Pharmacy to Dose: The Critical Care Podcast: Recent Episodes
Nick Peters
Pharmacy to Dose: The Critical Care Podcast discusses critical care and its pharmacotherapy in a fun and entertaining manner. Each episode features a special guest, a subject matter expert, talking with host Nick Peters.
2023 Neurocritical Care Society Annual Meeting Pharmacist-featured research
02:24 – Multicenter comparison of the safety and efficacy of clopidogrel versus ticagrelor for neuroendovascular stents featuring Casey May, PharmD, BCCCP, FNCS 15:24 – Prevalence of augmented renal clearance in neurocritical care population: a prospective multicenter study (Neuro-ARC study) featuring Sherif Mahmoud, BSc (Pharm), MSc, PhD, FNCS 24:41 – Derivation and validation of an equation to predict free valproate concentration in intensive care patients featuring Ji Liu, PharmD, BCCCP 43:05 – Effect of IV push levetiracetam and lacosamide implementation on turn-around times and cost featuring Veronica Bonderski, PharmD, BCCCP 53:25 – Neurostimulant prescription rates in patients with neurologic injuries AND Statin effects on inflammatory biomarker concentrations in patients with mild traumatic brain injury: a potential target for intervention featuring Sulaiman Almohaish, PharmD, BCPS and Gretchen Brophy, PharmD, BCPS, FCCP, FCCM, FNCS, MCCM 66:20 – Effect of melatonin on the use of antipsychotic medications in the intensive care unit featuring Madeline Mitchell, PharmD, BCPS 77:10 – Pharmacists decrease number of protocol discordant four-factor prothrombin complex concentrate orders for oral anticoagulant-associated intracranial hemorrhage in a community emergency department featuring Ifoma Ofoegbuna, PharmD, BCCCP 84:12 – Clinical pharmacist-driven electronic data capture of medication administration records in the ELECTRO-BOOST multicenter study featuring Andy Webb, PharmD, BCCCP
Link to research poster PDFs: https://pharmacytodose.com/2023/09/13/2023-ncs-pharmd-research-highlights/
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2023 Pharmacy to Dose Award Winner Celebration
08:04 – Deborah Wagner, Publication of the year winner 11:35 – Megan Rech, Mentor of the year winner 13:32 – Brian Gilbert, Conference speaker of the year winner 15:45 – Melissa Thompson Bastin, Preceptor of the year winner 18:14 – Alyssa Meester and Adam Smith, Tag Team Tandem of the year winner 21:54 – Grace Erdman, PGY2 resident of the year winner 24:45 – Ruben Santiago and Andy Webb, Co-Social media star winners 28:17 – Carolyn Bell, People’s Choice award winner 30:56 – Mojdeh Heavner, MVP award winner 34:06 – Rob Maclaren, Living legend award winner
2023 Award Winners: https://pharmacytodose.files.wordpress.com/2023/09/the-2023-pharmacy-to-dose-award-winners.pdf
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Trial of the Week: Phenobarbital for Acute Alcohol Withdrawal Special Guest: Joseph Lam, PharmD
Joseph Lam joins me to highlight the 2013 trial published in the Journal of Emergency: Phenobarbital for acute alcohol withdrawal: a prospective, randomized, double-blind, placebo-controlled study. Joe shares his experience in the trial and all he did behind the scenes. Plus, we discuss the role of phenobarbital at that time, what this study found, what do we still need to know on this topic, and much more.
Reference list: https://pharmacytodose.files.wordpress.com/2023/09/phb-in-aws-references.pdf
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Arrhythmias in the Emergency Department Special Guests: Kyle DeWitt, PharmD, BCPS Lance Ray, PharmD, BCPS, BCEMP
05:30 – Intro/background 10:10 – Atrial arrhythmias 56:40 – EKGs/Ventricular arrhythmias 72:35 – Bradyarrhythmias/take-home points
Reference List: https://pharmacytodose.files.wordpress.com/2023/09/arrhythmias-in-the-ed-references.pdf
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Trial of the Week: ATHOS-3 Angiotensin II for the Treatment of Vasodilatory Shock Special Guest: Dr. Ashish Khanna, MD, MS, FCCP, FCCM, FASA
Dr. Ashish Khanna joins me to highlight the ATHOS-3 trial, where Dr. Khanna is the principal investigator and first author of the NEJM publication. We discuss the history of angiogensin II, research prior to ATHOS-3, highlight findings from the ATHOS-3 trial, writing for NEJM, experience leading a large prospective RCT in the critically ill, what research do we have since this landmark publication, and much more.
Reference list: https://pharmacytodose.files.wordpress.com/2023/09/athos3-references.pdf
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Trial of the Week: Insidious Harm of Medication Diluents
Special Guest: Carolyn Magee Bell, PharmD, BCCCP
Carolyn Bell joins me to discuss her first author research study, the Insidious Harm of Medication Diluents. We review what the perception around balanced fluids was in 2016, advice for prospective research, ultimate trial take-aways, things she would do different, bribing other Pharmacists, and much more.
