The Elective Rotation: A Critical Care Hospital Pharmacy Podcast

Show notes at pharmacyjoe.com/episode95. In this episode I’ll: 1. Discuss evidence on the efficacy of ketamine IM for acute behavioral emergencies. 2. Answer the drug information question “Can a patient with an allergy to contrast media receive amiodarone?” 3. Share a resource for antimicrobial stewards.

Show notes at pharmacyjoe.com/episode95

In this episode I'll:

1. Discuss evidence on the efficacy of ketamine IM for acute behavioral emergencies.

2. Answer the drug information question "Can a patient with an allergy to contrast media receive amiodarone?"

3. Share a resource for antimicrobial stewards.

Article

Ketamine as Rescue Treatment for Difficult-to-Sedate Severe Acute Behavioral Disturbance in the Emergency Department

Lead Author: Geoffrey Kennedy Isbister

Published in Annals of Emergency Medicine May 2016

Background

I’ve discussed the idea of using ketamine as rescue therapy for acute behavioral emergencies in episode 16 & episode 84.

The longer the emergency lasts, the greater the risk of physical harm or bodily fluid exposure to hospital staff. It can take 10 minutes or multiple doses for IM benzodiazepines / antipsychotics to work.

Objective

The authors sought to investigate the

Show notes at pharmacyjoe.com/episode94. In this episode I’ll discuss the use of flumazenil.

Show notes at pharmacyjoe.com/episode94

In this episode I'll discuss the use of flumazenil.

Shout out to “Pharmacy Ashkan” for suggesting this topic and sending many of the references that are linked in this episode.

Flumazenil is a competitive benzodiazepine receptor inhibitor. It is classified as an antidote to benzodiazepines.

Indications

The approved indications for flumazenil are:

- Reversal of conscious sedation and general anesthesia

- Suspected benzodiazepine overdose

The usual dose is 0.2 mg over 15-30 seconds, repeated every minute if needed. The onset of action is 1-2 minutes and the effect lasts for about 1 hour.

Controversy in benzodiazepine overdose

Many providers insist on not using flumazenil in benzodiazepine overdose scenarios due to

Show notes at pharmacyjoe.com/episode93. In this episode I’ll: 1. Discuss an article about high dose heparin for VTE prophylaxis in obese patients. 2. Answer a drug information question about vitamin K. 3. Share a resource for lab assay interference by non-vitamin K oral anticoagulants.

Show notes at pharmacyjoe.com/episode93

In this episode I'll:

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

2. Answer a drug information question about vitamin K.

3. Share a resource for lab assay interference by non-vitamin K oral anticoagulants.

Article

Safety and Efficacy of High-Dose Unfractionated Heparin for Prevention of Venous Thromboembolism in Overweight and Obese Patients

Lead author: Mishna Joy

Available online pre-publication from the journal Pharmacotherapy

Objective

The authors sought to determine the safety and efficacy of high-dose subcutaneous unfractionated heparin (UFH) for prevention of venous thromboembolism (VTE) in

Show notes at pharmacyjoe.com/episode92. In this episode I ll discuss how I provide analgesia & sedation to critically ill patients who have taken buprenorphine.

Show notes at pharmacyjoe.com/episode92

In this episode I’ll discuss how I provide analgesia & sedation to critically ill patients who have taken buprenorphine.

Buprenorphine is an opioid partial agonist. It is used to treat acute & chronic pain, opioid withdrawal, and opioid dependence. Buprenorphine has a very high affinity for the mu opioid receptor. This high affinity results in competition with or displacement of other opioid analgesics at the mu opioid receptor.

Due to buprenorphine being a partial mu opioid agonist, it's opioid effects plateau at higher doses and it behaves like an antagonist. The half-life of buprenorphine depends on the dosage form used, but it is generally greater than 24 hours.

As a result, it can be challenging to provide analgesia and sedation to critically ill patients who have recently taken buprenorphine.

There are several different ways to work through this challenge. The first decision to be made is

Show notes at pharmacyjoe.com/episode91. In this episode I’ll: 1. Review an article about using imatinib for bleomycin interstitial pneumonitis. 2. Answer the drug information question “Should daptomycin or linezolid be used for VRE bacteremia?” 3. Share a resource provided by another pharmacist in the Pharmacy Nation slack group.

Show notes at pharmacyjoe.com/episode91

In this episode I'll:

1. Review an article about using imatinib for bleomycin interstitial pneumonitis.

2. Answer the drug information question "Should daptomycin or linezolid be used for VRE bacteremia?"

3. Share a resource provided by another pharmacist in the Pharmacy Nation slack group.

Article

Imatinib for bleomycin induced pulmonary toxicity: a case report and evidence‐base review

Lead author: Iouri Banakh

Published in the journal Clinical Case Reports May 2016

Background

Bleomycin is an antibiotic chemotherapy agent that is used for management of Hodgkin's lymphoma and testicular cancer. Bleomycin is known to cause lung toxicity including bronchiolitis obliterans with organizing pneumonia (BOOP), eosinophilic hypersensitivity, and interstitial pneumonitis (referred to as Bleomycin interstitial pneumonitis or BIP). Imatinib (a tyrosine kinase inhibitor) has been associated with successful treatment of BIP in a few case reports.

Case Report

The authors report a case of a 69 year old male with