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1.
Korean Journal of Medicine ; : 341-351, 2021.
Article in Korean | WPRIM | ID: wpr-902245

ABSTRACT

Background/Aims@#Despite proper use of pharmaceuticals, adverse drug reactions (ADRs) can lead to problems related to patient safety. We analyzed the characteristics of ADRs, particularly serious adverse events (SAEs), in a single tertiary medical institution. @*Methods@#Spontaneous ADR report data collected from 2010 to 2019 in Seoul National University Hospital were assessed. Causality was evaluated according to the World Health Organization-Uppsala Monitoring Centre criteria. Age, sex, onset, severity, seriousness, and system organ class (SOC) of ADRs and SAEs were analyzed. @*Results@#During the study period, a total of 49,955 individual case safety reports were assessed as possible, probable, or certain. Although the number of gastrointestinal ADR reports was high (25.9%), severe cases were uncommon (2.6%). By contrast, the number of hematologic disorders was low (6.6%) but 39.2% of them were severe. Among ADRs, 10.2% were assessed as SAEs, the proportion of which was high at extreme ages and in males. Body as a whole-general disorders were the most frequently reported SOC for SAEs, followed by skin and appendage disorders. Antineoplastic agents and antibiotics were the most common causative agents of SAEs and ADRs. Anaphylactic reaction was the most frequent SAE (6.5%). @*Conclusions@#The proportion of SAE differs according to SOC and drug. Attention should be paid to SAEs in children and older adults because the rate of SAEs is significantly higher at extreme ages.

2.
Article in English | WPRIM | ID: wpr-901859

ABSTRACT

Objective@#We investigated arthralgia and myalgia associated with the use of oral bisphosphonate (BP) by conducting a survey of patient. @*Methods@#The pharmacists conducted a survey between 1 Oct 2019 and 30 Sep 2020 among patients who were dispensed BP in community pharmacies to assess their demographic and medical characteristics, and their experiences with, and process for pain. Logistic regression analyses were performed to find the risk factors associated with the pain, and the odds ratios (OR) and 95% confidence intervals (CI) were determined. @*Results@#A total of 160 patients who used BP participated in the survey (74 [46.3%] used risedronate; 61 [38.1%] used alendronate; 23 [14.4%] used ibandronate), and 20 (12.5%) of them experienced pain. Significant statistical differences of the characteristics between patients who experienced pain or not were observed regarding menopause, and parity. Compared with women who had one or two parity, women who had more than three parity were associated with the decreased risk of pain (OR, 0.24; 95% CI, 0.04-0.98). Moreover, steady exercise was associated with the decreased risk of pain compared to less exercise (OR, 0.37; 95% CI, 0.14-0.98). @*Conclusion@#Our findings suggest that the risk of pain in BP-treated patients might be different regarding the different ingredients of BP, and dosing frequency. This survey highlights a need for a further safety research to understand the factors influencing the pain associated with the BP treatment.

3.
Article in English | WPRIM | ID: wpr-901847

ABSTRACT

Background@#Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. @*Methods@#Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. @*Results@#Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. @*Conclusions@#In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

4.
Article in English | WPRIM | ID: wpr-901845

ABSTRACT

Background@#and Objective: The use of potentially inappropriate medications (PIMs) increases the risk of negative health outcomes, including drug-related admissions. Tools for structured medication review have been developed to ensure optimal medication use and safety. Here, we aimed to evaluate medication use review (MUR) tools for community-dwelling older patients. @*Methods@#We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses Statement (PRISMA). We searched PubMed, Embase, and the Cochrane Library from 1991 to 2020, excluding tools that are specifically applied to hospitalized patients or nursing home residents. We identified the most common inappropriate medications, drug-disease interactions, drug-drug interactions and prescribing omissions presented among tools. @*Results@#From among 9,788 identified reports screened, 60 met our inclusion criteria; finally, 27 were eligible for data analysis considering originality and up-to-dateness. Most tools presented explicit criteria (93%), and only one was specific to community-dwelling elderly. The most common PIM was tricyclic antidepressants. Use of diltiazem and verapamil in patients with heart failure and the combination of nonsteroidal anti-inflammatory analgesics and warfarin were the most frequent disease-specific PIM and druginteraction, respectively. @*Conclusions@#Although several medication review tools have been developed for older adults, specific guidelines for community-dwelling populations remain limited. Furthermore, the list of PIMs differed among available tools. In future, specific but integrating MUR tools need to be developed for clinical practice considering this population.