Reference list: https://pharmacytodose.files.wordpress.com/2023/08/medication-diluent-trial-of-week-references.pdf
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Aneurysmal Subarachnoid Hemorrhage (aSAH) Part II Special Guest: Casey May, PharmD, BCCCP, FNCS
04:24 – Guideline overview 09:15 – Blood pressure management 22:03 – Nimodipine 31:15 – Antifibrinolytics 36:58 – Hyponatremia and adjunctive treatments 46:20 – Seizure prophylaxis 49:10 -- Cerebral vasospasm/DCI treatment 52:46 -- Gaps in guidelines, future trials, ideas for future studies 60:25 – Take-home points
Reference List: https://pharmacytodose.files.wordpress.com/2023/08/asah-part-ii-references.pdf
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Trial of the Week: Tamiflu Dosing Review Special Guest: Melissa Thompson Bastin, PharmD, PhD, BCCCP, FCCM
Melissa Thompson Bastin joins me to discuss her review on oseltamivir dosing in the critically ill. We give an overview of the H1N1 pandemic, treatment regimens we used in the past, findings from this review, present-day oseltamivir dosing, applying lessons learned from H1N1 pandemic to the COVID-19 pandemic, and much more.
Reference list: https://pharmacytodose.files.wordpress.com/2023/08/tamiflu-dosing-trial-of-week-references.pdf
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Heart Failure with Preserved Ejection Fraction (HFpEF) and Guideline/Consensus Document Writing Special Guest: Dave Dixon, PharmD, FACC, FAHA, FCCP, FNLA, BCACP, CDCES, CLS
02:57 – Experience and advice with guideline/consensus document writing 19:40 – HFpEF definition, complications, acute presentation, and HFpEF mimics 36:17 – HFpEF GDMT treatment 61:50 – Future directions and take-home points
Reference List: https://pharmacytodose.files.wordpress.com/2023/08/hfpef-references.pdf
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ARDS Part II Special Guest: Steven Lemieux, PharmD, BCPS, BCCCP
03:45 – ESICM guidelines and ARDS definition 11:50 – Phenotypes and respiratory support 23:50 – Corticosteroids 34:40 – NMBA, pulmonary vasodilators, and VV ECMO 44:00 - Fun facts and take-home points
Reference List: https://pharmacytodose.files.wordpress.com/2023/08/ards-part-ii-references.pdf
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Trial of the Week: CATS
Special Guest: Scott Benken, PharmD, MHPE, BCPS-AQ Cardiology, FCCM, FCCP
Scott Benken joins me to discuss the upcoming 2023 Chicagoland Critical Care Conference before reviewing the 2007 CATS study which compares catecholamine vasopressors and inotropes in septic shock. We cover the history of septic shock treatment, review the study results, current guideline recommendations, and much more.
2023 Chicagoland Critical Care Conference registration link:https://appserv7.admin.uillinois.edu/FormBuilderSurvey/Survey/uic_college_of_pharmacy/continuing_education/critical_care_2023/Survey
Reference list: https://pharmacytodose.files.wordpress.com/2023/08/cats-trial-of-week-references.pdf
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Trial of the Week: Unpeeling the Banana Bag
Special Guests: Aaron Cook, PharmD, FCCP, FNCS, FKSHP, BCCCP, BCPS Alex Flannery, PharmD, PhD, FCCM, BCCCP, BCPS
Listen to Aaron and Alex go into the history of this famous article, discuss how this paper, and how they still feel the impact years after publication.
