In this episode, I’ll discuss if antibiotic exposure intensity affects the risk of clostridioides difficile infection. Subscribe on iTunes, Android, or Stitcher The antibiotic spectrum index (ASI) was developed to classify commonly used antibiotics based on activity against relevant pathogens. In the ASI antibiotics are given points based on the number of unique pathogens they […]

In this episode, I’ll discuss if phentolamine is the only thing you can use for vasopressor extravasation. Subscribe on iTunes, Android, or Stitcher Extravasation is a complication of IV therapy that refers to the infiltration of tissues with a medication that is an irritant or vesicant. Infiltration can be done purposefully with therapeutic intent, such […]

In this episode, I’ll discuss assessing the risk of bias in a review of nonrandomized studies. Subscribe on iTunes, Android, or Stitcher According to training by Cochrane, bias in a meta-analysis is a systematic error or deviation from the truth. A risk of bias assessment of studies included in a meta-analysis is essential because the […]

In this episode, I’ll discuss what if it is not the sedative class that causes delirium – just the depth of sedation? Subscribe on iTunes, Android, or Stitcher Both the 2013 and 2018 SCCM guidelines for sedation in the ICU recommend avoiding benzodiazepine infusions for sedation in the ICU. The reason for this is in […]

In this episode, I’ll discuss what blood gas parameters can make you suspect methemoglobinemia. Subscribe on iTunes, Android, or Stitcher Methemoglobin is formed when the ferrous irons of heme are oxidized to the ferric state. The ferric hemes of methemoglobin are unable to bind oxygen, therefore, causing a functional anemia. Acquired methemoglobinemia is typically a reaction […]

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 of giving a full-dose cephalosporin challenge to patients with a moderate, severe, or unknown beta-lactam allergy. Subscribe on iTunes, Android, or Stitcher The label of “penicillin allergic” usually sticks to a patient’s medical record forever. The trouble is that many recorded allergies are actually intolerances, such as nausea, […]

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 the 4 categories of interventions to treat medication overdose and why antidote is not #1. Subscribe on iTunes, Android, or Stitcher I consider the 4 categories of interventions to treat medication overdose to be: #1 Supportive care #2 Antidote therapy #3 Decontamination #4 Enhance elimination As pharmacists, it is easy […]

In this episode, I’ll discuss the rare case when a very hypotonic solution may be indicated. Subscribe on iTunes, Android, or Stitcher A recent 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 […]

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 efficacy tradeoff when reducing apixaban dose in patients with end-stage renal disease. Subscribe on iTunes, Android, or Stitcher The prescribing information for apixaban recommends not reducing the dose when being used in patients with end-stage renal disease and atrial fibrillation. However, renal elimination accounts for 27% of apixaban clearance. […]