• 한국임상약학회지
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• 제19권1호
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• pp.1-17
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• 2009

Adverse drug reactions (ADR) caused by inappropriate prescription are responsible for major socioeconomic loss. Drug-drug interactions (DDI) has been recognized as a major part of ADRs and, therefore, healthcare professionals should prevent possible DDIs to minimize preventable ADRs. This study aimed to examine DDI information in drug information references and Korea Food & Drug Administration (KFDA) drug labeling information. Drug ingredients from the formulary of Health Insurance Review and Assessment Service in Korea (HIRA) were included for the study. DDI information source used for the study were Micromedex Drugdex and Drug Information Facts (DIF) with the DDI severity level of "moderate" or more. The DDI information in KFDA drug labeling were collected and compared. Drug ingredients were classified with KFDA Drug Classification and ATC Classification of WHO for the analysis. Among the total 1,355 drug ingredients satisfying inclusion criteria, 738 ingredients involved at least one DDI, which was described in Micromedex and/or DIF. Drug Ingredients of 176 involved DDI only described in KFDA drug labeling, but not Micromedex nor DIF. Drug ingredients of 35 which DDIs were described in Micromedex or DIF did not have DDI based on KFDA drug labeling. Micromedex and DIF retrieved 7,582 and 3,071 DDIs, respectively 57.6% and 58.5% of DDIs were also described in KFDA drug labeling. Central nervous system (CNS) drugs, cardiovascular system (CVS) drugs and the antiinfectives appeared to have higher frequency of DDIs among all drug classes. The highest number of DDIs with high severity level ("contraindicated" or "major") were the DDIs of CNS drugs. The antiinfectives are the second drug group having serious DDIs. The DDI pairs of the CNS drug and the antiinfective had the highest contraindication risk (13.6%). DDI information from Micromedex and DIF were not consistent with the result that only 465 ingredients' DDIs are common in both literature (total DDI numbers were 715 vs 488, respectively). And 1,652 DDI information are common in both references among 7,582 vs 3,071 DDIs, respectively. Only 55.2% of DDI information in the database contained in the KFDA drug labeling. Prescribers and pharmacists should pay attention to the drugs for CV system, CNS and infections because of higher risk of possible DDIs compared to other drug classes. KFDA drug labeling is not likely to be recommended as a good information source for DDI due to significant inconsistency of information. Drug information providers should be aware that DDI information from different sources are not consistent and therefore multiple references should be used.

• 대한약리학회지
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• 제7권1호
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• pp.67-76
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• 1971

The excretion of uric acid in man has been of great interest because of its importance as an end product in purine metabolism as well as of its role in causing gout. There are many differences in the modes of renal handling of urate among various species of animals. Uric acid actively secreted by the renal tubules of most vertebrate including amphibians, reptiles, and birds. On the other hand, in most mammals net tubular reabsorption of urate appears to be occurred with some exception, such, as Dalmatian dog. In the rabbits, however, the mechanism of renal excretion of uric acid has long been a subject of controversial results. Within a given group it was possible to find individuals with either net secretion or net reabsorption of urate depend on the experimental conditions. Excretion of urate can be depressed or enhanced by a variety of drugs belonging mainly to the aromatic acid group. Diodrast, probenecid, cinchophen and salicylates have been reported as uricosuric agents, on the other hand, lactate, benzoate, pyrazinoic acid, acetazolamide and chlorothiazide are known to be contraindicated to use for the patient with gout since these agents depress the excretion of uric acid from the kidney. However, complex and sometimes the paradoxical effects on the urate excretion by those above mentioned drugs are not uncommon. The experiments were designed to investigate the mechanisms of renal handling of urate as well as the effects of variety of drugs on the tubular transport of uric acid in the rabbits. Male or female white rabbits, from 1.5 to 2.5 kg in weight, were used. The experimental methods used in these studies were clearance, stop-flow, and retrograde injection techniques. The effects of saline, salicylate, chlorothiazide and probenecid were investigated in each experimental conditions. Results of the experiments were summarized as follows; 1. In the rabbits, the rate of urate clearance was always lower than the rate of inulin clearance. The filtration fraction of the urate was one third on an average, therefore, it is estimated that approximately two thirds of filtered urate was reabsorbed. 2. In the kidneys of rabbits, the urate clearance was increased significantly by administration of chlorothiazide and decreased by probenecid. The administration of salicylate had no effect on the rate of urate clearance. The filtration fraction of urate was increased by chlorothiazide and decreased by probenecid. 3. In the stop-flow studies, the U/P ratio of urate was higher than the U/P ratio of inulin in the proximal region, indicating the secretion of uric acid in the proximal tubules. The proximal peak was increased by chlorothiazide and inhibited by probenecid.4. In the retrograde injection studies, the reabsorption of urate in the proximal region was observed, and these reabsorptive transport of urate was depressed by either probenecid or by chlorothiazide. 5. No distal tubular activity was observed under any of these experimental conditions concerning urate transport. The results of these experiments show that probenecid inhibits both secretory and reabsorptive transport of uric acid in the kidney of the rabbits. The enhancement of secretory transport of urate by chlorothiazide in the clearance study was due to the secondary action of chlorothiazide which inhibits the reabsorptive transport of urate in the proximal tubules. It is evident that the urate transport in the kidneys of rabbits is bidirectional nondiffusive flux both secretory and reabsorptive directions in the proximal tubules.

