약물치료시 약물유전학의 중요성

노형근,Roh, Hyung-Keun 대한임상약리학회 1995 臨床藥理學會誌 Vol.3 No.1

국내 임상약리학 활동과 의의

노형근,Roh, Hyung-Keun 대한임상약리학회 2012 臨床藥理學會誌 Vol.20 No.1

Over the last two decades, Korean Society of Clinical Pharmacology has performed a pivotal role to have the concept of clinical pharmacology take root in Korea through various academic activities. Clinical pharmacology is not only a research discipline, but also a clinical specialty which aims to provide support for physicians and patients about rational use of drugs. Although it is difficult for any one individual to cover wide range of clinical pharmacology activities, the integrative aspects of the discipline are very important to the development and use of drugs. Recently the world has been faced with serious economic crises and pharmaceutical companies have been shrunken in their research and development, so that clinical pharmacology also has been internationally affected. However, clinical pharmacology has been rapidly grown up in Korea despite the negatively given condition. At this time it is important for physicians in this field to understand the background of our clinical pharmacology in order to complement and develop our current situation for the future. In this review the academic achievement in clinical pharmacology in Korea is valued through looking back our activities for the past twenty years.

임신시 향정신성 약물의 임상약리학

노형근,Roh, Hyung-Keun 대한생물정신의학회 1996 생물정신의학 Vol.3 No.2

Doctors who treat pregnant women ore usually cautious in writing their prescription for the drugs. The problem of which psychotropic medications ore sale during pregnancy seems to remain unsolved for many years. Although the rate of absorption is reduced due to a reduced rate of gastric emptying, the extent of absorption of drug is generally unchanged during pregnancy. Plasma volume and total body water increase during pregnancy. There is suggestion that drug metabolizing activity may be increased in pregnancy. Since the pregnancy increase the glomerular filtration rate significantly, drugs mainly eliminated by renal excretion will be cleared more quickly. Factors contributing to the potential teratogenecity of a drug include the type of compound, dose and duration of use, developmental stage of fetus at the time of exposure, and the effect of the drug on fetal pharmacokinetics. All major classes of psychotropic agents should be assumed to diffuse readily across the placenta to the fetus and to be present in some quantity in the breast milk. To decide when and how to start the drug treatment depends on an assessment of the risks related both with and without drug treatment of psychiatric disorders.

의학강좌-개원의를 위한 모범 처방전 : 급성 약물중독의 일반적 치료

노형근 ( Hyung Keun Roh ) 대한내과학회 2003 대한내과학회지 Vol.65 No.1

방사선 사고와 급성 방사선 증후군

노형근 ( Hyung Keun Roh ) 대한임상독성학회 2011 대한임상독성학회지 Vol.9 No.2

In mass casualty situation due to radiological accidents, it is important to start aggressive management with rapid triage decisions. External contamination needs immediate decontamination and internal contamination should be treated with special expertise and equipment to prevent the rapid uptake of radionuclides by target organs. Acute radiation syndrome shows a sequence of events that varies with the severity of the exposure. More severe exposures generally lead to more rapid onset of symptoms and severe clinical findings. After the massive exposure, various systems of the body reflect their severe damages that can lead to death within hours or up to several months. The disease progression has classically been divided into four stages: prodromal, latent, manifest illness, and recovery or death. Three characteristic clusters of symptoms including the hematopoietic syndrome, the gastrointestinal syndrome and the cerebrovascular syndrome are all associated with the acute radiation syndrome. The standard medical management of the patients with a potentially survivable radiation exposure includes good medical, surgical and supportive measures. Specific treatment with cytokines and bone marrow transplantation should be considered. The management of internal contamination is much the same as the treatment of poisoning. The standard decontamination should be applied to reduce uptake, and the chelating agents can be administered to enhance the clearance of radioisotopes. Radioactive iodine (131I) as one of the nuclear fission products can increase the incidence of thyroid cancer in children. Potential benefit of potassium iodide prophylaxis is greater especially in neonates, infants and small children.

국내 농약 제품표지 내용 및 유독성 표시의 적절성

오범진,노형근,김원,조규종,손유동,강희동,임경수,Oh Bum Jin,Roh Hyung-Keun,Kim Won,Cho Gyu Chong,Shon Yoo Dong,Kang Hui Dong,Lim Kyoung Soo 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.2

Purpose: The morbidity of pesticides are largely related with accidental ingestion in human. The four principal ideals of clarity, completeness, conformity and consistency of label are important to make a correct usage and prevent unnecessary health risk. The aim of this study is to evaluate the appropriateness of pesticides labelling practice in Korea. Methods: The photographic label images of pesticide products were gathered through visiting thirteen manufacturers that produce pesticide products in Korea. We scored labelling practice by guidelines of Food and Agriculture Organization of the United Nations in 1995. Results: From August 2005 to November 2005, we gathered 1,296 label images of pesticide and $58.3{\%}$ (755/1,296) of images were scored by check lists for reviewing label content. The average score of four check list categories was $71.9{\pm}2.2$. Each categorical score were $91.7{\pm}0.9$ for the information appearing on the label, $31.3{\pm}0.0$ for safety precaution, $77.7{\pm}2.0$ for instructions for use, $87.0{\pm}8.7$ for general configurations. In safety precaution, the sentence of keeping locked up the product and two mandatory safety pictograms were missed in all label images. In general configurations category, there was score difference in product package types between bottle and bag container ($85.1{\pm}9.0$ vs. $90.3{\pm}7.2$, p < 0.01). Conclusion: Although there was no comparable previous data, the score of safety precaution was lowest than other categories because the two mandatory safety pictograms and locked up warning sentence were missed. In general configurations, the colour contrast was more inappropriate in the labels on bottle than bag container.

