• 한국임상약학회지
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• 제33권1호
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• pp.1-7
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• 2023

Background: Along with the increase in the elderly population, concerns about polypharmacy, which can cause medication-related problems, are increasing. This study aimed to find out the association between drug-related factors and readmission in elderly patients within 30 days after discharge. Methods: Data of patients aged ≥65 years who were discharged from the respiratory medicine ward of a tertiary hospital between January and March 2016 were retrospectively obtained. The medication regimen complexity at discharge was calculated using the medication regimen complexity index (MRCI) score, comorbidity status was assessed using the Charlson comorbidity index (CCI), potentially inappropriate medications (PIMs) were evaluated based on the Beer 2019 criteria, and adverse drug events (ADEs) were examined using the ADE reporting system. Multivariable logistic regression analysis was used to evaluate the effect of medication-related problems on hospital readmission after controlling for other variables. Results: Of the 206 patients included, 84 (40.8%) used PIMs, 31 (15%) had ADEs, and 32 (15.5%) were readmitted. The mean age, total medications, MRCI, CCI, and PIMs in the readmission group were significantly higher than those in the non-readmission group. Age significantly decreased the risk of readmission (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.84-0.96) after adjusting for sex, length of hospital stay, and ADEs. The use of PIMs (OR, 2.38; 95% CI, 1.10-5.16) and increased CCI (OR, 1.50; 95% CI, 1.16-1.93) and MRCI (OR, 1.04; 95% CI, 1.01-1.07) were associated with an increased occurrence of readmission. Conclusion: PIMs were associated with a significantly greater risk for readmission than MRCI.

• 생물정신의학
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• 제28권1호
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• pp.7-12
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• 2021

Considering that the aged population increases and the mobility problem is pointed out as a factor that indisposes the quality of life, cognition, and mood, it is important to understand and evaluate the elderly's mobility. Factors that deteriorate mobility in the elderly include physical senility, various health changes including chronic diseases, polypharmacy as well as anticholinergics. Common mobility problems in old age are reduced gait speed, increased gait variability in walking length, careless walking, and frequent falls. Several studies have reported that decreased mobility and deterioration of gait can predict cognitive decline and emotional problems. Aerobic exercise, resistance exercise, and balance exercise are suggested as therapeutic interventions for mobility problems. Active correction for factors that reduce mobility in the elderly and prescribing physical activity can conserve the elderly's quality of life and help improve cognition and mood. There is a need for related research in the future.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제7권1호
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• pp.92-109
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• 1996

본 연구에서는 정상 지능 범위의 만성 특발성 경련 질환으로 치료중인 40명의 환아군과, 나이, 성별, 학업 성적, 지능 지수를 일치시킨 30명의 대조군을 대상으로, 국내외를 통해 신뢰도 및 타당도가 확인된 평가 도구들인, 부모용 아동 행동 조사표(Child Behavior Checklist)의 한국판, DSM-III-R에 따른 파탄적 행동 장애 척도(Disruptive behavior disorders scale according to DBM-III-R)의 한국판, 예일 아동 평가표(Yale children's inventory)의 한국판, 소아 우울 척도(Children's Depression Inventory)의 한국촌, 소아용 상태 및 특성불안 척도(State-Trait Anxiety Inventory for children)의 한국판, 피어스-해리스 자기 개념 척도(Piers-Harris self-concept questionnaire)의 한국판. 가정 환경 척도(Family environment Scale)의 한국판, 간이 정신진단 검사(Symptom check-list-90)의 한국판, 경련질환에 대한 부모태도 척도(Parent's attitude to epilepsy questionnaire)의 한국판, 아동 의존척도(self-administered dependency questionnaire)의 한국판을 사용하였고, 이들 결과로 부터 얻은 자료의 일부인 환아의 정신병리 부분과 경련 질환의 신경과적인 변수들인 환아의 성별 및 나이, 경련 질환 발병시 나이와 유병기간, 경련질환의 임상적 유형, 뇌파의 유형 최근 6개월간의 경련 빈도, 항경련 약물 치료력과 그 반응등과의 관련성을 평가하였다. 위에서 얻은 자료들을 토대로 분석하여 다음과 같은 연구 결과를 얻었다. 환아의 우울과 관계된 위험 요인은, 조기 발병(early onset), 복합성 부분 간질(complex partial seizure), 뇌파상 편측성 측두엽 이상(lateralized temporal focal abnormality in EEG), 약물 병합 투여(drug polypharmacy), 고 빈도 경련(high seizure frequency)임을 알 수 있었고, 이들 위험요인들은 상호 연관되어 있었다. 불안에 영향을 미치는 요인은 높은 연령. 뇌파상 편측성 측두엽 이상, 고 빈도 경련이었고, 학습 및 언어적 문제와 관련이 있는 위험 요인은 환아의 어린나이, 조기 발병, 복합성 부분 간질, 고빈도 경련 등이었다. 주의력 결핍 과잉행동 장애와 반항 및 품행장애에 영향을 미치는 위험 요인은 남성, 어린 나이, 조기 발병, 뇌파상 편측성 측두엽 이상, 고 빈도 경련등이었다. 위의 결과를 종합하면, 우울, 불안, 품행장애 및 주의력 결핍 과잉 행동장애에 공통적으로 관계되는 위험요인은, 뇌파상 편측성 측두엽 이상, 고 빈도 경련이라는 겻을 알 수 있었다. 향후 연구를 통해서는 신경학적 요인이외에 가족 및 사회-인구학적 위험 요인을 찾는 연구가 지속되어야 하며, 이를 통해 종합적 위험 요인 평가 작업과 치료적 대안을 제시하는 후속 작업이 지속 되어야 할 것 이다.

