간호원, 의사, 약사의 약물에 대한 지식과 간호원의 자아만족, 투약업무 수행간의 상관 관계

황보선,신재신 부산의대 1983 부산의대잡지 - 부산대학교 의과대학 Vol.23 No.2

항이뇨호르몬분비이상증후군 환자에서 Tolvaptan과 3% 염화나트륨의 저나트륨혈증 개선 효과 평가

안혜림,황보신이,최선 한국병원약사회 2020 병원약사회지 Vol.37 No.1

Background : The syndrome of inappropriate secretion of anti-diuretic Hormone (SIADH) is a disease, characterized by water retention and hyponatremia. According to the American Journal of Medicine treatment guideline, the administration of hypertonic saline (3% sodium chloride, 3% NaCl) is recommended for patients, who don’t respond to water restriction. Vasopressin V2 receptor antagonists such as tolvaptan can be administered to patients whose blood sodium concentration is not normalized by 3% NaCl or who have moderate to severe hyponatremia. However, the study that directly compared the effects of the two drugs was insufficient to evaluate the effect of vasopressin receptor antagonist and 3% NaCl. The purpose of this study was to compare and evaluate the effect of the tolvaptan tablet and 3% NaCl injection. Methods: From June 2015 through August 2016, all patients diagnosed as SIADH, with hyponatremia ([Na+]<135 mEq/L), were administered tolvaptan (T-group) or 3% NaCl (N-group). We analyzed electronic medical records retrospectively. Results : The mean daily dose of each drug was 14.5 mg of tolvaptan, 428.2 ml of 3% NaCl, and the serum sodium levels significant increased after administration in the T-group (n=26) and the N-group (n=79) (p<0.0001, respectively). In particular, an average increase of 11.6 mEq/L in the T-group and 6.5 mEq/L in the N-group was achieved during the first 24 hours (p<0.0001), and 12.6 mEq/L in the T-group and 9.5 mEq/L in the N group for 48 hours (p<0.0001), showing significant increases in the T-group. There was no significant difference in the proportion of patients with normalized serum sodium level following treatment (96.2% for the T-group, 81.0% for the N-group, p=0.111), and the mean number of days to normalization was significantly shorter for the T-group 1.4 days and 3.7 days for the N-group (p<0.0001). Side effects were nausea and vomiting in 3.9% (one patient) of the T-group, sensory abnormality and weakness in 2.5% (two patients) of the N-group. Average price per patient during treatment was 62,368 won in the T-group, and 11,682 won in the N-group (p<0.0001). Conclusion : Both drugs showed improvement in hyponatremia in SIADH patients, and tolvaptan made more rapid increase in sodium level in the blood compared to 3% NaCl. However, since the change in serum sodium due to tolvaptan is close to the recommended upper limit (within 12 mEq/L per 24 hours), there is risk of potential side effects. Thus, careful monitoring of sodium levels and dose adjustments are needed and also, it is necessary to select a medicine in consideration of the cost.

급성 이식편대숙주병 예방을 위한 Tacrolimus 적정 혈중농도 설정

김미진,박애령,황보신이,이정연 한국병원약사회 2020 병원약사회지 Vol.37 No.4

Background : Graft versus host disease (GVHD) is a major adverse effect of allogeneic stem cell transplantation and acute graft versus host disease (aGVHD) occurs in 40~50% of recipients. The incidence of aGVHD is higher with unrelated transplantation of incompatible human leukocyte antigen (HLA) and tacrolimus has been shown to be an effective immunosuppressant to prevent from aGVHD. Although there are studies to compare the incidence of GVHD with target blood concentration of tacrolimus, it is hard to conclude the optimal concentration of tacrolimus because of the difference in the study population and practice settings. The aim of this study is to evaluate the optimal concentration of tacrolimus to prevent aGVHD by analyzing the related factors of aGVHD incidence and side effects of tacrolimus. Methods : This study was retrospectively conducted on Korean adult patients who received tacrolimus after hematopoietic stem cell transplantation from July 2014 to June 2015. This study analyzed the concentration of tacrolimus according to the incidence of aGVHD and its related factors, and side effects of tacrolimus in each range of concentrations. Results : Among the 115 patients aGVHD occurred in 90 (78.3%) patients and the mean concentration of tacrolimus within 100 days post transplantation was 8.14 ng/ml in aGVHD group and 9.66 ng/ml in non aGVHD group (p=0.015). Mean concentration at 3 week post transplantation was 8.87 ng/ml in grade II-IV aGVHD and 10.09 ng/ml in grade 0-I aGVHD (p=0.048). The incidence of aGVHD was significantly lower with the mean concentration of tacrolimus within 100 days of post transplantation of ≥12 ng/ml group than others. In the analysis of side effect of tacrolimus, hyperkalemia was higher in ≥12 ng/ml group than <8 ng/ml group (p=0.02). Conclusion : In our study, the mean concentration of tacrolimus of 12 ng/ml within 100 days after transplantation tends to lower the incidence of aGVHD.

