Cefepime 약물 사용 평가

박혜원,범진선,안효초,김주신 한국병원약사회 2015 병원약사회지 Vol.32 No.3

Cefepime is fourth generation class, broad-spectrum cephalosporin. In contrast to older cephalosporins, cefepime penetrates the gram-negative cell more rapidly, targets multiple essential penicillin-binding proteins, and escapes the effects of many beta-lactamases due to the enzymes’ low affinity for the drug. However, it should be used judiciously because unnecessary, improper, and prolonged use may lead to the emergence of cefepime-insensitive bacteria and risk decline in its efficacy. Therefore, this study was performed to evaluate the use of cefepime and its efficacy. We retrospectively analyzed medical records of patients who received cefepime at Chonbuk National University Hospital, from January 2011 to July 2011. As a result, 169 cases were studied; the justification of use showed a high rate of appropriate use 161 cases(95.3%). A majority of the critical(process) indicators also showed a high rate of appropriate use 126~164 cases(74.6~100%). The dosage of cefepime was appropriate in 122 cases(72.2%). Duration of therapy was appropriate in 100% of patients with neutropenia, but other cases were lower. Complications occurred in 35 cases, including nephrotoxicity(9 cases), hepatotoxicity(4 cases), gastrointestinal effects(8 cases), hematologic effects(5 cases), fever(3 cases), skin reactions(5 cases) and neurotoxicity(1 case). In outcome measures, the total therapeutic response rate showed 60.9%. Cefepime was being used for appropriate reasons, but it was not being well monitored. Since the improper use of antibiotics can lead to an increase of multidrug-resistant bacterias, increased safety measures could be taken by authorized clinical pharmacists to prescribe antibiotics for proper use and ongoing monitoring. Additional studies will also need to be considered for a wider variety of clinical data.

타액선 종양에 대한 면역조직화학적 연구

김창원,범진선,서재홍 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.2

Biologic functions of lysozyme, lactoferrin, alpha l-antitrypsin, and alpha l-antichymotrypsin are concerned with antibacterial defense and inhibition of protease activity. Lysozyme is an enzyme which hydrolyses bacterial cell walls, It is secreted from saliva, tears, and sweat and is contained in glandular secretions. Lactoferrin is an iron-binding protein present in saliva, milk, sweat, urine, and secretions of the respiratory and digestive systems. Alpha 1-AT and alpha 1-ACT, inhibitors of proteinase, are contained in saliva, tears, milk, semen, and bile and in many glandular tissues, including salivary glands, It is suggested that these 4 substances might be involved in local and general defense mechanisms against bacterial and proteolytic enzymes. The present immunohistochemical study identifies lysozyme, lactofemn, alpha 1-AT and alpha-ACT staining in salivary pleomorphic adenoma and compares findings with normal salivary glands and inflammatory salivary glands. The results were as follows : 1) The immunohistochemical localization of lysozyme, lactoferhn, alpha 1-AT and alpha 1-ACT was usually confined to intercalated duct and striated duct in human salivary glands. 2) Positive staining for lactoferrin and lysozyme was confined to acinar cells in inflammatory salivary glands. 3) Immunohistochemical staining for lysozyme, lactoferrin alpha 1-AT and alpha 1-ACT in pleomorphic adenoma was usually present in luminal tumor cells of tubulo-ductal structures, which are of intercalated ductal origin, and was lacking in outer spindle cells of myoepithelial origin. In conclusion, Co-expression or simultaneous expression for lysozyme, lactoferrin, alpha 1-AT, and alpha 1-ACT in pleomorphic adenoma suggest that tumor cells are protected from proteolysis or degradation.

