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Deep Vein Thrombosis 환자에서 Warfarin 초기용량 5 mg/10 mg의 적절성 평가
장소희,이진주,최경희,이순실,손인자,김상준 韓國病院藥師會 2005 병원약사회지 Vol.22 No.2
BACKGROUND : Treatment of DVT consists of unfractionated or low-molecular-weight heparin for 5 to 7 days, together with oral anticoagulation with warfarin given for minimum 3 months. It takes several days from starting warfarin to reaching a therapeutic level. A therapeutic level means that the blood is anticoagulated enough to treat the thromboembolism, but not too much. Too much warfarin can lead to bleeding complications. So it needs to establish correct warfarin starting dose. But the correct warfarin starting dose is not definitely established in Korea. METHOD : We retrospectively examined the charts of 49 DVT (Initial dose 5 mg : 14 patient, 10 mg : 35 patients) patients to evaluate the appropriateness of warfarin starting dose 5 mg, 10 mg by 4 criteria. The criteria is time to reach target INR 2.0~3.0, side effect occurring rate, times of maintaining each INR range, dose changing frequency. RESULTS : There were no differences in time to reach target INR 2.0~3.0 between 2 group (10 mg vs 5 mg : 4.69 ± 1.76 vs 5.50 ± 1.9 day (P=0.166)). But side effect occurring rate (4% vs 0% (P=0.001)), times of maintaining INR greater than 2.0 (P..0.05), frequency of decreasing dose (P=0.001) were higher in 10 mg starting group. Times of maintaining INR less than 2.0 was higher in 5 mg starting dose (P=0.021). CONCLUSION : Considering the time to reach target INR 2.0~3.0, it seems to be appropriate to start warfarin dose both 5 mg & 10 mg. But there were some differences in baseline characteristics between 2 groups (baseline INR value, number of patients showing PLT..150K, body weight). So it needs reinforcing prospective study controlling patient-baseline characteristics.
Ciprofloxacin에 대한 집중 약물이상반응 모니터링
정선회,한동신,박경호,손인자,박병주,약물이상반응모니터링소위원회 한국병원약사회 2003 병원약사회지 Vol.20 No.1
Ciprofloxacin has been associated with various adverse drug reaction such as headache, skin rash, nausea, vomiting, diarrhea and abdominal pain. A 60-year-old female developed skin rash, itching, urticaria following the line of vein in injection site. After cessation of the infusion, these symptoms disappeared soon. Because there were three more patients who experienced these symptoms, intensive monitoring for evaluating this phenomenon more thoroughly. From July 11, 2002 to September 6, 2002, Seoul National University Hospital Adverse Drug Reaction SNUH ADR) Monitoring Subcommittee conducted intensive monitoring for all patients prescribed ciprofloxacin and then we identified 27 cases of adverse drug reactions among 88 patients during the monitoring period. The incidence of ciprofloxacin was 30.7 per 100 patients, 0.36 per 100 drug prescriptions. The contents of adverse drug reaction were skin rash, itching, urticaria, nausea, vomiting, dizziness and general weakness. Dose of ciprofloxacin was 200㎎/100㎎.bag and the Lot. No. were 2011~2016. The administration sites were mostly dorsum of the hand or forearm. The incidence of the adverse drug reactions was not related to the infusion rate of ciprofloxacin, but was less frequent when the anticubital vein was used for infusion than the smaller peripheral veins were used.
