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Contributing Factors on Pharmacokinetic Variability in Critically Ill Neonates.

Korean Journal of Clinical Pharmacy.2017;27(2):63-68. doi:10.24304/kjcp.2017.27.2.63

Neonates have large inter-individual variability in pharmacokinetic parameters of many drugs due to developmental differences. The aim of this study was to investigate the factors affecting the pharmacokinetic parameters of drugs, which are commonly used in critically ill neonates. Factors that reflect physiologic maturation such as gestational age, postnatal age, postconceptional age, birth weight, and current body weight were correlated with pharmacokinetic parameters in neonates, especially preterm infants. Comorbidity characteristics affecting pharmacokinetics in critically ill neonates were perinatal asphyxia, hypoxic ischemic encephalopathy, patent ductus arteriosus (PDA), and renal dysfunction. Administration of indomethacin or ibuprofen in neonates with PDA was associated with the reduced clearance of renally excreted drugs such as vancomycin and amikacin. Therapeutic hypothermia and extracoporeal membrane oxygenation were influencing factors on pharmacokinetic parameters in critically ill neonates. Dosing adjustment and careful monitoring according to the factors affecting pharmacokinetic variability is required for safe and effective pharmacotherapy in neonatal intensive care unit.
Amikacin ; Asphyxia ; Birth Weight ; Body Weight ; Comorbidity ; Critical Illness* ; Drug Therapy ; Ductus Arteriosus, Patent ; Gestational Age ; Humans ; Hypothermia, Induced ; Hypoxia-Ischemia, Brain ; Ibuprofen ; Indomethacin ; Infant, Newborn* ; Infant, Premature ; Intensive Care, Neonatal ; Membranes ; Oxygen ; Pharmacokinetics ; Vancomycin

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Providing Effective Feedback within Pharmacy Practice Education.

Jeong Hyun YOON

Korean Journal of Clinical Pharmacy.2017;27(2):55-62. doi:10.24304/kjcp.2017.27.2.55

Experiential education is a core curriculum of pharmacy education. In experiential education, formative feedback is an integral component of learning and teaching process. Feedback is defined as information provided by a preceptor regarding student's performance based on direct observation. With effective feedback, students can have opportunities to reinforce or correct behaviors and to acquire knowledge or skills. Students highly value and appreciate feedback. They rank provision of effective feedback as one of the most important qualities of preceptors. Preceptors, however, lack an understanding of feedback or practical skills necessary for providing effective feedback. As a result in reality, the feedback provided to students can be differentially effective in improving students' learning. This article describes a theoretical understanding of feedback including definition and value, as well as types of feedback. In addition, practical aspects in providing feedback, such as contents, timing, techniques, and models, are addressed. By understanding the value of feedback and mastering various feedback skills, preceptors will promote students' learning and enhance educational outcomes of experiential education.
Curriculum ; Education* ; Education, Pharmacy ; Formative Feedback ; Humans ; Learning ; Pharmacy* ; Students, Pharmacy

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A Comparative Study the USA, Europe and Korea Guidelines of Antiplatelet Therapy for Patients with Acute Coronary Syndrome.

Eun Joo JUNG ; Chae Won LEE ; In Hwan BAEK

Korean Journal of Clinical Pharmacy.2015;25(3):200-208.

OBJECTIVE: Patients with acute coronary syndrome (ACS) are typically managed with dual antiplatelet therapy of acetylsalicylic acid (aspirin) and P2Y12 receptor inhibitor. In this study, we discussed current and previous antiplatelet therapy guidelines and compared with guidelines of the USA (ACC/AHA), Europe (ESC) and Korea (KSC). METHOD: This study investigated from ACC/AHA Joint Guidelines (the USA), ESC Clinical Practice Guidelines (Europe) and Korea Society of Interventional Cardiology (Korea) web site, respectively. RESULTS: It is significant that difference between the current and the previous guidelines was integration of terminology from clopidogrel to P2Y12 receptor inhibitors since prasugrel and ticagrelor, new antiplatelet drugs, has been added. The other difference was all three guidelines has differences in dose of aspirin. The most notable difference was class of recommendation (COR) in P2Y12 receptor inhibitors. ACC/AHA and Korean guidelines recommend clopidogrel, prasugrel, and ticagrelor with COR IB; whereas, ESC recommend prasugrel and ticagrelor with IB which is higher than clopidogrel with IC. CONCLUSION: This research addresses important movement to revise the Korean existing guideline recommendations. New Korean antiplatelet therapy guideline should be avoiding obvious differences in ACC/AHA and ESC guidelines and harmonizing international guidelines.
Acute Coronary Syndrome* ; Aspirin ; Cardiology ; Europe* ; Humans ; Joints ; Korea* ; Prasugrel Hydrochloride

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A Systematic Review on the Vocational Pharmacy Education and Pharmacists' Role in the Singapore's Healthcare System.