• Biomolecules & Therapeutics
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• 제25권3호
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• pp.288-295
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• 2017

The incidence of polypharmacy-which can result in drug-drug interactions-has increased in recent years. Drug-metabolizing enzymes and drug transporters are important polypharmacy modulators. In this study, the effects of bosentan and rifampin on the expression and activities of organic anion-transporting peptide (OATP) and cytochrome P450 (CYP450) 2C9 and CYP3A4 were investigated in vitro. HEK293 cells and primary human hepatocytes overexpressing the target genes were treated with bosentan and various concentrations of rifampin, which decreased the uptake activities of OATP transporters in a dose-dependent manner. In primary human hepatocytes, CYP2C9 and CYP3A4 gene expression and activities decreased upon treatment with $20{\mu}M$ $bosentan+200{\mu}M$ rifampin. Rifampin also reduced gene expression of OATP1B1, OATP1B3, and OATP2B1 transporter, and inhibited bosentan influx in human hepatocytes at increasing concentrations. These results confirm rifampin- and bosentan-induced interactions between OATP transporters and CYP450.

• 생물정신의학
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• 제28권2호
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• pp.50-57
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• 2021

Objectives Clozapine is the most effective atypical antipsychotic agent for the treatment-resistant schizophrenia (TRS), however, only 40%-70% of TRS patients respond to clozapine. Moreover, TRS encompasses various symptom dimensions. Therefore, augmentation with other medications for clozapine is frequently applied. However, the prescription pattern of clozapine and combined medications in Korea is yet to be examined. This study aims to investigate the maintenance treatment pattern of clozapine and augmentation agents in one Korean tertiary hospital. Methods The patients with schizophrenia spectrum disorders under clozapine maintenance, defined as one-year clozapine continuation, were subjected for analysis. Medication data at one-year time-point after clozapine initiation was extracted and analyzed. Results Among total 2897 patients having clozapine prescription experience from January 2000 to December 2018, 1011 patients were on clozapine maintenance. The mean age of clozapine initiation was 30.2 ± 11.3 years, and the maintenance dose of clozapine was 217.8 ± 124.3 mg/day. Combination rate of antipsychotics, mood stabilizers, and antidepressants were 43.5%, 25.3%, 38.6%, respectively. Most frequently prescribed drugs in each category were aripiprazole, valproate, and sertraline. Olanzapine equivalent dose of combined antipsychotics was 10.4 ± 7.7 mg/day. Male patients were prescribed higher dose of combined antipsychotics and higher rate of antidepressants. Female patients had later onset of clozapine prescription. Patients with two or more combined antipsychotics were prescribed higher dose of clozapine and higher rate of antidepressants compared to patients with one combined antipsychotic. Conclusions Taken together, among the patients taking clozapine, a substantial rate of patients were under polypharmacy. The present findings based on the real-world prescription pattern could provide the valuable clinical information on the treatment of TRS-related conditions.

• 생물정신의학
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• 제8권1호
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• pp.37-46
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• 2001

Whenever a clinician manages the patients with depression, he may meet various problems that make it difficult to treat them. Even though he has good skills and knowledge about depression, some barriers will be appear during his practice. In general, the difficulties in treating depression are treatment-resistance, adverse effects of antidepressants, pregnancy in female patients, comorbid medical conditions, poor compliance, drug-drug interactions, and so on, which are related with pharmacological treatments. Here, only the two of them, the treatment-resistant depression and difficult problems concerned with pregnancy, were discussed. Some level of treatment resistance is the norm rather than the exception. As the treatment failure stems from inadequate treatment, it is important that the clinician should prescribe medications with sufficient doseage and adequate duration. And to overcome the treatment resistant depression the polypharmacy is necessary, in that case, the side effects and toxicities should be explored and managed immediately. So the clinician have to learn more about the pharmacokinetic and pharmacodynamic mechanisms of each drugs used in treatment of depression. When the risk of the fetus by the exposure is higher than the risk of untreated maternal psychiatric disorder, psychotropic medications should be used during pregnancy. Women who are maintained on psychotropics and become pregnant, as well as women with the new onset of psychiatric symptoms during pregnancy, should be carefully reassessed. However, data concerning the potential risk of long-term behavioral changes following prenatal exposure to psychotropics is rare, so further longitudinal follow-up studies are needed.