Flannery AH, Adkins DA, Cook AM. Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU. Crit Care Med. 2016 Aug;44(8):1545-52. https://pubmed.ncbi.nlm.nih.gov/27002274/
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Rapid Reaction: MERCY
Special Guests: Erin McCreary, PharmD, BCPS, BCIDP Jason Pogue, PharmD, BCPS, BCIDP
11:00 – Background, study methodology, and results 23:00 – MERCY deep-dive, discussion, and future considerations
MERCY: https://pubmed.ncbi.nlm.nih.gov/37326473/
Reference List: https://pharmacytodose.files.wordpress.com/2023/08/mercy-rapid-reaction-references.pdf
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Literature Review Series May 2023 Special Guest: Kelly Oldziej, PharmD
05:00 – Featured Articles 36:20 – Cardiology 47:20 – Infectious Diseases 51:00 – Emergency Medicine 59:22 – PharmD 66:15 – Grab Bag
Reference List: https://pharmacytodose.files.wordpress.com/2023/07/may-lrs-2023-references.pdf
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Amiodarone v. Lidocaine: Versus Series Special Guest: Matt Wanat, PharmD, BCPS, BCCCP, FCCM
05:50 – Out-of-hospital cardiac arrest 19:15 – In-hospital cardiac arrest 32:04 – Refractory ventricular arrhythmias 47:08 – Potpourri 52:26 – Closing statements
2023 Pharmacy to Dose Awards Ballot: https://forms.gle/9y2wTM8y8tgodvYUA
Reference List: https://pharmacytodose.files.wordpress.com/2023/07/amiodarone-vs-lidocaine-references.pdf
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COPD Special Guest: Ty Kiser, PharmD, FCCM, FCCP, BCCCP, BCPS
03:15 – Background & classification 07:10 – AECOPD 13:00 – Pharmacotherapy in AECOPD 32:40 – Maintenance medications 41:55 – Future research / wrap-up
2023 Pharmacy to Dose Awards Ballot: https://forms.gle/9y2wTM8y8tgodvYUA
Reference List: https://pharmacytodose.files.wordpress.com/2023/07/copd-references-1.pdf
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BP Control in Neurologic Emergencies Part II Special Guest: Andrew Webb, PharmD, BCCCP https://www.neurowiserx.com
02:25 – Antihypertensive treatment overview 10:02 – IV push agents 17:47 – Continuous IV agents 34:00 – Take-home points
Reference List: https://pharmacytodose.files.wordpress.com/2023/07/bp-in-neurologic-emergencies-part-ii-references.pdf
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Blood Pressure Control in Neurologic Emergencies Part I Special Guest: Andrew Webb, PharmD, BCCCP https://www.neurowiserx.com
03:50 – Background/pathophysiology 11:30 – AIS & thrombolysis 20:10 – AIS & thrombectomy 39:35 – Spontaneous intracerebral hemorrhage
Reference List: https://pharmacytodose.files.wordpress.com/2023/06/bp-in-neurologic-emergencies-part-i-references.pdf
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ESOC 2023 Rapid Reactions: TIMELESS and OPTIMAL-BP
Special Guest: Leslie Hamilton, PharmD, FCCP, FCCM, FNCS, BCPS, BCCCP
04:15 – TIMELESS trial 21:20 – OPTIMAL-BP trial
Reference List: https://pharmacytodose.files.wordpress.com/2023/06/esoc-2023-rapid-reaction-references.pdf
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2023 SAEM PharmD Research
02:10 – Emergency Medicine Resident Perceptions of the Educational Impact of Emergency Medicine Clinical Pharmacists with Francisco Ibarra, PharmD, BCCCP
12:10 – Impact of Emergency Medicine Pharmacists on Anticoagulation Reversal with Jaclyn Scalgione, PharmD, BCPS
24:25 – Incidence of Postintubation Hypotension after Rapid Sequence Intubation in Full vs. Reduced Dose Induction Agent with Alicia Mattson, PharmD, BCCCP
35:12 – Phenobarbital as an Adjunct to Benzodiazepines in the Setting of Alcohol Withdrawal with Amelia Slane, PharmD, BCPS
48:19 – Single Dose Aminoglycosides for Complicated Urinary Tract Infections in the Emergency Department with Jordan Jenrette, PharmD
61:53 – Effect of Intravenous vs. Oral First Dose Antibiotics in the Emergency Department on Hospital Admission with Jessica Pham, PharmD
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Rapid Reaction: INTERACT3
Special Guests: Keaton Smetana, PharmD, MBA, BCCCP, FNCS Todd Miano, PharmD, PhD, FCCM
04:05 – Background, methodology, and results 17:35 – Statistics consideration and breakdown 31:10 – Deep-dive and future considerations
2023 Award Nomination Link: https://t.co/G4NfEEBFaS
INTERACT3: https://pubmed.ncbi.nlm.nih.gov/37245517/
Todd Miano Figures: https://pharmacytodose.files.wordpress.com/2023/06/interact3_slides.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2023/06/interact3-rapid-reaction-references.pdf
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Literature Review Series Apr 2023
02:45 – 6-pack of studies 18:16 – Neuro 23:06 – Heme 27:55 – Infectious Diseases 31:20 – PharmD 36:44 – Grab Bag
Reference List: https://pharmacytodose.files.wordpress.com/2023/06/apr-lrs-2023-references.pdf
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Perioperative Emergencies: Part II Special Guests: Sara J. Hyland, PharmD, BCCCP Eric Johnson, PharmD, BCCCP Gourang Patel, PharmD, MSc, BCPS, BCCCP, FCCP, FCCM Rachel Wolfe, PharmD, MHA, BCCCP
2023 Award Nomination Form: https://forms.gle/5oRzFYoVyJdPNCDA6
04:10 – LAST 24:05 – Dantrolene 37:45 – Advice and Future Vision
Reference List: https://pharmacytodose.files.wordpress.com/2023/06/perioperative-emergencies-part-ii-references.pdf
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Recap of 2023 SCCM Congress
Special guest: W. Anthony Hawkins, PharmD, FCCM, BCCCP
SF review, unique sessions, speaker perspective, FCCM/awards, Dr. Glaucomflocken, late-breaking studies, exhibit hall, receptions, our favorite sessions and more.
