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4 & 4 Por Favor: Prophylactic Ondansetron + Intravenous Opiate – Is It Necessary?

Ondansetron is the most documented medication given in emergency departments throughout the United States.1 We have all heard someone ask, “Can I get an order for 4 and 4 for this patient?” in reference to 4 milligram (mg) of intravenous (IV) morphine and 4 mg of IV ondansetron. It has become common practice in many institutions to provide a prophylactic antiemetic prior to administering an IV opiate. All opiates carry a FDA warning that nausea [...]

By |2015-11-25T11:00:00-05:00November 25th, 2015|EM PharmD Blog|0 Comments

4 & 4 Por Favor: Prophylactic Ondansetron + Intravenous Opiate – Is It Necessary?

Ondansetron is the most documented medication given in emergency departments throughout the United States.1 We have all heard someone ask, “Can I get an order for 4 and 4 for this patient?” in reference to 4 milligram (mg) of intravenous (IV) morphine and 4 mg of IV ondansetron. It has become common practice in many institutions to provide a prophylactic antiemetic prior to administering an IV opiate. All opiates carry a FDA warning that nausea [...]

By |2015-11-25T11:00:00-05:00November 25th, 2015|EM PharmD Blog|0 Comments

The Dark Arts of Pharmacokinetics

It’s ok to give 1 gram of vancomycin. As long as they’re obese and the dosing interval is adjusted to follow the two compartment distribution model of vancomycin. Single, double or triple? In terms of vancomycin dosing kinetics, it’s an important question.  Pharmacokinetic teachings tell us to select the simplest model and fewest compartments necessary to describe the data adequately. Thus the single compartment model is frequently used in initial dosing of vancomycin.  For the [...]

By |2015-11-21T21:35:00-05:00November 21st, 2015|EM PharmD Blog|0 Comments

Vanishing Vasopressin

Vasopressin has gone by the way of atropine in the updated ACLS guidelines.1 But is this a reason to sachet into your next resuscitation/critical care meeting and suggest vasopressin be removed from your hospital’s crash carts? No. Don’t do it. Don’t just read the guidelines; read the primary literature. First and foremost, when we’re comparing vasopressin to epinephrine, one must remember the comparison agent (epinephrine) has not been shown to improve patient oriented outcomes, ie, neurologically [...]

By |2015-11-10T01:39:00-05:00November 10th, 2015|EM PharmD Blog|0 Comments

To Determine Abuse Potential Of A Drug Bring Two Turtles To The Temple Of The FDA

The FDA is wacky. Around every corner there seems to be another head scratching approval, denial, process or event. Answering a simple question took me down a new enlightening, and hilarious path. Now, this may sound Seinfeld-ish but ‘what’s the deal with controlled substances?’Lacosamide is a newer antiepileptic drug that you have likely seen on a medication reconciliation profile of a patient to two in your emergency department by now. With this newer drug, there [...]

By |2015-11-07T18:34:00-05:00November 7th, 2015|EM PharmD Blog|0 Comments