IV administration of insulin aspart or lispro

IV administration of insulin aspart or lispro. 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 [...]

By |2019-11-24T17:47:21-05:00October 28th, 2012|EM PharmD|1 Comment

Rabies Vaccine and Immune Globulin

ED Drug Shortage Showdown: Rabies Vaccine and Immune Globulin 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 [...]

By |2019-11-24T17:45:45-05:00October 25th, 2012|EM PharmD|0 Comments

Beta Blockers and Epinephrine

Pharmacy Consult: Beta Blockers and Epinephrine I had an interesting discussion in the ED the other day when I was talking about the importance of administering epi via IM for anaphylaxis.  Is there a diminished response to epi if a patient 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 [...]

By |2019-11-24T17:42:07-05:00October 22nd, 2012|EM PharmD|0 Comments

Ticagrelor (Brilinta) and Aspirin Interaction – Fact or Fiction

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 [...]

By |2019-11-24T17:42:07-05:00October 19th, 2012|EM PharmD|0 Comments

Epinephrine IM for Anaphylaxis

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 [...]

By |2019-11-24T17:42:07-05:00October 17th, 2012|EM PharmD|0 Comments

Amide and Ester Local Anesthetic Allergy

Amide and Ester Local Anesthetic Allergy An 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 [...]

By |2019-11-24T17:42:07-05:00October 15th, 2012|EM PharmD|0 Comments

Diltiazem IV to PO Conversion

This is a question that I’ve gotten a few times over the years is what is the diltiazem IV to PO conversion?  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, [...]

By |2019-11-24T17:42:07-05:00October 11th, 2012|EM PharmD|6 Comments

Including but not limited to: Thrombolysis Contraindications

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 [...]

By |2019-11-24T17:42:07-05:00October 8th, 2012|EM PharmD|0 Comments

So You’re An EM pharmacist: What Is It That You Do?

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 [...]

By |2019-11-23T21:29:18-05:00October 2nd, 2012|EM PharmD|0 Comments