Zolpidem 중독의 임상적 특징에 대한 연구

서주현,노형근,어은경,전영진,정구영,Suh, Joo-Hyun,Roh, Hyung-Keun,Eo, Eun-Kyung,Cheon, Young-Jin,Jung, Koo-Young 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.2

Purpose: The hypnotic effect of zolpidem is comparable to benzodiazepines, but has less abuse and addiction potential than benzodiazepines, so is one of the most commonly prescribed hypnotics. The frequency of acute zolpidem overdose has increased, but clinical analysis and severity predictors are not known in Korea. Methods: A retrospective evaluation of histories, clinical courses, and laboratory findings of each patient treated from June, 2000, to May, 2006, in a university hospital for acute zolpidem intoxication. Results: We evaluated 30 patients, including 16 co-intoxication cases. Twenty-five patients presented mental alterations but became alert within 2 days. All patients recovered completely. The median zolpidem concentration was 0.9 mg/L (range: $0.2{\sim}7.4\;mg/L$). There was a weak correlation between the amount ingested and zolpidem concentration (r=0.25). None of them presented severe laboratory abnormalities, and these abnormalities did not relate to zolpidem concentration. Conclusion: The clinical progress of acute zolpidem intoxication is mild. We could not predict zolpidem concentration or clinical severity from the amount ingested and could not predict the clinical course from laboratory findings in the emergency department.

많은 양을 음독한 급성 amitraz 살충제 중독 1례

서주현,노형근,Suh, Joo-Hyun,Roh, Hyung-Keun 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.1

Amitraz is used as farm-animal insecticide. Its side effects in humans are related to its pharmacological activity on alpha 2-adrenergic receptors. The case describes a previously healthy 46-year-old woman who intentionally ingested approximately 250mL of liquid amitraz. She presented with vomiting, altered mental status, miosis, dry mouth, hypopnea, metabolic and respiratory acidosis, hypotension, hypothermia, polyuria, metabolic acidosis, elevated serum aminotransferase and abdominal distension. Supportive treatments including mechanical ventilation, hydration, dopamine infusion, bicarbonate infusion and gastric decompression resulted in improvement. By hospital day 3, she recovered with resolution of abdominal distension. It is paramount to recognize amitraz poisoning when a pesticide-intoxicated patient presets with signs and symptoms consistent with organophosphate intoxicated patients but with greater alpha 2-adrenergic related symptoms such as decreased bowel motility and xerostomia.

염산으로 인한 중대한 부식성 손상 1례

박현주,이현규,김범수,노형근,Park Hyun-Joo,Yi Hyeon-Gyu,Kim Pum-Soo,Roh Hyung-Keun 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1

Acid ingestion can cause not only caustic injury on esophagus and stomach but also fatal outcome through systemic complications. We report the case of a patient who died early after severe caustic injury with strong acid. A 38-year-old man who ingested about 400ml of hydrochloric acid of unknown concentration was transferred to our hospital from a private clinic, in which he was managed with gastric irrigation through a nasogastric tube. He was complaining dyspnea and abdominal pain. Physical examination demonstrated tenderness and rebound tenderness on epigastric region. Severe metabolic acidosis and leukocytosis were noted. Radiological findings suggested perforation of gastrointestinal tract, although the physical signs were not typical. Endoscopy revealed caustic injuries of grade I on esophagus and of grade Ⅲ on stomach, which indicate more severe injury on the stomach than on the esophagus. Exploratory surgery was recommended but unfortunately not permitted by his family. Despite intensive measures, his vital signs deteriorated rapidly and he died 50 hours after the ingestion.

위세척의 올바른 이해와 적용

오범진 ( Bum Jin Oh ),노형근 ( Hyung Keun Roh ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.1

Gastric lavage is one of gastrointestinal decontamination methods which have been controversial in the clinical toxicology field for a long time. Expert groups of American and European clinical toxicologists have published the position papers regarding gastric lavage three times since 1997. They recommended that gastric lavage should not be used as a routine procedure in the management of acute intoxication, because they thought that there is no certain evidence of improving clinical outcome by its use. However, the studies they reviewed were not well-controlled randomized trials, which cannot be conducted in the clinical toxicology field due to variability of patients and ethical problems. Therefore, the results from these studies should be interpreted with caution. They also insisted that gastric lavage can be undertaken within 60 minutes of ingestion. The limitation of one hour after ingestion is too arbitrary and may cause a lot of misunderstanding. Formation of pharmacobezoar or gastric hypomotility after ingestion may significantly delay the gastric emptying time so that gastric lavage can be useful even after several hours or more in case of highly toxic substances or severe intoxication. Furthermore, as there are a number of serious intoxication by toxic pesticides with large amount in suicidal attempts in Korea, it seems that gastric lavage may be used more frequently in Korea than in Western countries. When deciding whether or not to use gastric lavage, all the indications, contraindications, and possible adverse effects should be taken into account on the basis of risk-benefit analysis. If the procedure is decided to be done, it should only be performed by well-trained experts.