ID in the EDQuick and dirty review: LinezolidDrug shortages and intravenous fluid shortages are reaching critical mass. Pharmacotherapeutic decisions are being forced, and unusual therapeutic strategies are being implemented. One of these scenarios is the substitution of vancomycin for linezolid for empiric treatment of various infectious disease indications. While a detailed therapeutic review would be more fitting for general practice, the bizzaro world of drug shortages is anything but general. So let’s review linezolid for [...]

//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js (adsbygoogle = window.adsbygoogle || []).push({ google_ad_client: "ca-pub-7409520543460672", enable_page_level_ads: true }); Angiotensin-II (Ang2) is now an FDA approved vasopressor. With this new addition to the available options, experts are combing over the available literature to determine whether or not to incorporate it into their daily practice. The ATHOS-3 trial has demonstrated that Ang2 is, at minimum, safe and effective when added to norepinephrine (or other similarly dosed vasopressor).1 While this trial should be critically appraised, [...]

There have been two recent FOAMed posts on the topic of endocarditis by REBEL EM and EMDocs. Both posts do a great job discussing risk factors, pathophysiology, signs and symptoms, and the diagnosis of endocarditis. However, we believe a more in-depth review of appropriate empiric antibiotic selection is prudent. As the ED pharmacist, we are ultimately responsible for making sure our patients get the most appropriate antibiotics. Additionally, whatever regimen is started downstairs is commonly continued [...]

Many institutions have implemented antimicrobial restriction programs where specific agents, based on toxicity, cost, or broad-spectrum of activity, require special permission for use. Often a page is required to initiate the request. During my infectious diseases PGY-2 I carried this antimicrobial approval pager, either approving the use of restricted agents or offering suggesting on alternative therapy. Fluoroquinolones (FQs) were by far, the most requested restricted antimicrobials, and also the most denied. In emergency departments without [...]

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 [...]