• 생물정신의학
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• 제4권2호
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• pp.198-210
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• 1997

To examine the double-faced thymoleptic(antidepressant and antimanic) effects of risperidone in mood disorders, this article reviews the psychotropic-induced mania, thymoleptic effects of antipsychotics, therapeutic effects of risperidone and risperidone(RIS)-induced mania(RIM) in mood disorders, risk factors of RIM, possible neurochemical mechanism of these thymoleptic effects, pathophysiological and clinical significance of thymoleptic effects, and suggestive clinical guideline of RIS in mood disorders. RIS appeared effective for bipolar disorder at a lower dose than that recommended for schizophrenia, especially in the cases of maintenance of mood stabilizers, and gradual titration from low doses. Manic induction/exacerbation can occur by chance during RIS treatment in mood disorders, schizoaffective disorders, and schizophrenias. The possible risk factors for RIM are refractory mood disorder, especially in bipolar I disorder with poor initial response ; refractory schizoaffective disorders, especially in bipolar type with poor initial response ; refractory chronic schizophrenias, especially with initial responses ; psychotic features ; higher initial doses ; rapid titration ; combined therapy with antidepressants in refractory depression ; and RIS monotherapy in mania/hypomania. RIS is a drug that preferentially block 5-HT2 receptors. The effects of low dose are due mainly to the blockade of 5-HT2 receptors. There are more gradual increase in D2 blockade with increasing dose and this D2 blocking properties become apparent at higher doses. This may be related to a modulation of dopaminergic transmission by 5-HT2 antagonism at lower doses with the direct action of RIS on DA receptors coming into play at higher dose. The serotonergic antagonistic effect may be important for its effects on depressive symptoms. This, together with adequate blo-ckade of D2 receptors, may not necessarily lead to destabilization of mood disorder, but rather to more therapeutic effects. Therefore, this dose-receptor affinity relationship with both antidepressant and antimanic effects according to treatment duration can explain a continuum of antidepressant effect, antimanic effect, behavioral stimulation, and manic/hypomanic induction/exacerbation. It was the recognition of a useful psychiatric side effects by a thoughtful observer with fertile minds that led to their ultimate utilization as psychotropic drugs, i.e., phenothiazine, MAOI, TCA, and lithium. And, in vivo pharmacological challenge by novel psychotropics, as a neurochemical probe, with more specific actions is a useful tool to select pharmacologically homogeneous subgroup of the same phenotypical(clinical) condition, to further study the unknown underlying pathogenesis of various mental illnesses. Finally, RIS may be a useful alternative or adjunctive drug for patients with mood disorders without psychotic features or refractory to treatment with standard antipsychotic drugs. The more conservative doses(tirated slowly from 1-3 mg/d) of RIS, and maintenance of mood stabilizer in the cases with risk factors of RIM are recommended in mood disorder.

• 보건행정학회지
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• 제25권3호
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• pp.185-196
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• 2015

Background: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. Methods: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. Results: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. Conclusion: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.

• Biomolecules & Therapeutics
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• 제13권2호
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• pp.65-77
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• 2005

Present article reviews about clinical pharmacology of mycophenolic acid (MPA), the active form of mycophenolate mofetil (MMF), as widely used component of immunosuppressive regimens in the organ transplantation field. MMF, used alone or concomitantly with cyclosporine or tacrolimus, has approved in reducing the incidence of acute rejection and has gained widespread use in solid organ such as kidney, heart and liver transplantation. The application of MPA and development of MMF has shown a considerable impact on immunosuppressive therapy for organ transplantation as a new immunosuppressive agent with different mechanism of action from other drugs after early 1990s. In particular aspect, use of MMF, a morpholinoethyl ester of MPA, represented a significant advance in the prevention of organ allograft rejection as well as allograft and patient survival. In considering MMF clinical data, it is important to note that there is a strong correlation between high MPA area under curve(AUC) values and a low probability of acute allograft rejection. Individual trials have shown that MMF is generally well tolerated and revealed that MMF decreased the relative risk of developing chronic allograft rejection compared with azathioprine. Recent clinical investigations suggested that improved effectiveness and tolerability will results from the incorporation of MPA therapeutic drug monitoring into routine clinical practice, providing effective MMF dose individualization in renal and heart transplant patients. Therefore, MMF has a selective immunosuppressive effect with minimal toxicity and has shown to be more effective that other agents as next step of immunosuppressive agents and regimens that deliver effective graft protection and immunosuppression along with a more favorable side effect.