Nu Ri KWON ; Eun CHO

Korean Journal of Clinical Pharmacy.2015;25(3):187-199.

BACKGROUND: Singapore has the stable healthcare system with utilizing pharmacist manpower in proper positions by demand of populations' health among Asian countries. OBJECTIVE: This study aims to systematically review (1) the pharmacists' role and (2) the pharmacy education system of Singapore in comparison with Korea. METHOD: We searched for information about academic, medical and governmental institutions related to professional pharmacists' practice in Singapore by primarily using database such as DBpia, KISS, Google Scholar and ProQuest and the official website of the Singapore Ministry of Health. We contacted and arranged the visit schedules with National University of Singapore, National Health Group's polyclinics, Agency for Integrated Care, National University Hospital, and community chain pharmacies. During onsite visits, we interviewed pharmacists working in each institution and obtained additional documents and materials relevant to this manuscript work. RESULTS: To become a registered pharmacist in Singapore, the pharmacy curriculum requires four full-time academic years and six additional months allotted for pre-registration training. Pharm.D. course is offered for pharmacy graduate students with additional two full-time years of study. Team teaching and inter professional education program seem the most significant method in pharmacy education. Pharmacists working at hospitals, polyclinics, and community pharmacies in Singapore take broader roles and offer more cognitive services such as smoking cessation program and medication reconciliation. Especially, pharmacists in Agency for Integrated Care fill the role of primary care providers for the continuing care of the community through the governmental support toward the patients-centered integrated care. CONCLUSION: Singaporean pharmacists take significant and active roles in collaboration with other healthcare providers. Efforts such as interprofessional pharmacy education and governmental endorsement of the systematic and interactive care between pharmacists and other medical providers in Singapore are needed to be urgently applied to Korea healthcare system for the promotion of population health.
Appointments and Schedules ; Asian Continental Ancestry Group ; Cooperative Behavior ; Curriculum ; Delivery of Health Care* ; Education, Pharmacy* ; Education, Professional ; Health Personnel ; Humans ; Korea ; Medication Reconciliation ; Pharmacies ; Pharmacists ; Pharmacy* ; Primary Health Care ; Singapore ; Smoking Cessation

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An Investigation of Current Status of the Clinical Practice Guidelines in Korea.

Pusoon CHUN ; Young Sook LEE

Korean Journal of Clinical Pharmacy.2015;25(3):178-186.

OBJECTIVE: Clinical practice guidelines (CPGs) are systematically developed statements aimed at helping optimal care of the patient in a given clinical circumstance. Because of the increasing evidence that active implementation of CPGs improve health outcomes, there is a growing awareness of the importance of guideline development and dissemination. The objective of this study was to investigate the status of CPG development and availability of the CPGs in Korea. METHOD: We searched in the Web sites of 180 organizations to identify CPGs which were developed and/or published in Korea until 1 July 2014. The data of titles, published year, publisher, distributer, and accessibility at the internet web of all CPGs were collected and analyzed. RESULTS: A total of 172 CPGs were developed and 80% had been released since 2009. Most (51.2%) were developed for management of 4 diseases: 28 for digestive system disease; 27 for infectious disease; 18 for endocrine and metabolic diseases; and 15 for neoplasms. Of the 172 CPGs, 150 CPGs were publicly available. Among the 150 CPGs, 78.7% (118/150) were developed by only one organization. CONCLUSION: To ensure the production of high-quality CPGs, it is necessary to collaborate with other relevant professional societies in guideline development process. In addition, stronger efforts on wider dissemination of CPGs must be employed at the country levels to promote implementation of CPGs in clinical settings.
Communicable Diseases ; Digestive System Diseases ; Evidence-Based Medicine ; Humans ; Internet ; Korea* ; Metabolic Diseases

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Tosufloxacin Tosylate Increased the Liver Enzyme Levels in a Bladder Cancer Patient with Normal Liver Functions: a Case Report.

