Transitional care for high-risk elderly patients pre/post discharge by collaboration between general hospital and community pharmacy: a pilot study

Park, Mi Seon,Lee, Ji Hee,Lee, Heung Bum,Kim, Ju Sin,Choi, Eun Joo Korean College Of Clinical Pharmacy 2022 한국임상약학회지 Vol.32 No.1

Background: Medication-related problems (MRPs) frequently occur during the discharge period. Elderly patients, particularly, are at high risk for these problems due to polypharmacy and the use of potentially inappropriate medications. The purpose of this study was to build and implement collaboration between general hospital and community pharmacies to address MRPs among high-risk elderly patients before/after discharge. Methods: This retrospective study was conducted between June and December of 2020. The inclusion criteria were patients with aged ≥65 years; residents of Jeonju; discharged from Jeonbuk National University hospital; either on medication of exceeding 10 medications (or high-risk medications) after hospitalization through the emergency room, or having severe illness. Patients received medication reconciliation and counselling by hospital pharmacists before discharge and home-visit pharmaceutical care as follow-up by community pharmacists after discharge. Results: Twenty-two patients agreed to home-visit pharmaceutical services. Fifteen and 11 patients completed the first and second home-visit pharmaceutical care service, respectively. Forty-two MRPs were identified in 15 patients. The types of high-frequency MRPs were incorrect administration of drug, adverse drug reactions, medication non-compliance, drug-drug interactions, lifestyle modifications, and expired medication disposal. After consultation with the pharmacist, 34 out of 42 MRPs were resolved. Conclusions: Transitional care for high-risk elderly patients before and after discharge was successfully built and implemented through a collaboration between general hospital and community pharmacies. This study suggests that home-visit pharmaceutical services may have positive effects on the safe use of drugs during the transition period; however, additional research is needed to expand on these findings.

Meta-analysis of the Efficacy and Safety of Grazoprevir and Elbasvir for the Treatment of Hepatitis C Virus Infection

강민구,강민정,지은희,유봉규,Kang, Min Gu,Kang, Min Jung,Ji, Eunhee,Yoo, Bong Kyu Korean College Of Clinical Pharmacy 2017 한국임상약학회지 Vol.27 No.3

Background: Recently, a fixed combination of grazoprevir and elbasvir (GE) has been introduced to the arsenal of chemotherapeutics to fight against this virus. The study aimed to provide information on the efficacy and safety of GE for the treatment of HCV infection by performing a meta-analysis of literature data. Methods: PubMed and EMBASE database searches were conducted. Among the literature retrieved, pivotal Phase III clinical studies were analyzed. Statistical analysis of the data was performed by RevMan. Results: Four pivotal Phase III clinical studies compared the efficacy and safety of GE. When HCV patients were treated with GE for 12 weeks, the sustained virologic response, defined as the viral RNA level below the lower limit of quantification at 12 weeks after the cessation of therapy (SVR12), was 94.7%. The clinical advantage of GE involves its use by patients with cirrhosis and/or renal failure without dose adjustment. If the genotype (GT) of the causative virus was GT1a with NS5A polymorphism or GT4 with resistance to peginterferon/ribavirin, treatment with GE plus ribavirin for 16 weeks resulted in a better outcome compared to treatment with GE alone for 12 weeks. Adverse events reported during the four clinical studies were 71.09% in the GE arms and it was 76.61% in the non-GE arms, with the most frequent events being mild central nervous system symptoms. Conclusion: GE was generally safe and effective for the treatment of HCV infection. However, since HCV mutates very rapidly and becomes resistant to antiviral agents, long-term monitoring should be mandatory.

Intranasal Insulin for Alzheimer's Disease and Amnestic Mild Cognitive Impairment: Systematic Review and Meta-analysis

사라 알라자르,진혜경,강지은,박소현,이정연,Alnajjar, Sarah,Jin, Hye Kyung,Kang, Ji Eun,Park, So Hyun,Rhie, Sandy Jeong Korean College Of Clinical Pharmacy 2017 한국임상약학회지 Vol.27 No.3