• The Korean Journal of Pain
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• 제24권3호
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• pp.137-140
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• 2011

Background: Although early reviews of clinical findings were mostly negative, there is still a widespread belief for the efficacy of preemptive analgesia among clinicians. In this study, we evaluated whether the preemptive use of ketamine decreases post operative pain in patients undergoing appendectomy. Methods: In double-blind, randomized clinical trials, 80 adult male patients undergoing an operation for acute appendicitis were studied. Patients were randomly assigned to two groups. In the operating room, patients in the ketamine group received 0.5 mg/kg of ketamine IV 10 minutes before the surgical incision. In the control group, 0.5 mg/kg of normal saline was injected. The pain intensity was assessed at time 0 (immediately after arousal) and 4, 12, and 24 hours postoperatively using the 10 points visual analogue scale (VAS). Results: Eighty patients (40 for both groups) were enrolled in this study. For all of the evaluated times, the VAS score was significantly lower in the ketamine group compared to the control. The interval time for the first analgesic request was $23.1{\pm}6.7$ minutes for the case group and $18.1{\pm}7.3$ minutes for the control (P = 0.02). The total number of pethidine injections in the first 24 hours postoperatively was $0.6{\pm}0.6$ for the case group and $2.0{\pm}0.8$ for the controls (P = 0.032). There were no drug side effects for the case group. Conclusions: A low dose of intravenously administered ketamine had a preemptive effect in reducing pain after appendectomy.

• 한국임상약학회지
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• 제28권1호
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• pp.1-9
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• 2018

Polypharmacy is increasing owing to an increase in the elderly population and multimorbidities associated with the increased risk of administration of potentially inappropriate medications (PIMs). The negative effects of polypharmacy on various health conditions and aspects, such as fall, fracture, mortality, cognitive function, and dementia, have been reported. The management of excess and inappropriate polypharmacy through proper interventions and local or national guidelines has been highlighted. The purpose of polypharmacy management is to appropriately prescribe medicines that are essential to treat diseases in patients and to avoid inappropriate polypharmacy, such as interactive or duplicate medicines under prescription and PIMs for specific diseases. Community pharmacists in Australia, the EU, USA, and Japan are collaborating with prescribers to review medications to ensure that the patients can be prescribed appropriate medications. The service cost is reimbursed by public or private insurers. A study in the United States has shown that even with medication review costs, the overall medication cost has reduced. In Korea, various projects such as Drug Utilization Review service and safe use of medicines have been conducted; however, no national guidelines or management measures have been established. It is necessary to implement a national long-term plan on polypharmacy management. Furthermore, a phased implementation plan is required. Shortly, active medication review services and education programs for healthcare professionals with the support of the government should be considered in Korea with reference to other countries in order to raise awareness of seriousness and risks of inappropriate polypharmacy.

• 대한한의학회지
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• 제33권3호
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• pp.200-230
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• 2012

Objectives: Ginseng, Panax ginseng C. A., white ginseng, has been used for thousands of years in Traditional Korean Medicine. Red ginseng can be made by a steaming process of white ginseng changing a variety of ginsenosides and ingredients such as dencichine. This article reviews red ginseng for mechanisms for pharmacodynamics and toxicity based on the content of ginseng's active ingredients, ginsenoside changed by steaming. Methods: The following electronic databases were searched: PubMed, Science Direct and Chinese Scientific Journals full text database (CQVIP), and KSI (Korean Studies Information) from their respective inceptions to June 2012. Results: Compared with unsteamed ginseng, the content of ginsenosides Rg2, Rg3, Rg5, Rh1, Rh2 and Rk1 called red ginseng-specific ginsenosides increased after the steaming process. Different ginsenosides have shown a wide variety of effects such as lowering or raising blood sugar and blood pressure or stimulating or sedating the nervous system. Especially, the levels of Rg2, Rg3, Rg5, Rh1, Rh2 and Rk1 were increased by the steaming process, showing a variety of pharmacodynamics in biological systems. Also, various processing methods such as puffing and fermentation have been developed in processing crude ginseng or red ginseng, affecting the content of ginseng's ingredients. The safety issue could be the most critical, specifically, on changed ginseng's ingredients such as dencichine. The level of dencichine was significantly reduced in red ginseng by the steaming process. In addition, the possible toxicity for red ginseng was affected by cytochrome P450, a herbal-drug interaction. Conclusions: The variety of pharmacological and toxicological properties should be changed by steaming process of Panax ginseng C. A., white ginseng. Even if it is not sure whether the steaming process of white ginseng would be better pharmacologically, it is sure that steaming reduces the level of dencichine causing a lower toxicity to the nervous system.

• 재활간호학회지
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• 제19권2호
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• pp.82-99
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• 2016

Purpose: The purpose of this study was to review systematically the effects of home based pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) patients using qualitative synthesis. Methods: Studies designed randomized controlled trials were identified to extract data and to assess the quality of studies in 8 domestic and 3 foreign search engines, and hand search reference reviews. Results: A total of 9 studies met the inclusion criteria. Overall, the methodological quality of the studies ranged from average to poor. Home based pulmonary rehabilitation consisted of exercise, education, and psychosocial interventions. Several exercises such as aerobic, strength, respiratory muscle training, and flexibility were used in home based pulmonary rehabilitation for COPD patients. Upper muscle exercise and walking were the most frequently used exercises. The most common topics for education were 'knowledge of the illness' and 'drug management'. Walking distance test (WDT) and quality of life (QoL) were the most frequently measured as the dependent variables to evaluate rehabilitation outcomes, followed by pulmonary function test (PFT) and dyspnea. WDT was the most effective outcome, followed by dyspnea, QoL and PFT. Conclusion: This study informed about the details of scientific and effective home based rehabilitation programs in COPD patients for future researchers and clinicians. These findings can help expand the recognition and accessibility of home based rehabilitation in COPD patients.

