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 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 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. […]

In this episode, I’ll discuss whether standard doses of apixaban are as effective as warfarin in severe obesity. Subscribe on iTunes, Android, or Stitcher Initial studies for apixaban such as ARISTOTLE had a median weight of 82 kg and did not focus on determining efficacy in a severely obese patient population. Because of the lack […]

In this episode, I’ll discuss how to judge whether a journal is reputable. Subscribe on iTunes, Android, or Stitcher Shout out to “Pharmacy Kelsey” for inspiring this episode! There are dozens of well-established journals that when we read an article in them, the thought never comes to mind “Is this journal reputable?” But there are […]

In this episode, I’ll discuss why I think a recent study about 3 days of outpatient remdesivir is probably not going to catch on. Subscribe on iTunes, Android, or Stitcher In the past week, a randomized trial was published in NEJM titled Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. This trial was […]

In this episode, I’ll discuss a novel metric for antibiotic stewardship. Subscribe on iTunes, Android, or Stitcher Days of Therapy (DOT) is probably the most common metric to track antimicrobial stewardship efforts related to antibiotic consumption. DOT is not a perfect metric as it is calculated by calendar day regardless of the number of doses […]

In this episode, I’ll discuss ketamine vs etomidate for RSI. Subscribe on iTunes, Android, or Stitcher Countless journal articles, podcast episodes, blog posts, and social media posts have been filled up comparing and contrasting the pros and cons of ketamine vs etomidate for sedation prior to rapid sequence intubation (RSI). While there are differences between […]

In this episode, I’ll discuss what predicts critical care pharmacist intervention – patient acuity or medication regimen complexity? Subscribe on iTunes, Android, or Stitcher It makes intuitive sense that both scenarios of high patient acuity and high medication regimen complexity would be legitimate ways of identifying ICU patients who are more likely to need pharmacist […]

In this episode, I’ll discuss how to answer a question like an experienced pharmacist, even if you’re brand new. Subscribe on iTunes, Android, or Stitcher The ED physician calls you on the phone and asks “What is the half-life of methadone?” How should you answer this question? This question is an example of an obscure […]

In this episode, I’ll discuss a recent article about vancomycin monitoring. Subscribe on iTunes, Android, or Stitcher Shout out to “Pharmacy David,” “Pharmacy Lisa,” and “Pharmacy Kathryn” at the Department of Pharmacy Practice & Science, University of Arizona for inspiring this episode! I can’t remember ever being as excited about a journal article as I […]