항응고약물상담 서비스( AC S )가 신경과 환자의 warfarin 치료효과에 미치는 영향

예경남,김재연,김희세,나양숙,신혜영,오정미 韓國病院藥師會 2005 병원약사회지 Vol.22 No.1

Pharmacist-managed anticoagulation service (ACS) are responsible for providing the patient education, adjustment of warfarin dosage, monitoring of side effect to maintain prothrombin time within the therapeutic range. Many studies have proven the therapeutics efficiency of ACS by showing the improvements in warfarin therapy while reducing warfarin related adverse effects. There are several hospitals in Korea that are operating the ACS. The ACS in Seoul Asan Medical Center (AMC) began to provide the ACS for the neurology patients treated with warfarin from April 2003 and its effectiveness remains to be evaluated. The purpose of this study was to evaluate the therapeutic effect of ACS by comparing the achievement rate of INR within the therapeutic range before and after ACS operation and by surveying the patient satisfaction of ACS. We compared the achievement rate of INR values within the therapeutic range during the six-month before the ACS (Pre-ACS) and after the referral to the ACS (Post-ACS). The study included 58 patients who had been previously managed by physician but now was managed by ACS. We have also surveyed the patient satisfaction of ACS A total 679 INR values were analyzed pre-ACS group consisted of 285(41%) cases while post-ACS group consisted of 411(59%) cases. The analysis showed that the achievement rate of INR values within the therapeutics range in post-group was significantly superior to the Pre-ACS(65.45% vs. 47.9%, p.0.0001). Furthermore post-group spent more time within the therapeutic range than the pre-ACS group (68.08% vs. 50.10%, p.0.0001). Seventy-nine patients completed the survey on the patient satisfaction. Most patients responded positively with ACS in 18 questions, which correspond with overall satisfaction on ACS, understanding of explanation, knowledge of their medication and non-medication (Cronbach α0.66, 0.77, 0.84, 0.68 respectively). In conclusion, ACS improved the anticoagulation control in neurology patients treated with warfarin by effectively maintaining the INR level within the therapeutics range. The levels of patient satisfaction on ACS and knowledge of the disease and medication were superior.

통풍을 동반한 고혈압 환자에서 요산감소를 위한 losartan과 다른 ARBs간의 임상적 의미 평가

예경남,임성실,Ye, Kyong Nam,Lim, Sung Cil 대한약학회 2016 약학회지 Vol.60 No.4

Elevated serum uric acid was a risk factor for the development of cardiovascular disease, particularly in patients with hypertension (HTN). In a recent study, losartan is only ARBs on serum uric acid level reduction. However, the effects of losartan on serum uric acid levels in the patients concomitantly treated with urate lowering agents have not been fully elucidated. The purposes of the present study were to evaluate the clinical effects of losartan compared with other ARBs on serum uric acid level in hypertensive patients concomitantly treated with urate lowering agents. Data were retrospectively retrieved from medical records of patients with the diagnosis of HTN and gout who were treated with antihypertensive agents (ARBs) and urate lowering agents. Serum uric acid were measured at 0, $1^{st}$ and $2^{nd}$ OPD f/u after the ARB treatment was started. 59 patients were selected by the research protocol. Of these, 9 took losartan, 16 took olmesartan, 5 took irbesartan, 3 took telmisartan, 8 took valsartan, 5 took candesartan, 2 took fimasartan and 11 not took ARBs. Losartan did not significantly reduced serum uric acid compared with the other ARBs during follow-up (2.37 mg/dl vs. 2.36 mg/dL, p = 0.68). And, this effect was still continued (2.87 mg/dl vs. 2.66 mg/dl, p = 0.58). In conclusion, this study shows that losartan has no effect on reducing serum uric acid levels in hypertensive patients with gout at combination antihypertensive agent and urate lowering agents. Further related studies are needed to confirm these results.

