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One and Done: Single-Dose Antimicrobials in the ED

We are all familiar with this label on the vials and packages of antimicrobials that have been prescribed to us over the course of the years: How often is this to likely occur among patients discharged from the emergency department? The most challenging part of providing patients with prescriptions for antimicrobials to be filled once they are discharged from the emergency department is the fact that (a) there is no guarantee that the prescription will [...]

By |2012-11-29T13:35:00-05:00November 29th, 2012|EM PharmD Blog|1 Comment

Vancomycin Loading Dose In The ED

Vancomycin dosing in EDs has been on a journey from “a gram” for everyone towards a weight based dosing scheme.  This shift has been driven by a number of sources, but namely by the Infectious Disease Society of America, American Society of Health-System Pharmacists and Society of Infectious Disease Pharmacists' (IDSA/ASHP/SIDP) guideline recommendations for vancomycin therapeutic monitoring.1 The change in dosing strategy is similar to other ID discussion nowadays; resistance and multidrug resistant pathogens are [...]

By |2012-11-26T15:03:00-05:00November 26th, 2012|EM PharmD Blog|0 Comments

Silibinin for Amatoxin Poisoning: Preventing the Last [Thanksgiving] Supper?

Ingestion of cyclopeptide mushrooms can lead to irreversible hepatotoxicity that may potentially be life-threatening. The mechanism by which hepatotoxicity occurs is through the activity of α-amanitin, which is taken up by hepatocytes and inhibits DNA-dependent RNA polymerase II, preventing DNA transcription into mRNA, which consequently halts the process of protein production. This causes injury of organ systems that are highly dependent on protein synthesis, such as the gastrointestinal mucosa, kidneys, and liver, which eventually leads [...]

By |2012-11-22T13:18:00-05:00November 22nd, 2012|EM PharmD Blog|1 Comment

Aminophylline and Bradyasystolic Cardiac Arrest

When it comes to drug therapy in cardiac arrest, we just can’t get it right.  Granted, the heterogeneity of the causes of cardiac arrest as well as patient population characteristics make it difficult to find a drug (or combination of drugs) that will improve survival.  But that doesn’t stop us from looking for one.  Take for instance, aminophylline. Yes, aminophylline.The ethylenediamine salt of theophylline, aminophylline is thought to counteract the effects of adenosine on the [...]

By |2012-11-19T11:53:00-05:00November 19th, 2012|EM PharmD Blog|0 Comments

Immunogenicity of Alteplase: Never Say Never

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. [...]

By |2012-11-15T13:30:00-05:00November 15th, 2012|EM PharmD Blog|0 Comments

Pharmacy Consult: Nitroglycerin Paste to IV Conversion

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 [...]

By |2012-11-12T16:36:00-05:00November 12th, 2012|EM PharmD Blog|4 Comments

Playing the Cards Right with Nicardipine

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 [...]

By |2012-11-08T13:37:00-05:00November 8th, 2012|EM PharmD Blog|0 Comments

Pharmacy Consult: Extended Zosyn Infusion in the ED

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 [...]

By |2012-11-05T16:27:00-05:00November 5th, 2012|EM PharmD Blog|0 Comments

The Pharmacists Role

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.  [...]

By |2012-11-02T15:06:00-05:00November 2nd, 2012|EM PharmD Blog|0 Comments