A few weeks ago, we received an interesting question from one of the ED attending physicians regarding the immunogenicity of alteplase. Providing him with an answer made me realize to not take for granted the information available regarding the differences between the various thrombolytic agents, and reading more about this topic made me a bit humbled by the years of research and clinical experience that went into what we currently know today about these agents. [...]

While I’m not a huge fan of nitroglycerin paste, I understand it’s clinical usefulness. The ability of slapping on an inch of paste to relieve chest discomfort is certainly non-invasive and can achieve effective results.  With this simplicity, a degree of randomness exists with regard to the ability to titrate the dose.  If the desired clinical effect is not achieved, how much more can we apply safely? Conversely, if hypotension results, how long will the [...]

Since starting my residency, nicardipine has become one of the drugs that I have grown to love…maybe even becoming one of my favorite drugs to use for blood pressure control, especially in neurological emergencies such as acute ischemic stroke and subarachnoid hemorrhage. Time and time again, it has never failed me in these settings. It’s like a best friend who shows up at the right place and at the right time who knows exactly what [...]

Extended infusion beta-lactam antibiotic administration is a growing trend in US hospitals. This dosing strategy takes advantage of the pharmacodynamics properties of drugs like Zosyn (piperacillin/tazobactam), improving time over the MIC (T>MIC) to susceptible bacteria while providing cost savings. Based on computer Monte-Carlo simulations, dosing Zosyn 3.375g IV q8 infused over 4 hours, the same probability of achieving a therapeutic T>MIC is reached as dosing Zosyn 3.375g IV q6 infused over 30 minutes.  It’s a [...]

The recent weather events here in NY and NJ made me admire the efforts of the staff at NYU to evacuate their patients and caused me to reflect on what it was like being part of the evacuation for Irene last year.  The pharmacy department of NYU and all other hospitals in the area worked behind the scenes, away from the news, to ensure each evacuated patient was sent with three days worth of medication.  [...]

So I live in jersey city and Sandy decided my street belongs in the Hudson River. I'll be back up and running in a few days. Stay tuned!

Open the Pyxis or Omnicell or fridge in your ED where insulin is stored. How many different vials are stocked? If you’re like most other EDs in the USA you’ll find a rapid acting insulin (aspart, glulisine, lispro) mainly used for hospital sliding scale regimens, insulin regular (fast acting) for IV use, an insulin mix (NPH or aspart/aspart protamine), and a long acting insulin (glargine or detemir) for maintenance.  With similar sounding, appearing and often [...]

By: Nadia Awad, Pharm.D. It seems like nowadays, every ED drug and its mother is on a manufacturer shortage. Epinephrine? Check. Etomidate? Check. Succinylcholine? Check. Sodium bicarbonate? Check. Some are on shortage for only a short period of time and may seem like that they were never gone to begin with, while others may be on a critical long-term shortage for various reasons. Pharmacists and pharmacy buyers alike are literally pulling their hair out trying [...]

I had an interesting discussions in the ED the otherday when I was talking about the importance of administering epi via IM for anaphylaxis.  Is there a diminished response to epi if a patients is on a beta-blocker?Let’s clarify: patients on chronic non-selective beta-blocker therapy may have a blunted effect of epinephrine in anaphylaxis but epinephrine administration may also result in profound hypertension and bradycardia or heart block.Non-selective beta-blockers will blunt the bronchodilatory effects of [...]

When the literature behind ticagrelor hit, there seemed to be a short-lived cheer. Where prasugrel (Effient) fell short, this drug excelled - superior (composite endpoint of vascular death, MI and stroke) to clopidogrel (Plavix) with no excess bleeding. What followed was a resounding thud since 10% of the population in PLATO, who were from North America, did not see this benefit. But the confusion didn’t end there.  Especially for pharmacists…In a mysterious turn of events, [...]