Incidence and Risk Factors for QT Prolongation associated with Fluoroquinolones

최은정,범진선,안효초,박승용,이흥범 한국병원약사회 2023 병원약사회지 Vol.40 No.2

Background : Despite the high bioavailability and broad-spectrum activity of fluoroquinolones (FQs), their administration can lead to corrected QT prolongation. However, there is a lack of information on the incidence and risk factors for FQ-induced long QT in critically ill patients. Our objective is to determine the incidence of QT prolongation and identify the associated risk factors under real-time 24 hour monitoring. Methods : We conducted a retrospective review of medical records of critically ill patients from January to December 2018. In additioon to continuous bedside monitoring with lead II, 12-lead electrocardiography was performed regularly daily and immediately on suspected QT prolongation. The criteria for long QT were defined as QTc ≥ 450 ms for men and ≥ 470 ms for women. Dummy variable regression was performed to analyze QT interval changes before and after QT prolongation, and multivariate logistic regression was performed to identify the risk factors independently associated with QT prolongation. Results : Among 455 admitted patients, FQs were administered in 126 patients (46 female; median age, 77 years [interquartile range=63-81]) and the FQs administerd were levofloxacin (n=43), moxifloxacin (n=35), gemifloxacin (n=15), or ciprofloxacin (n=46). QT prolongation was noted on 119 cases (85.6%) after FQ administraion. The greatest QT interval difference was observed in patients receiving levofloxacin (95% confidence interval [CI]: 36.28–68.62, p < 0.001). The use of loop diuretics (OR: 7.66; 95% CI: 1.12–52.47), co-morbid sepsis (OR: 8.81; 95% CI: 1.18–65.96), and number of medications with known risk of torsade de pointes based on CredibleMeds (OR: 4.83; 95% CI: 1.18–19.79) were identified as independent risk factors. Conclusion : QT prolongation was observed frequently in critically ill patients using FQs. Among the FQs, levofloxacin had the highest incidence of QT interval differences. Therefore, these results suggest that caution is needed when administering FQs in critically ill patients, particularly those with sepsis and those receiving levofloxacin infusion.

Tigecycline 약물 사용 평가

김경은,허미정,범진선,안효초,김주신 한국병원약사회 2016 병원약사회지 Vol.33 No.3

Tigecycline is a wide-spectrum intravenous glycylcycline and is generally active against most gram-positive and gram-negative bacteria, including anaerobes, atypical bacteria and many species of multidrug-resistant bacteria. This agent presents a predictable pharmacokinetic profile and minimal drug interaction. It is generally well tolerated, with nausea being the most common adverse event. However, currently FDA warned about increased risk for death in patients who received tigecycline for serious infections. Therefore, this study was performed to evaluate the use of tigecycline and its efficacy. We retrospectively analyzed medical records of patients who received tigecycline at Chonbuk National University Hospital, from January 1, 2013 to December 31, 2014. As a result, the justification of appropriate use showed a rate of 69 cases (86.2%). Tigecycline was properly used according to the criteria in 51-80 cases (81.2-100%), while culture and sensitivity were infrequently performed before the initial dose. The mean duration of administration was 18±15 days. Complications in tigecycline use were usually GI problems including nausea (12 cases), vomiting (6 cases) and diarrhea (2 cases); the treatment efficacy response rate was 57.5%. This study showed that tigecycline was being used for appropriate reasons, but not being well monitored. Inappropriate use of tigecycline can lead to cause multidrug-resistant bacteria and unexpected side effects. So, a cautious attitude is required in its use.

末梢神經腫瘍에서 GFAP의 免疫組織化學的 表現에 關한 硏究

기근홍,조국형,범진선 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.2

Glial fibrillary acidic protein (GFAP) is one of the intermediate filament proteins, It is avaUable for identification of tumors glial cell origin in central nervous system. The specialized cells of the peripheral nervous system could express GFAP. The materials for our study consisted of 25 neurofibroma and 15 neurilemmoma, that resected for diagnosis or definite treatment at Chosun University Hospital from January, 1989 to December, 1991. All cases were performed of immunohistochemical stain for GFAP, vimentin and S-100 protein by ABC method. Immunoreactivity was evaluated and compared with the reactivity of GFAP, vimentin and S-100 protein. All cases of neurofibroma and neurilemmoma was positively stained in the neoplastic cells to the vimentin and S-100 protein. GFAP were positively stained in 10 of 25 neurofibroma (40%) and 11 of 15 neurilemmoma (73%). In the neurilemmoma, the positive cells were found primarily in cellular area, rarely in verocay bodies. Dermal neurofibromas were negative for GFAP, except of deeply located plexiform neurofibromas. Positive tumor cells were usually bipolar and spindle-shaped. The GFAP positive tumor cells were appeared around in hyalinized vessels in many cases.

