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YAKUGAKU ZASSHI, 121(3),193-213, 2001
The following topics are described: 1. chemistry of β-lactamases; 2. β-lactamases from Streptomyces including distribution of β-lactamases in actinobacteria, properties of β-lactamases from Streptomyces, cloning and regulatory mechanism of expression of β-lactamase genes from Streptomyces and evolution and classification of β-lactamases in general; 3. penicillin-binding proteins from Streptomyces including β-lactam-producing- and non-producing strains and 4. eukaryotic-type protein kinases from Streptomyces including cloning of the genes and evolution and classification of eukaryotic-type protein kinases in general.
Key words--β-lactamases; Streptomyces; eukaryotic-type protein kinases; penicillin-binding proteins; gene; drug resistance
YAKUGAKU ZASSHI, 121(3),215-220, 2001
We performed an investigation on the patients' demand for community pharmacy based on the analysis of questionnaire responses on community pharmacy services from the patients at 32 pharmacies in Tokyo and Osaka. In the previous study, we developed seven evaluation indices for pharmacy services, and showed that the functions most sought by patients in the “ideal pharmacies” were “Attitude of pharmacy/pharmacist”, “Convenient hours” and “Information management”. The objective of this study is to determine the relationship between these pharmacy functions and patient satisfaction by analyzing responses from the same questionnaire survey. Overall satisfaction score with the “pharmacy used today” was employed as the dependent variable, while the six factors derived from the 26-item evaluation scale in the questionnaire by factor analysis were used as the independent variables. As a result of analysis, it was found that four variables had a signi<0136>cant positive correlation with patient satisfaction, one had a significant inverse correlation, and one showed no significant correlation (p<0.05). These results suggest that: attitude of the pharmacists such as general attitude and specialized activities of pharmacy/pharmacist such as providing information and explanations, and convenience of hours are not only judged to be important by patients, but also influence their satisfaction; comfortable facilities and availability of OTC drugs, while rated relatively low by patients in terms of importance, do influence their satisfaction; and convenience of location does not influence patient satisfaction. It was also indicated that insufficient inventories of prescribed medications have an impact upon patient satisfaction. This investigation offers evidence to provide patient-based pharmacy services.
Key words--community pharmacy; patient satisfaction; evaluation scale; pharmacy practice; and prescription
YAKUGAKU ZASSHI, 121(3),221-232, 2001
The level of understanding of taking medicine was examined at the start and the end of medicine-taking guidance, based on the estimation by pharmacists and inpatients. Six items for the estimation, such as “the way of taking medicines” were evaluated using a five-grade system. The significant improvement was observed in all items, suggesting that inpatients' understanding is improved by the guidance. A markedly positive correlation was found between the estimation by inpatients and that by pharmacists (p<0.001). This confirms the appropriateness of estimation by pharmacists. Inpatients whose estimation was significantly different from that by pharmacists (difference of two grades or more) were examined to identify clear and potential problems with taking medicine. The problems were classified into such seven categories as “types of medicine”. For each item with differences in estimation (two grades or more), problems were biased in some specific categories. On the basis of such a bias, a flow chart was prepared to clarify problems. In addition, a standard pharmaceutical management and guidance services program was drafted, in which measures in observation, treatment and education against problems by pharmacists were described according to the frequency of occurrence. Information about the program available on the Internet enables its use by other hospitals.
Key words--medicine-taking guidance; quality estimation; standard pharmaceutical service; patient's understanding; Internet
YAKUGAKU ZASSHI, 121(3),233-237, 2001
The effect of mouth wash on the removal of drug residues in both mouth and pharynx after the use of fluticasone propionate dry powder inhaler (FP-DPI) was studied. The concentration of FP in mouth wash after sprinkle and inhalation of Flutide®50, 100, 200 Rotadisk® was determined by HPLC-UV. The total amount of the removed FP was measured by the sum of the concentration of FP in 5 times of mouth washes. The mouth wash procedures removed totally 79.3±4.4% (50μg), 68.5±3.6% (100μg), 69.3±3.4% (200μg) of sprinkled amount of FP and 29.5±11.1% ( 50μg ), 35.6±6.6% (100μg), 31.6±8.3% (200μg) of inhaled, respectively. It was required for the removal of 90% of the totally recovered FP to do two times of mouth washes in each case. These data suggest that the mouth wash is an effective precaution for candidiasis induced by FP delivered by DPI.
