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1 1024 O1-001 O1-010 O2-001 O2-010 O3-001 O3-010 O4-001 O4-010 /TDM 1000 O5-001 O5-010 / O6-001 O6-010 //NST/ O7-001 O7-014 //// O8-001 O8-014 O9-001 O9-014 /// 1400 O O //DPC// 1025 O O O O / O O O O // O O /TDM/ O O ///NST O O /

2 F :00~11:00 O1-001 ICU/CCU O1-002 Linezolid O1-003 O1-004 O :01~12:01 O1-006 de-escalation O1-007 ICTde-escalationcarbapenem O1-008 O1-009 O F 4,5 10:00~11:00 O O O2-003

3 19 O2-004 O :01~12:01 O2-006 Capsaicinindomethacin O2-007 O2-008 O2-009 CCl4caspase-3, -8, -9 O2-010 RT-PCR1 PHA F 10:00~11:00 O3-001 O3-002 O3-003 Microsoft Access O O3-005 Cockcroft- GaultMDRD 11:01~12:01 O3-006 FEC75, FEC100

4 O3-007 O3-008 O3-009 HPLC LCMS O F /TDM 10:00~11:00 O O4-002 PKC O4-003 ph O4-004 O4-005 /TDM 11:01~12:01 O4-006 O O4-008 VCM24TDM O4-009 O4-010 VCM

5 F 1 / 10:00~11:00 O5-001 CYP O5-002 CYP2C9 PISCS O5-003 O5-004 O5-005 / 11:01~12:01 O5-006 O5-007 O5-008 O O5-010 per Pharmacy F //NST/ 10:00~11:00 O6-001 O6-002 O6-003 O6-004 HPLC

6 O //NST/ 11:01~12:01 O6-006 O6-007 O6-008 O6-009 O F 1-3 //// 14:00~15:24 O7-001 MRSA O7-002 C.difficile O7-003 MRSA O7-004 O7-005 O7-006 O7-007

7 19 //// 15:25~16:49 O7-008 O7-009 O7-010 CABG O7-011 K O7-012 O7-013 O F 14:00~15:24 O8-001 UGT1A1CPT-11 O8-002 Anthracycline rebamipide O8-003 TDM O8-004 O8-005 grade3 3 O O8-007 G-CSF

8 15:25~16:49 O8-008 O8-009 CPT-11 O O8-011 O8-012 Nedaplatin O8-013 Gefitinib Erlotinib O F /// 14:00~15:24 O9-001 HTML O9-002 O9-003 O9-004 O9-005 egfr O9-006 MAGE-3 O9-007 P-gp

9 19 /// 15:25~16:49 O9-008 O9-009 O9-010 O9-011 O9-012 O9-013 O F 1 //DPC// 14:00~15:24 O O O O O O O10-007

10 //DPC// 15:25~16:49 O Xa O ICU/CCU O DPC DPC data O HIV O O O F 9:15~10:39 O O O O O O O

11 19 10:40~12:04 O O O AD/HD O O O O F / 9:00~10:00 O O O /50M50133NPH O O / 10:01~11:01 O O O

12 O O / 11:02~11:50 O O O NaNa O F // 9:00~10:00 O M5E O O O O // 10:01~11:01 O13-006

13 19 O O O O // 11:02~12:02 O O O DS O O F 14:00~15:00 O QOL O Ca/Mg O weekly Paclitaxel/Carboplatin O O14-005

14 15:01~16:13 O O O weekly O O O F /TDM/ 14:00~15:00 O O in vitro O P-glycoprotein paclitaxel O O /TDM/ 15:01~16:13 O15-006

15 19 O O TDM1 TDM O TDM2 O TDM O Bilirubinirinotecan F 1 ///NST 14:00~15:00 O O O O O POS ///NST 15:01~16:13 O O O16-008

16 O O O F / 14:00~15:00 O O O O / 15:01~16:13 O O O OD30mg O % O DPC O O17-004

2

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