Physostigmine is a reversible cholinesterase inhibitor used in the management of antimuscarinic toxicity.  It differs from pharmacologically similar medications, such as neostigmine and pyridostigmine, due to its tertiary amine structure, which facilitates entry into the central nervous system.  By crossing the blood-brain barrier, we can expect it to be effective for reversal of both peripheral and central signs of the antimuscarinic toxidrome [1].Inhibition of the cholinesterase enzyme will cause an increase of acetylcholine in the [...]

Listen to the podcast by clicking on the link below (link to iTunes here): Episode 3: Pipeline Antidotes for Target Specific Oral Anticoagulants Show Notes: Core content from this episode discussed in: DiPiro's Pharmacotherapy, 9th Edition, Chapter 9 Goodman and Gilman's The Pharmacological Basis of Therapeutics, 12th Edition, Chapter 30 Published articles and references and ongoing trials related to pipeline antidotes for target specific oral anticoagulants discussed during this episode: Idarucizumab [also known as aDabiFab] [...]

One of the most entertaining emergency physicians I work with has fallen head over heels in love with intravenous (IV) acetaminophen. He jokes that he orders the product at least once per shift just to get a “visit” from me. I trade jabs, asking how many golf trips he’s received from the manufacturers of IV acetaminophen (trade name Ofirmev).I had the opportunity a few years ago to complete a formulary review of the IV acetaminophen [...]

Note: This post has been featured on MedPage Today, with personal commentary provided within the piece.For those of you who may have missed it on Twitter yesterday, the Drug Enforcement Administration (DEA) has officially classified tramadol as a Schedule IV substance within the United States under the Controlled Substance Act, which will be effective as of August 18 of this year. You may be wondering, “So, what’s the big fuss about tramadol that led to [...]