Nimodipine Shortage: What About Nicardipine   Drug shortages continue to wreak havoc on health care in US hospitals.  It seems every day there is yet another drug, more critical to medicine than the last, that’s unavailable due to shortages. Over the past few weeks, nimodipine has been going, going, gone.  Now reaching for alternatives, in this case, is proving difficult as a result of limited data on alternatives leaving many in a troubling situation.  Nicardipine, [...]

Cocaethylene: Not Your Old Coca-Cola We all know that the effects produced from the toxic ingestion of cocaine and alcohol as separate entities are excessive stimulation and pronounced depression, respectively. So what are the effects of the toxic ingestion of both compounds together? Enter cocaethylene...and it is far from the Coca-Cola produced during your great grandmother's time. Cocaethylene (also known as ethylbenzoylecgonine) is produced from the concomitant ingestion of cocaine and alcohol. It is formed [...]

Push-Dose Pressors: Phenylephrine Originating in anesthesia, promoted in emergency medicine by EMCrit.org and EMRAP, the utilization of push dose pressors has been growing. While there doesn’t exist much data to back up its use, I think the clinical experience speaks for itself.  In my experience has been generally good with recommending push dose phenylephrine aka. “Neostick,” if the dose is appropriate (80-100 mcg, not 20mcg) and the timing is appropriate (not after hours of hypotension).  [...]

The Trauma Cupid's Arrow: Intracardiac Epinephrine A patient is wheeled into your trauma bay after a nasty head-on collision on a major highway. According to the paramedics, the downtime and length of anoxia in the patient is unknown, and because of this, the patient is intubated. Vital signs are unobtainable, and pulses are lost on the scene. The patient is now in pulseless electrical activity (PEA), and cardiopulmonary resuscitation is initiated. The decision is made [...]

Digoxin Potassium and Calcium Very little of what we do on a daily basis, as pharmacists, fit into discrete silos.  In contrast to our didactic education (or mine, at least), chapters are studied focusing on specific disease states, medication classes are analyzed individually and cases are discussed with rarely more than one problem.  Of course learning to walk before you run through study and comprehension of the basic components and methods of problem solving is [...]

Cold Lysis: Alteplase in the Hypothermic Patient Let us say that you have a patient who presents with cardiac arrest with a rhythm of pulseless electrical activity. After going through a mental checklist of the 6Hs and 6Ts, you are highly suspicious that the patient has experienced a pulmonary embolism, and the decision is made to administer alteplase. You are informed that the rectal temperature of the patient is 32°C. An interesting question can be [...]

Sports Pharmacy While in pharmacy school, I was fortunate enough to have an athletic scholarship. Balancing the responsibility to work out before and after class four days per week, compete on the weekend and study in-between was certainly challenging. But being a pharmacy student-athlete, I found, to be more interesting and though-provoking by marrying the two together: pharmacy and athletics - drug/supplements and performance. Most athletes competing at a high level are focused on improving [...]

A Closer Look at Glucagon for Esophageal Foreign Body Reaching for that vial (or two) of glucagon to manage the patient who presents to your emergency department with an esophageal foreign body obstruction (EFBO)? Think again. The first reports of its use for managing patients with EFBOs came about in the 1970s, when it was first discovered that glucagon had direct relaxation properties on the lower esophageal sphincter (LES), which is comprised of smooth muscle. [...]