• The Korean Journal of Pain
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• 제28권1호
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• pp.4-10
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• 2015

Etifoxine (etafenoxine, $Stresam^{(R)}$) is a non-benzodiazepine anxiolytic with an anticonvulsant effect. It was developed in the 1960s for anxiety disorders and is currently being studied for its ability to promote peripheral nerve healing and to treat chemotherapy-induced pain. In addition to being mediated by $GABA_A{\alpha}2$ receptors like benzodiazepines, etifoxine appears to produce anxiolytic effects directly by binding to ${\beta}2$ or ${\beta}3$ subunits of the $GABA_A$ receptor complex. It also modulates $GABA_A$ receptors indirectly via stimulation of neurosteroid production after etifoxine binds to the 18 kDa translocator protein (TSPO) of the outer mitochondrial membrane in the central and peripheral nervous systems, previously known as the peripheral benzodiazepine receptor (PBR). Therefore, the effects of etifoxine are not completely reversed by the benzodiazepine antagonist flumazenil. Etifoxine is used for various emotional and bodily reactions followed by anxiety. It is contraindicated in situations such as shock, severely impaired liver or kidney function, and severe respiratory failure. The average dosage is 150 mg per day for no more than 12 weeks. The most common adverse effect is drowsiness at the initial stage. It does not usually cause any withdrawal syndromes. In conclusion, etifoxine shows less adverse effects of anterograde amnesia, sedation, impaired psychomotor performance, and withdrawal syndromes than those of benzodiazepines. It potentiates $GABA_A$ receptor-function by a direct allosteric effect and by an indirect mechanism involving the activation of TSPO. It seems promising that non-benzodiazepine anxiolytics including etifoxine will replenish shortcomings of benzodiazepines and selective serotonin reuptake inhibitors according to animated studies related to TSPO.

• 한방비만학회지
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• 제6권2호
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• pp.17-27
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• 2006

Objectives : Ma-huang (Ephedra sinica) is frequently prescribed for obesity management in oriental medicine. The main component is ephedrine alkaloids which can have serious adverse side effects such as heart attack, stroke, sudden death. There are no scientific guidelines for Ma-huang usage in the safe treatment of obesity in oriental medicine. We reviewed published studies on its safety to make evidence based guidelines. Methods : We searched electronic databases up to May 2006. We limited evidence to controlled trials for efficacy or safety, case reports for safety, and studies for Ma-huang contents analysis. Results and Conclusions : In clinical trials for weight loss, Ma-huang and ephedrine promote modest short-term weight loss but have no serious adverse effects, have only a few adverse effects associated with increased risk of psychiatric, autonomic, gastrointestinal symptoms and heart palpitations. In case reports, there have been serious adverse effects including stroke, heart attack, and death using typical doses of ephedrine or no associated illness. There are factors related to serious adverse effects, such as overuse, lack of standardization, individual sensitivity, and interactions with other drugs. Studies relating to these factors should be analyzed for safe use of Ma-huang and ephedrine. After analyzing related studies, we suggest guidelines for Ma-huang usage. We propose that the dosage should be within 4.5-7.5g per day for up to 6 months for generally healthy individual. It's use is contraindicated in individuals with heart disease, thyroid disease, diabetes mellitus, hypertension, psychiatric disorders, glaucoma, urination disorders, enlarged prostate, persons using MAOIs, methyldopa and sympathomimetic agents.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권1호
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• pp.21-32
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• 2022

