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 [...]

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 [...]

I am generally pretty good about not letting my personal life affect my work environment. As we all know, the combination is not usually a great one, especially if things occurring your personal life impact your approach to work, your attitude with others that you are working with, and the work being produced. However, once a year, without fail, the creep of my personal life into my work and professional life occurs. No matter how [...]

Listen to the podcast by clicking on the link below (listen to iTunes here): Episode 2: Counting Stars, Not Dollars: EMP Interventions Show Notes: From the ASHP Guidelines on Emergency Medicine Pharmacy Services (my emphasis in bold): Research on pharmacist interventions in the inpatient setting has demonstrated improvement in patient outcomes through optimized pharmacotherapy regimens, improved monitoring of medication therapy, and avoidance of adverse medication events. In addition, pharmacist participation in patient care has been shown to significantly reduce the costs associated with [...]

The link to the podcast in iTunes is here.Episode 1: The Next Step in Upstairs Care, DownstairsShow Notes:The research and evidence for emergency medicine pharmacists is out there in mass quantity. The ASHP Emergency Care section has done the most complete collection of the existing data and links to the manuscripts.(http://www.ashp.org/emergencycare)Selected citations:Medication errors occur in up to 60% of ED patients - Patanwala AE, Warholak TL, Sanders AB, et al. A prospective observational study of medication [...]

Drug delivery has always been a fascinating subject for me. Some of us may take for granted the countless hours dedicated toward the research, design, and development of new drugs and delivery systems in order to optimize the ability for a drug is able to reach its site of action; essentially, to make sure that the drug that we think will work will actually "do its thing." One such mechanism of enhancing drug delivery is [...]

Part of my responsibility as a pharmacist for the ED includes reviewing medication-related incident reports. I recently came across one case in which a nurse administered 0.3 mg of 1:1000 epinephrine for an anaphylactic reaction by the intravenous (IV) route instead of the intended intramuscular (IM) route. The nurse that gave the medication immediately recognized the error, called the ED attending physician to the bedside, and the patient was closely monitored until the effects of [...]