors, knowledge level and influencing choice factors of non-prescription drugs (OTCs) on consumers since sales of OTCs at the outside of pharmacy in Korea, and to confirm the changes in perception of consumers for OTCs policy through check of perception level for current OTCs policy. Methods: Data was collected from April 2014 to May 2014 from questionnaires by 418 adults who are in university located in Seoul or live in Seoul Metropolitan area but not health science major and healthcare providers. Results: The female gender was 56.6% and University students were 73.9%. The ratio by age was as follows: below 25 (60.9%), 26-30 (18.2%), 30-40s (14.9%) and 50-60s (6.0%). The knowledge level of OTCs for use of medicine, dose and side effects was generally low and especially they knew little how to deal with side effects after taking OTCs on sale at the outside of pharmacy, even though over one year has passed since the policy. The proportion of those who thought the current OTCs policy has problems regarding safety issues since the policy was very high and it was also high that the study group thought there are problems with the current way to sale OTCs and educate employees. Conclusion: After selling OTCs at the outside of pharmacy, the consumers still lacked knowledge of OTCs and did not get correct information properly. Especially, they had little information about the way to deal with side effects after taking OTCs. Public policy should be based on the health of the people and the public health is a national health priority. When all these things are taken into consideration, the government has to strengthen the OTCs policy and provide a safer environment with the accurate drug information for people than developing OTCs policy in the future.

Objective: This study was conducted to compare the adherence, clinical and economical utility of fixed- dose combination tablets of sitagliptin/metformin with concomitant administration of sitagliptin and metformin in patients with type 2 diabetes mellitus. Methods: Adherence was measured as the medication possession ratio (MPR) of ≥ 80%, and MPR was calculated as the number of total prescription days divided by the total treatment period. Hemoglobin A1C (HbA1c) differences between baseline and predetermined periods were analyzed. Proportions of patients who achieved HbA1c less than 6.5% for three or more consecutive times were compared. To evaluate cost-effectiveness, prices of sitagliptin, metformin and sitagliptin/metformin tablets were investigated. Results: More than 90% of patients showed adherence in both groups (92.0% in fixed-dose combination group vs 95.9% in concomitant administration group), and there was no statistically significant difference (P = 0.113). Proportion of patients with HbA1c less than 6.5% for three or more consecutive times tended to be somewhat higher in fixed dose combination group than in concomitant administration group without a statistically significant difference (32.6% vs. 28.0%, P = 0.344). Total price of metformin and sitagliptin was cheaper up to 222 KRW in the case of fixed-dose combination tablets compared to the case of concomitant administration. Conclusion: The sitagliptin/metformin fixed-dose combination tablet had a similar patient adherence and was not significantly different in efficacy to the concomitant administration of each component. In terms of drug prices, fixeddose combination tablets were cheaper than concomitant administration of each tablet.

Objectives: Current studies are debating on the association of vascular calcification and the benefit of treatment to lower serum phosphorus level in patients with chronic kidney disease. The aim of this study was to evaluate the association of mortality and risk of vascular calcification in patients with CKD who were taking phosphate binders. Methods: This study was conducted through retrospective medical chart review for 420 patients aged 18 years and older who were admitted for chronic kidney disease. Results: Vascular calcification was not statistically significantly associated with increased mortality in patients with CKD [16.7% vs. 19.2%; 95% CI; 0.388 to 1.818 (p=0.656)]. Intervention of calcium-based phosphate binders was not significantly associated with vascular calcification in patients with CKD [9.1% vs. 12.5%; 95% CI; 0.364 to 1.358 (p=0.292)]. Ca x P product ≥ 55 mg2/dL2 was not significantly associated with increased 1 year mortality in patients with CKD [25.4% vs. 17.5%; 95% CI; 0.851 to 3.013 (p=0.142)]. Intervention of sevelamer was significantly associated with reduced 1 year mortality in patients with CKD than that of patients who did not take sevelamer [6.3% vs. 25.3%; 95% CI; 0.044 to 0.880 (p=0.020)]. Conclusion: There was not a statistically significant association between vascular calcification and phosphate binder’s use. But phosphate binder use was significantly associated with decreased mortality in patients with CKD.

