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

In this episode of Pharm So Hard, Jimmy Pruitt, PharmD, BCPS, BCCCP, and Craig Cocchio, PharmD, DABAT discuss his position at High Yields Med Reviews and how his recent experience of being a patient has changed him professionally.

The post Episode 57. Provider to Patient Experiences Catching up with Craig Cocchio, PharmD, DABAT appeared first on The Pharm So Hard Podcast.

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The post Episode 55. Vasopressin and the VAM-IHCA Study with Christian Kroll and Jimmy Pruitt appeared first on The Pharm So Hard Podcast.

The post Episode 54. Pharm So Hard Spotlight & 2 Year Anniversary with Joshua Kiptoo, Dan Giddings, and Christian Kroll appeared first on The Pharm So Hard Podcast.

Head over to the PACU at Pharmacy-Acutecareuniversity.com

The post Episode 53. I Love These Jeans! Pharmacogenomics with Amanda Elchynski appeared first on The Pharm So Hard Podcast.

• Rapid sequence intubation (RSI) is a process whereby an induction agent and a neuromuscular blocking agent are given in rapid succession to facilitate endotracheal intubation
• The immediate post intubation period in the ED is a critical time for continued patient stabilization.
• While physical adjuncts like securing the tube, in line suctioning, and elevating the head of the bed are part of general post intubation management, post intubation analgesia and sedation is a key component to remember.
• Depending on the paralytic used, clinicians can be eased into the assumption that the patient is tolerating the ventilator and not in need of sedation or analgesia
• Administering analgesia and sedation is key to preventing patient awareness during paralysis and preventing PTSD

The Pharm So Hard Podcast

Episode 52: Just a Prop For Me Please: Post-Intubation

Guest Speaker: Jimmy L. Pruitt III, PharmD, BCPS, BCCCP

Host: Jimmy L. Pruitt III, PharmD, BCPS, BCCCP

1. Theme Music Intro
2. Brief intro of host
3. Intro of the Guest
4. Speaking Points
   1. Why this topic important?
   2. Briefly Describe the intubation process
   3. What are some common causes of Pain in the ED
      1. Acute pain can invoke a stress response, resulting in a hypercatabolic state, decreased tissue perfusion, and impaired wound healing. Uncontrolled pain decreases a patient’s immune response to infection by suppressing natural killer cell activity and neutrophil function.
   4. Are there any short and long term consequences of pain in critically ill patients?
      1. Acute pain can invoke a stress response, resulting in a hypercatabolic state, decreased tissue perfusion, and impaired wound healing. Uncontrolled pain decreases a patient’s immune response to infection by suppressing natural killer cell activity and neutrophil function.
         1. a traumatic injury.
         2. a. Health-related quality of life is decreased in up to 20% of patients.
         3. b. Chronic pain is reported in up to 40% of patients.
         4. c. Posttraumatic stress disorder is reported in 5%–20% of patients.

1. What are the agents you use for analgesia for post-intubation analgesia
   1. Fentanyl
      1. Dose
      2. PK/PD
   2. Morphine
      1. Dose
      2. PK/PD
   3. Hydromorphone
      1. Dose
      2. PK/PD

1. Ketamine
   1. Dose
   2. PK/PD

1. Are there any data to support using bolus therapy versus infusions?
2. How do you monitor Sedation in intubated patients?
3. Is there a level of sedation that is preferred? Deep vs Light?
4. What is analgosedation and how do you do it appropriately?
5. What are the most common sedation agents
   1. Propofol
   2. Midazolam
   3. Dexmedetomidine
6. Any Literature of the value of a pharmacist in post-intubation sedation?

The post Episode 52. Just A Diet Prop for Me: Post-Intubation Analgesia and Sedation appeared first on The Pharm So Hard Podcast.

The post Episode 51. Beta-Blocker Use in Cocaine Induced Chest Pain appeared first on The Pharm So Hard Podcast.

Joost Wiersinga W. eta al. JAMA Review 2020 doi:10.1001/jama.2020.12839

Tocilizumab

• 1/8/2010 FDA approval for treatment of moderate to severe rheumatoid arthritis

• 8/31/2017 FDA approval for treatment of CAR T cell-induced cytokine release syndrome

• 6/24/2021 EUA authorization for COVID-19 hospitalized adults and children

Baricitinib

• 6/1/2018 FDA approval for treatment of moderate to severe rheumatoid arthritis

• 11/19/2020 EUA for baricitinib in combination with remdesivir for COVID-19 hospitalized adults and children

The post Episode 50. The Immune System Needs to Calm Down: Pharmacologic Management with Tocilizumab and Baricitinib appeared first on The Pharm So Hard Podcast.

Episode Summary: In this episode of Pharm So Hard, Jimmy Pruitt, PharmD, BCPS, BCCCP discuss the pharmacotherapy of cannabinoid hyperemesis syndrome.

The post Episode 49. Stay off the Weed! The Pharmacologic Management of Cannabinoid Hyperemesis Syndrome appeared first on The Pharm So Hard Podcast.

“I always teach trainees that as long as you understand the pathophysiology behind a problem and the mechanisms behind the drugs we have available, we can find out where these 2 areas overlap and come to a rationale thought process”

• Important to understand that elevated ICP and CE can happen together, or they can happen independently of each other, or one can happen and lead to the other

• Certain neurologic injuries may cause one specific type of CE during the early phase of injury, and another type of CE during the later phases

• 5 primary types of CE, but I’ll focus on the 2 most common: vasogenic and cellular/cytotoxic -Briefly Describe vasogenic edema & cellular / cytotoxic edema

• Broad summary – sedation, fever control, dexamethasone, osmotic diuretics, hypertonic sodium

• -Discuss mannitol and the straight forward mechanism
• -Discuss how mechanism with HTS isn’t fully understood and compare the two primary thought processes
• -Discuss how we aren’t just talking hypertonic sodium and the breadth of hypertonic sodium solutions that have been studied and can be used

• -Pre-hospital administration
• -Dosing – discuss Cruz data & how this has been removed from TBI and CE guidelines
• -Dosing interval
• -Acute ICH administration
• -Rate of administration -Monitoring and AKI

• Na Goals
• -Bolus vs Infusion
• -Concentrations
• -Does it work when patient already has high Na?
• -Central vs peripheral
• -Rate of administration -Monitoring and other adverse effects

Click to access 60246e97b2d7821b9f9a47be_HTS%20vs%20mannitol%20pharmacy%20friday.pdf

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