ABSTRACT
<b>Objective: </b>Distigmine can cause cholinergic crisis as the side effect. In 2010, the safety information of distigmine was announced and its dosage was changed up to 5 mg per day. However, the malpractice that a pharmacist dispensed over dose of distigmine caused severe health damages in a community pharmacy. Therefore, we made the protocol with the urologists for the appropriate use of distigmine, including contents of monitoring the side effects. The purpose of this study was to measure using the protocol was useful for the propulsion of proper use of distigmine.<br><b>Methods: </b>The protocol was introduced in 10 community pharmacies and 1 hospital pharmacy from December 2013 to April 2014, and the patients and pharmacists were filled out the answer to the questions that we have made. The protocol consisted of five main checks; the dosage, lower urinary tract symptom, presence of renal disease, combined drugs, and signs of the side effects. Each patient was filled out the checklist given by the pharmacist to monitor the signs of the side effects for 2 weeks.<br><b>Results: </b>The 3 prescriptions of distigmine (18.8%) were more than 10 mg per day. Although 2 patients were confirmed diarrhea and sweating etc., they were mild. The pharmacists significantly more (<I>p</I><0.05) answered that the protocol made their motivation to do the pharmaceutical interventions. All of the patients answered that the pharmaceutical interventions made them relieved.<br><b>Conclusion: </b>The use of protocol that we made supported pharmacists to do the pharmaceutical interventions and patients welcome them.
ABSTRACT
Renal plasma flow (RPF) and glomerular filtration rate (GFR) are decreased in patients with heat stroke. Heat stroke after prolonged exercise under high temperatures is usually associated with hypotension and dehydration, leading to decreased RPF. However, whether renal blood flow (RBF), RPF, and GFR are increased or decreased during immersion in mild warm water remains unknown.<br>Para-aminohippurate clearance (C<sub>PAH</sub>), sodium thiosulfate clearance (C<sub>thio</sub>), and creatinine clearance (C<sub>cr</sub>) were determined in 14 healthy men aged 19 to 27 years old (mean±SD, 22±2), 161 to 181cm (171.5±6.3) tall, and weighing 52 to 78kg (64.2±7.4) without immersion at about 25°C (room temperature) and during immersion in water at 41±0.5°C.<br>C<sub>PAH</sub>, C<sub>thio</sub>, and RBF significantly increased during immersion compared with those without immersion (P<0.0001, P<0.03, P<0.0001, respectively). C<sub>cr</sub> did not change (P=0.108). The filtration fraction (FF) was significantly decreased (P<0.001). Levels of plasma atrial natriuretic peptide, aldosterone, anti-diuretic hormone and renin did not significantly differ between these two conditions.<br>This investigation suggests that daily immersion at 41°C is beneficial for renal function.