Clinical Application of Pharmacogenetics: What is the future?

Charles D. Sands 한국임상약학회 2004 학술대회 Vol.2004 No.1

韓國에서의 臨床藥學展望

Sands, Charles D. 한국병원약사회 1987 병원약사회지 Vol.4 No.2

Ⅰ. Historical Development and Definition ; A number of factors have spurred the development of clinical pharmacy. These include : (1) disregard of public needs by the health care system, (2) the absence of a single group with responsibility for drug use control, (3) overeducated and under-utilized pharmacists, (4) diminished demand for compounding of drugs, and (5) inadequate drug knowledge by health professionals and patients. Clinical pharmacy can be defined as a health science speciality whose responsibility is to assure the safe and appropriate use of drugs in patients through the application of specialized knowledge and functions in patient care. Ⅱ. Functions and Services of Clinical Pharmacy ; The scope of pharmacy includes drug development, drug control and drug use. Clinical pharmacy deals primarily with drug use and involves providing drug information, pharmacokinetics, therapeutic specialization and patient specific managment/consultation. Ⅲ. Development of Clinical Pharmacy in Korea ; In my opinion, the initial stimulation for the development of Clinical Pharmacy in Korea began with the efforts of Dr. Yun Sung Chough of the College of Pharmacy, Seoul National University. Ⅳ. Problems and Challenges for the Future ; In promoting the continued growth of clinical pharmacy in Korea, there are many obstacles to overcome. Probably the greatest challenge lies in the area of the promotion of the concept of rational drug therapy. There is much that is not rational about drug therapy in Korea. and it will take the combined efforts of all health care professionals to overcome this problem. Pharmacists must play a leading role in this effort. V. The Future of Clinical Pharmacy in Korea ; In my opinion, the future of clinical pharmacy in Korea is very bright. Korea has the opportunity to become one of the leading countries where clinical pharmacy is practiced. Clinical pharmacy services should and can be provided in all hospital and community pharmacies in Korea. To accomplish this, it will take much effort and sacrifice on the part of all pharmacists but the rewards to the profession and to the patient will be great.

한국소아 기관지 천식 환아에서 연령에 따른 Theophylline 의 대사에 관한 연구

(Charles D . Sands),이희정,조혜영,윤운기,오지섭,류환선,손기호 대한소아알레르기호흡기학회 1995 Supplement Vol.5 No.1

N/A

活性炭 數回 經口投與에 의한 Theophylline의 藥物動態에 미치는 影響

孫基鎬,Sands, Charles D.,Jones, Daniel,Robinson, J. Daniel 한국병원약사회 1987 병원약사회지 Vol.4 No.2

The effect of multiple dose oral activated charcoal on theophylline pharmacokinetics was studied in five healthy, non-smoking, Caucasian adults in a randomized crossover clinical trial. Following an intravenous infusion of aminophylline(6 ㎎/㎏) subjects received either ⑴ activated charcoal 140gm in divided dosed over 12 hours(treatment group) or ⑵ water (control group). Serum theophylline concentrations were measured from 0 to 24 hours after the aminophylline infusion. Pharmacokinetic parameters were derived by fitting data points to a two compartment model using a non-linear least squares regression computer program. Treatment with activated charcoal decreased serum theophylline 1/2 from 10.3 to 5.6 hours and the serum AUC from 189.2 to 94.5mcg/㎖·hr, and increased total body clearance of theophylline from 0.590 to 1.099㎖/min/㎏. These results confirm previous reports that multiple dose activated charcoal increased the total body clearance of theophylline in healthy subject, and suggests that this treatment may prove be efficacious in the treatment of theophylline poisoning. Especially in areas where hemodialysis and hemoperfusion are not available.

Effect of Dupilumab on Sleep Apnea Severity in Patients With Chronic Rhinosinusitis

김상욱,Sands Scott A.,Vena Daniel,Hess Lauren B.,Calianese Nicole A.,Konefal Robert James,Taranto-Montemurro Luigi,Azarbarzin Ali,Czeisler Charles A.,Laidlaw Tanya M.,Wellman Andrew 대한수면학회 2023 sleep medicine research Vol.14 No.2

Patients with chronic rhinosinusitis (CRS) report improved sleep quality after dupilumab, an anti IL4/13 therapy. Concurrent CRS and obstructive sleep apnea (OSA) cases are not rare, and CRS seemingly raises nasal resistance. Thus, we hypothesized that improved sleep quality by dupilumab therapy in CRS patients might be due to lowered nasal resistance and subsequent improvement of unrecognized comorbid OSA. Patients with concurrent CRS and OSA were recruited. Nasal resistance was measured invasively with transnasal pressure and flow data collected during normal respiration in the supine position. Results from the first five participants did not support our hypothesis. Subjective and objective measures for CRS and nasal resistance values were improved with dupilumab therapy in CRS patients with nasal polyps. However, apnea severity and sleep-related subjective parameters did not change. In the patients with CRS without nasal polyps, no significant changes in either CRS or OSA-related measures were observed.

