In this episode, I’ll discuss the importance of timely ordering and administration of antiparkinsonian medications for patients in the ED. Subscribe on iTunes, Android, or Stitcher It is well established that maintaining the medication regimen for a patient with Parkinson’s disease is essential and that not doing so can have deleterious effects on morbidity and […]

In this episode, I’ll discuss the problem with hypo-osmolar solutions in neurological patients. Subscribe on iTunes, Android, or Stitcher The administration of hypo-osmolar IV solutions causes an increase in water into the brain.  This is because an intact blood-brain barrier is permeable to water but not electrolytes.  When the blood brain barrier is intact, and […]

In this episode, I’ll discuss the impact two new recommendations in the Surviving Sepsis guidelines on hospital pharmacy practice. Subscribe on iTunes, Android, or Stitcher The new Surviving Sepsis Guidelines are out and at least two new recommendations are going to keep hospital pharmacists busy implementing. The first is on extended infusions of beta-lactam antibiotics: […]

In this episode, I’ll discuss the impact of achieving an aggressive PK/PD target for beta-lactams in critically ill patients. Subscribe on iTunes, Android, or Stitcher Therapeutic drug monitoring for beta-lactams has not yet made it to the mainstream in all hospitals, but data continues to accumulate that I believe will eventually compel clinicians to check […]

In this episode, I’ll discuss suppressing unnecessary allergy alerts for beta-lactams with dissimilar side chains. Subscribe on iTunes, Android, or Stitcher Hospital laboratories routinely suppress antibiotic sensitivity data on microbiology reports in the name of antibiotic stewardship. The practice is fairly straightforward – if E. coli is sensitive to ceftriaxone, there is no reason to […]

In this episode, I’ll discuss the rare case when a very hypotonic solution may be indicated. Subscribe on iTunes, Android, or Stitcher A commentary published in AJHP argues for abandoning the use of extremely hypo-osmolar intravenous solutions to treat hypernatremia. The authors consider extremely hypotonic solutions to be 0.225% sodium chloride (also called one-quarter normal […]

In this episode, I’ll discuss oral vs IV phosphate replacement for critically ill patients with mild to moderate hypophosphatemia. Subscribe on iTunes, Android, or Stitcher IV phosphate is frequently used to replace low serum phosphate levels in critically ill patients. However this often requires the administration of significant amounts of IV fluid, which can complicate […]

In this episode, I’ll discuss the impact of ceftriaxone on the development of pneumonia and noninfectious outcomes after out-of-hospital cardiac arrest. Subscribe on iTunes, Android, or Stitcher While previous studies have shown that ceftriaxone can prevent pneumonia after out-of-hospital cardiac arrest (OHCA), the effects on other outcomes, such as mortality and the development of resistance, […]

In this episode, I’ll discuss endobronchial instillation of epinephrine, cold saline, and saline to prevent bleeding in patients undergoing endobronchial biopsy. Subscribe on iTunes, Android, or Stitcher Severe bleeding as a result of an endobronchial biopsy has the potential for serious and even fatal patient outcomes. Providers routinely administer medications through the channel of the […]

In this episode, I’ll discuss how to judge whether a journal is reputable. Subscribe on iTunes, Android, or Stitcher There are dozens of well-established journals that when we read an article in them, the thought never comes to mind “Is this journal reputable?” But there are also journals with little or even no peer review, […]

In this episode, I’ll discuss oral beta-lactams for complicated UTIs. Subscribe on iTunes, Android, or Stitcher Most oral beta-lactams (especially cephalosporins)have usually been avoided when treating complicated UTIs out of concern for reduced effectiveness. However, in light of increasing resistance and toxicity issues with fluoroquinolones and trimethoprim/sulfamethoxazole (TMP/SMX), researchers are re-examining oral beta-lactams to see […]

In this episode, I’ll discuss a novel metric for antibiotic stewardship. Subscribe on iTunes, Android, or Stitcher Days of Therapy (DOT) is probably the most common metric to track antimicrobial stewardship efforts related to antibiotic consumption. DOT is not a perfect metric as it is calculated by calendar day regardless of the number of doses […]