The Pharm So Hard Podcast: An Emergency Medicine and Hospital Pharmacy Podcast

By Jimmy Pruitt & Oscar SantaloMedicine Health & Fitness

The Pharm So Hard Podcast: An Emergency Medicine and Hospital Pharmacy Podcast episodes

April 26 Episode 130. Single-Dose Aminoglycosides for Resistant UTIs
In Episode 130 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by Hunter Rondeau, PharmD, BCIDP, AAHIVP, antimicrobial stewardship coordinator at SSM Health, to explore the growing role of single-dose aminoglycosides for urinary tract infections with limited oral treatment options.
Hunter shares how this strategy gained traction through emergency department culture-callback programs and antimicrobial stewardship efforts, highlighting real-world scenarios where a single IV dose can prevent unnecessary admissions, PICC placement, and prolonged antibiotic exposure. The discussion dives into the evolving resistance landscape, the rise of ESBL and CRE organisms, and the clinical decision-making needed to identify the right patients for this approach.
Jimmy and Hunter also review key evidence, including systematic reviews, IDSA guidance, and emerging emergency medicine data that support the safety and effectiveness of single-dose aminoglycosides. From patient selection and workflow implementation to provider education and follow-up, this episode offers practical insights for pharmacists looking to expand their impact in the ED and beyond.
If you’re interested in antimicrobial stewardship, emergency medicine pharmacy, and innovative ways to manage resistant UTIs while keeping patients out of the hospital, this episode is packed with pearls you can apply in practice.
The post Episode 130. Single-Dose Aminoglycosides for Resistant UTIs appeared first on The Pharm So Hard Podcast.
1 hr 1 min
October 31, 2024 Episode 118. Does Roc Rock and Succs Really Suck? Paralyzing Agents in RSI
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.
The post Episode 118. Does Roc Rock and Succs Really Suck? Paralyzing Agents in RSI appeared first on The Pharm So Hard Podcast.
29 min
August 08, 2024 Episode 8: Collaborative Pharmacy Consulting and Expanding Ambulatory Roles
In this episode, host Micaela Hayes, PharmD, welcomes Jaron Stout, PharmD, FASCP to discuss the dynamic field of collaborative pharmacy consulting and the expanding roles within ambulatory care. Dr. Stout shares his insights on the importance of interdisciplinary collaboration in enhancing patient care, the evolving responsibilities of pharmacists in ambulatory settings, and strategies for integrating pharmacy services into primary care. This episode highlights real-world examples and practical tips for pharmacists looking to broaden their impact in healthcare.
LinkedIn https://www.linkedin.com/in/dr-jaron-stout-pharmd-fascp-55383210/
https://www.linkedin.com/company/collaborative-pharmacy-consulting/
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1 hr 2 min
July 16, 2024 Episode 7. Collaborative Practice Agreements with Jessica and Marianna
In this episode, host Micaela Hayes, PharmD, delves into the world of collaborative practice agreements and the crucial role of pharmacists in this dynamic field. Joined by two experts from the Avant Institute, Dr. Jessica Sinclair, Director of Education and Research Outcomes at Avant Pharmacy and Wellness Center and Director of the Fellowship at Avant Institute, and Dr. Mariana Wilbur, faculty pharmacist and Assistant Director of the Fellowship at Avant Institute, the discussion covers the ins and outs of collaborative practice, best practices, and the future of pharmacy in ambulatory care. This informative and engaging episode offers valuable insights for anyone interested in the evolving role of pharmacists.
LinkedIn https://www.linkedin.com/company/avant-institute/
https://www.linkedin.com/in/marianna-w-616a4a94/
https://www.linkedin.com/in/jessica-sinclair-a114985a/
Website www.avantinstitute.com
Fellowship application https://www.avantinstitute.com/fellowship
Other Socials https://www.facebook.com/avantinstitute/
https://www.instagram.com/avantinstitute/
Additional training https://www.pharmacist.com/Education/Certificate-Training-Programs/Pharmacists-Getting-Paid-Through-Collaborative-Clinical-Services
Upcoming Conferences, etc. https://www.avantinstitute.com/symposium
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36 min
July 02, 2024Episode 116. Writing and Living InteGREAT with Andrea Sikora, Anthony Hawkins, and Susan Smith
Shownotes
Episode Title: Collaborative Insights on Creating Great Healthcare Teams with C3 Group Authors
Host: Jimmy Pruitt
Guests:
W. Anthony Hawkins, PharmD, FCCM, BCCCP
Clinical Associate Professor, Practice Site: Phoebe Putney Memorial Hospital (Albany, GA)
Clinical Specialist – Medical ICU and PGY-1 Residency Coordinator
Email: [email protected]
Twitter: @iamahawkins
Andrea Sikora, PharmD, MSCR, BCPS, BCCCP, FCCM
Clinical Associate Professor, Practice Site: Augusta University Medical Center (Augusta, GA)
Clinical Specialist – Cardiac ICU
Email: [email protected]
