In this episode, I’ll discuss recommendations on the dose of cefazolin for a CNS infection. Subscribe on iTunes, Android, or Stitcher When a CNS infection such as meningitis, ventriculitis, or a brain abscess is due to methicillin susceptible staph aureus, an antistaphylococcal penicillin such as nafcillin has been considered the first-line therapy. With the long […]

In this episode, I’ll discuss whether the beta-lactam should be given before vancomycin in patients with sepsis that need both antibiotics. Subscribe on iTunes, Android, or Stitcher While there is plenty of data to justify efforts to administer antibiotics to patients with sepsis quickly, there is little information to guide whether the order of administration […]

In this episode, I’ll discuss the IV vs nebulized route for tranexamic acid to treat hemoptysis. Subscribe on iTunes, Android, or Stitcher In the treatment of hemoptysis, tranexamic acid has been given via the IV route and topically via nebulization. These two routes of administration were compared in a randomized controlled trial for the first […]

In this episode, I’ll discuss N-acetylcysteine in non-acetaminophen-induced acute liver failure. Subscribe on iTunes, Android, or Stitcher Treatment of acute liver failure with N-acetylcysteine is the first thing that comes to mind if the liver failure is due to acetaminophen. However acute liver failure from causes other than acetaminophen may also respond to treatment with […]

In this episode, I’ll discuss four potential reasons for a false heparin anti-Xa level. Subscribe on iTunes, Android, or Stitcher Monitoring heparin infusions using anti-Xa levels instead of aPTT is becoming a widespread strategy in hospital laboratories. The main benefits of monitoring heparin by anti-Xa are said to be: Better correlation to actual heparin level […]

In this episode, I’ll discuss whether psychotropic medications other than benzodiazepines enhance respiratory depression from opioids. Subscribe on iTunes, Android, or Stitcher Benzodiazepines are known to increase the risk of respiratory depression in patients who are taking opioids, and the FDA mandates a boxed warning to this effect in the prescribing information for both opioids […]

In this episode, I’ll discuss tranexamic acid for controlling iatrogenic bleeding during flexible bronchoscopy. Subscribe on iTunes, Android, or Stitcher While pharmacists are not typically present when a bronchoscopy takes place, medications are involved both to help the patient tolerate the procedure and to address issues that come up as a result of the procedure. […]

In this episode, I’ll discuss adjunctive inhaled antibiotics for ICU patients with pneumonia and invasive ventilation. Subscribe on iTunes, Android, or Stitcher A theoretical benefit of using adjunctive inhaled antibiotics to treat ICU patients with pneumonia and invasive ventilation is that it allows for high concentrations at the site of the infection and the potential […]

In this episode, I’ll discuss why the CAP guidelines do not recommend treating most cases of suspected aspiration pneumonia with broadening antibiotic therapy. Subscribe on iTunes, Android, or Stitcher Broadening therapy in community-acquired pneumonia to cover potential anaerobes in the case of suspected aspiration pneumonia is a common occurrence. This results in the use of […]

In this episode, I’ll discuss the 4 clinical teaching roles for residency preceptors. Subscribe on iTunes, Android, or Stitcher The 4 teaching roles that ASHP wants PGY-1 residency preceptors to use are: 1. Instructing 2. Modeling 3. Coaching 4. Facilitating ASHP expects that PGY-1 residency preceptors have a working knowledge of these roles. During a […]

In this episode, I’ll discuss whether milrinone can be used in patients on CRRT. Subscribe on iTunes, Android, or Stitcher Occasionally ICU patients undergoing continuous renal replacement therapy (CRRT) will also require inotropic support for conditions like heart failure with reduced ejection fraction in the setting of decreased cardiac contractility. Dobutamine and milrinone are the […]

In this episode, I’ll discuss peripheral IV administration of 3% sodium chloride solution. Subscribe on iTunes, Android, or Stitcher Infusions of 3% sodium chloride are routinely recommended to be given through central, not peripheral IV lines. This recommendation is based on the theory that since the osmolarity of 3% sodium chloride exceeds 900 mOsm/L, it […]