Etsuro Sagara

Controlled release of lidocaine hydrochloride from buccal mucosa-adhesive films with solid dispersion

Solid dispersion films were prepared with a highly water-soluble medicine, lidocaine hydrochloride (LDC), water-insoluble ethylcellulose (EC) and water-soluble hydroxypropylcellulose (HPC). The release profiles of LDC from the solid dispersion films of different composition, and the suppression mechanism of the release in the LDC-EC-HPC system were studied. The release rate of LDC from the solid dispersion film as drug-reservoir was well controlled at EC/HPC composition ratio of 5/5. The mechanism of controlled release was speculated that there was a little release of HPC together with LDC, and the retained HPC was swelled in the film by the permeating fluid. Then, the release of LDC occurred via diffusion into the swelled HPC phase, causing a marked decrease in the release rate. The film for clinical use, which had the 30% LDC solid dispersion film, adhered almost completely to the buccal mucosa. These observations will provide useful information on clinical application of the LDC-EC-HPC solid dispersion film.

Online support functions of prescription order system and prescription audit in an integrated hospital information system

The role of the online prescription support functions of a prescription order entry system was analysed and the results of the prescription audit by pharmacists were examined. In the Kochi Medical School Hospital, an online prescription order system has been developed as part of an integrated hospital information system named IMIS (the Integrated Medical Information System), in which all the physicians enter their prescription orders into online display terminals. The prescription order entry system is provided with prescription support functions, which check the entered prescription data, issue warnings, and offer information about drugs or patients. The prescription order system reduces the incidence of simple prescription mistakes and greatly decreases the cases of inquiries by pharmacists. However, results of the analysis show that such functions as warnings of double order and repeated prescription of a drug do not work as well as expected. The system would thus require some kind of intelligence like that of the auditing pharmacists or that of the physicians with accurate knowledge of clinical pharmacology.

Analysis of the online order entry process in an integrated hospital information system

In Kochi Medical School Hospital, many online order systems have been developed as a part of the integrated hospital information system named IMIS KOCHI. The prescription, laboratory and radiology orders are used frequently and entered into the system by physicians. The distribution of entry duration of these orders by physicians was analyzed and it was found that the order entry is a completely random event and the entry process consists of the two Poisson processes; the quick process and the slow process. The two Poisson processes were observed even in the do-prescription order without correction by trained physicians. It is speculated that the quick process depends on availability in the order entry system and the slow process depends on peculiarities in clinics, and the mental condition of physicians.

Effect of Sterilization and Long-term Storage on Toxic Drug Adsorption to Activated Charcoal Suspension.

Three kinds of activated charcoal suspensions using a laxative solution as a dispersion medium were prepared to provide for acute intoxication. Used in the dispersion medium were 13.6% magnesium citrate, 15.0% magnesium sulfate and 75.0% D-sorbitol. These suspensions and a suspension using an isotonic sodium chloride solution as a dispersion medium (control) were sterilized for the purpose of long-term storage.The adsorption power was tested by a modified adspoption test of the JP XII medicinal carbon and a modified one of the USP XXII activated charcoal. The suspensions of magnesium citrate and D-sorbitol failed in the methylene-blue adsorption test of JP XII. The other suspensions passed every adsorption test. The adsorption power of the suspensions for phenobarbital, which is often responsible for drug poisoning, was estimated to be ca. 300 mg drug per gram of charcoal, and was stable over two months at room temperature. After 30 months of storage, the adsorption power decreased to 92% of its initial value while the magnesium sulfate suspension observed a reduction of 40%.We conclude that these suspensions are suitable activated charcoal formulations for provision to the emergency room due to the adsorption power and stability.

Preparation of Oil/Water Type Chlorophyll Emulsion as a Color Marker for the Identification of Lymph Nodes.

An O/W type chlorophyll emulsion was prepared as a color marker to identify the lymph nodes. The emulsion consisted of chlorophyll oil, sesame oil, glycerin, water and surfactants. The final formulation containing 4% of phosphatidylcholine and 1.5% of polysorbate 80 as surfactants was stable over seven days at room temperature. The emulsion was endoscopically injected into the gastric submucosa of the dog. Laparotomy after two days of injection of emulsion showed that the lymph nodes have been stained green. Histological findings of the liver, kidneys, pancreas, lungs and heart of the rats did not show the toxic effect; one week after intraperitoneal injection of 2 ml/kg of the emulsion. Therefore, the chlorophyll emulsion was an effective and safe color marker to identify the lymph nodes from their surrounding tissues during the surgery of the malignancy.