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2016.07.10 2015.06.26
今回は尋常性乾癬の新薬であるドボベット軟膏の服薬指導をまとめました。塗り薬ですが血清カルシウム及び腎機能の検査が定期的に必要な点や高カルシウム血症に対する注意を患者に対して行う点に注意が必要です。
ドボベット軟膏の基本情報
ドボベット軟膏の服薬指導で確認すること・伝えること
ドボベット軟膏の服薬指導で確認すること
ドボベット軟膏の服薬指導で伝えること
ドボベット軟膏の服薬指導薬歴例
【成分】カルシポトリオール(ドボネックス)水和物／ベタメタゾンジプロピオン酸エステル(リンデロンDP)配合剤
【効能・効果】尋常性乾癬
【用法・用量】1日1回
【名前の由来】Vitamin　DのDとV並びにbetamethasoneのbetをかけ合わせて命名されています。
・本邦初の活性型ビタミンD3とステロイドの配合外用剤
・1日1回の用法のためアドヒアランス向上が期待できる(ドボネックスは1日2回)
・従来のドボネックスとリンデロンDPの混合だと安定性の面で懸念がされていたが安定性を維持した製剤であるドボベットを使うことでこの問題を解決できる。
1週間に90gを超える使用は行わないこと。
【必要な検査】
血清カルシウム、腎機能（クレアチニン、BUN等）の検査を定期的（開始2～4週後に1回、その後は適宜）に行うことと記載があります。開始後の検査が2～4週後と明記されているのでこの時期に採血しているか確認が必要です。
顔や粘膜、きずのある所には使わないようにという注意や使用後の手洗い指示の記載、かゆみ、はれ、刺激症状、けん怠感、脱力感、食欲不振に関する記載があります。服薬指導で伝える必要がある項目が一通り記載してあるので用意しておくと有用です。
ドボベット軟膏の服薬指導で確認すること・伝えることをまとめました。確認することに関しては少ないですが、伝える項目は副作用や使用部位に関する内容があります。
①感染性皮膚疾患の有無【禁忌】
ドボベットは副腎皮質ホルモン剤を含むため「免疫抑制作用」により、感染性の皮膚疾患が増悪するおそれがあるため他のステロイド同様に禁忌に設定されています。
比較的頻度の多い感染性皮膚疾患としては帯状疱疹や水虫などがありますが、このような感染性皮膚疾患が併発し、ドボベット軟膏の使用部位と重なる場合は疑義照会で使用の可否を確認することが必要です。
① 高カルシウム血症の注意【重要な基本的注意】
過量投与により、または、皮疹が広範囲にある患者及び皮膚バリア機能が低下し本剤の経皮吸収が増加する可能性がある患者では、高カルシウム血症があらわれることがあるので、異常が認められた場合には、直ちに使用を中止し、血清カルシウム、尿中カルシウム等の生化学的検査による観察を行うこと【重要な基本的注意】
添付文書上は過量投与や皮疹が広範囲、皮膚バリア機能が低下した患者となっていますが、個人的には特にこれらの患者に限定せずドボネックスが処方された患者全例に高カルシウム血症の初期症状を伝えるのがよいと思います。高カルシウム血症の初期症状としては倦怠感、食欲不振、嘔吐、腹痛、筋力低下等を伝えて注意を促します。
②顔面の皮疹及び粘膜には使用しないこと【適用上の注意】
顔面に関してはドボベットの成分の1つであるであるカルシポトリオール単剤の製剤(ドボネックス軟膏)の添付文書に倣う形で記載されています。ドボベットのインタビューフォームでは顔面に使用しない根拠として「海外の臨床試験でドボベットを使用した50例中5例に、口の周囲あるいは鼻唇に灼熱感を伴った紅斑、鱗屑の発症が認められたため」と記載があります。
なお、ドボネックスは粘膜も禁止になっていますが、顔面及び粘膜は副腎皮質ホルモンの吸収が高くなる部位であることから、使用を禁止する注意として記載されているようです。
③本剤に触れた手で、顔面、傷口等に触れないように注意すること【適用上の注意】
傷口は吸収が上がってしまうため設定されています。
④使用後、顔面等への付着を避けるため、よく手を洗うこと【適用上の注意】
実際は使用前にも手をきれいにした方がよいので使用の前後とも手洗いをするように説明します。
かゆみ、はれ、刺激症状に関する注意【その他の副作用】
その他の副作用の項目にかゆみ、はれ、刺激症状があり指導せんにも記載があるため注意を促します。
S）乾癬
O）感染性皮膚疾患なし
万一かゆみ、はれ、刺激症状、倦怠感、食欲不振、嘔吐、腹痛、筋力低下等でる場合は受診指示。顔や傷、粘膜には使わないよう説明。使用の前後で手を洗うよう説明。
P）血清カルシウム値の測定の有無確認
新薬 皮膚 薬剤別服薬指導
セロクエルの服薬指導


英語 水原希子に関するニュース | Infoseekニュース
英語 水原希子に関するニュース
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第二弾となる「オーダー」篇、「打ち合わせ後」篇、「自主練習」篇では、水原希子さんがネイティヴ並みの発音でレストランにてオーダーをする様子や、夢をかなえる為に英語が必要だと心境を語る様子、更にオーディションに向け英語のセリフを地道に自主練習するシーンが盛り込まれており、第一弾に続き、ドキュメンタリーならではの水原さんの素顔を存分に捉えた作品となっています。ま [全文を読む]
