장기이식 약사의 역할에 관한 연구: 장기이식 입원 환자를 위한 처방 중재

정유진,안지현,석현주,이장익,장민정 한국병원약사회 2014 病院藥師會誌 Vol.31 No.6

Solid organ transplant patients are on polypharmacy with multiple immunosuppressantsand the roles of transplant pharmacists are essential for managing the medications of such patients. In this study, the therapeutic interventions performed by transplant pharmacists in solid organtransplant settings were evaluated. A total of 439 drug-related interventions performed by transplant pharmacists for 310 solid organtransplant patients admitted to Yonsei University Severance Hospital from March 2012 to June 2014were analyzed retrospectively. The interventions were implemented in person before and during thecounseling of patients with organ transplant diagnoses on the Electronic Medical Record or on using a Severance Drug Utilization Review (S_DUR) program. The average acceptance rate of the interventions by the physician in charge was 76.3% and variedin the method of intervention and the type of transplanted organs. If the pharmacist made interventionsdirectly in person to the physician, the acceptance rate was greater than the rate through theS_DUR program (235 out of 264 [89.0%] versus 100 out of 175 [57.1%], p<0.001). There was an increasingtendency of acceptance rate in the order of heart (1 out of 5, 20.0%), lung (33 out of 46, 71.7%),liver (105 out of 143, 73.4%), kidney (195 out of 244, 79.9%) and simultaneous solid organ transplant (1out of 1, 100%) (p=0.02). The rates also showed an increasing trend in the order of renal dosing (54out of 97, 55.7%), drug interaction (44 out of 68, 64.7%), medication use without an indication (41 outof 52, 78.8%), incorrect order in prescription (47 out of 53, 88.7%), untreated indication (65 out of 70,92.9%), drug administration error made by the patient or nurses (44 out of 46, 95.7%) and patient’scomplaints (12 out of 12, 100%) (p<0.001). Transplant pharmacists played important roles in preventing medication errors in solid organtransplant settings. Therefore, transplant pharmacists should take an active part in the multidisciplinarytransplant team, with effective communications on the management of transplant patients’medication.

眞鑑禪師의 梵唄에 관한 旣存 硏究 批判

최헌(Choi Heon),석현주(토론자) 부산대학교 한국민족문화연구소 2000 한국민족문화 Vol.15 No.-

The song form used in the Korean Buddhist ceremony, both by itself and for the accompaniment of the dances, is known as Beompea(Sanscrit: brah,a-bhan; Chinese: fanbei; Japanese: p?mbai). The Beompea of Hinayana and Mahayana are sung differently. These songs, sung in praise of Buddha, serve to calm the mind within by repressing the world without. They origib = nated in India the birthplace of Buddhism, were brouht into China, where they are said to have subsequently been developed during the 3rd century A.D., and were later transmitted to Korea and Japan. Although Buddhism is believed to have entered Korea is about 371 A.D., various sources list the emergence of Beompea in Korea to be as late as 645 (other sources state that it was briught into Korea during the Shilla period from Tang Dynasty China by Zen Master Jin-gam, who lived from 774~850). By the early part of the 9th century, however, the musical style of these songs had been altered to adopt them to the Korean idiom, and the dances are believed to have undergone a similar alteration from their Indian prototype some 650 years ago during the latter part of the Koryo period. According to his memorial inscrtiption, the Shilla Zen master Jin-gam (眞鑒禪師大空塔碑文) Tang in 804 as an official emissary and on his return in 830 instructed numerous pupils in chant(eosan 魚山 = Beompea). Samgukyusa(三國遺事), however provides evidence that this was not the first intriduction of chant into Korea. Furthermore, the Japanese monk Wonin(圓仁), a contemporary of Jin-gam, records in his diary of a journey to Tang(入唐求法巡禮行記) that he witnessed a ceremony held in a temple inhabited by natives of Shilla located on the Shantung peninsular(山東半島), at which three style of chant were performed-Tang, Japanese, and Shilla. It may therefore be assumed that it was the Tang style which Jin-gam learned and brought back to Korea. There are some study of the Beompea and Jin-gam in Shilla dynasty; Lee hye-gu, 'The Beompea of Shilla' Hankukeumakyeongu(韓國音樂硏究), 1957, Lee hye-gu, 'The history of Korean Beompea' Hankukeumakseoseol(韓國音樂序說), 1967, pp.337~356, Hahn Man-young, 'The Survey of Korena Buddhist Music' Bulgyoeumakyeongu(佛敎音樂硏究), 1981, pp.13~18, Song Pang-song, Hankukeumaktongsa(The History of Korean Music), 1984, pp.126~133, Kwon Oh-seong, 'Hankuk Beompe-auiyeoksa (The History of Korean Beompea)' Tongyang-bulgyoseongak-gyamunwha. 1999, pp.13~45, Kwon Oh-seong, 'Jin-gamseonsawa Shilla Beompea'(The Zen Master Jin-gam and the Beompea of Shilla)Jin-gamseonsauiyeoksajeokjejomyeong(The Historical Survey of the Zen Master Jin-gam), 2000, pp.81~87, Pak Peom-hun, Bulgyoeumakuijeolewa hankukjeokjeongaeegwanhanyeogu(The Study of Korean Buddhist Music). 1999, Pak Peom-hun, 'Jin-gamseonsa Beompeauieumakjeokteukjingegwan-hanyeongu(The Musicological Study on the Beompea of the Zen Master Jin-gam)' 2000, But these thesis or essays illustrated the Zen Master Jin-garn, and the Beompea of Shilla nearly the same. The first scholar who have studied about this topic, is Dr. Lee Hye-gu. The Study about this of other Scholar are similar to his study. Now, for the progressive study about this topic, we must study on the Beompea of India, China and Tibet.