5.
Article in English | WPRIM | ID: wpr-900104

ABSTRACT

Objective@#: While balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. @*Methods@#: This study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. @*Results@#: A total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. @*Conclusion@#: This study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.

6.
Korean Journal of Medicine ; : 341-351, 2021.
Article in Korean | WPRIM | ID: wpr-894541

ABSTRACT

Background/Aims@#Despite proper use of pharmaceuticals, adverse drug reactions (ADRs) can lead to problems related to patient safety. We analyzed the characteristics of ADRs, particularly serious adverse events (SAEs), in a single tertiary medical institution. @*Methods@#Spontaneous ADR report data collected from 2010 to 2019 in Seoul National University Hospital were assessed. Causality was evaluated according to the World Health Organization-Uppsala Monitoring Centre criteria. Age, sex, onset, severity, seriousness, and system organ class (SOC) of ADRs and SAEs were analyzed. @*Results@#During the study period, a total of 49,955 individual case safety reports were assessed as possible, probable, or certain. Although the number of gastrointestinal ADR reports was high (25.9%), severe cases were uncommon (2.6%). By contrast, the number of hematologic disorders was low (6.6%) but 39.2% of them were severe. Among ADRs, 10.2% were assessed as SAEs, the proportion of which was high at extreme ages and in males. Body as a whole-general disorders were the most frequently reported SOC for SAEs, followed by skin and appendage disorders. Antineoplastic agents and antibiotics were the most common causative agents of SAEs and ADRs. Anaphylactic reaction was the most frequent SAE (6.5%). @*Conclusions@#The proportion of SAE differs according to SOC and drug. Attention should be paid to SAEs in children and older adults because the rate of SAEs is significantly higher at extreme ages.

7.
Article in English | WPRIM | ID: wpr-894155

ABSTRACT

Objective@#We investigated arthralgia and myalgia associated with the use of oral bisphosphonate (BP) by conducting a survey of patient. @*Methods@#The pharmacists conducted a survey between 1 Oct 2019 and 30 Sep 2020 among patients who were dispensed BP in community pharmacies to assess their demographic and medical characteristics, and their experiences with, and process for pain. Logistic regression analyses were performed to find the risk factors associated with the pain, and the odds ratios (OR) and 95% confidence intervals (CI) were determined. @*Results@#A total of 160 patients who used BP participated in the survey (74 [46.3%] used risedronate; 61 [38.1%] used alendronate; 23 [14.4%] used ibandronate), and 20 (12.5%) of them experienced pain. Significant statistical differences of the characteristics between patients who experienced pain or not were observed regarding menopause, and parity. Compared with women who had one or two parity, women who had more than three parity were associated with the decreased risk of pain (OR, 0.24; 95% CI, 0.04-0.98). Moreover, steady exercise was associated with the decreased risk of pain compared to less exercise (OR, 0.37; 95% CI, 0.14-0.98). @*Conclusion@#Our findings suggest that the risk of pain in BP-treated patients might be different regarding the different ingredients of BP, and dosing frequency. This survey highlights a need for a further safety research to understand the factors influencing the pain associated with the BP treatment.

8.
Article in English | WPRIM | ID: wpr-894143

ABSTRACT

Background@#Post-transplant immunosuppression with calcineurin inhibitors (CNIs) is associated with kidney function impairment while mammalian target of rapamycin (mTOR) inhibitors, such as everolimus, can be used for its renal-sparing effects. In this study, we compared the efficacy and safety of everolimus with low dose tacrolimus (EVR+Low TAC) and conventional dose tacrolimus (TAC) in liver transplantation recipients. @*Methods@#Medical records of recipients who received liver transplantation at Seoul National University Bundang Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day everolimus was initiated and tacrolimus dosage was reduced. All patients were followed up for 1 year. Indicator of efficacy was the incidence of rejection and safety was evaluated by incidence of drug adverse events including renal function. @*Results@#Among 118 patients, there were 40 patients (33.9%) in EVR+Low TAC group. Incidence of rejection, including both biopsy proven acute rejection and clinical rejection, was similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However, incidence rates of dyslipidemia, oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. @*Conclusions@#In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased risk of dyslipidemia and oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to liver transplant recipients with nephrotoxicity after administration of conventional dose tacrolimus.

