In this episode, I’ll discuss how aggressively extremely high blood pressure should be managed in patients with ICH. Subscribe on iTunes, Android, or Stitcher AHA guidelines for the management of spontaneous intracerebral hemorrhage (ICH) split hypertension management recommendations into two groups based on the strength of available evidence.  The first group is those with a blood […]

In this episode, I’ll discuss the pharmacist’s role in predicting the need for intubation. Subscribe on iTunes, Android, or Stitcher Because of how drug delivery systems are set up in most US hospitals with medications stored in automated dispensing cabinets, there can be a considerable delay between the time a physician makes a decision to […]

In this episode, I’ll discuss the risk factors for not attaining target beta-lactam levels in ICU patients. Subscribe on iTunes, Android, or Stitcher For beta-lactam antibiotics, an adequate time above the MIC is essential to achieve clinical success. However, critically ill patients undergo physiologic changes that may make achieving adequate time above MIC difficult. This […]

In this episode, I’ll discuss opportunities for antibiotic stewardship before hospital discharge. Subscribe on iTunes, Android, or Stitcher A primary focus of antibiotic stewardship programs is to reduce unnecessary antibiotic use among hospital inpatients. Reducing unnecessary antibiotic use upon hospital discharge is not a popular focus among the majority of stewardship programs. However, a significant […]

In this episode, I’ll discuss 3 reasons to consider holding lithium in critically ill patients. Subscribe on iTunes, Android, or Stitcher Chronic medications, especially neuro-active ones, are often resumed in the ICU as soon as critically ill patients can tolerate them.  Lithium, however, has a particularly narrow therapeutic range and the potential for toxicity to […]

In this episode, I’ll discuss a tip for taking care of patients with a rare disease. Subscribe on iTunes, Android, or Stitcher There exists a large number of rare diseases that any given pharmacist might encounter once in their practice, if at all. Many of these diseases are exacerbated by certain medications but because of their […]

In this episode, I’ll discuss the first randomized controlled trial of midodrine for weaning vasopressors. Subscribe on iTunes, Android, or Stitcher Using midodrine to wean ICU patients off of vasopressors is a common strategy and one that I have used in my practice and discussed in previous episodes. The general principle is that some ICU patients […]

In this episode, I’ll discuss lab interference from the supplement biotin. Subscribe on iTunes, Android, or Stitcher The prevalence of biotin use may be as high as 7.7% according to a 2018 survey of an ED patient population. This supplement is sold as having effects on hair, nail, and skin health. Alternate names for biotin are […]

In this episode, I’ll discuss expectations for the onset of action of IM medications used for acute agitation. Subscribe on iTunes, Android, or Stitcher When caring for an acutely agitated patient, the delay between IM medication administration and the onset of action can seem exceedingly long. Staff and patient safety continue to be at risk until […]

In this episode, I’ll discuss using heparin anti-Xa levels to evaluate apixaban, rivaroxaban, fondaparinux, and danaparoid levels. Subscribe on iTunes, Android, or Stitcher Anti-Xa inhibitors such as apixaban, rivaroxaban, fondaparinux, and danaparoid do not have readily available assays, yet there is often a clinical need to determine their presence or absence. Because heparin anti-Xa assays are […]

In this episode, I’ll discuss the use of tetanus immune globulin. Subscribe on iTunes, Android, or Stitcher Tetanus Immune Globulin can be part of successful tetanus post-exposure prophylaxis for certain patients as well as tetanus treatment. In post-exposure prophylaxis scenarios, tetanus immune globulin provides immediate but temporary passive immunity to tetanus. The immunity is conferred because […]

In this episode, I’ll discuss three ways to tell the difference between serotonin syndrome and neuroleptic malignant syndrome. Subscribe on iTunes, Android, or Stitcher Muscular rigidity, significant hyperthermia, and autonomic instability are all common features of serotonin syndrome and neuroleptic malignant syndrome. While these two syndromes are very similar in presentation, they can usually be differentiated […]