약사에 의해 탐지된 항암제 처방오류 분석

이현주,양미경,조주희,김성은,석현주,김현아 한국임상약학회 2010 한국임상약학회지 Vol.20 No.2

노인의 Medication Error 및 고찰

황계자,김재송,박제은,안지현,김미현,손은선,이아연,석현주,박순배 한국병원약사회 2003 병원약사회지 Vol.20 No.2

환자의 치료를 돕기 위해 약사의 일을 하고 있는 우리의 소임을 다시 한번 되새기며 약사로서 이러한 오류가 발생했을 때 자기를 질책 및 처벌하거나 혹은 은폐하여 오류에 대한 불법행위나 죄를 완화하려는 시도 보다는, 약사의 직업윤리차원에서 발견 즉시 보고하여 그 즉시 대처한다면 큰 사고로 확대되는 것을 방지할 수 있다. 또한 그러한 오류의 재발을 방지하기 위해서 오류 사례에 대한 공지 및 약사 교육 등의 노력이 필요하다고 하겠다. 그리고 일반적으로 노인환자는 본인이 복용하는 약물의 이름을 잘 모르고 언제부터 처방 받았는지 무슨 목적으로 복용하는지도 모르고 여러 가지 약물을 복용하는 경우가 많으므로, 환자에 대한 약물 교육을 일반 환자보다 더욱 철저히 하여, 미국의 경우처럼 환자에게 복약상담을 하고 복용방법에 대한 환자의 이해 정도를 확인하며, 환자 가족까지도 교육시킬 수 있는 복약상담이 노인환자에서는 요구된다. 이러한 철저한 복약상담을 국가 정책적 차원으로 장려하거나 수가 책정 등의 노력을 보여줘야 하겠다. 더 나아가 error에 대한 개인적 또는 의료인 각 집단적인 관심보다는 미국의 경우처럼 국가적 차원의 error 방지에 대한 대책 마련도 필요할 것이다. 인터넷 검색 기술이 날로 발전하여 환자 및 그 보호자들의 의료지식이 나날이 증가하고 있고 이러한 해박한 지식을 바탕으로 환자들의 권리주장도 높아지고 있다. 이러한 환경변화에 의해 의료소송도 점차 증가하고 있고, 소송 시 지불액의 단위도 점점 커지고 있는 현 상황에서 투약오류에 의한 소송도 앞으로 늘어갈 것으로 예측된다. 따라서 이러한 투약사고를 미연에 방지할 수 있는 체계적인 관리지침을 개발하여 병원 약사가 숙지할 수 있도록 하는 것도 매우 중요한 작업이고, 관리지침에 맞추어 약사의 지속적인 교육과 바코드 시스템 도입 등 조제 환경의 개발 및 미국과 같은 오류 예방 시스템의 개발도 필요하다. 또한 장기적인 안목에서 병동환자를 위한 약사의 병동 임상활동 등도 오류 예방책으로 도입할 수 있을 것이다.