Twitter: @AndreaSikora
Susan E. Smith, PharmD, BCPS, BCCCP
Clinical Associate Professor, Practice Site: Piedmont Athens Regional Medical Center (Athens, GA)
Clinical Specialist – Medical/Surgical ICU
Email: [email protected]
Twitter: @SESmithPharmD
Trisha N. Branan, PharmD, BCCCP, FCCM
Clinical Associate Professor, Assistant Department Head for Professional Education
Practice Site: Piedmont Athens Regional Medical Center (Athens, GA)
Email: [email protected]
Twitter: @TrishaBrananPharmD
Christopher M. Bland, PharmD, FCCP, FIDSA, BCPS
Albert W. Jowdy Professor in Pharmacy Care, Co-Founder of SERGE-45 and Teach Me Pharm
Practice Site: Southeast GA Campus, Savannah, GA
Email: [email protected]
Twitter: @ChrisBlandPharmD
Summary: In this episode, Jimmy Pruitt engages with the C3 Group authors, Andrea Sikora, Anthony Hawkins, and Susan Smith from the University of Georgia College of Pharmacy. They delve into their collaborative journey of writing the book InteGREAT: A Guidebook for Creating Great Healthcare Teams. The discussion covers the challenges, milestones, and pivotal moments experienced during the book’s creation. They explore the vision and goals behind the book, its structure, and how it aids in building and optimizing healthcare teams. The authors share insights on the importance of team development, building relationships, leveraging individual strengths, and achieving alignment within the team. The episode also highlights how the book impacts clinical teams and the professional activities of the authors.
Key Takeaways:
Collaborative Writing: The authors share their experiences in writing the book collaboratively, including the challenges and milestones.
Vision and Goal: The book aims to provide a comprehensive guide for creating effective healthcare teams, drawing from the authors’ knowledge and experiences.
Book Structure: InteGREAT is structured into three main sections: principles of a team, building a great team, and growing and optimizing a team for sustainability.
Team Development: Investing in team development is crucial for building strong foundations.
Building Relationships: Leveraging individual strengths and building relationships are key to creating a great team.
Finding Alignment: Achieving alignment within the team is essential for sustained success.
Practical Application: The book offers concise chapters with reflection questions to help teams apply the concepts discussed.
Professional Impact: The book complements the professional activities of the authors and positively impacts clinical teams.
Chapters:
03:10 What inspired C3 to write InteGREAT
04:38 Early challenges in writing InteGREAT
08:58 Vision and goals of InteGREAT
12:51 Major milestones in writing InteGREAT
16:30 Organizing the writing process
18:53 Pivotal moments during the process
22:12 General structure and main chapters of the book
29:03 Potential impact of the book
34:22 Stories or feedback from readers who’ve applied these ideas
38:47 Next Projects
41:04 How the book is influencing your roles
42:26 How to get access to InteGREAT
43:00 Closing Remarks
Book Information:
Title: InteGREAT: A Guidebook for Creating Great Healthcare Teams
Purchase: Amazon
UGA C3 Critical Care Collaborative: For more information about the UGA C3 Critical Care Collaborative, visit the UGA College of Pharmacy website.
https://www.critcarecollab.com
The post Episode 116. Writing and Living InteGREAT with Andrea Sikora, Anthony Hawkins, and Susan Smith appeared first on The Pharm So Hard Podcast.
0 min
June 18, 2024 Episode 6. The Great Debate: Unpacking the Controversy of GLP-1 Agonists
The post Episode 6. The Great Debate: Unpacking the Controversy of GLP-1 Agonists appeared first on The Pharm So Hard Podcast.
38 min
February 16, 2024 Episode 111. Pulse Check! Kyle Stupca’s Study on Esmolol & Dose-Capped Epi
PACUPrep BCEMP 6 Week Fasttrack Program
PACUPrep – 6 Week Fastrack – Pharmacy & Acute Care University (pharmacy-acutecareuniversity.com)
This Pharm So Hard episode titled “Pulse Check! Kyle Stupca’s Study on Esmolol & Dose-Capped Epi” is a deep dive into the innovative research conducted by Kyle Stupca on emergency cardiac care. The episode hosted by Jimmy Pruitt aims to explore Stupca’s groundbreaking study which focuses on the use of Esmolol and dose-capped epinephrine in treating life-threatening cardiac arrhythmias like ventricular fibrillation and pulseless ventricular tachycardia. The discussion covers Stupca’s personal journey and motivations in emergency medicine research, delves into the specifics of his study’s methodology, findings, and the challenges faced during research. A significant part of the episode is dedicated to discussing the practical implications of these findings for emergency cardiac care and envisaging the future of this field with unlimited research resources. This episode is designed to enlighten healthcare professionals, particularly pharmacists and physicians, about the evolving role of pharmacology in emergency medical scenarios, emphasizing the critical impact of research in this domain.

