Earticle

The goal of this research was to find out the effect of dispensing error prevention program on the incidence of the error in a university hospital pharmacy in Daegu. Dispensing error in this research was defined as the error identified during double-checking process, so it does not mean that the wrong dispensing was administered to patient. Drug name error was the most frequently found error, accounting for about one third of all dispensing errors, and was followed by counting error, strength error, dosage form error, and others. Similar drug name was identified as the most frequent reason for the error, taking up about two thirds of all drug name errors. In this research, six months of dispensing error prevention program resulted in statistically significant reduction of dispensing error by 42 percent. Therefore, it is recommended that hospital pharmacy implement such prevention program regularly to reduce the incidence of the error. Finally, it appears that drug approval authority should closely check the similar drug names and have power to command pharmaceutical company to change the name if pertinent.

This study investigated the effect of long-term administration of pioglitazone on the harmacokinetics of verapamil in rats. Pharmacokinetic parameters of verapamil were determined after oral administration of verapamil (9 mg/kg) in rats coadministered pioglitazone (0.5 mg/kg) or pretreated with pioglitazone (0.5 mg/kg) for 3 and 9 days. Compared to oral control group, the presence of pioglitazone significantly (p<0.05) increased the area under the plasma concentration-time curve (AUC) of verapamil by 48.6% (coad), 61.1% (3 days) and 56.5% (9 days), and the peak concentration (Cmax) by 65.1% (coad), 76.8% (3 days) and 66.4% (9 days). The absolute bioavailability (AB%) of verapamil was significantly (p<0.05) higher by 6.2% (coad), 6.7% (3 days), 6.5% (9 days) compared to control (4.2%), and presence of pioglitazone was no significant change in the terminal half-life (t1/2) and the time to reach the peak concentration (Tmax) of verapamil. Our results indicate that pioglitazone significantly enhanced oral bioavailability of verapamil in rats, implying that presence of pioglitazone could be effective to inhibit the CYP3A4-mediated metabolism of verapamil in the intestine. Drug interactions should be considered in the clinical setting when verapamil is coadministrated with pioglitazone.

아미카신은 그람음성균 감염에 사용하는 아미노글리코사이드계 항생제로 이독성 및 신독성 등의 부작용과 큰 개인차로 혈중농도 모니터를 통한 투여계획이 필요한 약물이다. 본 연구에서는 16명의 위암환자에서 비선형최소자승 회귀분석과 베이시안 분석에 의한 아미카신의 약물동태에 분석오차의 영향을 연구하였다. 약물투여는 아미카신 7.5 mg/kg을 30분에 걸쳐 12시간 간격으로 등속 주입하였으며, 혈액 채취는 정상상태에 도달되었다고 판단되는 첫 약물투여 72시간 후에, 약물 주입 5분전과 주입이 끝난 뒤 30분과 2시간에서 세차례 채취하였다. 혈청중 약물농도는 형광편광 면역법으로 측정하였다. 분석오차를 위해 0, 5, 15, 30, 60 및 80 μg/ml에 해당하는 아미카신 혈중농도(C)을 네차례 측정하여 각 혈중농도의 표준편차 (SD)을 구하였다. 아미카신 분석오차를 위한 다항식이 SD=0.3017+(0.00538C)+(0.00112C2), R2 =0.974이었다. 이 식에서 구한 SD 값으로 분석시 가중치를 주었을 때, 비선형최소자승 회귀분석에 의한 아미카신의 약물동태학적 파라메타 (Vd, Kel, Kslpoe, t1/2)에 유의성있는 영향을 주었으나, 베이시안 분석에 의한 아미카신의 약물동태학적 파라메타에는 영향이 없었다. 이 다항식에 의한 분석오차를 비선형최소자승 회귀분석에 의한 아미카신 약물동태학적 파라메타 분석시 적절히 사용하면 안전하고 효율적인 투여계획을 할 수 있다.

This study investigated social relief schemes for serious adverse drug reactions in foreign countries and deduced lessons and implications for Korea to implement the scheme. A social relief scheme for serious adverse drug reactions provides reliefs for diseases and such health effects as disabilities or deaths that were caused by adverse reactions to pharmaceuticals prescribed at hospitals and clinics as well as those purchased at pharmacies notwithstanding their proper use. The US and the UK do not have specific relief schemes for adverse drug reactions but apply rules of strict liability or negligence. New Zealand and Nordic countries provide no-fault compensation schemes for health effects or injuries caused by medical treatments or medicinal products. Japan and Taiwan have operated the schemes since 1980 and 2000, respectively. In designing the scheme in Korea, we suggested that cases eligible for relief be confined to serious adverse reactions such as death or disability and then extended to diseases. It is desirable to encourage the reporting system of adverse drug reactions and quality use of medicines for the relief scheme to work efficiently.

Objectives: Overactive bladder(OAB), defined as ‘urgency, with or without urge incontinence, usually with frequency and nocturia’, is a major burden for patients and impairs quality of life. The aim of this study is to evaluate the cost-effectiveness of antimuscarinic agents for the treatment of overactive bladder including quality of life in societal perspective. Methods: A decision-analysis model was developed to compare the cost-effectiveness of solifenacin and tolterodine IR over 12 weeks. We used data from the published literature to develop the framework for the model. Resource utilization and costs were calculated with public institutional data and supplemented this information with clinical expert opinion, where necessary. Results: The expected costs per patient for solifenacin were 48,762 KRW less expensive than tolterodine IR over 12 weeks. Also, all outcomes including quality of life for solifenacin were more effective than tolterodine IR over 12 weeks. In conclusion, solifenacin dominates tolterodine IR and appears to be cost-effective options for the management of overactive bladder.

