In this episode, I’ll discuss Low dose versus standard dose four-factor prothrombin complex concentrate for factor‐Xa inhibitor reversal in spontaneous and traumatic intracranial hemorrhage. Subscribe on iTunes, Android, or Stitcher While guidelines recommend 50 units/kg when 4 factor prothrombin complex concentrate (4FPCC) is used for factor‐Xa inhibitor reversal in intracranial hemorrhage, lower doses of 25 […]
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Episode 607: Don’t let the antipsychotics out of the ICU!
In this episode, I’ll discuss the unwarranted continuation of antipsychotics after ICU and hospital discharge. Subscribe on iTunes, Android, or Stitcher Although the use of antipsychotics to treat ICU delirium does not have robust patient-focused outcomes data, they are frequently used. Usually antipsychotics are started when a patient with ICU delirium becomes agitated to the […]
Episode 606: What is the conversion of oral methadone to IV?
In this episode, I’ll discuss the bioavailability of methadone. Subscribe on iTunes, Android, or Stitcher Popular tertiary references suggest a conversion ratio of oral to IV methadone of 2:1, meaning 10 mg of oral methadone is equivalent to 5 mg of IV methadone. But a team of researchers recently published a scoping review on the […]
Episode 605: Protamine Shortage Options
In this episode, I’ll discuss the protamine shortage. Subscribe on iTunes, Android, or Stitcher In March 2021 the ASHP Shortage list reported that the manufacturer of protamine was experiencing delays leading to a shortage. Protamine can be used as an emergency reversal agent for heparin and partial reversal agent for low molecular weight heparin. Significant […]
Episode 604: Why does warfarin need overlap with another anticoagulant when treating VTE?
In this episode, I’ll discuss why warfarin needs overlap with another anticoagulant when treating VTE. Subscribe on iTunes, Android, or Stitcher The CHEST guidelines state: It is now standard practice to start anticoagulant treatment after VTE with a heparin (unfractionated or low molecular weight) together with a VKA, overlap the two drugs for at least […]
Episode 603: What is the incidence of anaphylaxis to sugammadex?
In this episode, I’ll discuss the incidence of anaphylaxis to sugammadex. Subscribe on iTunes, Android, or Stitcher Concerns over the rate of anaphylaxis to sugammadex delayed the US approval of the drug, with the FDA issuing a not approvable letter in 2008 citing in part concerns about allergic reactions. When sugammadex was approved in 2015 […]
Episode 602: Does using haloperidol for ICU delirium reduce mortality?
In this episode, I’ll discuss whether using haloperidol for ICU delirium reduces mortality. Subscribe on iTunes, Android, or Stitcher While many pharmacologic therapies have been studied to treat ICU delirium, the recommendations from the latest SCCM PADIS guidelines is: We suggest not routinely using haloperidol, an atypical antipsychotic, or a HMG-CoA reductase inhibitor (i.e., a […]
Episode 601: Can hypotension from propofol be predicted?
In this episode, I’ll discuss the prediction of hypotension from propofol when used as an ICU sedative. Subscribe on iTunes, Android, or Stitcher Hypotension from ICU sedatives like propofol and dexmedetomidine can complicate patient management. I discussed predicting hypotension from dexmedetomidine back in Episode 563. Hypotension from propofol in the ICU can also be reasonably […]
Episode 600: What is the mechanism of interaction between ACE inhibitors and angiotension II?
In this episode, I’ll discuss the mechanism of interaction between ACE inhibitors and angiotension II. Subscribe on iTunes, Android, or Stitcher Shout out to Academy member JCR for inspiring this episode! The vasopressor angiotensin II carries a warning in the prescribing information that “ACE inhibitors may increase response to angiotensin II”. No information on why […]
Episode 599: Enoxaparin is associated with lower rates of mortality than unfractionated Heparin in hospitalized COVID-19 patients
In this episode, I’ll discuss an article that compares mortality in COVID-19 patients who received enoxaparin vs those who received unfractionated heparin. Subscribe on iTunes, Android, or Stitcher Managing coagulopathies in patients hospitalized with COVID-19 is one of the more challenging aspects of care for these patients. While prospective trials are ongoing, a retrospective analysis […]
Episode 598: What rifamycin-opioid interactions are most significant?
In this episode, I’ll discuss a review article that identifies the most significant rifamycin-opioid interactions. Subscribe on iTunes, Android, or Stitcher Opioids have a narrow therapeutic index and many undergo metabolism by the CYP450 enzyme system. Rifamycins such as rifampin and rifabutin have the potential to induce CYP450 enzymes are thereby interfere with the therapeutic […]
Episode 597: Hypotension from ketamine for rapid sequence intubation
In this episode, I’ll discuss an article about hypotension from ketamine for rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher Hypotension is an undesirable effect of rapid sequence intubation, and can occur from the medications used to facilitate intubation or from decreased venous return due to positive pressure ventilation. Because ketamine has a side effect profile […]
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