Pesticides, Herbicides, Fungicides and Insecticides Barium Sources Rodenticide/insecticide and depilatories Barium sulfate (contrast) Effects/MOA Causes hypokalemia due to redistribution - inh Ca-activated K rectifier channels → QT prolong Clinical Manifestations Paralysis Severe hypoK within 2 hours Parkinsonism findings on MRI MGMT/Notes White powder that resembles FLOUR Pulmonary  ORAL sodium sulfate or Mg sulfate (not IV- converts to barium sulfate=bad) HD Methyl bromide Effects/MOA Oral and dermal routes  Direct cytotoxic (intact methyl bromide) and alkylating agent [...]

Agonists, Antagonists And Various Key Points GABA antagonists Colchicine (Mandrake, Mayapple) Clozapine (chlorpromazine?) Cicutoxin (water hemlock aka cowbane) Bicuculline B-lactams (piperacillin/tazobactam) Lindane (aldrin) Pyrethroids/pyrethrins (AND Na channel opener) Picrotoxin Thujone (absinthe) Tetramine (cage convulsant) TCAs GABA-B agonists GHB GBL, GHV, GVL 1,4-BD Phenibut (adrafinil) Glycine antagonists Similar to GABA but glycine receptor is a Cl- inhibitory receptor in the spinal cord. Strychnine Normal mental status until late phases when metabolic complications from convulsions cause AMS. [...]

Toxic Events Epping jaundice Methylene dianiline Essing bakery Arsenic Minamata bay Methylmercury Ouch-ouch Cadmium Phossy jaw Phosphorus Rice oil disease / Chloracne Dioxin, polychlorinated biphenyls Seveso italy TCP Ginger jake TOCP Parkinsons MPTP/MPP+ Silo gas/welding gas Nitrogen dioxide (sulfur dioxide?) Dry cleaners Methylene chloride (carbon monoxide) Popcorn workers lung Acrolein/fromaldehyde Roncovite/Dow Beer Cobalt Manchester, Staffordshire beer Arsenic Exit signs Tritium Bhopal Methylisocyanate DBCP Male infertility Goiana institute of radiotherapy Cesium 137 For more chapters, visit [...]

Four steps to reading a scientific paper In part 1 we discussed the first stage of analytical reading which outlined how to define what is the article about as a whole. The second stage of analytical reading builds upon this to deepen our understanding of the article we’re reading. By understanding the structure of this purpose.  I do have to admit that this second stage can be rather time-consuming. The purpose of this technique is [...]

How to analyze any article The misconception we carry about many of our faculty, preceptors, and mentors is that they have read everything ever written. At times this might seem true, it’s almost always not. But that’s not to say they aren’t well-read. In fact, in their own specialty area, or area of interest, they are incredibly well-read; that is, in terms of truly comprehending the core evidence. In reality, they may have read fewer [...]

How to read a scientific article Early in many APPE rotations, pharmacy students are assigned a journal article to read, digest, then present to a group in the form of a journal club. The tenents of this exercise are to engrain the methodological technique for critically appraising a scientific manuscript. While the exercise can be exhaustive, it does not always accomplish its intended mission. While yes, students will learn how to properly critically appraise an [...]

PharmSoHard Podcast Anavip and Crofab EPISODE 18: THE MANAGEMENT OF SNAKE BITES WITH CRAIG COCCHIO, PHARMD, DABAT https://pharm-so-hard.com/2020/04/14/episode-18-the-management-of-snake-bites-with-craig-cocchio-pharmd-dabat/ More from EM PharmD: Anavip versus Crofab – The ultimate debate Anavip versus Crofab – The ultimate debate. You may think this only applies to folks in the south, but there are venomous snakes in every state. Having at least a basic knowledge of antivenoms can be incredibly useful information. Over the past few months I’ve been [...]

Pharmacist Code Response SLLS Once a skill becomes second nature, it’s easy to take it for granted. We often forget the struggle and the confusion we once had prior to mastery of the said skill. So every once in a while it’s useful to revisit and reassess our skills to make sure we don’t miss steps and take shortcuts. It’s also another opportunity to help those around us who may be at another phase in [...]

Clinical Apprenticeship: Octreotide and Pantoprazole Compatibility For some reason, there exists some disconnect between how some clinical pharmacists come by their knowledge. Almost as if it’s some secretive pact we hold where information is only exchanged under full moons in the middle of July. While there may be some mysterious goings-on I’m not aware of, the simple matter of truth is that in almost every circumstance, it’s just experience and knowing where to look. So [...]

COVID Is Our Enemy The threat of COVID has penetrated every aspect of our lives. Despite reading, learning, and understanding as much as you can, rational actions are supplanted by irrational behavior. For every precaution taken in every-day life, there is someone else in the community who’s ignoring safety recommendations and putting us, our family and our co-workers at risk. Observing these actions, reading these opinions and hearing incomplete information we become frustrated and angry [...]