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Literature Review Series
Dec 2022
00:26 – Life/podcast update; 08:40 – Top 5; 24:50 – BP management; 28:55 – IV fluids; 31:40 – Lost in my mind; 39:28 – Front of the fridge
Reference List: https://pharmacytodose.files.wordpress.com/2023/01/lrs-dec-2022-references.pdf
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Literature Review Series
Dec 2022
00:26 – Life/podcast update; 08:40 – Top 5; 24:50 – BP management; 28:55 – IV fluids; 31:40 – Lost in my mind; 39:28 – Front of the fridge
Reference List: https://pharmacytodose.files.wordpress.com/2023/01/lrs-dec-2022-references.pdf
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Literature Review Series
Apr 2022
Special Guests: Philip Jacobson, PharmD and Andi Ray, PharmD
07:10 – 6-pack of studies; 45:20 – Don’t go breaking my heart; 55:20 – Ventilator blues; 65:00 – Front of the fridge Pt I and II
Reference List: https://pharmacytodose.files.wordpress.com/2022/10/lrs-apr-2022-references.pdf
Full Article List: https://docs.google.com/document/d/1EcldymfgaszAcKmYlr6wYt4XRI5_GFhQo4DeqrGAfAE/edit?usp=sharing
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Literature Review Series
Mar 2022
Special Guests: Paige Miller, PharmD and Jontae Warren, PharmD
05:00 – 6-pack of studies; 45:00 – Lost in my mind; 55:20 – When we were young; 66:50 – Don’t go breaking my heart; 79:40 – Front of the fridge
Reference List: https://pharmacytodose.files.wordpress.com/2022/09/lrs-mar-2022-references.pdf
Full Article List: https://docs.google.com/document/d/1X43sqQX9IYRKJ2hGSp5gneqzL0OQcxeGJMGgKs2Bu54/edit?usp=sharing
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PCCs for PharmDs Part II
Special Guest: Scott Dietrich, PharmD, BCCCP
@PCC_PharmD
Reference List: https://pharmacytodose.files.wordpress.com/2022/08/pccs-for-pharmds-part-ii-references.pdf
04:45 – Fixed dose PCC; 11:58 – Time to administration; 15:00 – 3-factor v. 4-factor PCC; 19:12 – 4-factor PCC v. 4-factor aPCC; 30:36 – No anticoagulation reversal; 33:36 – PCC in surgery; 37:40 – PCC in trauma; 40:51 – PCC v. andexanet alfa; 54:10 – Guideline recommendations; 62:00 – Future studies; 69:10 – Take home points
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Things We Wish We Knew During Residency
Special Guests: ACCP Critical Care PRN Officers
Leslie Hamilton, PharmD, FCCP, FCCM, FNCS, BCPS, BCCCP; Mojdeh Heavner, PharmD, BCPS, BCCCP, FCCM; Susan Smith, PharmD, BCCCP, BCPS
03:25 – ACCP Critical Care PRN discussion
28:35 – Residency roundtable
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Literature Review Series
Feb 2022
Special Guests: Aaron Hunsaker, PharmD and Kelsey Rhoten, PharmD
05:41 – 6-pack of studies; 46:09 – Dust in the wind; 55:20 – Under pressure; 65:04 – Lost in my mind; 74:54 – Front of the fridge
Reference List: https://pharmacytodose.files.wordpress.com/2022/06/lrs-feb-2022-references.pdf
Full Article List: https://docs.google.com/document/d/18g5UqJqMGvm_q9qfTiEuETV34TMaWRWbQbKzfi_vbDA/edit?usp=sharing
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Literature Review Series
Jan 2022
Special Guests: Michael Behal, PharmD and CJ Wilson, PharmD
08:13 – 6-pack of studies; 60:20 – Every breath you take; 68:35 – Under pressure; 76:43 – Lost in my mind; 84:10 – Front of the fridge
Reference List: https://pharmacytodose.files.wordpress.com/2022/06/lrs-jan-2022-references.pdf
Full Article List: https://docs.google.com/document/d/1Z2FDNWO6uhJjYINdnTn_ruBJHOT9s-etPyNFYmJokD0/edit?usp=sharing
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Literature Review Series
Nov/Dec 2021
Special Guests: Callee Brooks, PharmD and Andy Jatis, PharmD
05:00 – 6-pack of studies; 48:25 – Ventilator blues; 60:10 – Lost in my mind; 72:38 – Don’t go breaking my heart; 81:42 – Front of the fridge
Reference List: https://pharmacytodose.files.wordpress.com/2022/05/nov_dec-2021-references.pdf
Full Article List: https://docs.google.com/document/d/1E-inQwnlcNqkvq6q657UdFEZ4x9Zd_Bi_ii0iOALS3Q/edit?usp=sharing
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Management of Beta Blocker and Calcium Channel Overdose
Special Guest: James Leonard, PharmD, DABAT
@leonardjbrx
Reference List: https://pharmacytodose.files.wordpress.com/2022/04/bb-and-ccb-overdose-references.pdf
Topics covered: Activated charcoal, Hemodynamics, Calcium, High dose insulin, Lipid emulsion therapy, Glucagon, Pharmacotherapy for refractory cases, Advanced therapies
“What would really happen: Medicine in the movies”
- Old School
- Knives Out
- Wedding Crashers
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I wanted to talk to the Friends of the Pod about what's been going on behind the scenes and what to expect in the future.
