Nitroglycerin Shortage: Giving Nesiritide Another Look National drug shortages are presenting a new and unique way of considering alternative drug therapies for various disease states. Of note, the most recent drug shortage impacting EDs and sparking new debate and rehashing of old data is intravenous nitroglycerin. IV Nitro is used ubiquitously in EDs and pre-hospital settings primarily for acute coronary syndromes and acute decompensated heart failure/acute pulmonary edema.  While other dosage forms of nitroglycerin exist, [...]

Preparedness for Mass Casualty Events The blackout of the Eastern United States and Canada in August 2003. Hurricane Sandy in October 2012. The horrific events of the Boston Marathon in April 2013. What do all of these events have in common? These mass casualty events affected numerous individuals, and institutions in these affected areas had to suddenly respond to patients impacted by these events in addition to handling patients who had already been hospitalized at [...]

A Pharmacists Guide Medication Safety On Earth Lately, I’ve been on a kick of nurturing my inner Canadian by reading a few books by notable figures from the Great White North.  The first was the latest autobiography of Dr. David Suzuki (any respectable Canadian should need no explanation of who he is) and the second was a book (An Astronauts Guide To Life On Earth) written by a Canadian astronaut, Dr. Chris Hadfield, about his [...]

PDE-5 Inhibitors and Nitrates: What to Do in the Critically Ill Patient? Let us say that you have a 50-year-old female patient who presents to the emergency department with a history of pulmonary arterial hypertension and signs and symptoms consistent with acute decompensated heart failure. The patient presents with acute shortness of breath and is in severe respiratory distress. Vital signs include blood pressure of 182/90 and heart rate of 110. A beside ultrasound is [...]