비소세포폐암환자에서 백금착화합물을 포함한 항암화학요법의 비교
신은정,유순호,이병구,손인자,이숙향 한국병원약사회 2001 병원약사회지 Vol.18 No.3
Non-small cell lung cancer (NSCLC) remains the leading cause of cancer related death and 5-year survival rate is approximately 10-15%. Platinum-based chemotherapy has been demonstrated to improve survival in advanced NSCLC. Platinum-based paclitaxel and gemcitabine combination therapy considered moderately active regimen in patients with advanced NSCLC and warrants comparison with existing Platinum-based regimen in randomized trial. The aim of this study was to evaluate toxicity and efficacy of Platinum-based paclitaxel and gemcitabine combination therapy. The medical charts of fifty-six patients with NSCLC, who met selection criteria from January 2000 to March 2001, were reviewed retrospectively. They received one of three regimens greater than 2 cycles up to 7 cycles; paclitaxel (140㎎/㎡) and cisplatin (60㎎/㎡), paclitaxel (120㎎/㎡) and carboplatin (300㎎/㎡), gemcitabine (1000㎎/㎡) and cisplatin (60㎎/㎡). Data collection and analysis included baseline characteristics, hematologic and non-hematologic toxicity profiles according to WHO toxicity criteria and overall response according to clinician's opinion on basis of clinical results. As results, WHO grade above 2 hematologic toxicity occurred high in gemcitabine/cisplatin arm (9.6%) compared with other two arms (paclitaxel/cisplatin 2.8% vs. paclitaxel/carboplatin 5.8%). WHO grade above 2 non-hematologic GI toxicity occurred high in paclitaxel/carboplatin arm (5.2%) compared with other two arms(paclitaxel/cisplatin 3.4% vs. gemcitabine/cisplatin 2.5%). WHO grade above 2 non-hematologic excluding GI toxicity occurred high in paclitaxel/cisplatin arm(8.8%) compared with other two arms(paclitaxel/carboplatin 7.9% vs. gemcitabine/cisplatin 2.6%). Common side effects included nausea/vomiting, peripheral neuropathy and alopecia. Comparing toxicity profiles for the three regimens revealed no significant difference. Overall response rate was 22% for paclitaxel/cisplatin arm, 31% for paclitaxel/carboplatin arm, and 15% for gemcitabine/cisplatin arm. Comparing response rate for the three arms revealed no significant difference. The median survival period was 12.2 months for paclitaxel/cisplatin arm, 18.3 months for paclitaxel/carboplatin arm, and 8.3 months for gemcitabine/cisplatin arm. Comparing survival for the three arms revealed no significant difference. There were several limitations of this study, uncontrolled baseline disease, baseline toxicity, number of patient and number of effective cycles for the treatment group. Further well-designed study is required and pharmacist's role in ADR monitoring should be emphasized.
갱생 옥내급수관 수돗물에서 비스페놀-A 분포 및 위해성 평가
정관조(Gwanjo Jeong),손보영(Boyoung Son),이인자(Inja Lee),안치화(Chihwa Ahn),김준일(Junil Kim),문보람(Boram Moon),이수원(Suwon Lee),안재찬(Jaechan Ahn),김복순(Bogsoon Kim),정득모(Deukmo Chung) 대한환경공학회 2016 대한환경공학회지 Vol.38 No.7
본 연구에서는 에폭시 수지 갱생 옥내급수관 수돗물에 대해 비스페놀-A 실태조사를 실시하였고, 비스페놀-A가 수돗물 음용에 있어 인체에 미치는 영향을 파악하기 위해 위해성 평가를 실시하였다. 원수 중 비스페놀-A는 50~118 ng/L로 채취된 모든 시료에서 정량한계 10 ng/L 이상으로 검출되었다. 이것은 주변지역의 하수 방류수나 지천에 의한 비스페놀-A 유입에 의한 것으로 판단된다. 정수에서의 비스페놀-A는 불검출되었으며, 고도정수처리 공정에서 모두 제거된 것으로 추정되었다. 응집-침전과정과 오존 및 염소에 의해 산화되어 제거되거나 다른 산화 부산물질로 변화한 것으로 판단된다. 옥내급수관 수돗물의 경우, 에폭시 갱생공사를 실시하지 않은 수돗물 모두에서 비스페놀-A는 검출되지 않았다. 그러나 에폭시 갱생공사를 실시한 옥내급수관 수돗물에서 비스페놀-A가 불검출에서 최대 521 ng/L로 범위로 검출되었으며, 채취된 시료의 68%가 정량한계 이상으로 검출되었다. 검출된 비스페놀-A의 최대값(521 ng/L)에 대한 위해도 지수 산정 결과, 위해도 지수(HQ)는 약 0.004로 수돗물 섭취에 의한 위해판단 기준값 0.1 이하로 나타나 음용에 안전한 것을 확인하였다. In this study, the survey of bisphenol-A in indoor water service pipes rehabilitated with epoxy resin was conducted and the risk assessment was done to investigate the effect on the human health to drink tap water. Bisphenol-A in raw water was detected in a range of 50~118 ng/L in all samples, where the limit of quantification was 10 ng/L. This is caused by inflow of the sewage effluent or the tributaries of the surrounding area containing bisphenol-A. Bisphenol-A was not detected in finished water after the advanced water treatment process. It was achieved by its removal from the processes of flocculation-precipitation and oxidation of ozone and chlorine and by being changed to other by-product materials. For the indoor water service pipe, bisphenol-A was not detected in all cases which was not coated with epoxy resin. However, when epoxy resin is lined within the indoor water service pipe, bisphenol-A was identified at maximum level of 521 ng/L and was detected above the limit of quantitation at 68 percentages of all samples. The Hazard Quotient (HQ) at the maximum level (521 ng/L) of the detected bisphenol-A is 0.004, which is less than the reference value of 0.1 for the tap water intake. Therefore, it is considered that the detected levels of bisphenol-A in this study would be safe to drink tap water.