Indices for dose regulation for irinotecan (CPT-11) toxicity are diarrhea, reduction in neutrophil (NEUT) count, and level of UDP-glucuronyltransferase (UGT), which is involved in conjugation of the active metabolite SN-38. An association with the glucuronosyltransferase (UGT) 1A1 gene polymorphism has been reported. Therefore, we investigated UGT1A1 gene polymorphism and the incidence of side effects in patients who received FOLFIRI±αat our institution from November 2008 to March 2017. UGT1A1 genetic testing was performed, and 25 cases treated with FOLFIRI±αwere included. Age, sex, height, weight, and body surface area (BSA)were analyzed. UGT1A1 genotype was determined as follows:*1/*6 heterozygous (*6 he genotype), *1/*28 heterozygous (*28 he genotype), homozygous, and compound heterozygous (compound genotype). We also investigated the combination drugs (classified as he genotype) and wild type. In addition, the initial dose of CPT-11/5-FU bolus, initial relative dose intensity (RDI) (％), and blood toxicity in the first course were investigated. Mean age was 70.4±8.6 years, UGT1A1 genotype was*28 he in 5 cases, *6 he in 6 cases, and wild type in 14 cases. There were no cases of compound he or homo type. There was no significant difference between the initial dose and the initial RDI. Reduction in leukocyte count was seen in 2 cases with Grade(G)3*6 he and in 2 cases with G4*28 he. Platelet count was reduced in 2 cases with G4*28 he, 2 cases with G4*2 he, 2 cases with G4*28 he, and in 2 cases with*6 he. In this study, there was no significant difference in the initial dose and initial RDI for*6 he, *28 he, and wild type. However, *28 he and *6 he showed hematologic toxicity of G3 or more. Also, the frequency of the he genotype tended to be higher than that of wild type. Thus, it is necessary to clarify the significance of weight loss in the he type in future.

There have been few reports on suvorexant (SUV), a benzodiazepine-agonist hypnotic, used concomitantly with benzodiazepines (BZDs) or non-benzodiazepines (non-BZDs). Therefore, we investigated the use of SUV in patients taking BZDs and non-BZDs. Subjects were 73 individuals who were prescribed SUV while taking either BZDs or non-BZDs for 4 weeks or more from November 2015 to the end of March 2017. Subjects were divided into three groups as follows: those with no weight change compared to baseline (the non-weight loss group (n = 32)), those with some weight loss (the weight loss group n = 23)), and those who discontinued the drugs (the withdrawal group (n = 18)). Age, sex, presence or absence of antipsychotic medication, continuation rate of SUV in each week after 4 weeks, and diazepam equivalent value before and after SUV administration were compared in each group. In addition, we investigated the occurrence of side effects after SUV initiation. When comparing the SUV continuation rate at 24 weeks in each group, no significant difference was found between the 3 groups, but at 8 weeks, the weight loss group showed significantly decreased rates compared to the non-weight-loss group. When diazepam conversion values were compared before and after BZD and non-BZD administration, significant differences were found in the non-weight-loss group, weight-loss group, and withdrawal group before administration. Side effects were 18.8％ in the non-weightloss group, 13.0％ in the weight loss group, and 16.7％ in the withdrawal group; 6.3％, 8.6％, and 16.7％ were in the central nervous system. It was thought that continuation rate might fall by concomitant use of SUV with BZDs or non-BZDs. For patients using SUV when taking BZDs or non-BZDs, it is desirable not only to reduce or stop the BZDs or non-BZDs, but also to be aware of withdrawal symptoms. This is because side effects may increase following discontinuation. Despite causing weight reduction, it is also important to consider improved safety.

Sodium glucose co-transporter 2 (SGLT2) inhibitors typically have various secondary effects in addition to the hypoglycemic effect. Therefore, we examined their effectiveness and other secondary effects. We targeted 86 patients with type 2 diabetes treated with SGLT2 inhibitors for the first time from June 2014 to the end of March 2017 at our hospital. Mean body mass index (BMI) was 28.69±4.91kg/m2. Body weight, BMI, and levels of hemoglobin A1c (HbA1c), aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γ-GTP), estimated glomerular filtration rate (eGFR), triglyceride (TG) and uric acid (UA) were significantly lower,while hematocrit (HCT), blood urea nitrogen (BUN), creatinine (Cre), and high-density lipoprotein cholesterol were significantly higher 2 months after than before administration of SGLT2 inhibitors. A significant negative correlation was observed between HbA1c, body weight, AST, ALT, γ-GTP, BUN, low-density lipoprotein cholesterol (LDL-C), and change in UA before and 2 months after administration of SGLT2 inhibitors. HbA1c was lower in patients with high HbA1c before treatment, and weight loss was noted in patients with increased body weight before treatment. These results suggest that SGLT2 inhibitors may be highly effective in patients with type 2 diabetes with uncontrolled obesity. In addition, potential risk factors for cardiovascular events and deranged liver function test values were identified, and there was a possibility that long-term SGLT2 inhibitor use could induce cardiovascular events, but with possible improvement of fatty liver. However, because it was observed that HCT was elevated and renal function was impaired, it may be necessary to administer rehydration therapy in the initial stages of treatment and to continuously monitor renal function.

Engaru-Kosei General Hospital expanded its pharmacist duties in hospital wards in April 2018 following the nationwide switch to out-of-hospital prescriptions. The purpose of this study was to examine the effect of pharmacists’ ward duties on nursing duties. Pharmacists expanded their duties to cover drug distribution management, infusions of total parenteral nutrition (TPN) mixed with drugs, and aseptic preparation of 24-h infusions (including peripheral parenteral nutrition). The effects were compared between April 2018 before the expansion of duties and May-September 2018 after the expansion, and we compared the number of meetings set up to discuss nurses’ overtime hours and patient problems. In addition, interviews were conducted about the changes experienced on site. Drug distribution management averaged 3,150 cases/month. The number of TPN mixed infusions was 25 cases/month before expansion and this increased to 88 cases/month after expansion. The number of mixed injections of 24-h infusions was 296/month. Nurses' overtime hours did not decrease significantly, but the number of meetings increased from 47/month to 79.4/month. In the interviews, positive responses were obtained about, for example, the increased number of meetings held and more time for patient care. The pharmacist and the nurse collaborated to improve work by using their expertise, we think that the results obtained from work improvement contributed to the improvement of medical quality and medical safety.