Link to the Study
Kyle Stupca LinkedIn
EMPoweRx Conference
PACUPrep BCEMP Question Bank
The post Episode 111. Pulse Check! Kyle Stupca’s Study on Esmolol & Dose-Capped Epi appeared first on The Pharm So Hard Podcast.
27 min
November 14, 2023Episode 110. The use of Methylene Blue for Refractory Hypotension with Rosa Malloy-Post, MD
Join us for an amazing experience in acute care pharmacotherapy at the EMpoweRx Conference on April 26-27th.

Click below for more info.
More Info on EMpoweRx
Guest For the podcast

Rosa Malloy-Post
Hometown: Brooklyn, NY
College: Fort Lewis College Durango, CO
Medical school: University of Colorado
What you love about living in/moving to Charlotte: The food and the trees. Coming from Denver it’s nice to have some greenery. The variety and concentration of good food is impressive, I haven’t had a bad meal yet.
What you see yourself doing in 10 years: Who knows? I’m opened to exploring fellowship opportunities in toxicology or palliative care. I enjoy teaching so I see an academic career in my future. I’ll most likely be somewhere in the mountain west.

Methylene blue
History and Background
First synthesized in 1876 by Heinrich Caro at BASF as a blue textile dye, originally named “methyl blue”
In 1891, Paul Ehrlich discovered it could stain certain microorganisms and used it to differentiate bacterial species
Used as antiseptic/antibacterial in late 1800s, including treating tropical diseases like malaria
Approved by FDA in 1959 as a treatment for methemoglobinemia, a condition where hemoglobin is oxidized to the ferric (Fe3+) form, making it unable to carry oxygen. Doses of 1-2 mg/kg IV can reduce methoglobin levels by acting as an electron donor.
Studied as potential treatment for hypotension starting in 1980s. Case reports showed benefit in refractory septic shock. Proposed as nitric oxide scavenger and vasopressor.
Multiple human studies in 1990s looked at methylene blue for sepsis. Showed transient improvements in blood pressure but no mortality benefit.
CLASS
heterocyclic aromatic molecule
MECHANISM OF ACTION
two opposite actions on Hb
(1) low concentrations: methylene blue -> NADPH-dependent reduction to leucomethylene blue (due to action of methaemoglobin reductase) -> reduces methaemoglobin -> Hb
(2) high concentrations: methylene blue -> converts ferrous iron of reduced Hb to ferric ion -> forms methaemoglobin
inhibits guanylate cyclase (which is stimulated by NO and other mediators), thus decreasing C-GMP and vascular smooth muscle relaxation
MAO inhibition

Dose
Methaemoglobinaemia
1-2mg/kg IV over 5 minutes followed by saline flush; repeat at 30-60 min if MetHb levels not falling
repeat dose every 6-8h when MetHb continues for days, e.g. dapsone toxicity
Vasoplegia
1.5-2 mg/kg IV over 30-60min

