One and Done: Single-Dose Antimicrobials in the ED

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) [...]

By |2019-11-24T17:41:48-05:00November 29th, 2012|EM PharmD|1 Comment

Vancomycin Loading Dose In The ED

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 another ID discussion nowadays; resistance [...]

By |2019-11-24T17:41:48-05:00November 26th, 2012|EM PharmD|0 Comments

Silibinin for Amatoxin Poisoning: Preventing the Last Thanksgiving Supper

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 [...]

By |2019-11-24T17:41:48-05:00November 22nd, 2012|EM PharmD|1 Comment

Aminophylline and Bradyasystolic Cardiac Arrest

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 [...]

By |2019-11-24T17:41:48-05:00November 19th, 2012|EM PharmD|0 Comments

Allergic reaction to alteplase

Allergic reaction to alteplase - 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 [...]

By |2019-11-24T17:41:49-05:00November 15th, 2012|EM PharmD|0 Comments

Pharmacy Consult: Nitroglycerin Paste to IV Conversion

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 to slap 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, [...]

By |2019-11-24T17:41:49-05:00November 12th, 2012|EM PharmD|4 Comments

Nicardipine for acute stroke

Nicardipine for acute stroke: 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 [...]

By |2019-11-24T17:41:49-05:00November 8th, 2012|EM PharmD|0 Comments

Pharmacy Consult: Zosyn Extended Infusion in the ED

Pharmacy Consult: Zosyn Extended 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 [...]

By |2019-11-24T17:41:49-05:00November 5th, 2012|EM PharmD|0 Comments

Clinical pharmacist specialist

Clinical pharmacist specialist 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 [...]

By |2019-11-24T17:42:07-05:00November 2nd, 2012|EM PharmD|0 Comments