Objectives: This was to evaluate the current usage of three erythropoietin stimulating agents (ESA) and their efficacy for management of anemia in peritoneal dialysis (PD) patients with chronic kidney disease. Methods: It was a retrospective comparative study through review of electronic medical records of chronic kidney disease patients undergoing PD at a tertiary teaching hospital from January 1998 to June 2013. Results: Average administration frequency was 1.66 times/week in EPO group, 0.75 times/week in DA group, and 0.19 times/week in MPG-EPO group. At the first 4 weeks, there were significant differences in mean hemoglobin levels between EPO and DA groups (9.25± 1.28 g/dL, 10.02±0.95 g/dL each, p = 0.018) and also in hemoglobin response rates (10.0%, 45.2% each, p = 0.008), but since after 4 week, there had been no significant differences. There also showed no significant differences in achievement of hemoglobin target between the two groups. When converted to MPG-EPO in EPO/DA groups, there showed a slight increase in hemoglobin levels of both groups. MPG-EPO was the highest compared with two other drugs by the average cost based on the average weekly dose. Conclusion: EPO, DA, and MPG-EPO showed similar effects in treatment of anemia of PD patients based on hemoglobin target range (11.0~12.0 g/dL) which NFK-K/DOQI guidelines suggest. Though the average cost of MPG-EPO was higher than the other two drugs, the number of PD patients using MPGEPO has increased and it is thought that long half-life and low administration frequency of MPG-EPO have improved the compliance of PD patients who have to self-administrate.

Objectives: The aim of this study was to identify the causal relationship between use of levocetrizine or cetrizine, and liver injury, by comparing frequency and pattern of hepatotoxicity in levocetrizine or cetrizine prescribed patients. Methods: This is a retrospective observational study, using data retrieved from electronic medical record system. Among 1164 patients prescribed levocetrizine or cetrizine during study period (Jul, 2009 – Jun, 2010) at Seoul National University Hospital, 543 patients with more than 4- time liver function test (LFT) results were included in final analysis. Liver injury was defined as greater than 3 times elevated level of alanine aminotransferase or 2 times elevated level of alkaline phosphatase or total bilirubin, compared to upper limit of normal, in patient with normal liver function at baseline. The frequency and pattern of liver injury were assessed. Results: Incidence of liver injury in patients prescribed with levotcetrizine or cetrizine were 1.48% and 2.94%, respectively. With few exceptions, most injuries were shown to be hepatocellular type. Rapid recovery was observed after drug cessation and long term use tends to be associated with incidence of liver injury. In patient with digestive system disorder, rate of liver injury was significantly higher (p=0.011). Conclusion: The result of this study implies potential need of liver toxicity monitoring, especially in patients taking long term levecetrizine or cetrizine or in patient with digestive system disorder. However, prospective large scale observational study is needed to confirm liver injury associated with the use of levocetirizine or cetirizine.

Objectives: This paper was aimed to investigate the adhesion control standards of pain relieving patch (PRP) drugs and to survey it’s adverse effects on the skin of patients for safe use of PRP drugs. Methods: In this study, the related documents of PRP drugs of Korea pharmacopoeia (KP), United States pharmacopoeia (USP), Japanese Pharmacopoeia (JP), European pharmacopoeia (EP), and information web sites of the Ministry of Food and Drug Safety (MFDS) were surveyed. Also, the past and current labeling of PRP drugs marketed in the pharmacy was investigated and compared. Results: In KP and JP, the lower limit standard for PRP's adhesion control is established, but the upper limit standard is not designated. In USP and EP, neither the lower nor upper limit standard is established. The main reasons of skin adverse effects are considered as inherent adverse reactions of the applied drugs for PRP. Another reason is involved in patient's medication mistakes related to PRP's adhesion control, respiratory depression of skin according to physical skin closure, and microbial growth, etc. Conclusion: For safe use of PRP drugs, we proposed ensured guidelines like additional instructions of pharmacist's prescription and detailed labeling systems for usage of PRP drugs applied on skin.