Screw up Kcentra reconstitution? Yea, I do it too. Kcentra, our beloved four-factor prothrombin complex concentrate comes packaged as a lyophilized powder from the manufacturer. When needed, it is reconstituted with its accompanying diluent and handy-dandy transfer device. Then, the transfer device becomes a port to withdraw the now reconstituted drug from and either into an empty bag, or syringe for administration. In real life, that process can sometimes go [...]

  Do you think we should use Vitamin C + Thiamine + Hydrocortisone in sepsis? Welcome to the EM PharmD podcast! In this episode, I'll breakdown the recent VITAMINS trial published in JAMA. The question has been on everyone's mind - should septic patients get Vitamin C? Have questions or comments? Email me at craig@empharmd.com Don't forget to check www.empharmd.com for new updates and the latest information about everything emergency [...]

Tyler Perry's Colchicine Part 2 In a previous post, I discussed the use of colchicine following acute MI in the COLCOT study. Leading up to the discussion, I briefly touched on the pharmacology of colchicine. But since this drug is so unique and fascinating, particularly with regards to its toxicology, I wanted to have a separate post to discuss just that. It often seems as though the interest in a [...]

COLCOT- Colchicine for acute myocardial infarction If you started to practice after 2011, you likely have no experience with colchicine. Before the FDA began its unapproved drug initiative in 2006 which sought formal regulatory review of medications that previously fell under “grandfather” laws. Since colchicine was available prior to the 1938 Food, Drug, and Cosmetic Act, it was never required to establish safety and efficacy for FDA approved indications.[1,2] The [...]

Is metformin the fountain of youth? Growing up, I was an avid listener of Paul Harvey. My parents would turn on the radio every morning so I could listen to “the rest of the story.” I would eat my breakfast on the floor, sitting in front of the radio- as if by sitting closer would bring me closer to the story. Each time I click onto the Apple Podcast app [...]

How to evaluate references of residency candidates: the meta reference. A practice that I have been developing over the past few months has been to wait 24 hours before responding to certain emails, questions, or inquiries. By doing so, it has been intended to help be become less reactive and more thoughtful when encountering these events. While it is a bit of an exercise itself to learn what can wait [...]

Capsaicin for cannabinoid hyperemesis syndrome - It’s is one hot therapy. As a result of cannabis liberalization policies in many states, interest in methods to manage cyclic vomiting syndromes are heating up. By now, many ED providers are aware of the common complaint of patients with excessive vomiting with reported histories of marijuana consumption.[1,2] These cases, patients describe vomiting that was once resolved by hot showers, is no longer controlled. [...]

How PGY2 interviews differ from PGY1 You’re in it for another year. Congratulations. The time spent now will pay dividends in the future. Since you’re in the market for a PGY2, it likely means you’ve also been successful in landing a PGY1. From your experience in the interview process, you can take much of what made you an attractive candidate the first time around and apply it again this time. [...]

Pharmacy Residency Interview Tips: the onsite edition. Although ASHP Midyear is over, the interview season is just getting started. The deadline for most residency applications is around the corner and many programs will start sending out onsite invitations sometime in January. While the anticipation and stress can start to get to you, this is no time to lose focus. So let’s begin to prepare how to nail your onsite interview. [...]

PillPack by Amazon Pharmacy: The healthcare disruptor we’ve been waiting for.  This post was co-authored by Timothy Dy Aungst, PharmD, a digital health expert who blogs regularly at the The Digital Apothecary. Alexa, what’s my last blood sugar reading?  Your last blood sugar reading form 38 minutes ago was 145 mg/dL. Your pharmacist has adjusted your next pre-meal insulin dose to 8 units based on the diet ordered through Whole [...]

Let's go on a trip with Ayahuasca. What does Ayahuasca have to do with Parkinsonism? History doesn’t repeat itself, but it rhymes. Concocting a synthetic derivative of a desirable drug, created to evade regulation or the law, sounds like a story out of a 2019 headline. But it would be naive to think this is a unique point in drug abuse history. In fact, it’s happened before (and will likely [...]

Anavip: is the juice worth the squeeze Authors: Scott Dietrich, PharmD, BCCCP, @PCC_PharmD Ryan Rogoszewski, PharmD, BCCCP, @RyanRogoPharmD Craig Cocchio, PharmD, BCPS, DABAT, @iEMPharmD Background  Over 5,000 snakebites are reported to US poison centers each year.[1] The vast majority of snakebites in the US result from the Viperidae (aka “pit viper”) family of snakes. The sub-family most commonly found in the US includes the Crotalids which are made up of [...]

The Argument for BPS Certification of EM Pharmacists: Looking forward, not back.  EM Pharmacists are indispensable assets to modern healthcare. This petition for EM recognition by BPS is an anthology of the amazing efforts of EM pharmacists that have transformed emergency care. Each pharmacist innovating practice in EDs has established high levels of care, earned recognition on merit, and has been regarded in the medical community as experts. They have [...]

Reddit AMA - I'm a PGY-2 RPD Part 2 For a recap, here's Part 1 Recently on Reddit, I conducted an “ask me anything” conversation on the r/pharmacyresidency community. The inspiration behind the AMA was simply to help residency hopefuls feel more comfortable in the upcoming recruitment season. There were a number of individuals who asked questions and I wanted to share some of the top questions and answers provided. [...]

Reddit AMA - I'm a PGY-2 RPD Recently on Reddit, I conducted an “ask me anything” conversation on the r/pharmacyresidency community. The inspiration behind the AMA was simply to help residency hopefuls feel more comfortable in the upcoming recruitment season. There were a number of individuals who asked questions and I wanted to share some of the top questions and answers provided. Before going further, I do want to emphasize [...]