Recently, the number of outpatients who visit the hospital only for the examination is increased in Ofuna Chuo hospital.  It is important that the pharmacists manage the contrast media used to these outpatients for the rational drug therapy.  However, there are a few hospitals where the pharmacists work in the laboratory.  Therefore, we investigated the effect of the providing drug information by pharmacists to the patients received magnetic resonance cholangiopancreatography (MRCP) in the laboratory.  The subjects were consisted of 38 patients who were taken with Bothdel®Oral Solution 10 during receiving MRCP.  The pharmacist instructed the patients about Bothdel®Oral Solution 10 before MRCP.  The percentage of patients who were already treated with the other drugs was 92.0%.  The 4 patients were taken the drugs interacted with Bothdel®Oral Solution 10 and then were able to prevent the drug interaction by the pharmacist.  Also, the patients were taken the questionnaire form about the adverse events of this drug and sent it to the pharmacy by mail after more than 5 days.  As the results, the gastrointestinal symptoms such as a loose stool and a diarrhea were reported 28.5% of the patients.  In addition, as the adverse events other than listed in the package insert, epigastric distress, heaviness of the head and hot flash, were shown in each of a patient, respectively.  In conclusion, it was very important that the pharmacists provide the information of rational use of contrast media to the patients who received examination.

Objective: Sodium valproate granules (VPA granules) are extremely hygroscopic, deliquesce slowly in the air, and aggregate depending on temperature and humidity conditions. Although pharmacists are required to maintain drug storage conditions until the time of dispensing, they cannot keep track of the actual storage conditions maintained by the patients thereafter. Therefore, we investigated the actual temperature and humidity of the storage conditions maintained by the patients after delivery of the VPA granules.Methods: We conducted a prospective observational study at Kameda Medical Center on pediatric outpatients who were prescribed VPA granules from July 5, 2018 to February 20, 2019. A portable data logger capable of measuring temperature and humidity for 24 h was delivered at the time of dispensation. At the following visit, the data logger was collected, and data about temperature and humidity were obtained. We defined the suitable temperature as 1.0-30.0℃ and suitable humidity as 75.0% or less.Results: In this study, 13 patients were included. In total, 18 data loggers were distributed, and the return rate was 100.0%. The storage temperature was outside the suitable range in 0.8% of the total observation time whereas the humidity exceeded 75.0% in 1.7% of the total observation time.Conclusion: Storage of medications after dispensation was evaluated, and certain temperature and humidity deviations were observed. As storing a drug in an inappropriate environment changes the nature of the drug, affecting its efficacy and safety, it is necessary to educate patients on the proper methods to store oral medications.

Objective: Providing patients with information and medication instruction regarding direct oral anticoagulant (DOAC)antagonists is becoming increasingly important. Comprehensive knowledge of DOAC antagonists can expedite the transportation and treatment of emergency cases, such as bleeding with antagonists, in hospitals. We investigated the awareness of idarucizumab and whether the information provided in the Risk Management Plan was reflected in the actual provision of information and medication instruction.Methods: Pharmacists in dispensing pharmacies and Kameda Medical Center were included in the survey conducted from May 2022 to June 2022. Using a web-based questionnaire, we obtained answers to questions related to idarucizumab awareness. Respondents answered a series of questions regarding idarucizumab awareness, sources of information, patient information, and medication instruction.Results: We received responses from 1,118 people. In all, 25.9% pharmacists were aware of idarucizumab, and 10.3% provided information and medication instruction on DOAC antagonists to patients. Pharmaceutical companies, books, drug information departments, workshops, and wholesalers were the sources of information on idarucizumab for 24.8, 21.0, 19.0, 10.7, and 3.1% of the pharmacists, respectively.Conclusion: Pharmacists had knowledge of DOAC antagonists and provided information and instructions to patients infrequently. Improved awareness will lead to prompt response during the occurrence of adverse events such as bleeding.

Objective: The success rate of third-line treatment for Helicobacter pylori (H. pylori) infection has been reported to depend on the use of antibacterial agents, potassium-competitive acid blockers, and proton pump inhibitors. However, there is insufficient information on the success rate of H. pylori treatment due to the differences in the clinically used drugs. Here, the factors influencing the success rate of third-line treatment for H. pylori infection was investigated.Methods: Patients aged 20 years or older, who had received third-line treatment for H. pylori infection from January 2013 to December 2021 at the Kameda Medical Center were included. The exclusion criteria were as follows: patients with unknown treatment results and discontinuation of treatment. The primary endpoint was treatment success rate, based on the differences in the treatment regimen and drug choice, which was retroactively investigated from medical records. Confounding factors were adjusted by multivariate logistic regression analysis.Results: Treatment regimens containing sitafloxacin resulted in higher treatment success rates (p<0.05). Multivariate logistic regression analysis showed that the administration of sitafloxacin was the only statistically significant factor influencing treatment success. However, vonoprazan also tended to influence treatment success.Conclusion: Treatment with sitafloxacin and vonoprazan increases the success rate of third-line treatment against H. pylori infection.