Isoniazid와 Nitrofurantoin으로 유발되는 간 세포독성에 대한 식물추출물의 보호효과

변에리사,정길생,리빈,양숙현,범진선,이동성,려혜자,안인파,김윤철 한국생약학회 2009 생약학회지 Vol.40 No.2

Isoniazid was discovered in 1950’s and since then it has been widely used as a synthetic bactericidal agent in the treatment of tuberculosis. However, the adverse effect of isoniazid has been reported to show significant hepatotoxicity in approximately 1-2% of patients. Nitrofurantoin {1-(5-nitro-2-furfurylideneamino)-hydantoin} is a synthetic nitrofuran that is commonly used for the treatment and prophylaxis of urinary tract infections, but its use is associated with liver cirrhosis and fatal liver necrosis. Therefore, studies for natural products with protective effect on the isoniazid- and/or nitrofurantoin-in duced hepatotoxcity would be valuable as the potential therapeutic use. 107 plants sources were collected at Mt. Baekdu, and extracte d with methanol. These extracts had been screened for the protective effects against isoniazid- and/or nitrofurantoin-induced cyt otoxicity in HepG2 cells at the both 100 and 300 µg/ml. Five methanolic extracts, Acanthopanax senticosus, Acer mono, Asparagus schoberioides, Fagopyrum tataricum, Potentilla centigrana, showed significant protective effects against isoniazidinduced hepatotoxicity. Two methanolic extracts, Acer mono and Leonurus artemisia, showed significant protective effects against nitrofurantoin-induced cytotoxicity in HepG2 cells.

Effectiveness and Safety of Tolvaptan for the Management of Hyponatremia: Risk of Inadvertent Overcorrection

박미선,박승용,박성주,범진선,안효초,김주신,이흥범 한국병원약사회 2018 병원약사회지 Vol.35 No.4

Background : Hyponatremia is the most common electrolyte disturbance in hospitalized patients and has been associated with increased morbidity and mortality. Tolvaptan, a vasopressin receptor antagonist, is increasingly used for the treatment of euvolemic and hypervolemic hyponatremia. The aim of this study was to evaluate the effectiveness and safety of tolvaptan for the management of hyponatremia. Methods : This study was a retrospective evaluation of 106 patients who received at least one dose of tolvaptan for hyponatremia at a single tertiary academic hospital between January 2014 and June 2015. The primary endpoint was the change in serum sodium concentration after tolvaptan administration within 24 hours, with secondary endpoints of overcorrection and adverse effects. Results : The mean initial dose of tolvaptan was 20.2±7.2 mg and the median duration of treatment was 15 days (range, 1-261 days). The maximal changes in sodium levels at 24 and 48 hours were 8.2± 4.7 mmol/L and 10.5±15.3 mmol/L, respectively. Of 99 patients in whom sodium concentrations were followed up, sodium overcorrection was observed in 26 (26.3%) patients, which was associated with concomitant use of an enzyme inhibitor (odds ratio [OR] = 4.80, 95% Cl: 1.27-18.15). However, sex, body mass index (BMI), serum albumin, a daily dose of tolvaptan, and concomitant use of hypertonic saline did not show any significant difference in overcorrection. The most commonly reported adverse effects were mild and related to aquaresis, such as polyuria, thirst, and constipation. However, severe adverse amioeffects such as hyperkalemia, hypotension, and one death related to osmotic demyelination were also reported. Conclusions : Tolvaptan is effective for treating hyponatremia. Nevertheless, the drug should be used cautiously due to serious adverse effects related to sodium overcorrection.

An Analysis of Adverse Drug Reactions in Patients Visiting the Emergency Department

박미선,김주신,조시온,안효초,범진선 대한응급의학회 2018 대한응급의학회 학술대회초록집 Vol.2018 No.2

Hepatoprotective Lignan Compound from Schizandrae Fructus on Tacrine-induced Cytotoxicity in Hep G2 Cells

김현철,안인파,정길생,범진선,오승환,이혜숙,권지웅,권태오,김윤철 한의병리학회 2006 동의생리병리학회지 Vol.20 No.5

In the course of search for hepatoprotective agents from oriental traditional medicines, one compound was isolated from the MeOH extract of the fruits of Schizandra chinensis, and its structure was determined as gomisin J (1). The evaluation for hepatoprotective activity of isolated compound 1 on drug-induced cytotoxicity was conducted, and compound 1 showed protective effect with an EC50value of 86.0 ± 5.3 μM against tacrine-induced cytotoxicity in Hep G2 cells. One of the well-known hepatoprotective agents, silybin, used as a positive control, and the hepatoprotective effect of compound 1 is similar with that of silybin (EC50 value = 90.5 ± 9.8 μM).

자유연제 : 완전정맥영양요법에서 MCT지질유제의 장관점막에 대한 위축방지 효과

유희철,김철오,김행순,김주신,범진선,김동찬,조백환 한국정맥경장영양학회 2001 한국정맥경장영양학회 학술대회집 Vol.2001 No.-