Listen to the podcast by clicking on the link below (link on iTunes available here):  EMPOWER Episode 4 - Rapid Oral Loading of Antiepileptic Drugs (AEDs) in the Emergency Department Show Notes: Core content from this episode discussed in: DiPiro's Pharmacotherapy, 9th Edition, Chapter 40 Goodman and Gilman's The Pharmacological Basis of Therapeutics, 12th Edition, Chapter 21 Selection portions of Winter's Basic Clinical Pharmacokinetics, 3rd Edition ACEP Clinical Policy (updated in 2014): Huff JS, Melnick [...]

Flecainide and propafenone are the only Class Ic antiarrhythmic drugs (AADs) available in the United States. These agents block the fast sodium channels within cardiomyocytes, thereby decreasing the rate of rise and magnitude of the action potential. This causes a slowing of conduction velocity, without increasing the effective refractory period. While these agents are particularly useful for atrial fibrillation (AF) and atrial flutter, utilization remains low because their contraindications exclude many patients who would otherwise [...]

Topical antibiotic therapy for ear infections isn’t something you’re going to see as an earth shaking presentation at a good conference, or in a heated debate between the Swami and anyone who dare challenge him. It’s not even something that you would think is driven by dogma and anecdote rather than evidence.  Rarely is it even a thought that is questioned upon reviewing an order or writing a prescription. Generally, the whole subject is held [...]

For those of you who participated in the EM PharmD JC, thank you!Here is the video of the Google Hangout. If you have any questions or comments for the JC or to add to the discussion, please feel free to write in the comments in the Google+ feed of the event page or Twitter using the #EMPharmD hashtag. The citations for the articles again were:Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid [...]

Please join us tomorrow (Wednesday, August 13th) at 2:00 PM EST for the EMPharmD JC.  We will be discussing the following articles:Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009 Jul 25;374(9686):293-300. PMID: 19573904ANDCohen L et al. The Effect of Ketamine on Intracranial and Cerebral Perfusion Pressure and Health Outcomes: A Systematic Review. Ann Emerg Med. 2014 Jul [...]

So you have a patient who presents to your emergency department after being brought in by EMS with a three-day history of nausea and vomiting. The patient has had what he describes as a “pretty rough weekend” and admits to have consumed large quantities of alcoholic beverages. While you are examining the patient, the patient has two episodes of tonic-clonic seizures, both episodes subsiding with administration of benzodiazepines. Labs are collected, and the complete metabolic [...]

One week from today on Wednesday, August 13th at 2 PM EST I will be hosting the first EM PharmD Journal club via Google Hangout. The current Rutgers EM Pharmacy PGY-2 residents will be presenting two articles.Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009 Jul 25;374(9686):293-300 PMID: 19573904AND Cohen L et al. The Effect of Ketamine on Intracranial and [...]

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 [...]