INDICATIONS
methaemoglobinemia
— symptomatic
— asymptomatic with >20% MetHb, or >10% if risk factors such as anaemia or ischemic heart disease
vasoplegic shock post cardiopulmonary bypass
other possible roles in critical illness: hepatopulmonary syndrome, septic shock
other uses have included use as an antimalarial agent, anti-cancer treatment, treatment of ifosfamide neurotoxicity, as a dye/stain (e.g. test for aspiration), priapism
CONTRA-INDICATIONS
G6PD deficiency (lack of NADPH prevents methylene blue from working and may lead to haemolysis)
renal impairment
methaemoglobin reductase deficiency
nitrite-induced methaemoglobinaemia due to cyanide poisoning
hypersensitivity
ADVERSE EVENTS
inability to monitor oxygen saturation by SpO2 or continuous central venous saturation monitoring
non-specific symptoms: dizziness, headache, confusion, chest pain, shortness of breath, nausea and vomitng
local pain and irritation
blue staining of mucous membrane may mimic cyanosis
paradoxical methaemoglobinaemia due to direct oxidative effect on Hb (typically at very high doses > 7 mg/kg)
acute haemolytic anemia in G6PD deficiency (typically doses >15mg/kg)
anaphylaxis
MAO inhibiton may contribute to serotonin toxicity or hypertensive crisis
Key Clinical Studies
Levin et al. 2004 RCT in post-CABG vasoplegic shock
28 patients, MB 2 mg/kg vs placebo
Marked improvement in hemodynamics
Mortality benefit – 0% vs 21% in placebo group (p=0.01)
Kirov et al. 2001 RCT in established septic shock
20 patients, MB vs placebo
Increased MAP, decreased vasopressor needs
Porizka et al. 2020 retrospective study
Looked at MAP increase ≥10% to define “responders”
Improved survival in responders
Franz et al. 2021 case series
11 patients with post-cardiotomy shock
82% rate of MB response based on 20% MAP increase
Survival benefit in responders (92% vs 50%)