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2021 Surviving Sepsis Campaign Guideline Updates
Special Guests: Carolyn Bell PharmD, BCCCP and Brittany Bissell, PharmD, PhD, BCCCP, FCCM
Reference List: https://pharmacytodose.files.wordpress.com/2022/02/2021-sepsis-guideline-updates-references.pdf
05:00 – General thoughts and historical perspective; 12:10 – qSOFA; 14:44 – Author diversity; 19:10 – IV fluids; 27:15 – Vasopressors; 33:12 – Antibiotics (and antifungals); 46:10 – Adjunctive treatments; 57:40 – Hopes for future guidelines; 61:35 – Gender inequity and sexual harassment in pharmacy
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Literature Review Series
Sept/Oct 2021
Special Guests: Sara Groome, PharmD, BCIDP and Alyssa Sykuta, PharmD, BCCCP
Reference List: https://pharmacytodose.files.wordpress.com/2022/02/sept_oct-2021-references.pdf
06:10 – Sepsis 6-pack; 47:55 – In my blood; 59:55 – Ventilator blues; 72:00 – Review Room; 82:38 – Front of the Fridge
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Literature Review Series
July/August 2021
Special Guests: Hannah Brokmeier, PharmD and Natalie Haddad, PharmD
Reference List: https://pharmacytodose.files.wordpress.com/2022/01/july_aug-2021-references.pdf
06:45 – 6-pack of studies; 46:20 – Ventilator blues; 57:30 – Don’t go breaking my heart; 68:30 – Front of the fridge
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Vasoactives in Septic Shock Part II
Special Guest: Patrick M. Wieruszewski, Pharm.D., BCCCP
Reference List: https://pharmacytodose.files.wordpress.com/2021/12/vasoactives-in-septic-shock-ii-references.pdf
02:51 – Background into vasodilatory shock and its outcomes; 04:14 – Signs/symptoms of septic shock; 05:09 – Norepinephrine as first-line vasopressor; 09:05 – Using second-line vasopressors; 17:04 – Human physiology and hemodynamics; 21:02 – More important: time to treatment or vasopressor choice; 22:16 – Taking biomarkers/genetic markers from the research lab to clinical practice; 28:22 – Vasopressin use in septic shock; 43:14 – Angiotensin II updates; 66:00 – Epinephrine in septic shock; 69:32 – Vasopressor stewardship; 72:40 – One wish for septic shock management
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Introduction to Mechanical Ventilation
Special Guests: Andrea Sikora Newsome, PharmD, BCPS, BCCCP, FCCM
Reference List: https://pharmacytodose.files.wordpress.com/2021/11/mechanical-ventilation-references.pdf
05:49 – Indications for mechanical ventilation; 12:45 – Principles of critical care; 16:40 – Review of respiratory cycle; 20:04 – Common terminology (Tidal volume, FiO2, PEEP); 32:01 – Ventilator modes; 39:15 – Pressure v. volume control; 47:00 – Inspiratory pressure, plateau pressure, and autoPEEP; 51:50 – Ventilator weaning; 61:00 – Take-home points
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Literature Review Series
May/June 2021
Special Guests: Nikko Bonavoglia, PharmD and Alyssa White, PharmD
Reference List: https://pharmacytodose.files.wordpress.com/2021/09/may_june-2021-references.pdf
06:40 – Six pack of studies; 41:00 – Anticoagulation/Reversal “Let it Bleed”; 55:40 – Sepsis with a sprinkle of random “Start Me Up”; 69:35 – PADIS “Ventilator Blues”; 78:50 – Pharmacist-driven studies “Front of the Fridge”
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Targeted Temperature Management (TTM)
Special Guests: Scott Benken, PharmD, BCPS-AQ Cardiology, FCCM
Reference List: https://pharmacytodose.files.wordpress.com/2021/08/ttm-references.pdf
08:05 – Preferred nomenclature; 09:20 – TTM history; 11:30 – Optimal temperature; 14:45 – Ways to lower temperature; 17:20 – Guideline recommendations; 20:50 – TTM2 trial; 28:05 – Future areas of research; 33:05 – TTM PK/PD changes; 39:50 – Shivering; 45:10 – Rapid-fire questions; 58:30 – Creating electronic TTM protocols; 61:15 – Take-home points
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Literature Review Series
Mar/Apr 2021
Special Guests: Ashley Barlow, PharmD and Brooke Barlow, PharmD
Reference List: https://pharmacytodose.files.wordpress.com/2021/07/mar_apr2021-references.pdf
07:19 – Six-pack of studies; 48:15 – Sepsis; 59:14 – Pain, agitation, delirium, and neuromuscular blockade; 73:50 – Infectious diseases and pharmacokinetics; 82:36 – Pharmacist-driven studies
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Rapid Sequence Intubation (RSI)