Objectives: Inferior alveolar nerve block (IANB) is commonly used for mandibular dentoalveolar surgery. The objective of this study was to evaluate and compare the effectiveness of coadministration of dexamethasone (4 mg/mL) or adrenaline (0.01 mg/mL) as an adjuvant with lignocaine 2% in IANB during third molar surgery (TMS). Patients and Methods: This double-blind, randomized controlled trial was conducted between March and August 2020. The investigators screened patients needing elective TMS under local anesthesia. Based on strict inclusion and exclusion criteria, patients were enrolled in this study. These patients were assigned randomly into two study groups: dexamethasone group (DXN) or adrenaline group (ADN). Outcome variables were postoperative edema, trismus, visual analogue scale (VAS), perioperative analgesia, onset time, and duration of IANB. Results: Eighty-three patients were enrolled in this study, of whom 23 (27.7%) were eliminated or excluded during follow-up. This study thus included data from 60 samples. Mean age was 32.28±11.74 years, including 28 females (46.7%) in the ADN (16 patients, 57.1%) and DXN (12 patients, 42.9%) groups. The duration of action for DXN (mean±standard deviation [SD], 4:02:07±0:34:01 hours; standard error [SE], 0:06:00 hours; log-rank P=0.001) and for ADN (mean±SD, 1:58:34±0:24:52 hours; SE, 0:04:42 hours; log-rank P=0.001) were found. Similarly, time at which 1st analgesic consume and total number of nonsteroidal antiinflammatory drugs need to rescue postoperative analgesia was found statistically significant between study groups (t (58)=-11.95; confidence interval, -2:25:41 to -1:43:53; P=0.001). Early-hours VAS was also significantly different between the study groups. Conclusion: A single injection of dexamethasone prolongs the duration of action of lignocaine 2% IANB. Additionally, it can be used in cases where adrenaline is contraindicated.

• Advances in pediatric surgery
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• 제12권2호
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• pp.167-174
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• 2006

Central venous catheter (CVC) for long-term venous access is indispensable for various reasons including hyperalimentation, frequent blood sampling, frequent IV drug use in pediatric patients. We report clinical experience of surgical neonates in whom CVC was inserted primarily via great saphenous vein into suprarenal inferior vena cava. From March 2004 to March 2006, we performed CVC insertion via saphenous vein - contralateral side to main wound - into suprarenal inferior vena cava in surgeries of neonates. 2.7Fr or 4.2Fr, single lumen, tunneled Broviac catheters (Bard Access system, Inc, Salt Lake City, Utah) were used. Skin exit site of tunneled catheter was located in ipsilateral flank area just below edge lower rib. At the end of the procedure, location of the catheter tip was confirmed by plain radiography of abdomen. We retrospectively reviewed the admission records of the patients including nursing staff charts. Nine (50.0 %) patients were male and nine (50.0%) were female. Median gestational age was 38 weeks (range, 29-42 weeks) and median birth weight was 3,105 gm (range, 1,040-3,720 gm). Median age at catheter insertion was 38.5 days (range, 1-236 days). The purpose of CVC insertion was short-and long-term hyperalimentation in nine (50.0 %) patients. CVC insertion was performed in operation room under general anesthesia in sixteen (88.9 %) patients (in these cases, CVC insertion was performed just prior to concurrent operation) and neonatal intensive care unit (NICU) under local anesthesia with adequate sedation in two (11.2%). During the admission period (total catheter-indwelling time: 553 days), CVC functioned well without any significant side effects. Transient swelling of the ipsilateral leg (n=1, 5.6 %) and transient migration of catheter tip (n=1, 5.6 %) were noted, which did not affect function of the indwelled CVC. Mean catheter-indwelling time was 30.7days (range, 3-72 days). All catheters were removed electively except two mortality case. Complications, such as thrombosis, infection, kinking or extravasation of drugs, were not observed in our study period. Tunneled trans-great saphenous vein inferior vena cava catheters are not only comparable to cervical CVCs in terms of function and complication rates, but also very beneficial in selected patients, especially those in whom cervical approach is technically impossible or contraindicated.

• 여성건강간호학회지
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• 제5권3호
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• pp.389-409
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• 1999