관상동맥 약물 용출 스텐트 삽입 후 항혈소판제제 3제요법과 2제요법의 임상적 효과 비교

예경남,김정태,이숙향 한국임상약학회 2012 한국임상약학회지 Vol.22 No.2

단일 의료기관에 자발적 보고된 약물이상반응 발생률 조사

예경남,천영주 한국병원약사회 2022 병원약사회지 Vol.39 No.1

Background : Despite various activities for improving spontaneous adverse drug reaction (ADR), studies on the incidence of ADR are insufficient. Therefore, we intend to improve the ADR activity by calculating the incidence rate reported by a hospital through the data warehouse and selecting drugs requiring intensive monitoring. Methods : This was a retrospective frequency analysis study. A total of 949 ADR cases reported spontaneously were collected, and the ADR incidence rate was calculated by data warehouse query. The collecting items are the reporting date, gender, age group, medical department, drug name, ingredient name, drug classification name, outcomes, severity, and causality. Results : Of all cases, the frequency in the medical department was surgical 482 (50.8%), internal medical 188 (19.8%), and others 282 (29.7%). The frequency was higher among women (63.3%) and 60s (24.2%). The top five frequency of ADR ingredients was tramadol (238), cefotetan (62), pethidine (58), iohexol (36), ceftriaxone (31). The incidence rate of ADR reports associated with each drug are as follow: tramadol injection 0.86%, pethidine injection 0.24%, fentanyl injection 0.14%, and oral combination tramadol/acetaminophen 0.14%, iohexol 0.3%, iomeprol 0.3%, iodihexol 0.3%, and iopamidol 0.2%. Conclusion : As a result of calculating the ADR incidence rate in a hospital using a data warehouse program, activities for improving ADR reports should be more sustained. Also, it is necessary to monitor intensively for antibiotics, analgesics, and contrast media.

복약순응도 증진을 위한 환자 대상 약물 색채선호도에 관한 기초연구

예경남(Kong Nam Ye),김민정(Min Joung Kim),김정태(Jung Tae Kim),임성실(Sung Cil Lim) 대한약학회 2015 약학회지 Vol.59 No.1

Everyone has own color preference and the color preference can affect human psychology in various good or bad ways. Especially patients with chronic diseases often have depressed mood to take pills for their disease treatment. Therefore we evaluate the possibility of their color preference to pharmacotherapy in good way which increases the compliance of pharmacotherapy. We performed this study by a Questionnaire survey for total 150 agreed patients at K University hospital from Aug 7 to Sep 30, 2014. Questionnaire survey was performed to choose color of providing color kit (11 different color range kit) depend on each 16 questions which asked the patient characteristics, health condition, general color preference, color preference for medicine and expectation for drug compliance. In results, most preferred color was blue (20%), whereas disliked color was black (30%) in general life. However, most preferred color for pill was white (32%), for syrup was also white (31%) or orange (28%), and for vitamin was yellow (47%). When we asked the possibility of increasing compliance, if the current taking pill color will be changed for your preference color like a candy bar, 50.4% of respondents marked 4 or 5 of like-scale expressing positive opinion on it. In conclusion, compliance is very important to succeed the treating disease and may apply the psychologic application such as each patient color preference for drug compliance in the future.

정신과 외래 환자의 색채선호도와 중추신경계 약물치료 환자들의 복약순응도에 관한 기초연구

천영주(Young Ju Cheon):예경남(Kong Nam Ye),송해란(Hae Lan Song):김 태(Tae Kim):박진경(Jin Kyung Park),김정태(Jung Tae Kim),임성실(Sung Cil Lim) 대한약학회 2019 약학회지 Vol.63 No.4

Abstract The wavelengths of color stimulate the hypothalamus and induce psychological reaction. The relationship between color preference and psychiatric disorders has been studied for a long time. This pilot study performed to investigate mutual relationship between color preference and medication adherence on 155 psychiatric outpatients (65 for major depression disorder, 68 for anxiety disorder, 22 for bipolar disorder). We asked three questionnaires about a favorite color, a hatred color and self-assessment adherence, and conducted cross-analysis of the difference of color preference between result of this study and preceding study (2015). And we investigated the color distribution ratio of central nervous system therapeutics for oral solid formulation. The most favorite color was purple in major depressive disorder patients, and green in anxiety disorder and bipolar disorder patients. Purple-blue-green, the short wavelength colors were preferred in all subjects. This result presented a significant difference with preference of non-psychiatric patients. Of the 131 oral solid formulations, 46.6% were white color. So far, the favorite color has not yet been applied to patients’ medication. Because the favorite color of psychiatric patients is distinguished from that of non-psychiatric patients, the color preference might consider application in psychiatric medications.