Special Guests: Haley Peters, PharmD, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2021/06/rsi-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2021/06/rsi-references.pdf
05:05 – Over-arching considerations; 09:45 – Neuromuscular blockers; 31:35 – Pre-induction agents; 46:46 – Induction agents; 72:23 – Obesity dosing considerations; 81:21 – Difficult airways; 84:30 – Take-home points
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Literature Review Series
Jan/Feb 2021
Special Guests: Abagail Kirwen, PharmD and Paige Morgan, PharmD
Reference List: https://pharmacytodose.files.wordpress.com/2021/05/jan_feb2021-references.pdf
07:13 – Six-pack of Studies; 39:06 – Review Room; 52:20 – Glance at the Guidelines; 61:58 – Kinetics Corner; 73:37 – Front of the Fridge
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Updates in COVID-19 Pharmacotherapy
Special Guests: Amy Dzierba, PharmD, FCCM, FCCP, BCCCP
Mitchell Buckley, PharmD, FASHP, FCCM, FCCP, BCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2021/04/covid19-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2021/04/covid19-references.pdf
03:25 – Tocilizumab; 22:21 – Corticosteroids; 37:50 – Anticoagulation; 72:50 – Potpourri/Take-home points
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ICU Liberation (ABCDEF) Bundle
Special Guest: Joanna Stollings, PharmD, FCCM, BCPS, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2021/04/icu-liberation-bundle-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2021/04/icu-liberation-bundle-references-ii.pdf
03:48 – What is the ABCDEF bundle?; 08:35 – Barriers to bundle implementation; 12:14 – Excluding patients; 14:18 – A: Assessing/preventing/treating pain; 20:27 – B: Spontaneous awakening/breathing trials; 26:27 – C: Choice of sedation; 38:40 – D: Assessing/prevention/treating delirium; 42:09 – E: Early mobility/exercise; 45:40 – F: Family engagement and involvement; 49:16 – Importance of multidisciplinary involvement; 52:58 – Bundle implementation with COVID-19; 60:21 – Advice for those looking to implement the ICU Liberation Bundle; 64:30 – Pharmacist’s role in successful bundle implementation
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Hypertensive Crises (Emergency/Urgency)
Special Guest: Deepali Dixit, PharmD, BCPS, BCCCP, FCCM
Show Notes: https://pharmacytodose.files.wordpress.com/2021/02/htn-crises-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2021/02/htn-crises-references.pdf
06:50 – Diagnosis; 09:17 – Clinical presentation; 11:14 – Common causes; 13:36 – HTN urgency management; 17:50 – HTN emergency BP goal; 23:26 - IV push v. continuous IV infusions; 28:30 – Aortic dissection/Esmolol; 34:10 – Acute ischemic stroke/Hydralazine; 40:25 – Intracranial hemorrhage/Nicardipine; 44:48 – ACS/Labetalol; 49:20 – ADHF/Nitrates; 56:08 – Miscellaneous medication pearls; 59:33 – Pregnancy treatment; 64:10 – Take-home points
4th Annual Multidisciplinary Tri-State Critical Care Virtual Symposium
Details: https://rutgers.cloud-cme.com/course/courseoverview?P=5&EID=8158
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Oncologic Emergencies
Special Guest: Siu Yan Amy Yeung, PharmD, BCPS, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2021/02/oncologic-emergencies-show-notes-1.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2021/02/oncologic-emergencies-references.pdf
06:00 – Oncologic emergency overview; 10:12 – Tumor lysis syndrome; 46:40 – Hypercalcemia of malignancy; 67:12 – Superior vena cava syndrome; 75:05 – Take-home points
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Trauma Alert Part II: ICU Management
Special Guest: Melanie Smith Condeni, PharmD, BCPS, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2021/01/trauma-alert-icu-management-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2021/01/trauma-alert-icu-management-references.pdf
05:25 – Pain, agitation, and delirium management; 24:30 – VTE prophylaxis; 48:47 – Open fracture antibiotics; 52:16 – Identifying infections; 57:03 – Neurostorming; 66:42 – TBI clinical pearls; 82:34 – Bowel regimens; 87:14 – Take-home points
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Practice-Based Research
Special Guest: Alex Flannery, PharmD, FCCM, BCCCP, BCPS
Show Notes: https://pharmacytodose.files.wordpress.com/2021/01/practice-based-research-show-notes-1.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2021/01/practice-based-research-references-1.pdf
