Survey on the Status of Descriptions regarding Reference Information for Dispensing and Medication Support in the Interview Form / 医薬品情報学

Objective: We examined the descriptions of reference information regarding the dispensing process in the interview form (IF). If there was no description, we determined the test data’s availability from the pharmaceutical company.Methods: The survey targeted 78 drugs that complied with the new description IF guidelines, for regular tablets and capsules launched from April 2018 to December 2021. The survey was conducted between March 13th and June 14th, 2022. We investigated the reference information regarding the stability of the medications during the crushing and simple suspension method during dispensing.Results: Regarding the data related to the stability of medications during the crushing process, ten drugs were described as having “data available,” 18 drugs were to be “inquired individually,” 31 drugs had “no applicable data,” and 14 drugs had “no items.” Regarding the status of descriptions on the simple suspension method, ten drugs were described as having “data available,” 18 drugs had data that was to be “inquired individually,” 32 drugs had “no applicable data,” and 14 drugs had “no items.” Regarding the 35 drugs for which both the stability during crushing and the simple suspension method were listed as either “no applicable data” or “no items,” we contacted the pharmaceutical companies to inquire about the test data for the stability during the crushing and simple suspension method. We found that four drugs had “data available” on the stability of medications during the crushing process, while six drugs had “data available” on the simple suspension method.Conclusion: Many IFs that complied with the new description guidelines had items for reference information regarding dispensing. However, the test data’s description was not sufficient. Furthermore, even if there is no description of reference information regarding dispensing in the IF, we confirmed that the pharmaceutical company owns the test data.

Analysis of Awareness and Perception Alteration of Simple Suspension Method by a Workshop for Hospital Pharmacists / 社会薬学

The conventional crushing method for administration of drugs to patients with feeding tubes has been commonly used at the Hyogo College of Medicine College Hospital. Compared with this conventional method, the simple suspension method can reduce drug degradation due to light and moisture absorption as well as avoid drug loss and contamination. We conducted a workshop to introduce this method to pharmacists. We asked the participants to fill a questionnaire-based survey both before and after the workshop to determine the effects of the workshop on the change in the degree of awareness among participants about these methods. The awareness of participants about the simple suspension method was approximately 80% before the workshop. Approximately 60% of participants answered that they had questions about simple suspension method from individuals from other occupations, suggesting a high awareness of this method. After the workshop, approximately 98% of participants answered that they were “satisfied” or “slightly satisfied,” suggesting that they were in favor of introducing the suspension method. The results of text mining indicated a requirement for participants to consider incompatibilities and to educate the nursing department. Participants who actively considered the proposal of simple suspension method had an altered perception toward the introduction and utilization of this method. Therefore, this survey suggested that workshops could alter the perception and behavior of pharmacists about the methods of drug administration via feeding tube.

Survey on Accumulated Drug Information by Pharmaceutical Companies about Crushed or Simply Suspended Internal Medicines / 医薬品情報学

Objective: We conducted a survey on drug information accumulated by pharmaceutical companies about the adequacy of administration of crushed or simply suspended internal medicines through enteral feeding tube, examination methods to confirm adequacy and inquiries from medical institutions to pharmaceutical companies about the adequacy of these methods.Methods: We sent a questionnaire to 162 pharmaceutical companies that sell internal medicines to collect information. The survey was conducted from May 1, 2016 to March 31, 2017.Results: The questionnaire response rate was 61% (99 companies responded). Eighty and 90 percent of the companies possessed information about the drug crushing methods and simple suspension methods used for administration of internal medicines,respectively. The type of information and examination methods used varied among the companies, was very limited, and was often limited to new drugs. The information acquisition rate about crushing methods was 69.3% in original examination methods of pharmaceutical companies. On the other hand, 90.3% of the information about simple suspension methods was obtained by the unified method of Hand Book of Simple Suspension Method.Conclusions: In the future, medical practice and patients will benefit if examination methods to confirm the adequacy of crushing and administration through feeding tubes are commonly and consistently obtained by pharmaceutical companies. Furthermore, it would be very useful for information of crushing methods and simple suspension methods to be included in package inserts and interview forms.

