In this episode, I’ll discuss alternatives to etomidate during the shortage. Subscribe on iTunes, Android, or Stitcher Despite there being multiple manufacturers, some institutions are unable to resupply etomidate stock due to shortages at nearly all manufacturers. The most common uses of etomidate are for sedation – either an anesthetic dose for rapid sequence intubation […]

In this episode, I’ll discuss how propofol appears to interfere with monitoring heparin using aPTT. Subscribe on iTunes, Android, or Stitcher Heparin and propofol have been used together in critically ill patients for decades, but is it possible that there has been a lab interference interaction between these two medications the whole time? A group […]

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 why vaccines aren’t given in the 14 days after non-elective splenectomy. Subscribe on iTunes, Android, or Stitcher This recommendation is based on a small study of 59 splenectomy patients where pneumococcal vaccine response at 1, 7, and 14 days post-splenectomy were compared. Better functional antibody responses against the serogroup and […]

In this episode, I’ll discuss amiodarone vs lidocaine for in-hospital cardiac arrest. Subscribe on iTunes, Android, or Stitcher The ACLS guidelines suggest either amiodarone or lidocaine for in-hospital cardiac arrest that is due to ventricular tachycardia or ventricular fibrillation (VT/VF). However this recommendation has always been based on data from out-of-hospital cardiac arrest studies. A […]

In this episode, I’ll discuss what an inpatient pharmacist needs to know about the outpatient CDC opioid guidelines. Subscribe on iTunes, Android, or Stitcher The CDC has updated its Clinical Practice Guideline for Prescribing Opioids for Pain and published it in the first Morbidity and Mortality Weekly Report of November 2022. The guideline specifically states […]

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 haloperidol for the treatment of delirium in ICU patients. Subscribe on iTunes, Android, or Stitcher Despite there not being strong literature support to justify use to improve outcomes, haloperidol is frequently used to treat ICU patients with delirium. A systematic review of the available evidence published in 2020 identified only […]

In this episode, I’ll discuss cefazolin and ertapenem combination therapy for refractory MSSA bacteremia. Subscribe on iTunes, Android, or Stitcher A recent case series published in Clinical Infectious Diseases describes the successful treatment of 11 patients with persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. The authors had an index case where they discovered apparent synergy against […]

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 whether phenobarbital offers a clinically meaningful advantage over benzodiazepines for alcohol withdrawal in the ED. Subscribe on iTunes, Android, or Stitcher Some clinicians prefer phenobarbital over benzodiazepines for alcohol withdrawal patients presenting to the emergency department. Like benzos, phenobarbital targets gamma-aminobutyric acid (GABA) receptors in the central nervous system. However […]

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 […]