In this episode, I’ll discuss anti-Xa monitoring of enoxaparin in VTE prophylaxis. Subscribe on iTunes, Android, or Stitcher An advantage of using enoxaparin for VTE prophylaxis is that it has predictable pharmacokinetics and pharmacodyamics which allow for either fixed dosing of 40 mg subQ once daily or 0.5 mg/kg in the case of obese patients. […]

In this episode, I’ll discuss using gabapentin to reduce benzodiazepine use in patients hospitalized with alcohol withdrawal. Subscribe on iTunes, Android, or Stitcher Because gabapentin’s mechanism of action fits the pathophysiology of alcohol withdrawal, many investigators have sought to test gabapentin for this condition. Chronic ethanol use affects receptors in the brain in two ways: […]

In this episode, I’ll discuss the bioavailability of methadone. Subscribe on iTunes, Android, or Stitcher Popular tertiary references suggest a conversion ratio of oral to IV methadone of 2:1, meaning 10 mg of oral methadone is equivalent to 5 mg of IV methadone. But a team of researchers published a scoping review on the bioavailability […]

In this episode, I’ll discuss the prediction of hypotension from propofol when used as an ICU sedative. Subscribe on iTunes, Android, or Stitcher Hypotension from ICU sedatives like propofol and dexmedetomidine can complicate patient management.  I discussed predicting hypotension from dexmedetomidine back in Episode 853. Hypotension from propofol in the ICU can also be reasonably […]

In this episode, I’ll discuss the AHA/NCS scientific statement on critical care management of patients after cardiac arrest. Subscribe on iTunes, Android, or Stitcher There is a lack of high-quality published research to support the critical care management of patients after cardiac arrest, and as a result there are few guideline recommendations in this area. […]

In this episode, I’ll discuss 5 changes to the ACLS guidelines that hospital pharmacists should know about. Subscribe on iTunes, Android, or Stitcher The ACLS guidelines have been updated for 2025 and published at cpr.heart.org, and updated algorithms can be found at this link. Some notable changes are: 1. Vasopressin has been downgraded from a […]

In this episode, I’ll discuss whether diuretics are safe for reducing fluid balance in critically ill patients. Subscribe on iTunes, Android, or Stitcher Interest in fluid balance and the associated adverse effects in ICU patients has grown considerably over the last decade. The general practice of reducing fluid balance, sometimes referred to as deresuscitation, is […]

In this episode, I’ll discuss the evidence supporting using cefazolin for MSSA bacteremia. Subscribe on iTunes, Android, or Stitcher The strongest data on what to use to treat MSSA bacteremia has always been for the penicillinase-resistant penicillins like nafcillin and cloxacillin. But these antibiotics have high rates of adverse events. Cefazolin has a much more […]

In this episode, I’ll discuss 5 steps an ED or ICU pharmacist can take to prevent awareness with paralysis. Subscribe on iTunes, Android, or Stitcher Awareness with paralysis occurs when a patient receives a paralytic for rapid sequence intubation but does not receive ongoing sedation before the induction agent wears off. In the context of […]

In this episode, I’ll discuss the balance between the risk of cerebral edema from severe hyponatremia vs osmotic demyelination from overly rapid sodium correction. Subscribe on iTunes, Android, or Stitcher The risk of irreversible neurologic damage from osmotic demyelination after overly rapid correction of severe hyponatremia is significant. Over the years the maximum recommended increase […]

In this episode, I’ll discuss whether a nasal MRSA screen is useful for choosing antibiotics in critically ill patients with an intra-abdominal infection. Subscribe on iTunes, Android, or Stitcher A recent multicenter, retrospective, cohort study looking at the performance of a nasal MRSA screen in predicting intraabdominal infection with MRSA was published in the journal Pharmacotherapy. […]

In this episode, I’ll discuss respiratory depression from phenobarbital when used for alcohol withdrawal syndrome. Subscribe on iTunes, Android, or Stitcher Phenobarbital is increasing in popularity among clinicians for use in the treatment of alcohol withdrawal syndrome. Even though there is less data available on patient outcomes using phenobarbital over benzodiazepines for severe alcohol withdrawal, […]