Key words--dry powder inhaler; fluticasone propionate; drug residue; mouth wash; effective precaution
YAKUGAKU ZASSHI, 121(3),239-245, 2001
Simple ketoprofen microspheres (MS) were prepared by the dry-in-oil method using ethylcellulose (EC) as a matrix polymer. Further, the microspheres modified by addition of polyethylene glycol (PEG) and hydroxypropyl cellulose (HPC), called MS-P and MS-H, respectively, were prepared. The in vitro release from MS, MS-P and MS-H was examined in the JP XIII second fluid, pH 6.8, at 37°C and 60 rpm. Chitosan-coated ketoprofen microparticles (Chi-MP) were prepared by the precipitation of droplets of chitosan solution containing MS, and their adhesion to the rat small intestinal mucosa was tested. The plasma concentrations after duodenal administration were investigated for ketoprofen powder suspension, MS and Chi-MP. The particle size was raised with the increase in amount of ketoprofen added. The drug content and addition of PEG or HPC affected the drug release rate. The microspheres with moderate drug content, prepared by addition of modest amount of PEG, exhibited better gradual drug release. Chi-MP showed a good mucoadhesion. The maximum plasma concentration of ketoprofen for Chi-MP was less than one-third of that for ketoprofen powder suspension. Chi-MP tended to show the higher and steadier plasma levels than MS.
Key words--chitosan-coated microparticle; simple microsphere; ;ketoprofen; plasma concentration; mucoadhesion
YAKUGAKU ZASSHI, 121(3),247-252, 2001
The school pharmacist in our hospital pharmacy used three graded textbooks about medicine for students at the Sukagawa School for the Health-Impaired (Fukushima Medical University Hospital Branch (H. I. school)). A revised textbook for 4th--6th grade elementary school students containing 12 important items of information about medicine, a new picture textbook for 1st--3rd grade elementary school students, and a new textbook containing practical data for junior high school students were prepared by supplementing original information with illustrations, simplified expression and large type face. Additionally, the pronunciation of Chinese characters was included in the textbook for the 1st--3rd grade elementary school students. In this study, 9 students from H. I. school and 37 students from Koyase junior high school took part in a questionnaire and an examination evaluating the usefulness of the lectures, and these textbooks, in regard to the student's recognition and understanding of medicine. Most students answered that the lectures and textbooks helped them to understand medicine. Furthermore, the results of the examination indicated that the students had a general understanding of medicine. In conclusion, we suggest that it is important for students in compulsory education to learn about medicine, and that according to the preliminary result of questionnaires and examinations, both the lectures and textbooks were useful to help the students to understand more about medicine.
Key words--compulsory education; medical education; textbook; questionnaire; examination
YAKUGAKU ZASSHI, 121(3),253-257, 2001
Persistent dry cough is well known as the most common side-effect of angiotensin-converting enzyme (ACE) inhibitors. We examined the relationship between a cough and ACE gene polymorphism, plasma bradykinin (BK), substance P (SP) and ACE inhibitor concentrations in patients with hypertension or chronic nephritis. First, ACE genotyping was carried out in 96 patients, 42 with coughs and 54 without coughs, which had been treated with various kinds of ACE inhibitors. However, no significant difference in the ACE genotypes was observed between the two groups. Second, the plasma concentrations of BK, SP and ACE inhibitor were measured in 12 patients, which were treated with trandolapril at a daily dose of 1 mg for 4--33 weeks. In 3 patients, the cough was induced during the trandolapril therapy, while it was induced not in 9 patients. The plasma levels of BK and SP did not significantly change after trandolapril administration in the patients with and without coughs. Between the two groups, there were no significant differences in the plasma levels of BK and SP either before or after the trandolapril therapy. Also the plasma concentrations of trandolapril and trandolaprilat, the active metabolite of trandolapril, did not significantly differ between the two groups. These results suggest that there is no significant relationship between the ACE inhibitor-induced cough and ACE gene polymorphism, plasma BK, SP and ACE inhibitor concentrations in patients with hypertension or chronic nephritis.
Key words--angiotensin-converting enzyme inhibitor; cough; genetic polymorphism; bradykinin; substance P; trandolapril