04:17 – Defining practice-based research; 06:02 – Importance of research; 12:38 – Developing infrastructure that supports research; 18:59 – Finding a good research idea; 22:15 – Research v. MUE; 25:48 – Reducing duplicate research studies; 28:00 – Developing an idea into a study; 31:52 – Study design resources; 35:23 – Research funding; 43:12 – Statistics; 47:05 – Manuscript publishing; 52:15 – Implementing results from practice-based research; 55:00 – Most common research pitfalls; 59:04 – Student/resident research mentorship; 62:00 – Practice-based research networks; 64:40 – Take-home points
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Alcohol Withdrawal Disorder
Special Guest: Kent Owusu, PharmD, BCCCP, BCPS
Show Notes: https://pharmacytodose.files.wordpress.com/2020/12/alcohol-withdrawal-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2020/12/alcohol-withdrawal-references.pdf
05:50 – Consequences of alcohol withdrawal; 06:56 – Diagnosis/Pathophysiology; 11:15 – Treatment goal; 12:20 – Alcohol for withdrawal prevention; 15:30 – Benzodiazepine treatment considerations; 25:45 – Monitoring tools; 30:40 – Phenobarbital; 38:50 – Dexmedetomidine; 43:20 – Ketamine; 47:40 – Propofol; 51:43 – Valproic Acid and Gabapentin; 58:25 – Take-home points
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Trauma Alert Part I: Acute Management
Special Guest: Brian Gilbert, PharmD, BCCCP, BCPS
Show Notes: https://pharmacytodose.files.wordpress.com/2020/11/trauma-part-1-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2020/11/trauma-part-1-references.pdf
05:12 – Pre-arrival preparation; 14:19 – Pharmacist role on trauma team; 15:40 – Primary survey; 23:37 – Massive transfusion protocol; 27:00 – Viscoelastography; 40:34 – PCC administration and dosage; 44:40 – Calcium; 51:00 – RSI/PAD considerations; 56:10 – Open fractures and antibiotics; 58:37 – Elevated ICP management; 62:37 – Take-home points
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2020 ACCP Annual Meeting Recap
Special Guest: Anthony Hawkins, PharmD, BCCCP
Reference List: https://pharmacytodose.files.wordpress.com/2020/11/2020-accp-annual-meeting-references.pdf
06:30 – Virtual v. in-person meetings; 30:35 – BIG announcement!; 34:15 – Poster sessions; 47:00 – Scientific sessions
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Pulmonary Hypertension
Special Guest: Brian Murray, PharmD, BCCCP
Reference List: https://pharmacytodose.files.wordpress.com/2020/09/ph-references.pdf
03:38 – Recent changes in PH management; 05:05 – PH classification; 10:22 – PH functional classification; 13:15 – PH diagnosis; 16:00 – Vasoreactivity challenge; 18:51 – Drug-induced PH; 21:08 – Short- and long-term PAH treatment goals; 23:50 – PH risk factors; 26:00 – Modifying outpatient PH medications/medication regimens; 33:03 – Fluid management in PH; 35:37 – VTE prophylaxis/treatment in PAH; 38:32 – Management of arrhythmias in PAH; 41:35 – CCB for PH treatment; 46:24 – Comparative studies in PH; 47:37 – Prostacyclins; 71:30 – Endothelin receptor antagonists; 76:04 – Phosphodiesterase inhibitors; 77:00 – sGC stimulator; 80:00 – Preferred treatment of PAH?; 84:53 – Vasopressors in patients with PH; 88:50 – Acute RV decompensation; 92:32 – Effect of positive pressure ventilation on PH; 94:55 – Management of outpatient PH infusion pumps; 97:22 – Take-home points
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Antithrombotic and Anticoagulant Therapy with Cardiac Devices
Special Guest: Craig Beavers, PharmD, FACC, FAHA, FCCP, BCCP, BCPS (AQ-Cardiology), CACP
Show Notes: https://pharmacytodose.files.wordpress.com/2020/08/ap-and-ac-with-cardiac-devices-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2020/08/ap-and-ac-with-cardiac-devices-references.pdf
04:35 – MCS Overview; Case I; 07:45 – IABP Overview; Case I Continued; 17:17 – IABP Anticoagulation; Case I Continued; 24:03 – Impella Overview; Case IIl; 31:50 – Impella Anticoagulation; Case II Continued; 52:00 – LVAD thrombosis/bleeding management; Case III; 62:47 – Anticoagulation with Watchmen device; Case IV; 72:20 – TAVR overview; Case V; 80:45 – IV cangrelor; 82:37 – Does MCS reduce mortality?; 84:28 – Future research; 85:25 – Take-home points
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Pediatric Critical Care Part I