그룹처방약품 집계를 이용한 약품 관리 업무 개선

천영주,예경남,김정보,정경주,김정태 한국병원약사회 2017 병원약사회지 Vol.34 No.3

Background : Group-order medicines (GOM) are requirements that have been steadily used in various clinical laboratories at a hospital. Since GOM is not recognized by an individual code, the number of GOM could not be totalized exactly until now. This results in a discrepancy between amount of health insurance claims and purchasing, leads to unreasonable inventory management and associated work, and increases unnecessary cost. We therefore developed a GOM-counting program (GOMP) for three months, from January to March 2016. Methods : The aim of this study was to evaluate a rational GOM-inventory management process through GOMP. We compared the following factors between pre- and post- GOMP application: characteristic value assignment, work process, and registering percentage of GOM-consignment stock. Results : After applying GOMP, the characteristic of GOM was converted from a requisition to prescription medicine. The issuing department was unified, and requisition work was replaced by an automatic electronic process. The amount of claims and purchasing was equalized after implementation of GOMP. The GOM-associated work process reduced to 5 steps compared to previous 8-9 steps. The registering percentage of consignment stock increased greatly, from 17.8% to 91.1%. Conclusion : Accurate aggregation is critical for proper drug inventory management. Application of GOMP in drug inventory management made it possible to streamline the work process, and to properly manage the consignment stock and drug inventory assets.

지속정맥주입 헤파린의 처방 및 투여 자동화 프로그램 적용을 통한 업무 개선 연구

천영주,예경남,김정옥,윤지은,박미혜,정경주,김정태,임성실 한국병원약사회 2015 병원약사회지 Vol.32 No.1

UFH (unfractionated heparin) has been classified as a high-alert medication by theInstitute for Safe Medication Practices due to its narrow therapeutic range and the risk of seriousadverse effects. To reduce medication errors, improve the patient safety, and simplify UFH relatedwork processes, we developed a UFH computerized system, HOAP (heparin order & administrationprogram). The aim of this study is to determine the safety and effectiveness of HOAP. The availabilityratio of HOAP went from 43% in Feb 2014 to 100% in June 2014. The HOAP reduced the number of steps required to order and administer heparin from 6 to 3 in physicians, and from 9 to 7 steps fornurses. A total of 167 patients were included in this study. Average run time of interventiondecreased significantly from 3-10 minutes to 1-3 minutes in physicians and nurses, respectively(physician: p=0.018, nurse: p=0.014). HOAP reduced the subjective run time per intervention by morethan 5 minutes. The HOAP reduced the prescription related errors from 5.7% to 0.1%, and reducedadministration related errors from 13.5% to 1.0% (p < 0.0001). The HOAP also decreased the timeinterval of the control infusion rate from 9.2 hrs to 5.9 hrs (p = 0.001), but there was no statisticallysignificant difference between the two groups in regards to reaching the target aPTT (42.1% vs39.0%). The difference in the mean bleeding scores was not statistically significant between pre andpost group. We concluded that HOAP is helpful in improving UFH related work processes, preventingmedication errors, and reducing the run time through standardization and automatization. Therefore,additional reserch is needed to demonstrate the clinical effectiveness of HOAP.

