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Pharmacy Consult: We accidentally just gave insulin aspart IV… Is that bad?

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 |2012-10-28T16:33:00-05:00October 28th, 2012|EM PharmD Blog|1 Comment

ED Drug Shortage Showdown: Rabies Vaccine and Immune Globulin

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 [...]

By |2012-10-25T10:54:00-05:00October 25th, 2012|EM PharmD Blog|0 Comments

Pharmacy Consult: Beta Blockers and Epinephrine

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 [...]

By |2012-10-22T13:30:00-05:00October 22nd, 2012|EM PharmD Blog|0 Comments

Ticagrelor (Brilinta) and Aspirin Interaction – Fact or Fiction

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, [...]

By |2012-10-19T13:20:00-05:00October 19th, 2012|EM PharmD Blog|0 Comments

Epinephrine IM for Anaphylaxis

Epinephrine dosing and administration for anaphylaxis can be a tricky situation. In a strange, non-conformist type of stubbornness, the concentration parenteral epinephrine products are listed as a ratio (1:1000 vs 1:10,000 vs 1:100,000), rather than a percentage. There have been numerous reports, and personal experiences, where patients end up getting a significant overdose, or underdose of epi from miscommunication, dosing error or picking the wrong ampule/vial/syringe.An often-overlooked administration (won’t call it an error) issue is [...]

By |2012-10-17T10:57:00-05:00October 17th, 2012|EM PharmD Blog|0 Comments

Amide and Ester Local Anesthetics

Ultrasound guided regional nerve block is an evolving trend in ED procedural sedation.  The thought being, local anesthetics could be used instead of benzodiazepines, ketamine or propofol, which could allow for earlier patient discharge from the ED and lower risk of complications (respiratory depression).Navigating the library of local anesthetics can be complex, particularly if your patient reports some allergy to lidocaine or prilocaine or if the drug is on shortage (an evolving problem in the [...]

By |2012-10-15T12:59:00-05:00October 15th, 2012|EM PharmD Blog|0 Comments

Diltiazem IV to PO Conversion

This is a question that I’ve gotten a few times over the years.  You’ve got a patient in AFIB that has been rate controlled after a bolus of diltiazem and is now on a diltiazem drip.  The hospital has a policy stating a patient on a diltiazem drip must go to a cluster or ICU bed but the patient could go to a general medical floor, or even go home.  What can be done for [...]

By |2012-10-11T10:46:00-05:00October 11th, 2012|EM PharmD Blog|6 Comments

Including but not limited to…. Thrombolysis Contraindications

An important, but all too often overlooked contraindication to thrombolytics for acute ischemic stroke is known bleeding diathesis including but not limited to current use of oral anticoagulants or an INR > 1.7 or a PT > 15 sec, heparin administration within 48 hours preceding stroke onset and an elevated aPTT at presentation, or platelet count less than 100,000 mm3.Including but not limited to… Very important, yet easily overlooked.  It also complicates matters, in that, [...]

By |2012-10-08T13:27:00-05:00October 8th, 2012|EM PharmD Blog|0 Comments

“So You’re An EM pharmacist…What Is It That You Do?”

I recently had a discussion about what makes a good EM pharmacist.  Below is a great essay by my EM pharmacy resident discussing just that. Being A Crystal Baller Nadia Awad, Pharm.D. There is one running theme that I have learned to appreciate and embrace since I started my emergency medicine pharmacy residency nearly three months ago. This theme can be summed up in one word: ANTICIPATION.Why is this important? For me, emergency medicine is [...]

By |2012-10-02T16:39:00-05:00October 2nd, 2012|EM PharmD Blog|0 Comments