The Elective Rotation: A Critical Care Hospital Pharmacy Podcast

Show notes at pharmacyjoe.com/episode105. In this episode I’ll: 1. Discuss an article about therapeutic drug monitoring of voriconazole. 2. Answer the drug information question “When alteplase is given for massive PE in a patient undergoing cardiopulmonary resuscitation, how long should CPR be continued?” 3. Share one of my top resources for keeping up to date [...]

Show notes at pharmacyjoe.com/episode105

In this episode I'll:

1. Discuss an article about therapeutic drug monitoring of voriconazole.

2. Answer the drug information question "When alteplase is given for massive PE in a patient undergoing cardiopulmonary resuscitation, how long should CPR be continued?"

3. Share one of my top resources for keeping up to date with medical literature.

Book

My book A Pharmacist’s Guide to Inpatient Medical Emergencies is now available in Amazon. Ever since I joined my hospital medical emergency team, I’ve been passionate about teaching other pharmacists how they can make a difference in patient outcomes by being part of the code team.

Episode 1 of this podcast was about how fewer patients die in the hospital when pharmacists are members of the cardiopulmonary resuscitation team. Now on the 1 year anniversary of The Elective Rotation Podcast I am excited to make this book available for other pharmacists to learn and refine the clinical skill of responding to inpatient medical emergencies. You can find a link to the book in amazon at clinicalpharmacybooks.com.

Article

Risk Factors for Voriconazole-Associated Hepatotoxicity in Patients in the Intensive Care Unit

Lead Author: Yan Wang

Published in: Pharmacotherapy Early Access July 2016

Background

When voriconazole cannot be administered due to hepatotoxicity, for infections such as invasive aspergillosis, salvage therapy with more toxic medications such as amphotericin is required.

Purpose

The authors sought to identify risk factors for voriconazole-associated hepatotoxicity and to report the incidence of hepatotoxicity in critically ill patients receiving voriconazole.

Methods

The study was

Show notes at pharmacyjoe.com/episode104. In this episode I ll discuss highlights from the new IDSA/ATS HAP/VAP guidelines.

Show notes at pharmacyjoe.com/episode104

I’ve ordered the proof copy for my book, A Pharmacist’s Guide to Inpatient Medical Emergencies and I look forward to hitting the final publish button very soon! To see the cover you can go to: clinicalpharmacybooks.com

In this episode I’ll discuss highlights from the new IDSA/ATS HAP/VAP guidelines.

The guidelines were published July 14, 2016 and are titled:

Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society

General information

These guidelines went 11 years between updates. Three major differences between the 2005 and 2016 guidelines are:

Show notes at pharmacyjoe.com/episode103. In this episode I’ll: 1. Discuss an article about increased mortality from epinephrine in cardiogenic shock. 2. Answer the drug information question “Can phenytoin cause hypothermia” 3. Share two resources for students to learn the basics of pharmacology.

Show notes at pharmacyjoe.com/episode103

In this episode I'll:

1. Discuss an article about increased mortality from epinephrine in cardiogenic shock.

2. Answer the drug information question "Can phenytoin cause hypothermia"

3. Share two resources for students to learn the basics of pharmacology.

Article

Current real-life use of vasopressors and inotropes in cardiogenic shock - adrenaline use is associated with excess organ injury and mortality

Lead author: Tuukka Tarvasmäki

Published in the journal Critical Care July 2016

Background

Vasopressors and inotropes are a vital part of supportive care given to patients with severely impaired hemodynamics and cardiac output in cardiogenic shock. The authors of this study sought to analyze current real-life use of these medications, and their impact on outcomes in cardiogenic shock.

Methods

The CardShock study enrolled 219 patients with cardiogenic shock in 9 hospitals across 8 European countries. The study was

Show notes at pharmacyjoe.com/episode102. In this episode I’ll discuss how to transition from dexmedetomidine to clonidine.

Show notes at pharmacyjoe.com/episode102

In this episode I'll discuss how to transition from dexmedetomidine to clonidine.

Dexmedetomidine is an IV alpha-2A adrenergic agonist. It has sedative effects and is used for the management of pain, agitation, and delirium in critically ill patients.

The use of dexmedetomidine was encouraged in the 2013 Society of Critical Care Medicine practice guidelines as part of a benzodiazepine sparing regimen. While dexmedetomidine is now available generically in the US market, it remains one of the most expensive IV sedatives for use in ICU patients.

At least two studies have evaluated whether enteral clonidine (also an alpha-2A adrenergic agonist) can be used to successfully transition patients off of dexmedetomidine. Clonidine has sedative effects, is inexpensive, and has excellent enteral bioavailability. Patients who are hemodynamically stable and no longer require rapid titration of sedative effect may be ideal candidates to transition from IV dexmedetomidine to enteral clonidine.

In 2015, two separate hospitals published dexmedetomidine to clonidine strategies. Maine Medical Center published a prospective observational pilot study while Partners Healthcare in Utah published a retrospective analysis.

Maine Strategy

The Maine strategy included patients with

Show notes at pharmacyjoe.com/episode101. In this episode I’ll: 1. Discuss an article about using propofol for toxin-related seizures. 2. Answer the drug information question “Should SSRIs be stopped in a patient with GI bleeding?” 3. Share a resource for critical care related information.

Show notes at pharmacyjoe.com/episode101

In this episode I'll:

1. Discuss an article about using propofol for toxin-related seizures.

2. Answer the drug information question "Should SSRIs be stopped in a patient with GI bleeding?"

3. Share a resource for critical care related information.

Article

Propofol Use for Toxin-Related Seizures

Lead author: F. Lee Cantrell

Published in Pharmacotherapy June 2016

Background

This article is a review of records from a poison control center. For some reason I’ve been finding a lot of these articles lately. I think this type of article is a great way to publish real world experience to help inform clinicians in areas that are not well studied.

Propofol is FDA approved for use as a sedative, but it also has anticonvulsant properties. Whether propofol is effective as treatment for toxin-induced seizures is unknown.

Purpose

The authors sought to characterize the use of propofol for toxin-related seizures as reported to a statewide poison system.

Method

The study was a