Picking up right where Part 1 left off, this episode zeroes in on the practical, high-stakes side of inpatient heart failure management. Dr. Cait Kulig returns to unpack key adverse effects of diuresis, strategies to overcome diuretic resistance, and how to approach add-ons, IV vasoactive agents, and inotropes.

Jimmy and Cait also dive into the impact of acute decompensated heart failure on pharmacokinetics, diuretic selection, and guideline-directed therapy across HFrEF and HFpEF—including tips for transitioning to ARNIs and remembering what really matters during inpatient optimization.

Whether you're adjusting diuretics or making big-picture decisions, this episode will help you level up your heart failure confidence.

In Part 1 of this two-part masterclass on acute heart failure, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, teams up with Cait E. Kulig, PharmD, HF-Cert, clinical cardiology expert and creator of CAR Rx Explain, to unpack the fundamentals of heart failure in a way that finally clicks.

From defining heart failure and understanding ejection fraction to breaking down volume status and the Forrester plot, this episode delivers clear, memorable teaching pearls for any pharmacist working with cardiac patients. Learn when to hold GDMT, how to think through diuretic strategies, and what questions you should be asking your patients on admission. This is heart failure demystified—through the lens of real-world clinical decision-making.

💡 Up next in Part 2: We pick up with the adverse reactions of diuresis, dive into overcoming diuretic resistance, and discuss IV vasoactives, GDMT classes, and more.

In Episode 124 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, explores the ongoing debate around anticoagulation reversal in patients with minor traumatic intracranial hemorrhage (TICH). Highlighting a recent multicenter study, Jimmy breaks down the data, challenges current guideline-driven practices, and raises critical questions about risk, patient selection, and clinical judgment. Tune in for a nuanced discussion that could reshape how we approach minor TICH in the emergency department.

In this episode of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, introduces the Society of Emergency Medicine Pharmacists (SEMP), a newly established organization dedicated to advancing the practice of emergency medicine pharmacy. Jimmy discusses SEMP's mission to optimize pharmacotherapeutic care in emergency departments through practice improvement, education, advocacy, research, and international collaboration. He highlights the importance of creating a unified global community for emergency medicine pharmacists and explores how SEMP aims to provide tailored support and resources for practitioners in this dynamic field. Tune in to learn how SEMP plans to shape the future of emergency medicine pharmacy and how you can get involved.​

In this episode of The Pharm So Hard Emergency Medicine Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by William Amarquaye, PharmD, to discuss Journavix, the first non-opioid pill approved for moderate to severe acute pain in over 20 years. They break down its mechanism as a NAV1.8 sodium channel blocker, compare it to existing analgesics, and analyze clinical trial data on its efficacy and safety. The conversation also tackles key considerations like side effects, drug interactions, and cost implications for real-world use.

Episode 120. Ketamine for Benzodiazepine-Resistant Status Epilepticus – A Game-Changer?

In this episode of The Pharm So Hard Emergency Medicine Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP dives deep into an exciting new study exploring ketamine as a rescue agent for benzodiazepine-resistant status epilepticus. Traditionally, managing refractory seizures often requires intubation, high-dose propofol, or other antiepileptics. But could ketamine provide rapid and effective seizure control in these critical moments?

Jimmy discusses key findings from the study, practical implications for the ED, and how this data could influence your choice of induction agents during intubation. Plus, he shares valuable clinical pearls and caveats when considering ketamine use in different patient populations.

00:00 Introduction

02:16 The Clinical Dilemma: Benzodiazepine-Resistant Status Epilepticus

03:39 Introducing the Study: Ketamine as a Rescue Drug

05:16 Key Findings: Rapid Seizure Termination

06:05 Safety and Dosing Insights

06:42 Clinical Implications: Ketamine in ED Practice

07:05 Caveats and Patient Populations

07:55 Conclusion

In Episode 119 of The Pharm So Hard Emergency Medicine Podcast, Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, dives into the COPY-ED study, which explores cephalosporins as a viable option for treating outpatient pyelonephritis. Jimmy challenges the fluoroquinolone-dominant narrative, breaks down the study’s methods and results, and highlights the implications for emergency medicine pharmacists.

In this episode of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, and guest Rosa Malloy-Post, MD, delve into the debate over the most suitable paralyzing agent for rapid sequence intubation (RSI). They weigh the advantages and disadvantages of Succinylcholine ("Succ") and Rocuronium ("Roc") by comparing their pharmacologic properties, onset, duration, side effects, and clinical use cases. Listen for expert perspectives, practical insights, and essential factors to consider when choosing the right agent in emergency settings, and find out if "Roc truly rocks" or if "Succs really suck.

In this episode, host Jimmy L. Pruitt III, PharmD, BCPS, BCCCP, BCEMP, welcomes Tessa R. Cox, PharmD, BCCCP, and Brian W. Gilbert, PharmD, MBA, FCCM, FNCS, BCCCP, to discuss their study on the early administration of subcutaneous (SQ) basal insulin in mild to moderate diabetic ketoacidosis (DKA). The episode covers the definition and treatment of DKA, the role of insulin therapy, and the design and results of the retrospective study, which found no significant difference in hospital length of stay between early and non-early SQ basal insulin groups. The discussion includes an analysis of the study outcomes, clinical implications, and the need for further research. Tessa R. Cox and Brian W. Gilbert share their expert insights on DKA management and the relevance of the study findings to emergency medicine.