Eun Joo CHOI ; In Ja SONG ; Ki Yon RHEW ; Hyonok YOON

Korean Journal of Clinical Pharmacy.2015;25(1):56-58.

SUMMARY: We report the first hepatic adverse effect of tosufloxacin tosylate in a muscle invasive bladder cancer patient with normal liver functions and with scheduling to undergo a surgical operation for a neobladder. Tosufloxacin tosylate 150 mg was administered to a 57-year-old man who maintained transurethral resection of bladder tumor (TUR-BT) postoperative multiple medications. His labs presented significant increases in alanine amino transferase (ALT) and aspartate amino transferase (AST) levels with 2-week compliance of 150 mg tablet three times a day. After discontinuing tosufloxacin tosylate, the levels slowly decreased and completely returned to normal ranges without any intervention in a few weeks. The Naranjo Causality Algorithm indicates a probable relationship between increased ALT and tosufloxacin. The patient was to have the second surgical operation as scheduled after getting normal range of ATL level. Therefore, tosufloxacin should be avoided in patients at risk for having liver dysfunctions or diseases if the patients have a schedule for any operation. BACKGROUND: Tosufloxacin tosylate has been shown to have favorable benefits as an antibiotic. Tosufloxacin tosylate may be considered to have the adverse effects such as nauseas, vomiting, diarrhea, abdominal pain, stomatitis, tendonitis, tendon rupture, headache, dizziness, drowsiness, insomnia, weakness, agitation including hemolysis in the event of glucose-6-phosphate dehydrogenase deficiency as other fluoroquinolones. More severe adverse reactions of tosufloxacin tosylate over the above common adverse effects of fluoroquinolones were thrombocytopenia and nephritis. It also is not well known that tosufloxacin can cause hepatic problem. Here the study reports the first hepatic reaction from tosufloxacin and might arouse heath care providers' attention to appropriate drug choice for patients.
Abdominal Pain ; Alanine ; Appointments and Schedules ; Aspartic Acid ; Compliance ; Diarrhea ; Dihydroergotamine ; Dizziness ; Fluoroquinolones ; Glucosephosphate Dehydrogenase Deficiency ; Headache ; Hemolysis ; Humans ; Liver Diseases ; Liver* ; Middle Aged ; Nausea ; Nephritis ; Reference Values ; Rupture ; Sleep Initiation and Maintenance Disorders ; Sleep Stages ; Stomatitis ; Tendinopathy ; Tendons ; Thrombocytopenia ; Transferases ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Vomiting

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Utilization, Safety, and Related Factors of Illegal Phosphodiesterase Type 5 Inhibitors in South Korean Men.

Bong Gi KIM ; Sun Young JUNG ; Kyoung eun KWON ; Byung Joo PARK

Korean Journal of Clinical Pharmacy.2015;25(1):50-55.

BACKGROUND: Phosphodiesterase Type 5 Inhibitors (PDE5Is), which are prescription drug in South Korea, have been concerned about misuse, overuse and illegal provision of the drugs. This study was performed to investigate utilization and safety of illegal Phosphodiesterase Type 5 Inhibitors (PDE5Is), and related factors among South Korean men. METHODS: A questionnaire survey was conducted from May to July in 2013 among 1,500 nationally representative general males using computer-assisted telephone interview (CATI). The questionnaire included the characteristics of population, the characteristics of PDE5Is use, the experience with the use of illegally obtained PDE5Is, and adverse events after PDE5Is use. RESULTS: Among study population, the 1,015 (67.7%) men answered that they have used the illegally obtained PDE5Is. Younger age, single, lower frequency of PDE5Is use in a lifetime was associated with an increased use of illegally obtained PDE5Is. The men experienced adverse events after PDE5Is use is 528 (35.2%). The most common adverse event was mild to moderate hot flashes. CONCLUSION: We need to enhance awareness about the risk of illegally obtained PDE5Is use, especially in younger men and single. Proactive educations and public relations on safe use of PDE5Is for proper patients are needed.
Hot Flashes ; Humans ; Interviews as Topic ; Korea ; Male ; Phosphodiesterase 5 Inhibitors* ; Prescriptions ; Public Relations

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Comparisons of Perception on Direct-to-Consumer Advertisements of Prescription Drugs between Healthcare Providers and Consumers.

Jiwun OH ; Kitai KIM ; Sook Hee AN ; Hye Sun GWAK

Korean Journal of Clinical Pharmacy.2015;25(1):42-49.