자유연제 (포스터)발표 : 강남성모병원 TPN 처방현황 분석

김진희,황은정,황보신이,이명덕 한국정맥경장영양학회 2006 한국정맥경장영양학회 학술대회집 Vol.2006 No.-

중환자실 재원 중 발생한 급성 신손상의 위험인자 평가

안서현,안혜림,황보신이,최선,나현오 한국병원약사회 2019 병원약사회지 Vol.36 No.3

Background : Acute kidney injury (AKI) is an abrupt loss of kidney function. Specifically, AKI occurring in intensive care units (ICU) is associated with increased mortality, morbidity, and length of hospital stay. Therefore, prevention and early treatment of AKI is important. This study analyzed the risk factors and prognosis of AKI in the ICU and evaluated correlations between the use of nephrotoxic drugs and the occurrence of AKI. Methods : In this retrospective study, patients who were treated more than 48 hours in the medical intensive care unit from March 2015 to June 2015, were included. Those who had received dialysis and had chronic kidney disease (CKD) stage 5 upon admission were excluded. AKI was defined as an increase in serum creatinine more than 150% from baseline, according to RIFLE (Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease) criteria. The patients were divided into two groups, the AKI group and the non-AKI group. Risk factors were analyzed by comparing such factors as underlying diseases and the use of nephrotoxic drugs in both groups. Results : A total of 148 patients met the inclusion criteria and were included in the analysis. AKI occurred in 69 patients (46.6%). The frequencies of sepsis, chronic obstructive pulmonary disease (COPD), and adult respiratory distress syndrome (ARDS), and the use of amphotericin B, colistin, vasopressors, and diuretics were significantly greater in the AKI group than in the non-AKI group (p 0.05). The number of concomitant nephrotoxic drugs used by patients in the AKI group was greater than in the non-AKI group. Significant effects of sepsis and colistin were confirmed with multiple regression analysis (p=0.020, p=0.005). Twenty-six patients in the AKI group recovered and the average recovery period was 8.8 days. Conclusions : AKI is a relatively common disease in ICU patients. Sepsis and use of colistin were shown to be important risk factors of AKI. Based on the results of this study, we suggest that active intervention by pharmacists is important for patients with these risk factors.

다제내성 Acinetobacter baumannii 또는 Pseudomonas aeruginosa에 의한 폐렴에서 Colistin 정맥주입과 분무요법의 치료 효과 및 안전성 비교