• Perspectives in Nursing Science
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• 제3권1호
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• pp.73-89
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• 2006

Complementary and alternative medicine has gained popularity and respectability in recent years in the United States. Since aging is often associated with chronic health conditions that commonly lead to physical and psychosocial disabilities (e.g., depression, functional and/or cognitive disabilities, and decreased quality of life), older adults often seek options to maintain health and treat chronic conditions as an adjunct to conventional medical care. Herbal products, the most commonly used among various complementary and alternative medicines (CAM), should be used with caution due to potential herbal-drug interactions (related to polypharmacy) and herbal-disease interactions (related to comorbidities). Five of the most common chronic conditions in older adults are chronic pain, cardiovascular problems, hypertension, diabetes, and chronic lung problems. A high rate of falls or risk of falling is also a problem unique to this older population. For these conditions, only a few types of CAM (e.g., acupuncture, qi gong, tai chi) were tested, with promising results. However, in spite of evidence supporting the use of certain types of CAM to alleviate some common chronic conditions, findings are limited in terms of other types of CAM tested and both short and long-term effects. More rigorous clinical trials of various CAM types are thus warranted to advance scientific knowledge and establish evidence-based practices to care for the growing number of older adults who deserve to have a better quality of life.

• Tuberculosis and Respiratory Diseases
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• 제70권5호
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• pp.384-389
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• 2011

The prevention of and the controlling of symptoms, reductions in the frequency of exacerbations, and disease severity are central to the pharmacologic therapy of chronic obstructive pulmonary disease (COPD). COPD patients are inclined to be older, have more comorbidities, and use polypharmacy as a result. Long-acting inhaled muscarinic antagonists (LAMAs) is a preferred treatment modality. However, the cardiovascular (CV) safety of anti-cholinergics, including LAMA, has been an issue. In contrast, the results of the UPLIFT trial and a pooled analysis of data from 30 trials of tiotropium illustrates the association of tiotropium with reductions in the risk of all cause mortality, CV mortality and CV events. And, the UPLIFT trial provides clues regarding the additive advantages of tiotropium in COPD patients who already are using long-acting inhaled ${\beta}_2$ agonists and inhaled corticosteroids. Following the contribution of tiotropium as a first LAMA, new LAMAs such as aclidinium and glycopyrrolate (NVA-237) seem to be emerging.

• 약학회지
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• 제59권4호
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• pp.190-200
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• 2015

Evaluation Project on Appropriate Prescribing (EPAP) which is analysing prescribing pattern and providing physicians feedback has begun in 2001. EPAP indicators are related to antibiotics for acute respiratory tract infections, overuse of injection, polypharmacy (no. of drugs prescribed together, no. of prescriptions with 6 or more drugs), prescribing of specific medication group (drugs for acid related disorders, NSAIDs, corticosteroids) and medication expenditure per prescription day. The aim of this study was to suggest a development plan for EPAP indicators suitable for domestic situation. A consensus group consisting of seventeen health care professionals evaluated significance of each therapeutic class for EPAP indicators expansion considering information such as magnitude of issue, prescribing indicators of foreign countries, reimbursement criteria by each therapeutic class. Based on the data and group survey, 5 classes were selected as candidates for prescribing indicators and we presented 24 indicators regarding 5 classes. The results suggested that we need to augment evaluation indicators of additional area.

• 대한치과의사협회지
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• 제48권1호
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• pp.27-37
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• 2010

Current trend of aging society suggests that many patients are at risk for various preoperative preparations and postoperative complications during and following invasive dental procedures, due to an acquired medically compromised conditions from systemic disease and/or from medications. The medical history is critical for the identification of patients potentially at risk for medically compromised and old aged patients' factors from dental treatment. The proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and some standard laboratory tests. Polypharmacy in old age, besides representing a risk in and of itself, points to the potential risk the underlying diseases that necessitated the drugs can present in the dental office. These diseases and medications can also present a risk to oral health. A sequence for categorizing drugs in a medication list is presented here to aid in the identification of potential risks in the dental treatment and management of patients with complex medical histories and drug regimens. Specific patient populations, such as pediatric, may have specific drugs or additional criteria that need to be considered. Practitioners must use the health history and the medication list in concert, using one to make sense of the other and utilizing all the information available from reviewing each one carefully in order to manage their increasingly complex patients safely and effectively.