종합토론 3

여미진 한국지역사회복지학회 2020 한국지역사회복지학회 학술대회 Vol.2020 No.6

조혈모세포 이식환자에서의 현행 tacrolimus 치료방법 평가

여미진,박수진,방준석,나현오 한국임상약학회 2010 한국임상약학회지 Vol.20 No.3

Tacrolimus 주사에서 경구로 투여 경로 변경 시 용량 설정비율의 변경에 따른 효과 비교

정지혜,여미진,박애령,김순주,나현오 한국병원약사회 2013 病院藥師會誌 Vol.30 No.4

In Seoul St. Mary’s Hospital, tacrolimus is used for prophylaxis of graft versus host disease (GVHD) after unrelated hematopoietic stem cell transplantation (HSCT). On the basis of our previous study, we changed the conversion ratio of 1:4 to 1:2.5 when the route of administration is switched from IV (intravenous) to PO (per oral). In this study, we aimed to confirm the pharmacokinetic and clinical reasonability of the adjustment of the conversion ratio by comparing the incidence of GVHD and the adverse drug reactions of tacrolimus before and after adjustment. Patients were evaluated in two different groups. Group A received HSCT in 2008 and was applied conversion ratio of 1:4 and group B received HSCT in 2010 and was applied conversion ratio of 1:2.5. We retrospectively reviewed the patient’s monitoring profile and electronic medical records for 3 months after HSCT. The proportion of maintaining the oral dosage that was set at the time of switching from IV to PO was higher in group B than group A (41.9% vs. 64.2%, P<0.0001). The incidence of acute GVHD was not significantly different between the two groups (51.4% vs. 60.5%, p=0.252). The incidence of the adverse drug reactions of tacrolimus appeared to be decreased in group B, except for neurological toxicity and hyperkalemia. In particular, diarrhea was statistically decreased in group B (p=0.0004). As clinical outcomes were not significantly different and the proportion of maintaining the initially set oral dosage was increased in group B, we suggest that the application of the 1:2.5 conversion ratio is reasonable when the route of tacrolimus administration is changed from IV to PO.

유방암 환자에서의 trastuzumab 주입관련반응 발생률 및 위험인자 분석

정지혜,김유진,여미진,박애령,김순주,황보신이,나현오 한국병원약사회 2018 병원약사회지 Vol.35 No.2

Background : Trastuzumab is a monoclonal antibody for use in the treatment of the human epidermal growth factor receptor-2 (HER2) often overexpressed in breast cancer. One of its common side effects of this therapy use is the infusion-related reactions. Conversely, it is noted that there are no guidelines for preventing these side effects in patients. In this study, we aimed to find grounds to support the safe use of trastuzumab based on an analysis of the incidence and risk factor of the infusion-related reactions in breast cancer patients receiving trastuzumab. Methods : We evaluated the infusion-related reactions of the breast cancer patients receiving the first trastuzumab between Jan 1, 2014 and June 30, 2015. For the analysis of the risk factors, we collected the patient’s information retrospectively using the access to the patient’s secured electronic medical records. Results : In this study, a total of 91 patients were evaluated, and the total number of trastuzumab administration was with 270 cases. The infusion-related reactions were identified in 18 patients and the incidence was recorded at 19.8%. All infusion-related reactions were occurred during the first dose. And the symptoms began in the average timeframe of 76.5 minutes after the administration. The incidence of the infusion-related reactions was 11.1% in patients receiving premedication, and 21.9% in the patients not receiving the premedication (p=0.31). Particularly speaking, the patients who were weighing more than 70kg had a significantly higher risk of infusion-related reactions, than the patients who were known to weighing less than 70kg (odds ratio 5.23; 95% CI, 1.32 - 20.67; P=0.01). And the higher patient's body mass index tended to occur more infusion-related reactions (odds ratio 1.15; 95% CI, 0.98 - 1.35; P=0.08). Conclusion : Based on this result, in order to administer the trastuzumab safely, we suggest that the prevention guideline for the infusion-related reactions need to be utilized to consider the patient's body weight, and it is necessary to strengthen the monitoring to continue until the latter half of the drug therapy administration.