안서현,이수진,안혜림,황보신이 한국병원약사회 2020 병원약사회지 Vol.37 No.1

Background : Multidrug resistant (MDR) Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) have emerged as major pathogens of pneumonia in the intensive care unit (ICU). Colistin is used as a drug of choice against pneumonia caused by these pathogens, but when it is administrated systemically, adverse effects such as renal toxicity and neurotoxicity limit its application. Recently, nebulized treatment of colistin has been widely applied to reduce these adverse effects, but the clinical data of nebulized colistin has been limited. The purpose of this study was to compare the efficacy and safety of nebulized colistin with intravenous colistin. Methods : A retrospective medical records review was conducted on patients admitted to the ICUs at a teaching hospital. The patients were diagnosed with pneumonia caused by MDR A. baumanniior P. aeruginosa and treated with colistin either by intravascular or nebulized form August 2015-July 2016. Results : This study included 88 patients, of whom 29 received intravenous colisitin (IV group), and 59 nebulized colistin (Neb group). The mean duration of treatment was 14.8 days in the IV group and 15.8 days in the Neb group (p=0.604). The success rate of treatment based on clinical response and negative conversion rate were not different between the two groups (58.6% vs. 54.2%, OR 0.84, 95% CI 0.34-2.06, p=0.697, respectively). The number of patients whose white blood cell count recovered to normal range during or after colistin treatment was significantly larger in the Neb group than the IV group (55.9% vs. 41.4%, OR 3.77, 95% CI 1.55-9.15, P=0.003, respectively). The negative conversion rate was not different between the two groups (41.4% vs. 37.3%, OR 0.84, 95% CI 0.34- 2.09, p=0.711, respectively). The serum creatinine difference before and after the colistin treatment was significantly greater in the IV group than in the Neb group (0.48±0.17 vs. 0.01±0.11, p=0.016). The acute kidney injury (AKI) incidence rate was also significantly higher in the IV group than the Neb group (62.1% vs. 23.7%, p<0.001, respectively). Conclusion : The efficacy of nebulized colistin was similar with intravenous colistin for ICU patients with pneumonia caused by MDR A. baumannii or P. aeruginosa. Also, nebulized colistin showed favorable results in serum creatinine change and the AKI incidence rate.

Digoxin의 약동학 자문 결과 분석

양성희,배성미,김순주,황보신이 한국병원약사회 2002 병원약사회지 Vol.19 No.3

Digoxin is a cardiac glycoside used for treatment of congestive heart failure(CHF) or atrial fibrillation. Because of the narrow therapeutic index and large interpatient pharmacokinetic variability, it is necessary to monitor the serum drug level. We collected routine clinical pharmacokinetic(PK) data from patients receiving digoxin therapy and analysed the patient's characteristics and digoxin PK parameters. Also we evaluated the acceptability rate of the recommendation and the causes of the sub or upper-therapeutic level. Of all the 408 patients, the old over 60 years was 282 patients(69%). The mean half life was 81.8±31.2hours and 48.1% was ranged from 50 to 79hours. For volume of distribution(Vd), the mean was 6.7±2.0L/㎏and 64.5% was ranged from 5.0 to 7.9L/㎏. One way ANOVA test showed that the variable with the greatest predictive value for digoxin PK parameters was creatinine clearance. The most reason for requests from physician was to confirm the appropriate dose(86.9%) and the total acceptability rate was 72.6%. Sub-therapeutic level was caused by low dose(37.4%), non-steady state concentration(24.9%) and noncompliance(11.5%). Upper-therapeutic level was caused by high dose(73.4%)and wrong sampling time(12.9%). We concluded that the clearance of digoxin was mainly influenced by creatinine clearance. But in the recommendation for the older patients, aging-related changes in renal function, body mass and possible interactions must be considered. Pharmacy based clinical pharmacokinetic consultation service can provide benifits by recommending appropriate dose and sampling time. For the more, patients instruction can improve therapeutic effect of digoxin.

의료기관의 Internet을 이용한 질의응답 업무 실태조사 : 약제과의 역할에 대한 고찰 Consideration of the role of pharmacy

한윤덕,최선,민미나,한옥연,황보신이 한국병원약사회 2002 병원약사회지 Vol.19 No.2

As information retrieval through internet has been popularized, a demand of medical information has been increased. But most medical information is provided by commercial web sites without evaluation the quality of information. So we suggested there were a demand for drug information supplement by special medical institutions. The aim of this research was to investigate medical information on the web sites of hospital, especially department of pharmacy, ad discuss methods of improvement. We selected the web sites of tertiary medical institutions had over 500 beds and evaluated question and answer (Q&A) sites on the webs in terms of consulting fields, overall organization and easiness of access. Among the consulting fields, we selected medicine Q&A field and estimated answering method, quality of Q&A and the time required to answer. We also conducted a verbal questionnaire survey of patients or their family to check the demands of medical information. Among the 39 institutions, 23 institutions(59%) performed Q&A on the webs and the consulting fields were mainly composed of disease(95.7%, 22 of 23) and medicine(26.1%, 6 of 23). Overall organization of Q&A sites was managed by central or each clinical department. Both management methods had similar rates(54.5%, 41%) but all Q&A sites of medicine was conducted by department of pharmacy. The access to the Q&A sites was easy regardless of consulting fields. We couldn't evaluate Q&A sites of medicine precisely because the only three web sites had conducted Q&A during the research period. As a result of questionnaire survey, 83.3% of answerers who were using internet expressed positive opinions about health information obtaining through the Q&A site of medical institution. But most people didn't know how to use the Q&A sites of hospital. In conclusion, disease consultation on the web was relatively activated but medicine consultation was very insufficient. So we should make an effort to provide medicine information on the web and discuss pharmacist's role in this part.