9.
Article in English | WPRIM | ID: wpr-894141

ABSTRACT

Background@#and Objective: The use of potentially inappropriate medications (PIMs) increases the risk of negative health outcomes, including drug-related admissions. Tools for structured medication review have been developed to ensure optimal medication use and safety. Here, we aimed to evaluate medication use review (MUR) tools for community-dwelling older patients. @*Methods@#We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses Statement (PRISMA). We searched PubMed, Embase, and the Cochrane Library from 1991 to 2020, excluding tools that are specifically applied to hospitalized patients or nursing home residents. We identified the most common inappropriate medications, drug-disease interactions, drug-drug interactions and prescribing omissions presented among tools. @*Results@#From among 9,788 identified reports screened, 60 met our inclusion criteria; finally, 27 were eligible for data analysis considering originality and up-to-dateness. Most tools presented explicit criteria (93%), and only one was specific to community-dwelling elderly. The most common PIM was tricyclic antidepressants. Use of diltiazem and verapamil in patients with heart failure and the combination of nonsteroidal anti-inflammatory analgesics and warfarin were the most frequent disease-specific PIM and druginteraction, respectively. @*Conclusions@#Although several medication review tools have been developed for older adults, specific guidelines for community-dwelling populations remain limited. Furthermore, the list of PIMs differed among available tools. In future, specific but integrating MUR tools need to be developed for clinical practice considering this population.

10.
Article in English | WPRIM | ID: wpr-892400

ABSTRACT

Objective@#: While balanced crystalloid (BC) could be a relevant fluid regimen with buffer system compared with normal saline (NS), there have been no studies on the optimal fluid for surgery of an unruptured intracranial aneurysm (UIA). This study aimed to compare the effects of fluid regimens between NS and BC on the metabolic and clinical outcomes of patients who underwent surgery for UIA. @*Methods@#: This study was designed as a propensity score matched retrospective comparative study and included adult patients who underwent UIA clipping. Patient groups were categorized as NS and BC groups based on the types of pre-operative fluid and the amount of fluid administered during surgery. The primary outcomes were defined as electrolyte imbalance and acidosis immediately after surgery. The secondary outcomes were the length of stay in the intensive care unit (ICU) and duration from the end of the operation to extubation. @*Results@#: A total of 586 patients were enrolled in this study, with each of 293 patients assigned to the NS and BC groups, respectively. Immediately after surgery, serum chloride levels were significantly higher in the NS group. Compared to the NS group, the BC group had lower incidence rates of acidemia (6.5% vs. 11.6%, p=0.043) and metabolic acidosis (0.7% vs. 4.4%, p=0.007). As compared to NS group, BC group had significantly shorter duration from the end of the operation to extubation (250±824 vs. 122±372 minutes, p=0.016) and length of stay in ICU (1.37±1.11 vs. 1.12±0.61 days, p=0.001). Throughout multivariable analysis, use of BC was found to be significant factor for favorable post-operative results. @*Conclusion@#: This study showed that the patients who received BC during UIA clipping had lower incidence of metabolic acidosis, earlier extubation and shorter ICU stay compared to those who received NS. Therefore, using BC as a peri-operative fluid can be recommended for patients who undergo surgery for UIA.

