The last post on EMPharmD concerning fixed-dose Kcentra was way back in June, 2015 and discussed a newly published article by Klein et al. examining 1500 units of 4-factor prothrombin complex concentrate (4PCC) for warfarin reversal.(1)  Since that post, only one additional article has been published regarding fixed-dose 4PCC, and unfortunately, Abdoellakhan et al. only used 1000 units per dose as part of their protocol. As to be expected with the lower dosing, achievement of [...]

In the process of caring for patients suffering from acute ischemic stroke (AIS), a cognitive bias shifts the focus of our typical approach to drug therapy selection. Rather than approach a problem and determine whether a drug is going to help, in the case of alteplase for AIS, we often look for reasons not to give this drug (contraindications) and fail to ask whether the given patient will benefit. Fewer still will ask, what is [...]

Pharmacists have been shown to improve adherence to advanced cardiovascular life support (ACLS) guidelines (1,2), and pharmacist involvement adds instant drug expertise during intense situations. Not to mention, the multidisciplinary team wants us there at the bedside. Nurses and providers surveyed have overwhelmingly (97%) believed that having a pharmacist present during a medical resuscitation enhances their ability to deliver safe, quality care to patients.(3) The large amount of code cart drugs suffering from national shortages [...]

Tranexamic acid (TXA), an antifibrinolytic agent used to prevent clot breakdown in hemorrhaging trauma patients, has been shown in the CRASH-2, MATTERS, and PED-TRAX trials to reduce overall mortality in adult and pediatric patients.1-3 Additional mortality benefits were seen in the MATTERS trial among patients who received a massive transfusion protocol (MTP) with a number needed to treat (NNT) of 15 in the overall cohort compared to a NNT of 7 in MTP cohort.2 Although [...]

I recently had the opportunity of recording a podcast episode for the Virtual Critical Care Rounds (VCCR) of the Society of Critical Care Medicine (SCCM) with Sean Kane, PharmD, BCPS (@ClinCalc). We discussed the nuances of acetaminophen toxicity and practical application of the Rumack-Matthew nomogram in the clinical setting. You can find the link to the podcast episode here (as well as other episodes of the SCCM VCCR). Some suggested references for the episode are [...]

IntroductionNausea and vomiting is a common ailment in pregnancy affecting approximately 70 to 80% of all pregnant women. (1) Ondansetron, a 5-HT3 receptor antagonist, is commonly used to treat nausea and vomiting of varying etiologies including hyperemesis gravidarum. (2) Recently the safety of ondansetron in pregnancy has been called into question. Concern for fetal abnormalities, including cardiac malformations and cleft palates caused by ondansetron have been raised, leading to a petition to the Food and [...]

I had the chance to talk with Sean P. Kane, PharmD, BCPS about angiotensin-converting enzyme (ACE) inhibitor-induced angioedema. And it was recorded!As part of the SCCM VCCR podcast, this episode we spoke about a variety of treatment approaches for ACE inhibitor-induced angioedema are discussed, including fresh frozen plasma, ecallantide, icatibant, and conventional therapies for undifferentiated angioedema. Here is the link, and some show notes to go along with it.Compared to a type 1 IGE mediated [...]

Obstetric emergencies can be challenging to many pharmacists given the critical nature of these diseases and the need for immediate recall of medication information ranging from teratogenicity to second/third line agents in light of drug shortages.(1-4) Ectopic pregnancy is one of those scenarios where advanced knowledge and comprehension of the medical management is essential for pharmacists working in emergency departments. This, in large part, is as a result of the frequent use of methotrexate for [...]

After 6 years of experience since completion of my residency training, I have felt a tremendous amount of growth. As I have said earlier, the more experience I gain, the more I respect those who have it, and realize how little I truly have. There is no hidden meaning or cryptic message. Rather than resisting advice or guidance, I now listen to someone who's been through it all and come out wiser. It's such an [...]

After 6 years of experience since completion of my residency training, I have felt a tremendous amount of growth. As I have said earlier, the more experience I gain, the more I respect those who have it, and realize how little I truly have. There is no hidden meaning or cryptic message. Rather than resisting advice or guidance, I now listen to someone who's been through it all and come out wiser. It's such an [...]