Rebamipide, (±)-2-(4-chlorobenzoylamino)-3-[2(1H)-quinolinon-4-yl] propionic acid, is used for mucosal protection, healing of gastroduodenal ulcers, and treatment of gastritis. It works by enhancing mucosal defense, scavenging free radicals and temporarily activating genes encoding cyclooxygenase-2. The purpose of the present study was to evaluate the bioequivalence of two rebamipide tablets, Mucosta® (Korea Otsuca Pharmaceuticals Co., Ltd.) and Mustar (Korean Drug Co., Ltd.), according to the guidelines of the Korea Food and Drug Administration (KFDA). The release of rebamipide from the two rebamipide formulations in vitro was tested using KP VIII Apparatus II method with pH 6.8 dissolution medium. Twenty six healthy male subjects, 23.46 ± 2.63 years in age and 66.62 ± 8.97 kg in body weight, were divided into two groups and a randomized 2 × 2 cross-over study was employed. After a single tablet containing 100 mg as rebamipide was orally administered, blood samples were taken at predetermined time intervals and the concentrations of rebamipide in serum were determined using HPLC with fluorescence detector. The dissolution profiles of two formulations were similar in the tested dissolution medium. The pharmacokinetic parameters such as AUCt, Cmax and Tmax were calculated, and ANOVA test was utilized for the statistical analysis of the parameters using logarithmically transformed AUCt, Cmax and untransformed Tmax. The results showed that the differences between two formulations based on the reference drug, Mucosta® were -5.08, 3.52 and -9.71% for AUCt, Cmax and Tmax, respectively. There were no sequence effects between two formulations in these parameters. The 90% confidence intervals using logarithmically transformed data were within the acceptance range of log 0.8 to log 1.25 (e.g., log 0.84~log 1.07 and log 0.90~log 1.17 for AUCt and Cmax, respectively). Thus, the criteria of the KFDA bioequivalence guideline were satisfied, indicating Mustar tablet was bioequivalent to Muscota® tablet.

The goal of this research was to identify problems associated with the management of nutrition support team (NST) in hospitals in Korea. Management status of NST in the hospitals was surveyed over the phone or interviewed by visit during August 2007. NST in foreign countries was collected by reference search and websites in the internet. Survey analysis also was performed during March, 2007 with forty-one medical staff in a university hospital located in Jinju, Kyungsangnamdo. Korean Society for Parenteral and Enteral Nutrition (KSPEN) was organized in 2001 and currently has thirty-three member hospitals with on-site NST as of August, 2007. Most of the member hospitals were big hospitals with more than 500 beds and were organized within five years. The most significant problem identified was the shortage of nutrition specialists exclusively involved in the NST. Survey analysis revealed that more than half of medical staff prescribed parenteral nutrition based on their own nutrition requirement calculation rather than consultation with NST. It appears that status of NST management of hospitals in Korea are considered to be at beginner stage and therefore, needs more aggressive advertising activity to increase consultation usage by medical staff.

Objective: The aim for this article was to evaluate and to clarify the current opinions of the registered pharmacists concerning their recognition and adoption rates about introducing the preceptorship into the clinical pharmacy internship and clerkship. Methods: A 25-question-questionnaire was developed and pilot tested. For 40 days of survey by both on-line and on site, 90 over 240 (37.5%) registered pharmacists responded and the data were analyzed with comparison to the groups working in community and hospital pharmacies. Results: The overall answers were affirmative and the respondents were very interested in the application of the clinical preceptorship to the pharmacy educational and to their clinical settings. Moreover, the qualification level and the implementation methods were proposed in detail. Conclusion: Although ninety pharmacists showed their views differently, most of the respondents regarded the preceptorship as an adequate training system for the pharmacy students as well as junior pharmacists at the time of initiation of the new 6-year pharmacy education system in Korea.

This study aimed to compare a microparticle enzyme immunoassay (MEIA) with a liquid chromatography-tandem mass spectrometry (LC/MS/MS) technique for the measurement of tacrolimus concentrations in adult liver transplant recipients, to investigate how the assay choice influenced the population pharmacokinetics of tacrolimus and to identify patient characteristics that affected pharmacokinetic parameters in each assay. Tacrolimus concentrations from 29 liver (n=52 paired-samples) transplant recipients measured by both MEIA and LC/MS/MS were used to evaluate the performance of these methods in the clinical setting. Tacrolimus pharmacokinetics was studied independently using MEIA and LC/MS/MS data in 70 adult patients using a population approach performed with NONMEM. Patient characteristics which influenced pharmacokinetic parameters in each assay were compared. The relation between LC/MS/MS and MEIA measurements was best described by the regression equation MEIA=1.465*LC/MS/MS- 1.336 (r=0.91). Multiple linear regression analysis showed significant inverse relationships between assay difference and hematocrit (Hct) (p<0.025) in liver graft recipients. In MEIA, the population estimate of tacrolimus CL/F and apparent volume of distribution (Vd/F) were found to be 10.1 L/h and 226 L, and in LC/MS/MS, 13 L/h and 305 L respectively. Neither patient's age, weight, gender, grafted hepatic weight, albumin concentration, nor markers of liver function influenced tacrolimus CL/F. The final model of CL/F was found to be 10.1+(Hct/Hct mean)12.0 in MEIA and 13+(1+Hct/578) in LC/MS/MS indicating that CL/F was influenced by hematocrit.