RESUMEN
The clinical efficacy of calcineurin inhibitors administered to renal transplant patients is considered to be a strong function of the area under the concentration time curve (AUC). Interestingly, monitoring timings of blood concentrations for two similar calcineurin inhibitors, cyclosporine (CYA; Neoral) and tacrolimus (TAC; Prograf) are different. Namely, CYA blood concentration is usually monitored at 2 h after administration (C(2)) substituted for peak concentration (C(p)) and TAC at trough concentration (C(t)). In the literature, data describing such characteristics of CYA and TAC have been presented in the past. However, each of these patient groups had different backgrounds. We have attempted to examine the behavior of blood concentration curves simultaneously for both CYA and TAC by establishing controlled groups of renal transplant patients with similar clinical backgrounds. Furthermore, we have analyzed the correlation with C(p) and C(t) versus AUC implementing area under the trough level (AUTL), or area above the trough level (AATL) as new pharmacokinetic parameters, such that C(2) for CYA and C(t) for TAC have been verified using controlled clinical data. We have also found distinct differences in the pharmacokinetics between CYA and TAC with the relationships between AUC, C(p), and C(t).
Asunto(s)
Ciclosporina/farmacocinética , Inmunosupresores/farmacocinética , Trasplante de Riñón , Tacrolimus/farmacocinética , Adulto , Área Bajo la Curva , Ciclosporina/sangre , Monitoreo de Drogas , Femenino , Humanos , Inmunosupresores/sangre , MasculinoRESUMEN
The six-year curriculum has been introduced into all pharmacy schools in Japan since April 2006. Those schools are currently preparing for an additional two years of pharmacy education and are in the process of reading the necessary educational infrastructure. However, students' expectations of the new curriculum and understanding of the professional roles of a pharmacist have yet to be investigated. Therefore we surveyed the first group of students on their expectations of the new curriculum and on their understandings of the newly emerging roles of pharmacists in general. Our questionnaire consisted of six questions, and we further had the students conduct self-evaluations using the admission interview items of a pharmacy school from the USA. Of the 440 first-year students, 89.1% responded. Based on the results of the survey, we found that the majority of students did not believe that pharmacists will have a respected role in multidisciplinary teams or in public. Approximately half of the students also said that they had no confidence in taking leadership roles or thinking logically when compared with the average person. We therefore believe that schools and pharmacy educators need to teach students pharmaceutical care and the various roles pharmacists can play in the future. Schools and pharmacy educators should also support students by providing training and introducing new methods of learning to develop their professional attitude and leadership skills.