11.
Article in English | WPRIM | ID: wpr-875186

ABSTRACT

Background@#Topical steroids are the most commonly prescribed anti-inflammatory agents in dermatology, and patients often experience various adverse events of topical steroid application. Patients’ awareness of adverse effects and understanding of coping strategies for these unwanted events are pivotal elements for the safe use of topical steroids. @*Objective@#This study aimed to assess the prescribing pattern of topical steroids and patient education for safe use by dermatologists and non-dermatology specialists in Korea. @*Methods@#A questionnaire was sent to dermatologists, pediatricians, and other specialists through an online survey.A total of 444 answers were analyzed; then, the numbers were adjusted according to the nationwide proportion of specialists prescribing topical steroids. The total number of respondents was set to 720 after the adjustment. @*Results@#Dermatologists prescribed topical steroids to 49% of their patients, while other specialist doctors prescribed to 6.4% of the patients. Mid-potency steroids were most commonly prescribed (52.9%), followed by low/weak potency (37.6%), in adjusted analysis. Overall, 12.5% of all respondents and 14.5% of dermatologists reported adverse events due to topical steroids within the last month. The physicians spent 2.1 minutes on average (2.0 minutes for dermatologists) for patient education on proper use of topical steroids. The majority (79.1%) of physicians informed patients of the fact that the prescription contained steroids, while some were reluctant to disclose this information because of the negative perception about steroids in the general population. @*Conclusion@#This survey provides thorough information on the current status of prescription, counseling condition, doctors’ perception of patients’ knowledge of adverse events, and proper use of topical steroids.

12.
Article | WPRIM | ID: wpr-836507

ABSTRACT

Background@#Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. @*Methods@#We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. @*Results@#The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26- 3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. @*Conclusions@#This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.

13.
Article | WPRIM | ID: wpr-831719

ABSTRACT

Background@#The coronavirus disease 2019 (COVID-19) pandemic has posed significant global public health challenges and created a substantial economic burden. Korea has experienced an extensive outbreak, which was linked to a religion-related super-spreading event. However, the implementation of various non-pharmaceutical interventions (NPIs), including social distancing, spring semester postponing, and extensive testing and contact tracing controlled the epidemic. Herein, we estimated the effectiveness of each NPI using a simulation model. @*Methods@#A compartment model with a susceptible-exposed-infectious-quarantinedhospitalized structure was employed. Using the Monte-Carlo-Markov-Chain algorithm with Gibbs' sampling method, we estimated the time-varying effective contact rate to calibrate the model with the reported daily new confirmed cases from February 12th to March 31st (7 weeks). Moreover, we conducted scenario analyses by adjusting the parameters to estimate the effectiveness of NPI. @*Results@#Relaxed social distancing among adults would have increased the number of cases 27.4-fold until the end of March. Spring semester non-postponement would have increased the number of cases 1.7-fold among individuals aged 0–19, while lower quarantine and detection rates would have increased the number of cases 1.4-fold. @*Conclusion@#Among the three NPI measures, social distancing in adults showed the highest effectiveness. The substantial effect of social distancing should be considered when preparing for the 2nd wave of COVID-19.

14.
Article in English | WPRIM | ID: wpr-901825

ABSTRACT

Background@#Drug-drug interactions (DDIs) in patients using oral anticancer treatment are more common than in those using injectable anticancer agents. In addition, DDIs related to anticancer treatment are known to cause clinically significant outcomes, such as treatment failure and severe toxicity. To prevent these negative outcomes, significant DDIs are monitored and managed using the information provided in drug databases. We aimed to evaluate the consistency of information on clinically significant DDIs for tyrosine kinase inhibitors (TKIs) between representative drug databases. @*Methods@#We selected clinically significant DDIs involving medications that are co-prescribed with TKIs and met the following criteria: the severity level of DDIs was equal or greater than “D” in Lexicomp® or “major” in Micromedex® . We then analyzed the consistency of the severity classification and evidence level between the drug databases. Spearman’s correlation coefficient was used to identify the relationship between DDI information in the drug databases. @*Results@#In total, 627 DDI pairs were identified as clinically significant; information on these was provided by Lexicomp® and Micromedex® for 571 and 438 pairs, respectively, and both drug databases provided information on 382 DDI pairs.There was no correlation between the severity and evidence level of DDIs provided in the two databases; Spearman’s correlation coefficient for Lexicomp® and Micromedex® was -0.009 (p=0.861) and -0.064 (p=0.209), respectively. @*Conclusion@#To judge the significance of DDIs, healthcare providers should consider that the information on DDIs may be different between drug information databases; hence, clinical factors must be considered concurrently.