This study was carried out to identify the differences between nursing needs and levels of satisfaction of postpartum women during the early postpartum period. The goal of this study was to obtain needed to develope the nursing quality for postpartum women. The subjects were 87 postpartum women who had vaginal delivery at 2 general hospital and 2 maternity hospital in the Ulsan City. The period for the data collection was from June 1 to 29, 1999. The data was gathered using an 98 items questionnaire which was a modified version of a questionnaire the developed by Y. J. Chun. Results found are as follows : 1. The general characteristics of the subjects : The majority of subjects were 25-29 yrs. (57.5%), high school and college graduates(96.5%), unemployed(75.9%), middle ranged economics(93.1%), had no religion(43.7%), male baby(52.9%), birth weight 3-3.5Kg(49.4%), wanted pregnancy(96.6%), no abortion history(50.6%), had antenatal care(89.7%), had prenatal education(32.2%), postnatal education(42.5%), intended breast feeding (46.0%), had resonable self confidence about self(20.7%), infant care(36.8%) and nuclear family pattern(82.3%). 2. The level of nursing needs of overall nursing care(3.93) and the levels of satisfaction(3.86) was relatively high. The nursing needs by category of nursing care, the highest need was in the emotional and psychological care(4.09), and the lowest need was in physical need(3.73). The satisfactions by category of nursing care, the highest satisfaction was in emotional and psychological care(4.11) and the lowest satisfaction was in education in self care(3.64). The significant differences between nursing needs and satisfactions were found on education in infant care(p=.005), and education in self care(p=.020). 3. Among items of physical care, 'accurate medication and treatment(4.21)', 'control of postpartum hemorrhage(4.13)', 'pain control and care of episiotomy wound (4.12)' and 'regular observation of postpartum conditions(4.09)' showed high nursing needs. 'Accurate medication and treatment(4.31)', 'regular observation of postpartum condition(4.24)', 'control of postpartum hemorrhage(4.22)' and 'pain control and care of episiotomy wound(4.12)' showed high satisfaction levels. 4. Among items of emotional and psychological care, 'personal treatment(4.32)', kind and faithful care(4.30)', 'detailed explanation on the treatment or nursing care(4.25)', 'adequate draping during the care and treatment(4.23)' and detailed explanation on a doubt(4.13)', showed high nursing needs, 'personal treatment(4.52)', 'kind and faithful care(4.45)', 'detailed explanation on a doubt(4.24)', 'detailed explanation on the treatment or nursing care(4.21)' and 'adequate draping during the care and treatment(4.18)' showed high satisfaction of nursing care. Difference between the level of nursing needs and satisfaction was significant except item of 'early contacts with their baby and breast feeding'. 5. Among items of environmental care, the highest level of need and satisfaction were on the items of 'neat bedding and clothes(4.05, 4.21)' and 'room cleansing or care of room(4.01, 4.28)'. Differences between the level of nursing care and satisfaction were 'room cleansing of care of room'. 6. Among items of educational needs on self care, 'sitz bath method(4.22)', 'high risk symptoms to immediate clinic visits(4.13)', 'the timing of tub bath(4.05)' and 'good secretion of breast milk(4.03)', showed high nursing needs, 'sitz bath method(4.22)' showed high satisfaction of nursing care. Differences between the level of nursing care and satisfaction were 'the timing of hair shampoo', 'the timing of tub bath', ' the method of pad change', 'postpartum exercise', 'good secretion of breast milk', 'maintenance of breast figure', 'contraindicated drugs in postpartum women', 'kegel exercise' and 'breast self examination'. 7. Among items of educational needs on infant care, 'immunization of infants(4.36)', 'symptoms of sickness to immediate clinic visits(4.28)'. 'safety and emergency care(4.28)', 'umbilical care(4.26)', 'feeding times and intervals(4.24)', 'normal growth and development of infant(4.24)' and 'infection control(4.22)', showed high level of nursing care, 'immunization of infants(4.21)', 'feeding times and intervals(4.17)', were high satisfaction items showed significant differences between the level of nursing care and satisfaction. 8. Relationship between nursing needs and levels of satisfaction among postpartum women were as follows : 1) Physical area : There were no significant differences in the level of nursing needs, but satisfaction levels were significantly different among 'working mothers', 'baby's weights', 'baby's sex', 'planning of feeding' and 'routes of receiving postpartum informations'. 2) Emotional and psychological area : The level of nursing needs were significantly different in the area of 'confidence in self care'. Satisfaction levels were significantly different among 'baby's sex', 'baby's weights', 'the confidence of infant care' and 'working mother'. 3) Environment area : There were on significant differences in the level of nursing needs, but satisfaction levels were significantly different among 'maternal age' and 'baby's weights'. 4) Education in self care : The level of nursing needs were significantly different among 'parity history' and 'type of family formation'. Satisfaction levels were significantly different among 'working mother', 'baby's sex', 'antenatal care', 'postpartum education', 'planning of feeding', 'routes of receiving postpartum informations'. 5) Education in infant care area : The level of nursing needs were significantly different among 'parity history'. Satisfaction levels were significantly different among 'baby's sex', 'receiving postpartum education or not' and 'working mother'.