ABSTRACT
Objective: Adverse reactions are sometimes induced by contrast media used for medical imaging and can be life-threatening. Thus, appropriate management is important for patient safety. The purpose of this study was to clarify the actual management of adverse reactions induced by contrast media in hospitals, the opportunities for intervention by hospital pharmacy departments and the attitudes of hospital pharmacists regarding the risk of adverse reactions.Methods: A self-administered questionnaire survey was conducted in the pharmacy departments of 16 hospitals (approximately 200 to 1,000 beds) located in the Tokyo metropolitan area of Japan. The survey asked about the presence or absence of internal rules or manuals regarding contrast media administration at each hospital, the management status of patients with risk factors for adverse reactions, the opportunities for interventions by pharmacists, and the opportunities for discussion regarding contrast media administration among pharmacists and other professionals.Results: Of the 16 hospitals, 10 responded to the questionnaires, and 7 of them had internal rules or manuals. These rules or manuals stipulated actions such as “do not administer contrast media” to patients with risk factor(s) for adverse reactions. For inpatients, there were opportunities for pharmacist interventions, such as drug management and guidance services and initial interviews upon hospital admission. However, for outpatients the opportunities for interventions were limited. At 5 of the 10 hospitals, pharmacists discussed contrast administration with physicians, radiologists, and other healthcare professionals.Conclusion: The present study reveal that many hospitals take great care in deciding on the administration of contrast media to patients at risk of adverse drug reactions. Our results indicate that the limited opportunities for “outpatient intervention" is an issue in the hospital pharmacy department's participation for proper use of contrast media.
ABSTRACT
<b>Objective: </b>Celecoxib has been reported to enhance the action of warfarin by inhibiting CYP2C9, its major hepatic drug-metabolizing enzyme, but sufficient information about the mechanism has not been obtained, especially in Japan.<br><b>Methods: </b>A study was conducted to investigate the prothrombin time international normalized ratio (PT-INR) and the warfarin sensitivity index (WSI) before and after concurrent administration of celecoxib, as well as the Drug Interaction Probability Scale (DIPS) scores to determine causality with drug interactions, in patients commencing concurrent therapy with celecoxib and warfarin at Kanagawa Prefectural Keiyukai Keiyu Hospital during the 4-year period from October 2011 to September 2015.<br><b>Results: </b>Analysis of 18 patients showed that the PT-INR increased significantly from 1.53±0.43 before concurrent therapy to 2.18±1.01 after concurrent therapy (<i>p</i>=0.0101). The WSI also increased significantly from 0.76±0.50 before concurrent therapy to 1.01±0.65 after concurrent therapy (<i>p</i>=0.0044). According to the DIPS scores, the causal relation was not rated as “Highly Probable” in any of the patients, while it was considered to be “Probable” in 3 patients, “Possible” in 10 patients, and “Doubtful” in 5 patients.<br><b>Conclusion: </b>The findings of this study suggested that when celecoxib treatment is initiated in patients who are already taking warfarin, attention must be paid to changes of coagulation profile, especially in elderly patients.
ABSTRACT
Although the trunk segment shows well-coordinated movements in concert with the arms and legs during bipedal walking, little is understood about the neural mechanisms controlling the trunk muscles in response to sudden tactile sensations in the foot during walking. This study examined the cutaneous reflexes (CR) to shed light on the neural mechanisms underlying the regulation of the trunk muscles during walking and standing. Eleven healthy men participated in the study. Electromyographic (EMG) activities were recorded in the trapezius (TRAP), erector spinae (ES), and rectus abdominis (RA) muscles. To elicit CR, non-noxious electrical stimulation of the sural nerve at the ipsilateral lateral malleolus was applied during treadmill walking and tonic contraction of the test muscles during standing. During walking, cutaneous nerve stimulation in the foot gave rise to facilitatory CR in all the muscles, and the amplitude of the CR was strongly modulated in a phase-dependent manner. The amplitude of the background EMG and the amplitude of the CR showed a highly significant correlation in all the muscle tested during standing. However, this was true only in the ES during walking. In the RA, the inhibitory CR during standing changed to a facilitatory one during walking. In addition, reflex ratios were significantly larger during walking than standing. These findings suggest that common neural mechanisms in limb muscles could function in the TRAP and RA, however, in the ES disparate neural mechanisms play a crucial role in modulating cutaneous reflexes during walking and standing.