Background: There is recent evidence that insulin resistance is responsible for increasing the risk of developing cognitive dysfunction. To systematically review the influence of intranasal insulin treatment on the cognitive function in Alzheimer's disease patients. Methods: Randomized controlled trials comparing the cognitive effects of intranasal insulin therapy in Alzheimer's disease patients with controlled interventions were retrieved from Pubmed, Medline, Embase and Cochrane library. Meta-analysis was conducted on the cognitive measurements with a subgroup analysis by dose, gender and apolipoprotein E allele 4 (ApoE ${\varepsilon}4$) status. Results: Seven randomized controlled trials were eligible for inclusion. Intranasal insulin had a positive influence on the cognitive function as compared to placebo without a statistical significance (standardized mean difference; SMD = 0.109; 95% confidence interval; CI -0.04 to 0.26; P=0.14). In subgroup analysis, a 20 IU dose of intranasal insulin induced a significant improvement in cognitive function (SMD = 0.14; 95% CI 0.05 to 0.24; P=0.004), but 40 IU did not show this effect (SMD = -0.01; 95% CI -0.11 to 0.09; P=0.82). ApoE ${\varepsilon}4$ positive patients showed a significant decline in cognitive function as compared to ApoE ${\varepsilon}4$ positive patients in the control group (SMD = -0.213; 95% CI -0.38 to -0.04; P=0.015). Such an effect was not apparent in ApoE ${\varepsilon}4$ negative patients. Gender had no influence on the cognitive outcomes. Conclusion: The results indicate that intranasal insulin may have beneficial effect in improving the cognitive function in Alzheimer's disease patients.

A Case of Rheumatoid Arthritis accompanied by Organizing Pneumonia Successfully Treated with Prednisolone, Clarithromycin and Tacrolimus

오에 마사시,Ohe, Masashi Korean College Of Clinical Pharmacy 2017 한국임상약학회지 Vol.27 No.3

A 74-year-old man suffering from cryptogenic organizing pneumonia (OP) visited our department with arthralgia accompanied with partial swellings of proximal interphalangeal and metacarpophalangeal joints with morning stiffness. A diagnose of rheumatoid arthritis (RA) was made. It was thought that OP was associated with RA. We initiated a treatment with salazosulfapyridine and loxoprofen for RA. Although this treatment was effective, it was discontinued due to the development of drug eruption. As an alternative, the patient was treated with prednisolone (PSL) and clarithromycin (CAM). This treatment demonstrated being effective for OP and RA, to a certain extent; however, the RA activity was not completely suppressed. In order to suppress the RA activity further, tacrolimus (TAC) was successfully added with increasing the dosage of CAM that is assumed to raise blood TAC concentrations. The present case shows that treatment with PSL, CAM and TAC may be effective in some cases of RA.

Fentanyl PCA Monotherapy and Fentanyl TTS Combination Therapy in Post-Operative Pain Management: Analyses of Spontaneous Adverse Drug Reaction Reports

박수정,정경혜,김은영,Park, Soo Jung,Jeong, Kyeong Hye,Kim, Eun Young Korean College Of Clinical Pharmacy 2018 한국임상약학회지 Vol.28 No.2

Objective: There have been many cases of spontaneous adverse drug reactions to fentanyl at a regional pharmacovigilance center in the hospital. To assess the factors causing the adverse drug reactions reported in patients receiving fentanyl patient-controlled analgesia (PCA) monotherapy or in combination with fentanyl transdermal therapeutic system (TTS) for acute post-operative pain management. Methods: We conducted a retrospective cohort study with all patients prescribed fentanyl PCA for pain management after orthopedic surgery at a single university hospital from June 2012 to May 2013. We analysed the factors causing adverse drug reactions reported by a spontaneous reporting system in patients receiving fentanyl PCA monotherapy and those receiving fentanyl TTS in combination with fentanyl PCA. Results: Based on the spontaneous adverse drug reaction reporting, the risk ratio for the incidence rate of adverse drug reaction in the fentanyl TTS combination therapy group was 3.04 (95 % CI: 2.4-4.00, P < 0.0001), which was approximately 3-fold higher than that reported for fentanyl PCA monotherapy. Only 60 % of the adverse drug reactions were reported. Conclusion: It is inappropriate to add fentanyl TTS to fentanyl PCA to manage post-operative acute pain. There is a need to improve adverse drug reaction reporting. We expect that regular analysis of adverse drug reactions reported at regional pharmacovigilance centre would aid in appropriate drug utilization by patients.