15.
Article in English | WPRIM | ID: wpr-901817

ABSTRACT

Background@#Despite the increased use of direct-acting oral anticoagulants, warfarin is still recommended as first-line therapy in patients with mechanical valves or moderate to severe mitral stenosis. Anticoagulation management services (AMSs) are warranted for patients receiving warfarin therapy due to the complexity of warfarin dosing and large interpatient variability. To overcome limited health care resources, we developed a messenger app-based chatbot that provides information to patients taking warfarin. @*Methods@#We developed “WafarinTalk” as an add-on to the open-source messenger app KakaoTalk. We developed the prototype chatbot after building a database containing seven categories: 1) dosage and indications, 2) drug-drug interactions, 3) drug-food interactions, 4) drug-diet supplement interactions, 5) monitoring, 6) adverse events, and 7) precautions. We then surveyed 30 pharmacists and 10 patients on chatbot reliability and on participant satisfaction. @*Results@#We found that 80% of the pharmacists agreed on the consistency of chatbot responses and 44% agreed on the appropriateness of chatbot. Furthermore, 47% of pharmacists said that they were willing to recommend the chatbot to patients. Of the seven categories, information on drug-food interaction was the most useful; 90% of patients said they were satisfied with the chatbot and 100% of patients said they were willing to use it when they were unable to see a pharmacist. We updated the prototype chatbot with feedback from the survey. @*Conclusion@#This study showed that warfarin-related information could be provided to patients through a messenger applicationbased chatbot.

16.
Article in Korean | WPRIM | ID: wpr-900958

ABSTRACT

Purpose@#To report a case of ischemic optic neuropathy caused by iron deficiency anemia (IDA) accompanied by ethambutol-induced toxic optic neuropathy.Case summary: A 64-year-old female patient presented with declining visual acuity. Four months prior, she had been taking ethambutol daily for tuberculosis. Corrected visual acuity was 0.3 in both eyes and a central visual field defect was revealed in visual field tests. In the color vision test, the right eye scored three and the left eye scored two. Ethambutol was stopped immediately under suspicion of toxic optic neuropathy; however, the corrected visual acuity gradually worsened to 0.05 in the right eye and the finger count was 50 cm in the left eye. The patient’s blood test showed signs of IDA. After 5 months of IDA treatment, the blood test results returned to the normal range and corrected visual acuity improved to 0.5 in both eyes. However, focal atrophy of the ganglion cell-inner plexiform layer was observed, requiring close monitoring of optical coherence tomography findings. @*Conclusions@#Ischemic optic neuropathy due to IDA may occur in a short period of time and may be difficult to diagnose if accompanied by ethambutol-induced toxic optic neuropathy. In the case of patients with progressive vision loss, prompt diagnosis and careful monitoring in follow-up evaluations are required.

17.
Article in English | WPRIM | ID: wpr-894121

ABSTRACT

Background@#Drug-drug interactions (DDIs) in patients using oral anticancer treatment are more common than in those using injectable anticancer agents. In addition, DDIs related to anticancer treatment are known to cause clinically significant outcomes, such as treatment failure and severe toxicity. To prevent these negative outcomes, significant DDIs are monitored and managed using the information provided in drug databases. We aimed to evaluate the consistency of information on clinically significant DDIs for tyrosine kinase inhibitors (TKIs) between representative drug databases. @*Methods@#We selected clinically significant DDIs involving medications that are co-prescribed with TKIs and met the following criteria: the severity level of DDIs was equal or greater than “D” in Lexicomp® or “major” in Micromedex® . We then analyzed the consistency of the severity classification and evidence level between the drug databases. Spearman’s correlation coefficient was used to identify the relationship between DDI information in the drug databases. @*Results@#In total, 627 DDI pairs were identified as clinically significant; information on these was provided by Lexicomp® and Micromedex® for 571 and 438 pairs, respectively, and both drug databases provided information on 382 DDI pairs.There was no correlation between the severity and evidence level of DDIs provided in the two databases; Spearman’s correlation coefficient for Lexicomp® and Micromedex® was -0.009 (p=0.861) and -0.064 (p=0.209), respectively. @*Conclusion@#To judge the significance of DDIs, healthcare providers should consider that the information on DDIs may be different between drug information databases; hence, clinical factors must be considered concurrently.

