The Elective Rotation: A Critical Care Hospital Pharmacy Podcast

Show notes at pharmacyjoe.com/episode110. In this episode I’ll discuss the treatment of coagulase-negative staphylococci infection.

Show notes at pharmacyjoe.com/episode110

In this episode I'll discuss the treatment of coagulase-negative staphylococci infection.

Show notes at pharmacyjoe.com/episode109. In this episode I ll: 1. Discuss an article about using high dose heparin for VTE prophylaxis in obese patients. 2. Answer the drug information question Do the new FDA quinolone warnings for mild infections change how they should be used in the ICU?” 3. Share a resource to help apply the [...]

Show notes at pharmacyjoe.com/episode109

In this episode I’ll:

1. Discuss an article about using high dose heparin for VTE prophylaxis in obese patients.

2. Answer the drug information question “Do the new FDA quinolone warnings for mild infections change how they should be used in the ICU?"

3. Share a resource to help apply the new definitions for sepsis.

Show notes at pharmacyjoe.com/episode108. In this episode, I ll discuss the treatment of drug-induced Torsades.

Show notes at pharmacyjoe.com/episode108

In this episode, I’ll discuss the treatment of drug-induced Torsades.

When responding to code blue, rapid response calls, and other medical emergencies, take the stairs instead of the elevator whenever possible. I discuss this and much more in my book A Pharmacist’s Guide to Inpatient Medical Emergencies.

Shout out to "Pharmacy Stephen" for leaving a review on my book at Amazon. Stephen wrote: A great read for pharmacists of all ages! I have been a critical care pharmacist for years and attended many codes. I still found lots of advice in this book that I plan to put into action! I particularly liked the advice on the pharmacist's role in code blue and all of the little tips to help ensure patient safety. It's a quick read and would be great required reading for residents.

Background

Torsades de Pointes, or polymorphic ventricular tachycardia is a rare but life-threatening arrhythmia. It can be the result of congenital or acquired (drug induced) long QT syndrome.

As pharmacists, we will spend a disproportionate amount of our time attempting to prevent drug-induced Torsades compared to the time we will spend treating it. In episode 12, I discussed how I evaluate drug interactions related to prolonged QTc interval and risk of Torsades.

Treatment

The best treatments for Torsades are

Show notes at pharmacyjoe.com/episode107. In this episode, I’ll: 1. Discuss an article about the use of banana bags in ICU patients. 2. Answer the drug information question “If a pharmacist programs an IV pump for infusion, does that count as administration?” 3. Share a resource that is a search engine containing a national compendium of [...]

Show notes at pharmacyjoe.com/episode107

In this episode, I'll:

1. Discuss an article about the use of banana bags in ICU patients.

2. Answer the drug information question "If a pharmacist programs an IV pump for infusion, does that count as administration?"

3. Share a resource that is a search engine containing a national compendium of package inserts.

Thank you all for your continued support spreading the word about my new book, A Pharmacist’s Guide to Inpatient Medical Emergencies. Shout out to listener Scott for being my first book review on Amazon! Scott writes: Every Hospital pharmacist who is or wants to be a member of the medical emergency team should have a copy of this book in their lab coat!

If you already have a copy of the book, it would be a tremendous help if you could write a brief review on Amazon. Reviews let others browsing the book know why you purchased it or how you use it in your practice to decide if it might help them. You can get to the book review page in Amazon by going here.

Article

Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU

Lead author: Alexander H. Flannery

Published in Critical Care Medicine August 2016

Background

ICU patients with alcohol withdrawal or chronic alcohol use disorder are often given a "banana bag" as standard therapy to replenish micronutrients and prevent Wernicke’s Encephalopathy.

Purpose

The authors assessed whether the contents and doses of micronutrients and electrolytes in standard banana bags met the needs of critically ill patients with

Show notes at pharmacyjoe.com/episode106. In this episode I’ll discuss how pharmacists can improve their working relationships with physicians.

Show notes at pharmacyjoe.com/episode106

IIn this episode I'll discuss how pharmacists can improve their working relationships with physicians.

Thank you so much for helping to make my book A Pharmacist’s Guide to Inpatient Medical Emergencies the #1 new release in the pharmacy category on Amazon! The "look inside” feature is now available on Amazon. You can go to clinicalpharmacybooks.com to see how to book is set up and to read through the first chapter.

I’ve done a lot of listening, watching, and reflecting on interactions between physicians and non-physicians. It seems, whether consciously or unconsciously, physicians place non-physicians they interact with into one of two categories:

1. Those that help the physician take care of the patient.

2. Those that make it harder for the physician to take care of the patient.

Other physicians make it into the first category automatically. They are constantly helping each other take care of patients in the form of consults.

Nurses are the physician’s eyes and ears, and the patient’s guardian angels. Nurses automatically get placed into the first category.

A Pharmacist’s job is clearly to help take care of the patient, but it is easy for us to be misconstrued. We need to work hard to avoid being placed in the second category. Take for example the simple case of discussing a drug interaction with a physician:

One pharmacist may say “I’m calling you because the computer says there is a serious interaction between valproic acid and meropenem."

Another pharmacist may say “I’m concerned that the meropenem will decrease serum levels of valproic acid, increasing the chance the patient may have a breakthrough seizure. Based on your progress note it looks like you are covering pseudomonas pneumonia. I’d like to switch the meropenem to cefepime to avoid the interaction."

While how you phrase a recommendation is important, I have 4 additional tips that I use to improve my working relationships with physicians.