OBJECTIVE: The aim of this study was to investigate the difference of perception on direct-to-consumer advertisement (DTCA) of prescription drugs between healthcare providers and consumers. METHODS: The online and offline survey was conducted from May 26th to June 5th, 2013. The questionnaire was composed of 15 items about perception on DTCA of prescription drugs. RESULTS: A total of 215 healthcare providers and 202 consumers responded to the questionnaire. Consumers had an overall positive attitude on permitting DTCA of prescription drugs and carried favorable views about the influence of the DTCA of prescription drugs on providing drug information, promoting communications between healthcare providers and consumers, and improving images of healthcare providers. Healthcare providers displayed negative perception for the needs of permitting the DTCA of prescription drugs compared to consumers. They showed somewhat skeptical perception about the influence of the DTCA of prescription drugs on necessities and efficiencies of delivering drug information, promoting communications between healthcare providers and consumers, and improving images of healthcare providers. Both healthcare providers and consumers were concerned about the increase of drug prices following the increase in advertisement expenses of pharmaceutical products. CONCLUSION: This study identified the perception differences on direct-to-consumer advertisements of prescription drugs between healthcare providers and consumers. This study could be of much help in the process of review on permitting DTCA of prescription drugs in Korea.
Delivery of Health Care* ; Health Personnel* ; Humans ; Korea ; Pharmaceutical Preparations ; Prescription Drugs* ; Prescriptions*

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Challenges in Patient Counseling and Medication Reconciliation for Foreign Inpatients in Korea.

Hye Kyung JIN ; Sandy RHIE

Korean Journal of Clinical Pharmacy.2015;25(1):34-41.

OBJECTIVE: This study is to evaluate the awareness, needs, and barriers in patient counseling for hospitalized foreign patients. As the number of foreign population increases in Korea, demands on quality of Korean health services are rapidly increasing. Previously most of the studies have focused on the availability and utilization of healthcare service, and prevalence of disease for foreigners, however, no study has been conducted on quality of direct-patient care such as patient counseling. METHOD: In the present study, a survey was conducted on a total of 161 participants between March 7 and May 7 in 2014. The study subjects were consisted with 103 foreign patients who had experienced inpatient care within 1 year and 58 hospital pharmacists who work in the hospital with foreign inpatients. RESULTS: Firstly, the hospital pharmacists were highly aware of the necessity of counseling for foreign inpatients. Secondly, the largest portion of barrier to patient counseling service was accounted a lack of foreign language skills. Lastly, the monitoring of efficacy, potential adverse reactions and discharge follow-up were emphasized. CONCLUSION: Effective communication skills would be essential to improve pharmaceutical care services to foreign inpatients.
Counseling* ; Delivery of Health Care ; Emigrants and Immigrants ; Follow-Up Studies ; Health Services ; Humans ; Inpatients* ; Korea* ; Medication Reconciliation* ; Pharmaceutical Services ; Pharmacists ; Prevalence

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Readability of the Product Labelling Information of Over-The-Counter Pharmaceuticals in Convenience Store.

Lak Young KIM ; Iyn Hyang LEE

Korean Journal of Clinical Pharmacy.2015;25(1):27-33.

BACKGROUND: Since November 2012, some of over-the-counter (OTC) medications have been sold in convenience store without pharmacist' s supervision. We purposed to examine if the product labels of OTCs provide sufficient information that is appropriate for consumers who may have low health literacy. METHODS: We compared the difficulty of words that are utilized in pharmaceutical product labels of interest (intervention) with those in the 6th grade textbook (control). Pharmaceutical products of interest were comprised of 13 OTCs which have been sold currently in convenience stores. We grouped words into the 4 levels of difficulty based on the Korean Vocabulary Classification for Education, and statistically tested words frequency in each level between OTCs and control. RESULTS: The 13 OTC labels included lay language (easier or equal to language used in primary school) about 10% less; professional language about 10% more (p < 0.001 in all). Labels for analgesics had the longest and most difficult information, followed by common cold preparations, muscle pain relievers as plaster or cataplasma and digestives. CONCLUSION: The 13 OTC labels might fail to provide appropriate information for safety use by consumers in terms of the difficulty level of words. The improvement of labels of OTC medications and consumer education strategies are called for safety use of OTC medications sold in convenience stores.
Analgesics ; Classification ; Common Cold ; Comprehension* ; Education ; Health Literacy ; Myalgia ; Organization and Administration ; Pharmaceutical Preparations ; Product Labeling* ; Vocabulary

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