18.
Article in English | WPRIM | ID: wpr-894113

ABSTRACT

Background@#Despite the increased use of direct-acting oral anticoagulants, warfarin is still recommended as first-line therapy in patients with mechanical valves or moderate to severe mitral stenosis. Anticoagulation management services (AMSs) are warranted for patients receiving warfarin therapy due to the complexity of warfarin dosing and large interpatient variability. To overcome limited health care resources, we developed a messenger app-based chatbot that provides information to patients taking warfarin. @*Methods@#We developed “WafarinTalk” as an add-on to the open-source messenger app KakaoTalk. We developed the prototype chatbot after building a database containing seven categories: 1) dosage and indications, 2) drug-drug interactions, 3) drug-food interactions, 4) drug-diet supplement interactions, 5) monitoring, 6) adverse events, and 7) precautions. We then surveyed 30 pharmacists and 10 patients on chatbot reliability and on participant satisfaction. @*Results@#We found that 80% of the pharmacists agreed on the consistency of chatbot responses and 44% agreed on the appropriateness of chatbot. Furthermore, 47% of pharmacists said that they were willing to recommend the chatbot to patients. Of the seven categories, information on drug-food interaction was the most useful; 90% of patients said they were satisfied with the chatbot and 100% of patients said they were willing to use it when they were unable to see a pharmacist. We updated the prototype chatbot with feedback from the survey. @*Conclusion@#This study showed that warfarin-related information could be provided to patients through a messenger applicationbased chatbot.

19.
Article in Korean | WPRIM | ID: wpr-893254

ABSTRACT

Purpose@#To report a case of ischemic optic neuropathy caused by iron deficiency anemia (IDA) accompanied by ethambutol-induced toxic optic neuropathy.Case summary: A 64-year-old female patient presented with declining visual acuity. Four months prior, she had been taking ethambutol daily for tuberculosis. Corrected visual acuity was 0.3 in both eyes and a central visual field defect was revealed in visual field tests. In the color vision test, the right eye scored three and the left eye scored two. Ethambutol was stopped immediately under suspicion of toxic optic neuropathy; however, the corrected visual acuity gradually worsened to 0.05 in the right eye and the finger count was 50 cm in the left eye. The patient’s blood test showed signs of IDA. After 5 months of IDA treatment, the blood test results returned to the normal range and corrected visual acuity improved to 0.5 in both eyes. However, focal atrophy of the ganglion cell-inner plexiform layer was observed, requiring close monitoring of optical coherence tomography findings. @*Conclusions@#Ischemic optic neuropathy due to IDA may occur in a short period of time and may be difficult to diagnose if accompanied by ethambutol-induced toxic optic neuropathy. In the case of patients with progressive vision loss, prompt diagnosis and careful monitoring in follow-up evaluations are required.

20.
Article in Korean | WPRIM | ID: wpr-785350

ABSTRACT

PURPOSE: To identify causative agents of the drug-induced anaphylaxis (DIA) by using the Korea Institute of Drug Safety & Risk Management-Korea Adverse Event Reporting System (KIDS-KAERS) database (Ministry of Food and Drug Safety) in Korea and to check their labeling information regarding anaphylaxis.METHODS: Among Individual Case Safety Reports from January, 2008 to December 2017, cases of DIA were analyzed for demographics, causative agents and fatal cases resulting in death. The domestic drug labeling, Micromedex and U.S. Food and Drug Administration (FDA) drug package insert, were reviewed to check if the labeling information on suspected causative agents contains anaphylaxis.RESULTS: A total of 4,700 cases of DIA were analyzed. The mean age was 49.85±18.32 years, and 2,642 patients (56.2%) were females. Among 8,664 drugs reported as causative agents, antibiotics (27.4%) accounted for the largest portion. There were 18 fatal cases: antibiotics (7 cases), antineoplastic agents (4 cases) were the major causative drugs for the mortality cases. Of 513 drugs reported as suspected causative agents, 103 (20.1%) did not list anaphylaxis as an adverse effect on domestic drug labeling and 16 (3.1%) did not reflect anaphylaxis in any of 3 adverse drug information.CONCLUSION: Analysis of 10-year data showed that antibiotics were the main cause of DIA and the mortality rate was 0.7%. In 3.1% of suspected drugs, there was no description of anaphylaxis in any of the drug labeling.


Subject(s)
Anaphylaxis , Anti-Bacterial Agents , Antineoplastic Agents , Demography , Drug Labeling , Female , Humans , Korea , Mortality , Pharmacovigilance , United States Food and Drug Administration
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