Prolonged effects of miconazole oral gel on warfarin anticoagulation even after treatment withdrawal.

OBJECTIVE: We investigated the effect of terminating miconazole oral gel (MOG) treatment on the anticoagulant activity of warfarin by evaluating changes in international normalized ratio levels (INR). METHODS: Data were collected from the medical records of 6 patients treated with warfarin and MOG. RESULTS: Following cessation of MOG treatment, increased INR and INR/dose levels were observed for an average of 15 days, showing that the anticoagulant activity of warfarin was increased for ~ 2 weeks. CONCLUSIONS: Closer monitoring of INR levels for at least 2 weeks may be required upon withdrawal of MOG treatment in patients treated with warfarin.

Concurrent administration of rituximab and CHOP chemotherapeutic agents for outpatients with CD20-positive lymphoma.

R (rituximab)-CHOP (cyclophosphamide, adriamycin, vincristin, and prednisone) is given to outpatients with CD20-positive lymphoma as a standard treatment. However, this regimen requires long-term infusion because of the necessity for monitoring the infusion reaction (IR) during R administration. In this study, pharmacological changes in anti-tumor agents were examined after the joint use of R and CHOP, and the possibility of concurrent administration of R and CHOP for outpatients was discussed. After combining antitumor agents with R, the binding capacity of R to the CD20 peptide and molecular changes in anti-tumor agents were measured by ELISA and LC/MS/MS-based analysis. At the same time, a pilot study involving concurrent administration of R and CHOP to patients with diffuse large B-cell lymphoma (DLBCL) was carried out after the first course of R-CHOP. After combining with either adriamycin or cyclophosphamide, the binding capacity of R to the CD20 antigen was equivalent to controls, and no molecular changes in adriamycin and cyclophosphamide were detected after combination with R. Twenty-one cases of DLBCL were treated safely with concurrent administration of R and CHOP. Twenty patients achieved complete remission after a full course of R-CHOP. The results indicated that long-term medication might not be necessary for outpatients treated with R-CHOP.

[Evaluation of experience-oriented hospital practical training by an examination].

Ehime University Hospital has been conducting a four-week practical hospital training course, consisting of 18 programs, for undergraduate students. The course includes experience-oriented programs, such as drug counseling training using case-based learning procedures (CBL practice), evidence based medicine (EBM practice) based on the provision of drug information, and training to avoid adverse drug reactions (pre-avoid practice). A previous study based on a questionnaire survey showed that experience-oriented programs enhanced students' understanding of the hospital practical training, while also increasing their satisfaction. In this trial, written examinations were given to 24 students to evaluate their clinical knowledge and problem-solving abilities at the start and the end of the practical hospital training course to evaluate the educational effects of this curriculum objectively. The problem-solving abilities were examined using a test of a case analysis, which required the students to answer multiple clinical problems or proposals. The examination scores on the clinical knowledge at the end of the practical hospital training course had significantly increased by 9.5% (p<0.01) in comparison to that at the start. In addition, the accuracy rate regarding their problem-solving abilities markedly increased by 28.8% (p<0.001). Moreover, the number of answers also significantly increased by about 1.5-fold (p<0.001). These results suggested that the experience-oriented programs for hospital practical training increased the clinical knowledge and the problem-solving abilities of these students.

Estimation of the initial dose setting of vancomycin therapy with use of cystatin C as a new marker of renal function.

In recent years, it has been suggested that the glomerular filtration rate (GFR) can be predicted on the basis of serum cystatin C concentrations and that this measurement is more sensitive than serum creatinine concentration as a marker of renal function. In this study, to investigate the clinical utility of the initial dose setting of vancomycin by the population mean method with use of serum cystatin C as a marker of renal function, we compared the correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine concentrations in elderly (>/=65 years old) and nonelderly (<65 years old) patients. An analysis of prediction accuracy (bias) and precision was evaluated by calculating the mean prediction error (ME), the mean absolute error (MAE), and the root mean squared prediction error (RMSE). For nonelderly patients (n = 50), there was no significant difference in the MAE based on the use of serum creatinine or serum cystatin C concentration. However, for elderly patients (n = 105), the MAE based on serum cystatin C concentration was significantly better than that based on serum creatinine level. These results suggest that serum cystatin C is a good marker of renal function in comparison with serum creatinine for dose setting of vancomycin, especially in an elderly population.

[Role of pharmacists in medical team on HIV infection].

Medical staff, including physicians, nurses, pharmacists, nutritionists, laboratory medical technologists, social workers, and case managers, should act as a team to support patients with human immunodeficiency virus (HIV) infection. The therapeutic purpose of a potent cocktail of anti-HIV drugs is to maintain undetectable plasma levels of HIV over the long term. To achieve this, it is necessary to maintain treatment compliance. However, noncompliance frequently occurs because of a poor understanding of HIV therapy or difficulty in taking anti-HIV drugs. Thus pharmacists should contribute as HIV medical team members by providing medication counseling to ensure treatment compliance or delivering drug information to achieve successful HIV therapy. We describe the roles of pharmacists on HIV medical teams at Ehime University Hospital in examples of nutritional disorder or pregnant women with HIV.