The Total Nutrient Additive (TNA) System

류환선,Sands, Charles D.,변순옥 한국병원약사회 1990 병원약사회지 Vol.7 No.1

CAPD Peritonitis 治療에 있어서의 初期 藥物 選擇

송미경,손기호,Sands, Charles D. 한국병원약사회 1989 병원약사회지 Vol.6 No.4

Peritonitis remains a common complication of Continuous Ambulatory Peritoneal Dialysis (CAPD) and still causes much CAPD morbidity. In the treatment of CAPD peritonitis many different antibiotics have been administered usually by the intraperitoneal or intravenous routes. Well controlled clinical trials have not been able to demonstrate that any particular antibiotic regimen is most efficacious. This paper reviews one case of gentamicin therapy in treatment of CAPD peritonitis that our TDM consult team experienced. We recommend that loading dose of 1.8㎎/㎏ and a maintenance dose of 1㎎/㎏ IP q￣ 48hours as dosing regimen for initiation therapy of CAPD peritonitis with gentamicin (or tobramycin) and recheck the trough SDC and then adjust the dose and dosing interval based on new result and the patient's clinical condition.

浸禮病院에서의 臨床藥物動態學的 諮問業務의 現況과 Case Report 一例

朴姸珠,孫基鎬,Sands, Charles D. 한국병원약사회 1987 병원약사회지 Vol.4 No.1

A Therapeutic Drug Monitoring (TDM) program was begun at the Baptist Hospital in November, 1985. Since that time over 1,700 requests for serum drug concentration(SDC) determination, analysis, and interpretation have been received. This program is supervised by the Therapeutic Drug Monitoring Committee, a sub-committee of the Drug Committee. Members of the committee include Dr. Kenneth Chang (clinical pathology), Dr. Soon Chul Hwang(internal medicine), Dr. Hong Bae Kim(pediatrice), Dr. Kwang Soeb Park(neurosurgery) and Dr. Charles Sands(pharmacy). Therapeutic Drug Monitoring(TDM) is an effective aid to clinicians in achieving optimal treatment with selected therapeutic agents. A serum drug determination, collected at the proper time and interpreted in the proper pharmacokinetic and clinical context, is a major step toward individualizing dosages for many drugs. Many factors must be considered when interpreting serum drug concentrations, since each patient has specific characteristics(e.g., genotype, coexisting disease, concomitant drug therapy, etc.) that may affect drug levels. The relationship between drug dosage and resulting concentrations in serum will also be influenced by such factors as the bioavailability of the dosage form used, patient body size, distribution through fluid compartments, and individual metabolic and excretion rates.

Digoxin을 投與받는 成人患者에 있어서 藥物動態學的 計算에 의한 Digoxin의 血中濃度豫測

김미영,박연주,Sands, Charles D.,오용식,전건웅 한국병원약사회 1987 병원약사회지 Vol.4 No.2

Four different pharmacokinetic methods of predicting steady state digoxin serum concentrations were compared retrospectively with measured steady state digoxin serum concentrations in ten adult patients with normal renal function undergoing digoxin therapy. All four methods predicted remarkedly similar results. The correlation between predicted steady state concentration and measured steady state concentrations was statistically significant. It would appear that any of the four methods is accurate enough for clinical use in patients with normal renal function, remembering that these methods may overestimate digoxin clearance and underpredict steady state concentrations in some elderly patients. Prediction of digoxin steady state concentrations by pharmacokinetic calculations in adults with normal renal function appears to be sufficiently accurate to be helpful in the interpretation of the measured steady state concentration and in the design of dosage regimens. It should be emphasized that monitoring of the digoxin serum concentration and the patient's clinical condition are the most reliable methods for ensuring efficacy and avoiding toxicity.

Gentamicin의 投與方法에 따른 藥物動態學的 비교에 관한 實驗

朴姸珠,孫基鎬,Sands, Charles D. 한국병원약사회 1986 병원약사회지 Vol.3 No.2

Gentamicin was administered in a single dose of 1㎎/㎏ to a healthy adult on two separate occasions; one time by I. V. bolus and the other by a 30 minute I. V. infusion. Serial blood samples were collected for 24 hours and various pharmacokinetic parameters calculated and compared. Gentamicin pharmacokinetics were best described by a three compartment model. Elimination half-life, Vd, AUC and time to peak concentration were similar for the two systems, but peak serum concentration was significantly different. The method of drug administration can have a profound influence on peak serum concentrations and time to attain peak. proper recommendations to obtain blood samples can be made only with the knowledge of drug pharmacokinetics and infusion method used in a specific institution.