Unusual Symptom of Hypertension associated with Amoxicillin

조영아,최은주,윤현옥,Cho, Young Ah,Choi, Eun Joo,Yoon, Hyonok Korean College Of Clinical Pharmacy 2020 한국임상약학회지 Vol.30 No.3

An 80-year-old Korean woman who previously experienced penicillin allergy presented to a dental hospital for treatment of a fractured tooth. A dentist extracted the tooth and prescribed her A-cillin (amoxicillin hydrate) 250 mg orally 3 times a day for 3 days and Carol-F^® (ibuprofen arginine) orally 3 times a day for 3 days. She received the prescriptions, returned home, and took one dose of each drug. One hour later, she experienced hypertension, itching, shortness of breath, and was unable to move her tongue to pronounce words. Approximately 6 hours after drug administration, the symptoms persisted, and the patient was admitted to an emergency medical center (EMC). The patient was discharged from the EMC after a one-night stay in the hospital for symptomatic treatment.

Real-world Adverse Events Associated with Fluconazole and Itraconazole: Analysis of Nationwide Data Using a Spontaneous Reporting System Database

이유경,이정민,천부순,Lee, Yu gyeong,Lee, Jungmin,Chun, Pusoon Korean College Of Clinical Pharmacy 2022 한국임상약학회지 Vol.32 No.3

Objective: This study aimed to investigate the occurrence and types of the adverse events (AEs) associated with oral fluconazole and itraconazole and factors associated with specific types of AEs. Methods: We analyzed AEs reported by community pharmacies nationwide over 10 years using the Korea Adverse Event Reporting System database. Various AE terms were categorized into 18 types, and concomitant medications were classified by drug-drug interaction (DDI) severity. The relationship between the specific type of AE and age, sex, and number of concomitant medications was investigated using multiple logistic regression analysis. Results: A total of 879 AE reports of fluconazole and 401 reports of itraconazole were analyzed; of these reports, 321 and 83 reports of fluconazole and itraconazole, respectively, described concomitant drug administration categorized as DDI severity of contraindicated or major. Women had a higher risk of psychiatric AEs associated with fluconazole use (OR, 1.587; p=0.042). Polypharmacy increased the risk for psychiatric AEs (OR, 3.598; p<0.001 for fluconazole and OR, 2.308; p=0.046 for itraconazole). In dermatologic AEs, the mean age of patients who received itraconazole was lower than that of patients who received fluconazole (46.3±16.8 vs. 54.9±15.4; p<0.001). Co-administration of fluconazole with 1-3 drugs increased the risk of neurological AEs (OR, 1.764; p=0.028). Conclusion: When using fluconazole and itraconazole, psychiatric AEs should be noted, particularly in women and in case of polypharmacy; moreover, when fluconazole is co-administered with other drugs, attention should be paid to the occurrence of neurological AEs.

The Effects of Tacrolimus versus Cyclosporine on Acute Graft Rejection Episode and Acute Renal Dysfunction Following Pancreas Transplantation

오정미,Oh, Jung Mi,Klassen, David Korean College Of Clinical Pharmacy 1999 한국임상약학회지 Vol.9 No.2

췌장이식의 성공률은 지난 10년 동안 상당히 상승되었다. International Pancreas Transplant Registry에 따르면 1995년 이래 미국에서만 매년 1,000건 이상의 췌장이식이 실시되고 있다. 장기이식후 나타나는 급성 거부반응은 이식 후 6개월 이내에 가장 높은 빈도수로 나타난다. 췌장이식환자에서는 신장을 이식한 것보다 두배나 높은 거부반응을 나타나며 이로 인한 입원율의 증가 항림프제(antilyinphocyte) 사용과 감염의 증가로 이환율이 높다. 더구나 Cyclosporine (CsA)을 기초로 한 면역억제제요법의 사용은 높은 급성 거부반응률(acute graft rejection)을 초래하여 이식한 장기의 조직손실이 문제가 되고 있다. 새로운 면역억제제인 Tacrolimus (FK506)의 사용은 이식환자에서의 거부반응을 감소시켜 생존율을 증가시키는 것으로 알려져 있다. Tacrolimus는 neutral macrolide로 cyclic peptide인 CsA과는 화학 구조는 매우 다르나 비슷한 면역억제 효과를 보인다. 하지만 Tacrolimus의 사용시 신경독성, 신독성, 특히 고혈당증의 발생률이 높아 일부 이식센터에서는 장기 이식 후에 사용하기를 꺼리기도 한다. 하지만 여러 연구논문에서 간과 신장 이식 후 급성 거부반응 예방에 Tacrolimus는 CsA에 비해 이점이 있는 결과를 발표하였다. 결과적으로, 현재 췌장이식 후 Tacrolimus를 기초로 한 면역억제의 효과에 대한 연구가 활발히 진행중이다. 따라서 본 연구에서는 1994-1996년 사이에 Tacrolimus 또는 CsA를 기초로 한 면역억제요법을 투여 받은 췌장이식환자 101명을 후향적으로 조사하여 Tacrolimus (n=54)와 CsA(n=57)의 급성 거부반응 예방 효과와 신부전 발생률을 비교하였다. 모든 환자는 항림프구 약물, Azathioprine, Prednisone을 이식 후 면역억제제로 투여 받았다 기준선으로부터 $20\%$ 이상의 혈청 creatinine의 상승이 있는 환자에서는 급성 신부전으로 정의하였고 신장생검법으로 거부반응을 진단하였다 Matched-pair analysis에 따르면 췌장이식환자의 6개월 생존율은 CsA군에서 $97\%$, Tacrolimus군에서 $96\%$로 별다른 차이가 없었으며 (p=0.57), 6개월간의 이식한 췌장의 보존율은 CsA군에서는 $88\%, Tacrolimus에서 $91\%$. 유의한 차이는 없었다(p=0.29). 췌장이식 후 6개월 동안 Tacrolimus의 사용은 생검으로 증명되는(biopsy-proven) 급성 거부반응의 발생빈도는 CsA보다 유의하게 낮았을 뿐만 아니라 (p<0.05) 거부반응 증상의 심각도 또한 감소시켰다 (p=0.03). 급성거부반응 발생빈도의 감소로 Tacrolimus군에서 antilymphocyte 치료가 유의하게 줄어들었다(p=0.01). CsA군에서 Tacrolimus보다 신부전의 발생률이 높았으나 통계학적 차이는 없었다. 췌장이식후의 최적의 면역억제요법의 결정하기 위해서는 향후 Tacrolimus와 CsA을 비교하는 전향적 무작위 연구가 필요하다.