조혈모세포이식 후 구강 내 이식편대숙주반응 치료에 사용된 Cyclosporine액의 국소적용 사례보고

이슬기,박수진,여미진,박애령,김순주,나현오,김희제 한국병원약사회 2012 병원약사회지 Vol.29 No.1

Abstract : Graft versus host disease (GVHD) is an important cause of morbidity and mortality in hematopoietic stem cell transplantation patients. Patients with oral GVHD may develop symptomatic severe oral ulceration, erythema, lichenoid and lupus-like changes, in addition to the dryness of the oral mucosa, due to involvement of the salivary glands. A combined use of cyclosporine or tacrolimus and methotrexate is a principal approach for prevention of GVHD. Corticosteroid is used as the first-line therapy, but clinical effects of the other treatments have not been proven yet. Moreover, there are possibilities of the adverse effects induced from systemic use of corticosteroids and immunosuppressive agents, thus, the need of adjuvant local therapies emerged. In this case report, we described the management of oral GVHD with topical cyclosporine solution. A 53-year-old female, diagnosed as Acute myeloid leukemia (AML), received an allogenic hematopoietic stem cell transplantation (HSCT) and developed GVHD, involving skin, gut and oral cavity. Management included systemic corticosteroids and topical agents, such as normal saline and chlorhexidine, to relieve oral symptoms. However, it did not show a significant improvement. The patient was readmitted for GVHD and cytomegalovirus retinitis after being discharged. At this point, oral GVHD was estimated as a total score of 10, the sum of erythema 3, linchenoid 1,ulceration 6 and mucoceles 0, by the National Institutes of Health (NIH) consensus scoring system with numerical rating scale (NRS) of 10 for pain. The patient was decided to use cyclosporine solution as an oral rinse in the condition of oral intake restriction due to bleeding tendency. We opted for the patient to use the cyclosporine solution. Oncology pharmacist instructed the patient to rinse the mouth with 5ml of cyclosporine solution for 5 minutes, three times a day. After two weeks, the application of cyclosporine mouth rinse resulted in an improvement of the oral GVHD;total score of 4 presented, as the sum of erythema 1, linchenoid 0, ulceration 3 and mucoceles 0,with NRS 4 in the pain. Application of cyclosporine mouth rinse is considered to be a remedy for oral GVHD to minimize the adverse effects induced from systemic therapy and to maximize curative value.

국내병원의 항암주사제 조제환경 및 약사 업무 현황 조사

강민경,박향민,이연주,김다진,이윤선,여미진,이연홍,문진영,허영설,김재연 한국병원약사회 2015 병원약사회지 Vol.32 No.2

Purpose : The American Society of Health-System Pharmacists has provided guidelines on handling hazardous drugs and updated its new and continuing concerns for health care workers. However, there are no such guidelines or regulations in Korea. This study aims to evaluate the work environment and the safety of healthcare workers during the preparation of antineoplastic agents in Korean hospitals. Methods : We invited a total of 110 hospitals with more than 500 beds to participate in our survey. Twenty nine hospitals participated. The self-completion questionnaire covered work place issues, the number of antineoplastic agent preparations, equipment and environmental quality control, and training about the handling of hazardous drugs. Results : There are three hospitals where the daily compounding number reached more than 600 and the average number per person was 36.5. The preparation room for hazardous drugs at nine hospitals remained positive or equal pressure. In addition, nine hospitals used a clean bench, which is not biologic safety cabinet. None of the 29 hospitals conducted an environmental sampling test to detect hazardous drugs and most of the hospitals performed an efficiency test of the biologic safety cabinet. All of the hospitals conducted personnel training and education about the safe handling of antineoplastic drugs but the length of the training period varied. In addition, none of the hospitals evaluate the health status of workers. Personal protective equipment included gowns, gloves, masks, hair caps and arm covers but not a respirator. The type of equipment and usage times varied. Most of hospitals complied with continuing preparation-compounding times of less than 2.5 hours. Conclusion : This was the baseline study to evaluate the work place and worker safety for the preparation of antineoplastic drugs. The result of our study demonstrates that it is necessary to establish standardized guidelines and improve working conditions for the handling of hazardous drugs in Korean hospitals.