Objective: Sodium glucose cotransporter 2 inhibitors (SGLT2i) are widely used for diabetes, chronic heart failure, and chronic kidney disease. However, the incidence of volume depletion in patients when pharmacists implement risk-minimization strategies is unknown. Risk factors for volume depletion requiring further treatment have not been investigated in detail. Therefore, we retrospectively investigated the occurrence and risk factors of volume depletion in patients taking SGLT2i. Methods: This study included patients 18 years or older using SGLT2i between November 2014 and December 2021. Patients prescribed an SGLT2i at another hospital who were referred to our clinic where their initial SGLT2i prescription was a continuation prescription, patients who were referred to another medical institution during their 52-week follow-up, patients who discontinued their visits to our clinic or unknown reasons were excluded. The pharmacist provided patients with risk management plan literature at their first provision of an SGLT2 inhibitor. The endpoints were the rate of patients on SGLT2i who experienced volume depletion, rate of hospitalization to treat volume depletion, discontinuation rate, and risk factors. Results: SGLT2i caused volume depletion in 12 patients (0.5 %) and hospitalization in 1 patient (0.04 %), 83.3% of them occurred within 3 months after starting treatment. Risk factors for volume depletion were identified as age ≧ 75 years, renal dysfunction with eGFR less than 60 mL/min/1.73 m2, history of chronic heart failure, and chronic kidney disease. Conclusion: This study revealed risk factors associated with SGLT2i-induced volume depletion, but further investigation is required with an increased number of cases.

Objective: Ritodrine, a β agonist, is a uterine tocolytic agent used to suppress preterm labor. In 2013, the European Medicines Agency (EMA) recommended that short-acting β agonists should be used for a maximum of 48 h. However, in Japan, they are widely used for long-term therapy (＞48 h). The EMA recommendation was informed to physicians by pharmacists. We retrospectively evaluated the safety of ritodrine by comparing outcomes before and after the provision of drug information (DI). We investigated whether the physicians' knowledge of the DI of ritodrine influenced performance, and affected the dose administered and the number of side effects reported.Methods: Women administered ritodrine for preterm labor between November 2011 and December 2015 were included in this single-centered retrospective study, which comprised two groups: before (Pre, from November 2011 to November 2013) and after (Post, from December 2013 to December 2015) DI provision. The frequency of cardiovascular side effects was the primary endpoint and the rate of long-term use was the secondary endpoint. The chi-squared test was used for statistical comparison and p＜0.05 was considered to indicate a significant difference.Results: The study comprised 91 patients administered ritodrine for preterm labor: 43 in the Post and 48 in the Pre. The frequency of cardiovascular side effects was 48.8 and 45.8 % in the Post and Pre, respectively (p＝0.64). The rate of long-term use was 65.1 and 79.2 % in the Post and Pre, respectively (p＝0.13).Conclusion: The DI provided by pharmacists increased physicians’ awareness of ritodrine use, which may have improved the safety of the drug. Thus, the provision of DI by pharmacists may enhance patient safety by promoting behavioral change in physicians.

Objective: We surveyed community pharmacists and hospital pharmacists on the usefulness of electronic package inserts since they replaced paper-based package insert information for prescription drugs.Methods: We conducted a questionnaire survey with 1,258 community pharmacists and 126 hospital pharmacists on how they search for package insert information, handle data revisions, use paper or electronic media, and their opinions on work efficiency.Results: Questionnaire responses were obtained from 178 community pharmacists (response rate: 14.1%) and 82 hospital pharmacists (response rate: 65.1%). Among respondents, 98.9% and 98.8% of community and hospital pharmacists used personal computers connected to the internet, and 30.9% and 56.1% of community and hospital pharmacists used personal digital assistants. As for package insert medium, 79.2% and 61.8% of community pharmacists used paper and electronic media for package inserts while 50.0% and 98.8% of hospital pharmacists used paper and electronic media. To nine of ten questions about work efficiency, more than half of the hospital pharmacists reported that efficiency increased with electronic package inserts. More than half of community and hospital pharmacists reported that revision made to electronic data were more quickly reflected in practice.Conclusion: The survey revealed that community pharmacists prefer paper-based package inserts, while hospital pharmacists prefer electronic package inserts to check package insert information. The results also showed that using electronic package inserts was perceived to improve work efficiency. Furthermore, personal digital assistants will become important in promoting electronic package inserts.