Nivolumab, Pembrolizumab의 임상적 사용 적정성, 유효성 및 안전성 평가

이민경,예경남,김정태 한국병원약사회 2020 병원약사회지 Vol.37 No.2

Background : Nivolumab (NV) and pembrolizumab (PB) are humanized IgG4 anti PD-1 monoclonal antibody that blocks the immune surveillance pathway and reactivates one’s immune system T-cell. The purpose of this study was to evaluate the adequacy of use in the real world, the efficacy of treatment, and the safety of adverse events. Methods : This study included those who received NV or PB at least once January 1, 2016, March 31, 2019. We excluded those unable to evaluate progressive disease (PD) or adverse events after NV or PB administration. Indications and prescribed doses were evaluated for use adequacy. We assessed the time to progression (TTP) as risk factors affecting the progressive disease (PD) and frequency of adverse events as safety evaluation. Results : Subjects were a total of 31 people, and 165 prescriptions were analyzed. The most common indications were non-small cell lung cancer (NSCLC), melanoma, hepatocellular carcinoma (HCC), and ovarian cancer. The fit rate of the indication was 100%. The average prescribed dose (%) 96.7±8.6% (72.5-108.1) of the approved dose, of which 22 (71%) were the optimal dose, seven were the low dose, and two were the overdose. Median TTP for efficacy evaluation was 84 days (46-136). Age, treatment group, and the prescribed doses were not significantly related to PD. The risk factors of developing PD were the appropriate dosage (%), no immune-related adverse events, and underlying disease. The presence of immune-related adverse events reduced the risk of PD by 0.078-fold (P<0.001). The appropriate dosage increased the risk of PD by 3.83-fold (p=0.018). Among the 230 cases, 18 cases (7.8%) of grade 3 and above adverse events were found. Among them, only one case was the immune-related adverse event. Conclusion : One TTP was outlier and required attention in interpretation. Immune-related adverse events significantly reducing the risk of PD requires further study.

한국적 의학 기준에 근거한 고혈압환자의 Angiotensin II Receptor Blockers와 Calcium Channel Blockers의 약물 평가

이옥상,천영주,예경남,윤희영,김정태,이윤정,임성실 대한약학회 2014 약학회지 Vol.58 No.2

Oriental lifestyle for treating diseases has been developed and well-accepted for a long time among Koreans. Sasang Constitution theory, originated from Korean traditional medicine, suggests that medication treat-ment should be differentiated by each patient’s body classification (So-yang [SY], So-eum [SE], Tae-yang [TY], and Tae-eum [TE]), in contrary to western medicine’s theory that medication should be applied equally by disease indication without such classification. However, the pharmacotherapeutic outcomes of these theories have not been compared to date. In this study, we aimed to compare the two theories by evaluating blood pressure (BP), which is lowered as a therapeutic outcome, among hypertensive patients taking angiotensin II receptor blockers (ARBs) or calcium channel blockers (CCBs), two most com-monly used antihypertensive classes in Korea. Methods: From April 2006 to June 2012, we retrospectively collected data on hypertensive patients with Sasang Constitution classification at Kyunghee University Hospital at Gangdong, one of the East-West collaborative medical centers in Korea. We collected information on age, gender, underlying diseases, anti-hypertensive drugs (ARB, CCB, ARB+CCB), and BP by reviewing the electronic medical records. We excluded patients with missing blood pressure at baseline or follow-up, or those who had a change in their antihypertensive drug class during follow-up. Results: We selected a total of 573 patients (SY: 165, SE: 158, TY: 0, TE: 250). Baseline BPs were on average 139.0/82.0 mmHg for SY, 137.8/78.5 mmHg for SE, and 138.7/79.2 mmHg for TE. In all three groups, CCBs were the most prescribed, followed by combination therapy with ARB+CCB, then ARBs. BP reduction after 1 month of initial medication was significantly different among the drug classes, but not in Sasang constitutional classification (ARB [SY: -12.4/-4.7, SE:-12.3/-2.5, TE: -8.6/-1.8], CCB [SY: -12.3/-5.4, SE: -13.0/-2.3, TE: -10.8/-6.0], ARB+CCB [SY: -15.6/-6.7, SE: -18.4/-8.1, TE:-20.2/-6.7], drug [P≤0.05/P>0.05], constitutional type [P>0.05/P>0.05]). Conclusion: We observed significant differences in reduction of blood pressure by classes of drugs (ARB+CCB>CCB>ARB) but not by Sasang constitutional classification. Therefore, current approach of antihypertensive pharmacotherapy assisted by Western medicine is appropriate for treat-ment of hypertension. However, further larger scale or prospective studies are required in order to confirm these results.