Amphotericin B 투여에 의한 신장 유해반응 분석

이송빈,김태경,고종희,안지현,김성은,석현주,김현아 한국임상약학회 2012 한국임상약학회지 Vol.22 No.4

원내 외과계 중환자실 재원 환자의 마약성 진통제 tapering현황 분석

이경아,김수희,조주희,안지현,손은선,김성은,석현주 한국병원약사회 2012 병원약사회지 Vol.29 No.4

Opioid analgesics strongly act on opioid receptors without any ceiling effect*. However, if such modality suddenly stops, it represents dependence and withdrawal symptoms. Therefore, this drug should be tapered to quit. In the intensive care unit where patients from moderate to severe pain are hospitalized, opioid analgesics are widely used for adequate pain control and sedation. At the Severance Hospital’s ICU, there is opioid analgesic protocol that includes fixed dilution rate and the fixed initial dose. However, for matters related to drug discontinuation, they are entirely determined by the clinical decision. As such, there are many occasions when the reinitiating of the opioid analgesics is needed due to withdrawal symptoms. Therefore, this study investigated the tendency of tapering opioid analgesics used in surgical intensive care unit (SICU). This study is targeting patients who were hospitalized at the Severance Hospital’s SICU and were treated with opioid analgesics for more than 3 days during March 1st ~ August 31st of 2011. Patients under the age of 7 were excluded. A total of 147 patients’opioid analgesic tapering trends were analyzed via medical records and clinical observation records. The frequency of opioid analgesics used at the Severance Hospital SICU appeared to be as follows: Fentanyl 114 cases (78.1%), Remifentanyl 29 cases (19.9%) and Morphine 3 cases (2.1 %). According to the result, tapering was applied in 86 cases (59.6%). The number of each drug applied to tapering was Fentanyl 68 cases (59.7%), Remifentanyl 16 cases (55.2%) and Morphine 2 cases (66.7%). The median value of medication days and the mean dose tended to be high in the tapering group. The median tapering time of each drug was as follows: Fentanyl 46 hour, Remifentanyl 29.5 hour and Morphine 114 hour. A number of cases that occur re-administration of opioid analgesics among the non-tapering group was as follows: Fentanyl 28 cases (60.9%) and Remifentanyl 9 cases (69.2%). Morphine was not re-administrated because the patient died during Morphine was administered. Moreover, the incidence of withdrawal syndrome among the non-tapering group was as follows: Fentanyl 22 cases (47.8%), and Remifentanyl 4 cases (30.8%). Therefore, this study emphasizes the pharmacists’role of mediating inappropriate drug discontinuation and encourages appropriate drug use through the survey. * Ceiling effect : referring to the level at which an independent variable no longer has an effect on a dependent variable.

원내 소아 환자에서 보고된 약물 부작용 사례 분석

금민정,박은혜,고종희,김수현,김성은,석현주 한국병원약사회 2011 병원약사회지 Vol.28 No.3

Starting from introducing the adverse drug reaction monitoring system in 1988, KFDA selected several tertiary hospitals including Severance hospital as local pharmacovigilance centers to improve the system. The centers have been expanded to 15 units in 2009 and each center has been collecting, evaluating, and reporting adverse drug reaction cases. The Severance hospital has been also performing the role with ADR monitoring system in OCS. Since the pharmacovigilance research network was launched in July 2009, managing the information has been built up and each center participated in national ADR reporting activation. The centers of the pharmacovigilance research network are monitoring ADR focused about the child, the old, and the drugs that prohibited in more than 5 countries by UN. From among these,children used to be excluded from clinical trial due to ethic and safety reason. As a result, there is no standard of indication or dosage for children and many medicines used to treat children are not licensed for such use (off-label use). Furthermore, children may have different pharmacokinetics and dynamics to adults and therefore have particular vulnerability to ADRs. Moreover,considering many children cannot express their symptoms clearly, medications used for children require careful observation. Thus, we analyzed present condition of reporting and characteristics of ADR in children based on 130 examples (284 cases) of ADR in children less than 12 at Severance hospital from January 2008, to December 2009. Through this research, we would suggest that more safe and reasonable use of medications for children can be caused by intensive ADR monitoring and DUR for children,and tried to find some expected role of pharmacists