Examination Regarding the Simple Suspension Method using Oral Anticancer Drugs / 社会薬学

To administer oral anticancer drugs safely, the simple suspension method has been introduced in many hospitals. Therefore, concerning drugs for which it is unclear whether or not this method is applicable, testing must be able to be conducted at any time. In this study, we investigated 20 oral anticancer drugs to expand information on the application of the simple suspension method. Disintegration/suspension and permeability tests were conducted, as described in the 3rd version of the Tube Administration Handbook for Oral Drugs. All products were disintegrated/suspended after 10 minutes. On permeability tests, there was no residue in any tube for tubal feeding. On the final evaluation, the products were regarded as suitable (grade 1). Bicalutamide tablets (80 mg, TCK and KN), which were analyzed in this study, were regarded as suitable (grade 1) on the final evaluation. On the other hand, the simple suspension method is not applicable for a brand-name drug, Casodex^® tablets (80 mg). This may be related to the different additives. Furthermore, the results suggest that, even when the simple suspension method is not applicable for a brand-name drug, it may become applicable for generic drugs. This may provide a new merit for promoting the use of generic drugs.

Development of a Novel Database That Rapidly Provides Valuable Information Efficiently Aimed at Improving the Safety of the Simple Suspension Method / 医薬品情報学

<b>Objective: </b>Many patients in Kagawa University Hospital are administered medicines prepared by the simple suspension method.  Pharmacists in charge of these patients receive inquiries from doctors and nurses regarding the suitability of medicines for the simple suspension method.  Answering these inquiries is complicated and time-consuming as multiple data sources need to be searched.  In order to simplify these complicated procedures, we herein attempted to develop a novel database to provide valuable information that could contribute to the safe performance of the simple suspension method, and evaluated its usefulness.<br><b>Method: </b>The specifications of the database were determined by analyzing previously answered inquiries.  To evaluate the usefulness of the database, we used test prescriptions and compared the amount of time required to gather information using the database and the conventional method, i.e., using books alone.  We also analyzed previous prescriptions with the database in order to determine what kinds of problems could be detected.<br><b>Results: </b>The investigation of previous prescriptions indicated that some medicines needed to be examined not only for their suitability for the simple suspension method, but also their incompatibility.  Therefore, we added a feature regarding the incompatibility of medicines to the database.  The time required to gather the information needed to answer the test prescription was shorter with our database than with the conventional method.  Furthermore, the database improved the detection of medicines that require particular attention for their properties including incompatibility.  An analysis of previous prescriptions using our database indicated the possibility of incompatibility in half of the previous prescriptions examined.<br><b>Conclusion: </b>Our database could rapidly provide information related to the simple suspension method, including the incompatibility of medicines.

Creating a List of Oral Anticancer Drugs using the Simple Suspension Method for Appropriate Therapy / 社会薬学

In cancer chemotherapy, it is very important to take into account the patient’s background. In recent years, a simple suspension method has attracted increased attention as a method that prevents changes in the stability and safety of various drugs. However, of 135 oral anticancer drugs, only 28 have been examined using this method, as of April 2013. In this study, we carefully investigated whether 53 oral anticancer drugs could be adapted to the simple suspension method, except for the 28 drugs that had already been previously reported. The results showed that most of these oral anticancer drugs could be adapted to the simple suspension method. Of seven drugs that were not adapted, six were generic drugs. In addition, it was clear that the evaluation of bicalutamide tablets was significantly different from our expected results. In conclusion, we were able to qualitatively assess all 53 oral anticancer drugs. This is equivalent to half of 107 untested drugs. These results provide useful information to cancer patients using oral anticancer drugs prepared using the simple suspension method.

The role of the pharmacist in determining the method of administration of medicines in suspension through a feeding tube / 医薬品情報学

<b>Objectives</b>: To optimize the treatment of patients on tube feeding, it is important to ascertain whether medicines are appropriate for administration by gastrostomy and nasogastric tubes.  In this study, we evaluated the drug information services provided to medical staff by clinical pharmacists related to 109 patients administered medication via a feeding tube in a neurological ward.<br><b>Design and Methods</b>: We analyzed the records of drug information services provided to medical staff from January 2006 to December 2007 at the Higashi Nagoya Hospital.  We classified drug information services for avoiding obstruction of the feeding tube and chemical changes into four categories: ‘formulation changes’, ‘medication changes’, ‘incompatibilities’ and ‘administration method’, and evaluated the acceptance rate of the pharmacists’ recommendations for drug therapy via feeding tube.<br><b>Results</b>: Drug information related to formulation and medication changes accounted for 130 and 88 cases, respectively.  Information related to incompatibilities accounted for 19 cases, involving anticipated chemical changes related to concurrent administration of drugs.  Information related to administration methods accounted for 24 cases.  The acceptance rate for information by medical staff was 92.0%.<br><b>Conclusions</b>: Drug information to medical staff by pharmacists contributes to improved safety for patients administered medication via feeding tubes.  The acceptance rate for drug information was high, and the provision of drug information by pharmacists in the neurological ward was considered useful.