The post Episode 110. The use of Methylene Blue for Refractory Hypotension with Rosa Malloy-Post, MD appeared first on The Pharm So Hard Podcast.
25 min
October 18, 2023Episode 109. STREAM-2 Study Journal Club with Nick Servati and Alex Cruz Pabon
Title: STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment–Elevation Myocardial Infarction: A Randomized, Open-Label Trial
Background/Purpose: STEMI guidelines recommend pharmaco-invasive treatment if timely primary percutaneous coronary intervention (PCI) is unavailable. In the STREAM-1 study (Strategic Reperfusion Early After Myocardial Infarction), a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction, compared with primary PCI but an excess of ICH in patients ≥75 years of age prompted a protocol amendment that halved the dose of weight-adjusted bolus tenecteplase. After the adjustment, there was no subsequent ICH. STREAM-2 sought to investigate if half-dose tenecteplase is effective and safe in older patients with STEMI.
Patient Population: (N=604)
Included:
Age ≥60 years*
Onset of symptoms < 3 hours prior to randomisation
12-lead ECG indicative of an acute STEMI (ST-elevation will be measured from the J point; scale: 1 mm per 0.1 mV):
≥2 mm ST-elevation across 2 contiguous precordial leads (V1-V6) or leads I and aVL for a minimum combined total of 4 mm ST-elevation
≥2 mm ST-elevation in 2 contiguous inferior leads (II, III, aVF) for a minimum combined total of 4 mm ST-elevation
Informed consent received
*Original protocol included patients ≥70 years of age but slow recruitment (+analysis of bleed starting ~60) prompted an amendment to include patients ≥60 years of age.
2020 Armstrong et al, trial design amendment
Performed an internal systematic review of the ASSENT trial series and their initial STREAM-1 trial à risk of major bleeding and/or ICH begins to increase around the age of 60 years
Amendment made in 2018, ~1 year into enrollment that lasted thru 2022
Exclusion criteria:
Expected PCI < 60 min from diagnosis (qualifying ECG) or inability to arrive at the catheterisation laboratory within 3 hours
Previous CABG
LBBB or ventricular pacing
Cardiogenic shock – Killip Class 4
Wt < 55 kg (known or estimated)
Uncontrolled HTN (sustained SBP >180 mmHg and/or DBP >110 mmHg) prior to randomisation
Known prior stroke or TIA
AC within 12 hours (UFH, enoxaparin, and/or bivalirudin or current use of OAC (i.e. warfarin or a NOACs)
Active bleeding or known bleeding disorder/diathesis
Known Hx of CNS damage (i.e. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to the head or cranium (i.e. < 3 months)
Major surgery, biopsy of a parenchymal organ, or significant trauma within the past 2 months (includes any trauma associated with the current MI)
Clinical Dx associated with increased risk of bleeding including known active peptic ulceration and/or neoplasm with increased bleeding risk
Known severe renal insufficiency
Prolonged CPR(> 2 minutes) within the past 2 weeks
Known acute pericarditis and/or subacute bacterial endocarditis
Known acute pancreatitis or known severe hepatic dysfunction, including hepatic failure, cirrhosis, portal hypertension (oesophageal varices) and active hepatitis
Dementia
Previous enrollment in this study or Tx with an investigational drug/device under another study protocol in the past 7 days
Known allergic reactions to tenecteplase, clopidogrel, enoxaparin and aspirin
Inability to follow the protocol and comply with follow-up requirements or any other reason that the investigator feels would place the patient at increased risk if the investigational therapy is initiated.
Treatment Regimen:
Intervention (Pharmacoinvasive): half-dose Tenecteplase followed by coronary angiography and PCI (if indicated) 6 to 24 hours after randomization (n=401)
TNKase Dosing
* 50 or 40 mg of drug reconstituted in 10 or 8 ml SWFI given as single weight-adapted IV bolus over 5 to 10 seconds
Control: Primary PCI (n=203)
*median time Sx to randomization
→ TNKase: 97 min
→ PCI: 92 min
*median times from randomization to Tx
→ TNKase: 10 min (could be pre-hospital) – so in total: 107 min or just shy of 2 h from sx to lytic
→ Sheath insertion: 81 minutes
Adjunctive therapy (in addition to intervention Tx):
Pharmacoinvasive Group
ASA: 150 to 325 mg
75-100 mg/d thereafter
Clopidogrel: 300 mg
Current guidelines rec NO LOAD for 75 years or older, however in this trial roughly 1/4th were 75 or older and would have received the 300 mg load
75 mg/d thereafter
SQ enoxaparin 0.75 mg/ kg + additional IV dose of 30 mg in patients ≤75 years (after amendment)
Was continued q12h until discharge or MAX 4 days
CrCl <30 = q24h dosing
Meds in the Primary PCI group (according to local guidelines)
Aspirin
P2Y12 antagonist
anticoagulants
Therapy considerations: If unsuccessful reperfusion 60-90 min after TNKase (≥50% ST resolution in the ECG lead with maximum ST-segment elevation and clinical stability): coronary angiography was undertaken 6 to 24 hours after randomization → rescue PCi if failed reperfusion based on ST resolution/instability
Methods:
Design:
Investigator-initiated, open-label, randomized, multicenter study
N=604
49 centres in 10 countries (Canada, France, Spain, Mexico, Brazil, Chile, Australia, Russia, Serbia, Montenegro)
From August 1, 2017 to September 12, 2022
Goal for power = 600 pts (400 pharm/200 PCI) → after 50% recruitment
Original protocol included patients ≥70 years of age but slow recruitment (+analysis of bleed starting ~60 yrs) prompted an amendment to include patients ≥60 years of age
Efficacy Endpoints:
PRIMARY: ST resolution (≥50%)
30-day composite of death, shock, HF, or reinfarction (not powered)
Shock: SBP<90min, req VP or interventions to maintain BP, HR>60 + Sx of end organ damage (UO<30 ml/hr, confusion, cold ext) OR CI<2.2 + PCWP>15