노인과 중년 당뇨병 환자의 골절의 발생 빈도 위험과 혈당조절의 관계

신혜연,Sin, Hye Yeon Korean College Of Clinical Pharmacy 2018 한국임상약학회지 Vol.28 No.3

Background: Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidney disease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney function are associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic control and baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients with T2DM. Methods: Patients who underwent a general medical check-up between 2009 and 2013 were selected from the Korean National Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assess the relationship between glycemic control and eGFR and risk of fracture prevalence. Results: Cumulative fracture prevalence were higher in patients with T2DM, irrespective of whether they had tight or less stringent glycemic control (fasting blood glucose [FBG] ${\geq}110mg/dL$). After adjustment for baseline age and FBG, tight and less stringent glycemic control was significantly associated with increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05-1.21, p=0.0005 vs OR=1.13, 95% CI, 1.06-1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalence in either older or middle-aged patients. Conclusion: Less stringent glycemic control significantly increased the adjusted risk of fracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic control on fracture prevalence.

Patterns and Persistence of Pharmacotherapy for Children and Adolescents with Attention Deficit Hyperactivity Disorder in South Korea

이경은,제남경,Lee, Kyeong Eun,Je, Nam Kyung Korean College Of Clinical Pharmacy 2018 한국임상약학회지 Vol.28 No.3

Objective: This study aimed to assess treatment persistence in Korean children and adolescents with attention deficit hyperactivity disorder (ADHD) and the factors influencing their adherence to ADHD pharmacotherapy. Methods: The study included patients between 6 and 18 years of age with ADHD who were taking various formulations of methylphenidate and atomoxetine on June 1, 2014. Patients were dichotomized as "persistent" or "non-persistent", depending on whether they continued ADHD therapy for 6 months (therapy persistence). We also investigated if the patients were taking the same medication(s) as before and also classified the patients as "medication persistent" or "non-persistent". Patient' characteristics were correlated with therapy persistence and medication persistence. Multiple logistic regression analyses were performed to assess potential risk factors for treatment persistence. Results: Overall, 3,317 patients were included in the analysis. A majority of patients were taking stimulants (82.0%), 16.2% were taking non-stimulants and 1.8% were taking a combination therapy of stimulants and non-stimulants. After 6 months, 2,290 patients (69.0%) continued to take medication for ADHD with 1,953 patients taking the same medication(s) as 6 months previously. Common positive factors for therapy persistence and medication persistence were identified as younger age, retardation, and developmental delay, and long-acting formulations of methylphenidate as either monotherapy or in a combination therapy may be used. Conclusion: ADHD medications were proven to improve academic performance and social skills of children. Collaboration between patients, parents, school staffs, and prescribers is required to improve the persistent use of ADHD medications.