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中国政府批判、反体制派支持と同じ意味を持ちます」 デスク「本人に深い意味はなかったんだろ」 記者「そのあたりを含めて、5分にわたって英語で謝罪した動画をアップしたんです」 デスク「英語できるんだ」 記者「父親が米国人、母親は日本生まれの韓国人ですからね。ペラペラっすよ」 デスク「まあ、彼女も中国市場に向けて仕事してるんだから、その謝罪は仕方ないんじゃね?」 [全文を読む]
in Hollywood」のテロップに続き、机とソファが置かれた殺風景な控室で、オーディション直前の水原希子さんが、緊張した面持ちで台本片手に英語のセリフを練習する様子を捉えています。1月18日（水）より放映予定の全7篇に及ぶドキュメンタリーCM並びに長尺映像「Borderless! Special Document Movie」では、どんな素顔が公開され [全文を読む]
本名を名乗り、英語で語りかけたこの動画は、再生回数30万回を超えてなお視聴者を増やしている。 発端は、中国のアーティストが天安門に中指を立てている写真作品に、水原がインスタグラムで「いいね！」とつけたこと。これが、中国内のネットユーザーからのバッシングを引き起こしたのだ。「同時に水原が靖国神社に参拝していたとされる写真まで出回り、中国人から“侵略戦争を美化 [全文を読む]
この動画では終始、英語でしゃべることで自分がアメリカ人であることを強調。だがそんな懸命のアピールも海外メディアにはいまいち伝わっていなかったようだ。海外事情に詳しいライターが説明する。「この謝罪動画はイギリスのBBCにも取り上げられるほどの話題を呼んでいます。しかし記事の見出しには『US-Japanese actress』（日米ハーフの女優）と書かれてお [全文を読む]
とても優しい映画！ベリーベリースウィート！」と日本語と英語を交えてトーク。しかし「妄想の中では、もっと日本語ペラペラなんです」と語り、おちゃめな素顔をのぞかせた。 ■ 大野拓朗/マンションのチラシでストレス解消？ 大野は「部屋が狭いから、マンションのチラシの間取りをよく見るんです。シアタールームとか、防音室、トレーニングルームが付いた部屋をよく空想してて、 [全文を読む]
「日清焼そば U.F.O.」新TV-CM 吉川晃司×水原希子 初共演！ハリウッド進出を目ろみ、日清食品史上初「全編英語 超Ｂ級ＣＭ」を製作！
しかし、そこに猛烈なスピードで迫る何かが・・・果たして、ソースとエクストリーム姫の運命やいかに!? [全文を読む]
“他では買えない”グルーポン特別企画 フジテレビ特番スタジオ観覧を0円で販売！グルーポン「WOW（ワウ）ディール」で番組観覧者募集！～1月28日（水）12:00より販売開始～
） ※1: ディール：英語で「取引」や「価値」という意味を表し、グルーポンが「毎日新しい価値を提供する（デイリー・ディール）」サイトであることからグルーポンサイト上に毎日アップされるサービスや商品を指す。 [画像: http://prtimes.jp/i/11644/6/resize/d11644-6-249398-0.jpg ] ■概要 【掲 載 画 面 [全文を読む]
当時画面の字幕には「K... K... K...」という英語の文字が流れたが、彼は最後までその言葉を言わなかった。一緒に居たメンバーのSOLは「僕たちはどんな意味が分かるよ」と意味深長な話を残した。また、二人はSNSのユーザ名に同じイニシャルのXXXを使っている。G-DRAGONは「xxxibgdragn」で、希子のアカウントは「xxxkiko」。さらに、 [全文を読む]
G-DRAGONは英語で「僕の2度目のALS（筋萎縮性側索硬化症）アイス・バケツ・チャレンジだ。ユンヌナ（ヌナ＝男性から年上の女性を指す言葉）、ユカちゃん、親愛なる希子（my dear Kiko）を指名する」と、以前に熱愛が報じられた水原希子を指名し、ファンらを中心に話題となった。G-DRAGONと水原希子は2010年、日本でデートを楽しむ姿がキャッチされ [全文を読む]
今日のあなたの“ラッキーソング”は？ オリコン英語星占い（2017年9月14日）
ORICON NEWS / 2017年09月14日07時50分
水原希子、英語でオーディション挑戦「人生1回だからチャレンジ」■12th Sagittarius（12位 いて座）「You will get nervous easily. Drink herbal tea to relax.」 緊張しやすい日。まずはハーブティーを飲んでリラックス。Lucky song＞＞Endless Summer/Going Craz [全文を読む]
英語でしゃべることでアメリカ人であることを強調。さらには謝罪とはまったく関係ない自分の生い立ちを説明し、まるで日本人じゃないから許してほしいという意味に取られてしまい、『日本を言い訳に使うな』と2次炎上。その騒動からたったの半年後に今回の発言ですから、水原本人は何気なく発した言葉かもしれませんが、今度は日本人アピールで媚びを売ってきたと受け取られています」 [全文を読む]


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「カレラ」最新アイテム「ジョシュ・ジェンセン・セレクション」をJALUX限定で発売 - ZDNet Japan
株式会社JALUX 2013年12月03日