전공의의 약사의 복약상담에 대한 인식도 조사

이지현,최혜정,홍경란,황보신이 韓國病院藥師會 2004 병원약사회지 Vol.21 No.4

Patient counseling for medicine is not generalized during hospital stay and on discharge. Pharmacists have tried to conduct counseling service to patients at several hospitals. A survey was conducted to assess physicians' perception and needsabout medication counseling service for advancing the service with a team approach. One hundred two(75.6%) out of 135 physicians responded the survey in St. Mary's Hospital during October, 2002. Questions were asked about four areas; 1) request experience of counseling by pharmacists, 2) current situation of providing medication information by physicians, 3) concerns and needs about counseling by pharmacists, 4) necessity and request intention in future for counseling by pharmacists. The survey showed that 63.7% knew counseling practice by pharmacists, but 73.8% haven't had request experience. Physicians provided medication information in explaining treatment therapy (52.0%). Oral medications that physicians desired to counsel by pharmacists were steroids, antidiabetics, anticancer agents, anticoagulants and antituberculosis agents. Physicians desired to counsel with emphasis on side effect (58.8%), compliance (55.9%). A primary negative concern was to counsel inconsistently from physician's intention (76.5%). Most physicians accepted pharmacist's role in medication counseling(94.1%) and thought pharmacist's counseling would improve outcome of pharmacotherapy (90.2%). Physicians had an intention of counseling request in 82.4%. This survey suggested that, physicians' perception was favorable and they had strong intention to request medication counseling with an expanded role of pharmacists. However, request process hasn't been fully utilized. Pharmacist's counseling should be advanced with a qualified counseling, facilitation of request process and advertisement of the service. It is also necessary for physicians to have confidence and consider pharmacists as core members of health care team.

제 2형 당뇨병 환자에서 Dapagliflozin의 안전성 평가

한영현,최혜정,민미나,한옥연,황보신이 한국병원약사회 2019 병원약사회지 Vol.36 No.2

Background : Dapagliflozin, an Sodium-glucose co-transporter 2 inhibitor, is an oral antidiabetic agent that controls plasma glucose levels by facilitating the excretion of glucose in the urine and its usage is on the rise. However, safety concerns with dapagliflozin have increased because of reports of adverse events, such as dehydration and acute kidney failure. Therefore, We studied the pattern of adverse events and the therapeutic effects of dapagliflozin for the safe use of the antidiabetic agent. Methods : A retrospective analysis was performed by reviewing the electronic medical record of type 2 diabetes patients who had been prescribed dapagliflozin in endocrinology medicine at St. Mary's Hospital between January 1st and December 31st, 2015. We reviewed records of adverse events and changes in hemoglobin A1c (HbA1c), fasting glucose levels, body weight and estimated glomerular filtration rate (eGFR). Results : There were a total of 589 patients in this study. Ninety-three patients experienced adverse events. Among these, 91 patients had taken dapagliflozin with other antidiabetic agents. Fifty-seven patients experienced adverse events within six months after taking dapagliflozin. The proportion of adverse events occurred in patients with metabolic and nutritional disorders, urinary system disorders, skin and appendage disorders, gastrointestinal system disorders at frequencies of 26.3%, 18.4%, 12.3%, and 12.3% respectively. Skin and appendages disorders and reproductive disorders were more common in females than in males (P 0.05). There were no serious adverse events. HbA1c, fasting plasma glucose, body weight and eGFR decreased by 0.65%, 25.66 mg/dl, 2.27kg, 0.73 mL/min/1.73 m2, respectively, from baseline to the first visit. Conclusions : Dapagliflozin was effective with no serious adverse drug effects. This study found that skin and appendage disorders and reproductive disorders were more common in females. In terms of effectiveness, dapagliflozin decreased body weight, as well as plasma glucose.