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TEDMED Talk – Publication Bias

"Evidence Based" Medicine - Ben GoldacreIt's amazing how fast ideas spread. I recently watched this TEDMED talk with the pharmacy students on my rotation as well as my pharmacy resident.  I've linked the Life In The Fast Lane post about it, since I've followed this site for a while and hope to see how the discussion grows.It's something we should all consider whenever interpreting data about new or old drugs... Are we getting the whole [...]

By |2012-09-29T12:34:00-05:00September 29th, 2012|EM PharmD Blog|0 Comments

The best drug you aren’t using: Fosphenytoin

Fosphenytoin (fosPHT) is not a new drug. It was designed to improve the water solubility of phenytoin (PHT) thereby reducing the risk of cardiac arrhythmias and hypotension during administration (from lack of propylene glycol, although PHT is still a 1b antiarrhythmic). Improved water solubility also eliminates the risk of tissue necrosis if extravasation occurs. This allows for much more rapid infusion of fosPHT (150mg/min) as well as ability to administer IM.  Unfortunately, the drug failed [...]

By |2012-09-27T13:10:00-05:00September 27th, 2012|EM PharmD Blog|0 Comments

Hypercalcemia: Pamidronate vs Zoledronic acid

We use IV bisphosphonates in acute hypercalcemia with theunderstanding that they’ll help achieve a normal calcium level in about 72hours.  Aside from the importantcomponents of this treatment that will have more of an immediate effect (fluid,diuretics, steroids, calcitonin); which bisphosphonate is best?Since oral bisphosphonates have extremely low bioavailablity(1-2%), IV agents like pamidronate and zoledronic acid become the two leadingcandidates.Even though these drugs do reach their peak effect for days,we do want to administer them as [...]

By |2012-09-25T10:51:00-05:00September 25th, 2012|EM PharmD Blog|0 Comments

Equiosmolar loads from sodium chloride vs sodium bicarbonate

It's an interesting dilemma when considering how exactly to safely integrate hyperosmolar sodium chloride products into the emergency department.  Stocking vials of 23.4% sodium chloride in the ED, whether in a Pyxis/Omnicell or a locked cabinet, creates an unnecessary risk for significant medication errors. Though no specific threshold exists for what is considered a 'concentrated sodium chloride' product by the joint commission, the decision must be made by the hospital P&T committee. Lower concentrations (3% [...]

By |2012-09-18T13:51:00-05:00September 18th, 2012|EM PharmD Blog|0 Comments


I was recently asked what I thought about FEIBA as a reversal agent for warfarin or dabigatran related bleeds.  At first, I was as excited about FEIBA as the individuals who asked me my opinion of the drug for this use. A prothombin complex concentrate that had active factor VII? In effect, a four factor PCC product available in the US? A small study suggesting it effectively lowers supratherapeutic INRs?[1] Sign me up!But then I [...]

By |2012-09-14T13:13:00-05:00September 14th, 2012|EM PharmD Blog|2 Comments


Welcome to the ED PharmD blog!My name is Craig Cocchio and I am an emergency medicine pharmacist.  I've created this blog to accomplish a few goals.1- To describe the activities of pharmacists practicing in the emergency department2- Share the experiences and knowledge of an established emergency medicine pharmacy team3- Create an open forum for discussion of all things emergency medicine, of course, focusing on medications4- Complement the various (and excellent) emergency medicine and toxicology blogs [...]

By |2012-09-06T13:12:00-05:00September 6th, 2012|EM PharmD Blog|2 Comments