• 한국임상약학회지
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• 제8권1호
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• pp.35-46
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• 1998

A retrospective study was conducted to evaluate the appropriateness of total parenteral nutrition (TPN) for 200 hospitalized adult patients in Samsung Medical Center from January 1st in 1995 to June 31st in 1997. Standard criteria were modified and determined from those stated by AJHP (American Journal of Health System Pharmacy) and ASPEN (American Society of Parenteral and Enteral Nutrition). The justification for indications was appropriate in $35\%,\;44\%,\;and\;32\%$ of the patient's in 1995, 1996, and 1997, respectively, without significant improvement over the last two and half years. Before and during the administration of TPN, several monitoring indicators were well documented, and monitoring frequencies were increased over two and half years period. However, the majority of the monitoring indicators were not found in the standard criteria range of $90\%$. The monitoring indicators for electrolyte balance, $PO_4$ and Mg, were not measured appropriately and resulted in the complications which could have been prevented. The indicator for lipid tolerance, triglyceride and the indicator for hemorrhagic incidence, prothrombin time (PT), were not well documented in comparison with other indicators. The indicators for the improvement in nutritional status, albumin and total protein, were appropriate in $90\%$ of the patients. Determination of TPN formula was based on the laboratory data and chart reviews, and it was appropriate in $98\%$. But the administration of lipid and vitamin K for the prevention of essential fatty acid deficiency and hemorrhage, respectively, was not carried out appropriately when the administration of TPN was prolonged, lasting more than 7 days. When a patient returned to oral or enteral feeding, TPN was terminated. However, increase in albumin level or weight was rarely observed. In conclusion, healthcare professionals should all work as a team and active participation to provide optimized nutrition support for partners.

• 한국한의학연구원논문집
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• 제17권2호
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• pp.47-56
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• 2011

Objective : This study reviews the articles about 'Side effect' published in the Japanese Journal of Oriental Medicine to better understand about side effects of herbal medication and to encourage clinicians, the authorities and the public to establish side effects reporting system. Method : We searched articles published in the Japanese Journal of Oriental Medicine by using keyword '副作用(Side effect)' in the CiNii. Results : Among the 118 articles collected, 14 are clinical articles about side effect of prescriptions, 13 are reports about side effect of prescriptions presented from Japanese Ministry of Health, Labour and Welfare, 36 are clinical articles about relief of side effects derived from taking western medicine by taking a herbal prescription, 8 are studies about the effect of a herbal prescription combined with western medicine or comparative studies between a herbal prescription and western medicine, and so on. Conclusions : Lots of articles deal with side effects of Aconiti Lateralis Radix Preparata, Bupleuri Radix and so on. When side effects occurred, removing a certain herbal drug or quitting a herbal prescription is helpful to relieve or disappear the side effects. And Side effects reporting system should be established to guide safe medication use and treatment for patients. In order to establish side effects reporting system, the standardization of herbal drugs is needed.

• 한국산학기술학회논문지
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• 제17권9호
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• pp.394-400
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• 2016

본 연구에서는 방송 광고의 음악과 관련된 규정의 변화를 비판적으로 검토하고 방송통신심의위원회의 사후 심의 결과를 분석하였으며 그 결과를 바탕으로 문제점에 대해 논의한 후 개선 방안을 제시하였다. 일반 주요 규제로서 동요와 민요 관련 규정의 경우, 동요의 개사는 금지(비 상업적 공익광고 예외)되며 민요의 개사는 가능하지만 가사에 상품과 관련된 표현은 금지된다. 편곡은 동요와 민요가 모두가능하다. 품목별 규정으로서 의약품의 경우 제품명을 노래 가사로 사용하는 것은 금지되며, 주류는 제품명 또는 제조사 등 제품과 관련된 명칭 및 음주를 권장하는 내용이 포함된 가사는 금지된다. 이와 같은 광고 음악의 제한 및 금지 규정의 근거는 불분명하거나 그 타당성이 미약한 부분이 있어 개선의 여지가 필요하다. 또한 모바일 디바이스 사용의 확산으로 방송과 인터넷 등 매체 간의 경계가 불문명한 시대에 청소년 등 특정한 계층을 보호할 목적으로 방송 광고만 규제하는 것은 비합리적이라는 지적을 받을 수 있기 때문에 개선할 필요가 있으며 이를 위해 미래에는 보다 타당성 있는 연구가 실행되어야 할 것이다.