In this episode, I’ll discuss opportunities for antibiotic stewardship before hospital discharge. Subscribe on iTunes, Android, or Stitcher A primary focus of antibiotic stewardship programs is to reduce unnecessary antibiotic use among hospital inpatients. Reducing unnecessary antibiotic use upon hospital discharge is not a popular focus among the majority of stewardship programs. However, a significant […]

In this episode, I’ll discuss 3 reasons to consider holding lithium in critically ill patients. Subscribe on iTunes, Android, or Stitcher Chronic medications, especially neuro-active ones, are often resumed in the ICU as soon as critically ill patients can tolerate them.  Lithium, however, has a particularly narrow therapeutic range and the potential for toxicity to […]

In this episode, I’ll discuss a resource for taking care of patients with a rare disease. Subscribe on iTunes, Android, or Stitcher There exists a large number of rare diseases that any given hospital pharmacist might encounter once in their practice, if at all. Many of these diseases are exacerbated by certain medications but because of […]

In this episode, I’ll discuss the management of suspected propofol dependence with phenobarbital in an adult patient with COVID-19. Subscribe on iTunes, Android, or Stitcher There is limited published information on propofol withdrawal syndrome. Authors recently published a case report of their experience treating a patient with suspected propofol dependence with phenobarbital in the American […]

In this episode, I’ll discuss whether there is an association between the sedative dose and postintubation hypotension and rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher When a patient who requires sedation for intubation also has hemodynamic instability, a common recommendation is to lower the dose of sedative given in hopes of preventing further […]

In this episode, I’ll discuss parenteral medication considerations for the ketogenic diet. Subscribe on iTunes, Android, or Stitcher A high-fat, low-carbohydrate diet may be prescribed to induce ketosis and help patients with epilepsy that is refractory to medical treatment. While dietary carbohydrate intake is tightly controlled in these patients, small amounts of carbohydrate from non-dietary sources […]

In this episode, I’ll discuss whether meropenem should be given by continuous infusion in critically ill patients. Subscribe on iTunes, Android, or Stitcher A continuous infusion of meropenem helps to ensure 100% time above MIC and is often employed for resistant infections. This has led some to question whether it is better to routinely give meropenem […]

In this episode, I’ll discuss the results of a pilot trial of sodium bicarbonate for metabolic acidosis in the ICU. Subscribe on iTunes, Android, or Stitcher Sodium Bicarbonate is frequently given to ICU patients to correct metabolic acidosis however evidence to support this indication is lacking and sodium bicarb is not a benign intervention without risk […]

In this episode, I’ll discuss expectations for the onset of action of IM medications used for acute agitation. Subscribe on iTunes, Android, or Stitcher When caring for an acutely agitated patient, the delay between IM medication administration and the onset of action can seem exceedingly long. Staff and patient safety continue to be at risk until […]

In this episode, I’ll discuss three tips for inpatient medical emergencies. Subscribe on iTunes, Android, or Stitcher Please note: There is an error in the recording that indicates this is episode 831 but it is, in fact, episode 833. Tip #1: ACE Inhibitor-Induced Angioedema When taking care of a patient with ACE inhibitor-induced angioedema, I focus […]

In this episode, I’ll discuss a cost-avoidance study of a redistribution process to reduce waste of emergency medications in drug boxes. Subscribe on iTunes, Android, or Stitcher Placing emergency medications throughout the hospital in drug boxes is essential to ensure their availability when emergencies arise. However, this leads to a large number of medications that […]

In this episode, I’ll discuss the role for ketamine in status epilepticus. Subscribe on iTunes, Android, or Stitcher The initial therapy for status epilepticus is to use one of the following benzodiazepines: Lorazepam 0.1 mg/kg capped at 4 mg IV Midazolam 0.2 mg/kg capped at 10 mg IM Diazepam 0.15 mg/kg capped at 10 mg IV […]