HF: requiring diuretics + pulmonary oedema/congestion, rales KC≥2,, PCWP >25 mmHg, dyspnea with pO2 < 80 mmHg or O2 sat < 90% in the absence of known lung disease
Reinfarction related to PCI or surgery
≤48 hrs after PCI: trops>5x 99th percentile; >20% trop rise if previously stable/falling; new ischemic changes ECG/angiography
>48hrs after PCI/CABG: Rise/fall of trops & ≥99th percentile URL % ≥1 of the following: • Sx of ischemia; • New significant ST-T changes or new LBBB; • Pathological Q waves in the ECG; • Imaging New loss of viable myocardium or new regional WMA; • Identification of an intracoronary thrombus eg stent thrombosis by angiography or autopsy
≤48 hrs after CABG: trops>10x 99th percentile; >20% trop rise if previously stable/falling + new Q waves/LBBB OR angiographic documented new graft or new native coronary artery occlusion or imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.
Safety Endpoints (ITT)
Stroke
Non-intracranial bleeding
Follow Up:
Results Avg. patient: 71 y/o male (two-thirds) with HTN (55%), DM. P/w inferior STEMI (~60%), mostly Killip class I (no signs of congestion) & great BP (SBP 130s), TIMI Risk score 4 (corresponds to a ~20% risk of 14-day death, new MI, recurrent MI, or ischemia req’ing repeat intervention; max score is 7 = 41% risk)
Efficacy:
ST resolution
→ Pharmaco-invasive: 85.2%
→ median declined from 3.0 to 1.0 mm
→ pPCI: 78.4%
*residual median sums of ST deviations were 4.5 versus 5.5 mm, respectively
* TIMI flow grade 3 at last angiography ≈87% in both groups. / 53.8% after TNKase versus 18.9% before PCI
Rescue PCI:168 (42.2%) patients randomly assigned to a pharmaco-invasive strategy at median 142 min from randomization
Of 401 pts given TNK, 345 (86%) went for angiography within 24 h (rescue or not), and most of them received stents (335 or 84% of total)
Composite Clinical endpoint
→ Pharmaco-invasive: 12.8% (51/400)
→ pPCI: 13.3% (27/203)
(RR,, 0.96 [95% CI, 0.62–1.48])
→ 3/37 non-cardaic deaths in pharmaco-invasive group related to ICH
Safety:
ICH
→ Pharmaco-invasive: 6 (1.5%)
3 protocol violations (excess AC 2/6 and uncontrolled HTN [174/117] in 1/6)
Therapeutic IV UFH during rescue PCI despite full-dose IV/SC LMWH
This underscores the value of pharmacist involvement – authors commented “underscores the hazard…also reinforces the need for clear and timely communication regarding given treatments between various members of the health care team when rapid transitions in STEMI care unfold.”
→ 1ry PCI: 0
RR 6.61 (0.81-53.84)
Non-ICH bleeding
→ Pharmaco-invasive: 5/400 (1.3%)
→ 1ry PCI: 2/203 (1.0%)
RR 1.27, 95% CI 0.25-6.48 → no difference
Stroke
→ Pharmaco-invasive: 9/400 (2.3%)
→ 3 fatal (0.75%), none in pts>75 y
→ 1ry PCI: 1/203 (0.5%)
Pre-specified subgroup analysis
Only found 1 significant difference in favor of pharmaco-invasive strategy, which was when pts were randomized to TNK within 60 minutes
Aligns with the idea of a “golden hour” where lytic therapy is most efficacious within the 1st 60 minutes
Limitations:
Not powered to show a difference in clinical events
Possibility of heterogeneity between meds for pPCI in local guidelines
Protocol violations could have influenced increased bleeding risk
Unblinded intervention (for obvious reasons), but could have contributed to bias
Conclusion:
TNKase ½ dose led to comparable ECG changes as 1ry PCI in early presenting, older pts w/ STEMI
Nick – One of my personal takeaways – this trial and the continued adoption of pharmaco-invasive strategies even in the most recent ACS guidelines (2023 Europeans) highlights the continued challenge in accessing timely PCI even in developed STEMI networks
Based on 2010 census data and 2011 AHA data, ~85% of the US is within 1 hour of a PCI Center.
However that leaves 50 million Americans (a decade ago) farther out
Sadly, even when holding rural & urban locations as a constant, low-income areas and highly Hispanic communities had the largest delays to PCI
Growth of PCI capable centers continues around resource-risk areas leading to a worsening imbalance despite continued growth in health-care infrastructure
Higher ICH risk w/ TNKase
Although that risk remained the same as the original STREAM-1 trial from a decade ago (1.5%), and 0 events have occurred in those 75 or older since the original protocol amendment in STREAM-1 for ½ dose TNK
PCI is preferred but if unavailable, ½ dose pharmaco-invasive strategy is a reasonable alternative, provided that CI to fibrinolysis are observed and excess anticoagulation is avoided
Do we feel comfortable broadening this rec to alteplase?
Only trial for alteplase was the EARLY-MYO rial which was ½ dose tPA for a pharmaco-invasive strategy in China that excluded those >75 years
2023-STREAM-2Download
The post Episode 109. STREAM-2 Study Journal Club with Nick Servati and Alex Cruz Pabon appeared first on The Pharm So Hard Podcast.
43 min
September 26, 2023 Episode 108. Discussing DEI, Transparency, and Advocacy in Pharmacy with Sarah Cummins and Kevin Astle
The Tweet/EMail : (7) Sarah Cummins (@SC_PharmD) / X (twitter.com)

The Response: 8) ACCP on X: “In the latest President’s Column, Elizabeth Farrington responds to member feedback from last month’s “From the Desk of the ACCP President.” Read her response here: https://t.co/bkO52ztiHv https://t.co/hEUECYH1ib” / X (twitter.com)

The post Episode 108. Discussing DEI, Transparency, and Advocacy in Pharmacy with Sarah Cummins and Kevin Astle appeared first on The Pharm So Hard Podcast.
44 min

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An Emergency Medicine and Hospital Pharmacy Podcast

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About The Pharm So Hard Podcast: An Emergency Medicine and Hospital Pharmacy Podcast