동종 조혈모세포 이식 후 면역억제제 복용 환자에서의 약물 부작용 평가

장한나,고종희,오명현,손은선,김성은,석현주 한국병원약사회 2010 병원약사회지 Vol.27 No.1

Cyclosporine and tacrolimus are essential immunosuppressants for allogenic hematopoietic stem cell transplantation patients to prevent GVHD(graft versus host disease). However, these drugs have considerable interindividual variability in pharmacokinetics and a narrow therapeutic window. Maintaining optimal therapeutic blood concentration of these drugs is necessary to promote engraftment and to avoid toxicities. The side effects such as hyperlipidemia,hypertension, hyperglycemia, renal or liver dysfunction may cause a treatment-related death, and to treat these side effects may be administered with various medication. They can greatly affect the quality of life, morbidity and mortality of the patients. The objectives of this study were to evaluate the side effects of cyclosporine and tacrolimus in the allogenic hematopoietic stem cell transplantation patients under the routine clinical settings. From July 2008 to July 2009, we studied 30 patients with acute lymphocytic leukemia(ALL), acute myelogenous leukemia(AML), chronic myelogenous leukemia(CMA), aplastic anemia(AA), or myelo-dysplastic syndrome(MDS) who had received hematopoietic SCT in Yonsei University Health Care System. Patients’medical records and medication histories from graft pretreatment until discharge or death were reviewed retrospectively. We analyzed the patient's age, sex, underlying disease, donor, conditioning regimen, blood cyclosporine or tacrolimus concentration, medication side effects appeared after administration of immunosuppressive drugs, such as whether treatment-related death respectively. Results of comparing the cyclosporine and tacrolimus group did not show a big difference to hyperlipidemia, hypertension, renal dysfunction. Hyperglycemia and liver dysfunction in the tacrolimus group was significantly.

심방세동 환자에서 Warfarin 단일요법과 Warfarin-Aspirin 병용요법 간의 출혈경향 발생과 뇌졸중 예방효과 고찰

박지은,이정은,서인아,고종희,안지현,손은선,김성은,석현주 한국병원약사회 2013 병원약사회지 Vol.30 No.1

Atrial fibrillation (AF), the most common sustained arrhythmia, confers an independent risk factor for stoke. If the disease is not treated, stroke risk will increase more than five times, and about one in three people will experience a stroke during their life time. Therefore, AF needs active management, and anticoagulation therapy is effective in the prevention of stroke. Warfarin and aspirin, the medicines for the prevention and treatment of thromboembolism, are effective in the prevention of stroke in AF. Medication is determined by stroke risk, generally classified by CHADS2 score. Warfarin is recommended primarily for high-risk patients, and aspirin is recommended for low-risk patients and those unable to take warfarin. Despite the combined warfarin-aspirin therapy is not recommended in general, complementary effects are expected due to different mechanisms of the drug. However, some cases have been reported that the combination of these medications just administered to increase bleeding risks and did not represent a remarkable therapeutic effect. Therefore, this study is in 2011, Jan. 1 to Oct. 31 in outpatients with AF who underwent the anticoagulation therapy, and patients were classified according to medication uses. This study was analyzed cardiovascular diseases, medical treatments, and hematologic data. In addition, this study retrospectively analyze the status of anticoagulation therapy in patients with AF. The warfarin group and warfarin+aspirin group were 54 and 51 patients and average duration of drug administration were 4.7 and 3.6 months, respectively. Bleeding events occurred in 5 and 6 patients in warfarin group and warfarin+aspirn group, respectively. Retrospective analysis of the two drugs showed no significant differences between the bleeding risk and stroke prevention, additional research is needed for the clinical evaluation of the combination therapy of warfarin and aspirin.

원내 DUR 프로그램을 통한 신기능 변화에 따른 약사의 중재활동

김태희,신윤정,윤은형,고종희,안지현,손은선,김성은,석현주 한국병원약사회 2012 病院藥師會誌 Vol.29 No.3

The kidney is an excretory organ that eliminates substances from outside or produced in the body via renal excretory process. In addition, the kidney has an important role in the process that eliminates drugs or their metabolites. Thus, impaired renal function may induce the change in drug effects or adverse effects. Therefore, dosage or dosing interval adjustment is important in the consideration of impaired renal function. In Severance hospital, there are many in patients with severe disease or who are receiving a number of drugs. The frequency of drug usage that needs taking into account the patients’renal function is also high. Thus, it is recommended that dosage or dosing interval adjustment needs to depend on drug guidelines and the role of pharmacists is important in intervention. This study represented the results of drug evaluation using Severance hospital’s DUR (Drug Utilization Review) program by pharmacists from January 1 to January 31, 2011. The result represents that appropriate drug usage was 49.0% taking into account patients’renal function. Based on this study, we suggest that doctors should monitor drug usage more carefully in renal impairment and pharmacists should intervene more actively using the DUR program.