The best drug you aren’t using: Fosphenytoin

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 [...]

By |2019-11-24T17:42:08-05:00September 27th, 2012|EM PharmD|0 Comments

Hypercalcemia: Pamidronate vs Zoledronic acid

Hypercalcemia: Pamidronate vs Zoledronic acid We use IV bisphosphonates in acute hypercalcemia with the understanding that they’ll help achieve a normal calcium level in about 72hours.  Aside from the important components 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 [...]

By |2019-11-24T17:42:08-05:00September 25th, 2012|EM PharmD|0 Comments

Osmolarity of 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 |2019-11-24T17:42:08-05:00September 18th, 2012|EM PharmD|0 Comments


FEIBA and PCCs 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 [...]

By |2019-11-24T17:42:08-05:00September 14th, 2012|EM PharmD|2 Comments
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