Special Guest: Joseph LaRochelle, PharmD, BCPPS, FCCP
Resource List: https://pharmacytodose.files.wordpress.com/2020/08/pediatric-critical-care-part-i-resources.pdf
04:22 – Applying adult principles to kids?; 06:01 – Neonatal/pediatric vital signs; 10:25 – Pediatric/neonatal PK changes; 20:34 – Cytochrome P450 metabolism; 31:20 – Pediatric renal function/elimination; 44:22 – Pediatric v. adult dosing; 51:10 – Pediatric medication safety principles; 60:45 – Memorizing pediatric dosing; 70:13 – Pediatric weights; 74:26 – Pediatric Pharmacist training; 84:20 – Advice for Pharmacists; 86:43 – Take-home points
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Ventricular Arrhythmias
Special Guest: Matthew Wanat, PharmD, BCPS, BCCCP, FCCM
Show Notes: https://pharmacytodose.files.wordpress.com/2020/07/ventricular-arrhythmias-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2020/07/ventricular-arrhythmias-references.pdf
04:00 – What are arrhythmias?; 05:30 – Why are arrhythmias harmful/dangerous?; 06:58 – Risk factors; 09:12 – Common atrial arrhythmias; 10:19 – General arrhythmia treatment principles; 12:45 – When to use rhythm control for AF; 14:37 – Adenosine; 22:04 – Non-sustained VT/PVCs; 27:00 – Monomorphic v. Polymorphic VT; 30:53 – Torsades de Pointes; 34:16 – QTc prolongation; 42:18 – VF v. VT; 43:29 – Pulseless VT/VF; 49:30 – Amiodarone; 54:55 – Lidocaine/Mextiletine; 64:10 – Sotalol; 67:40 – Sodium channel blockers; 70:25 – Isoproterenol; 73:43 – BB/CCB; 78:29 – Long-term management; 80:34 – Stroke risk with ventricular arrhythmias; 82:20 – Prevention; 83:40 – EKG Interpretation; 86:48 – Step-wise approach; 88:13 – Take-home points; 90:00 – Small talk
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White Coats for Black Lives
Special Guests:
Earnest Alexander, PharmD, BCCCP, FCCM
Sheriff Gbadamosi, PharmD
Jason Jones, PharmD, BCPS, BCCCP
Reference List: https://pharmacytodose.files.wordpress.com/2020/07/white-coats-for-black-lives-references.pdf
05:01 – How did we get here?; 27:16 – What emotions have you felt over recent events?; 45:40 – Why is this movement different?; 51:30 – Are these protests necessary/effective to enact change?; 59:20 – Inequality within the criminal justice system; 71:50 – Differences in treatment/outcomes for black patients; 83:43 – Systemic racism within US healthcare system; 87:09 – Is this a public health issue?; 91:55 – Importance of the diversity on the healthcare team; 95:35 – Increased pressure/stress being a black team member; 100:20 – Being an anti-racist; 104:40 – “All Lives Matter”; 109:55 – Powerful/Impactful media recommendations or further reading; 118:37 – Being a productive ally to the Black Lives Matter movement; 123:38 – Final thoughts
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CRRT Medication Dosing
Special Guest: Bruce Mueller, PharmD, FCCP, FASN, FNKF
Show Notes: https://pharmacytodose.files.wordpress.com/2020/06/medication-dosing-in-crrt-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2020/06/medication-dosing-in-crrt-references.pdf
04:05 – Effect of AKI on patient outcomes; 08:40 – Different RRT modalities; 13:56 – How long has CRRT been used?; 17:35 – CRRT for all ICU patients?; 22:06 – When to avoid CRRT; 23:28 – CRRT definitions; 43:20 – Medication underdosing on CRRT; 51:27 – Older CRRT dosing studies v. newer studies; 54:29 – Drug properties that increase CRRT clearance; 58:36 – Does CRRT modality affect medication clearance?; 60:02 – Antibiotic retiming; 61:20 – Drug reference dosing recommendations; 64:20 – Dosing when patient is on CRRT and not in AKI; 66:40 – Anticoagulation for CRRT; 75:13 – Hybrid CRRT modalities; 81:45 – General dosing considerations; 83:23 – CRRT dosing drug references
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Aneurysmal Subarachnoid Hemorrhage
Special Guest: Casey May, PharmD, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2020/06/asah-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2020/06/asah-references.pdf
02:51 – Types of intracerebral bleeds; 06:19 – Types of subarachnoid hemorrhage; 08:25 – Pathophysiology of aSAH; 10:45 – Risk factors; 12:48 – Classic aSAH presentation; 16:36 – Classificiation systems; 22:25 – Prioritizating acute management of aSAH; 25:15 – Blood pressure goals; 26:21 – Preferred anti-HTN agent?; 28:25 – Biggest concerns with anti-HTN agents; 31:08 – ICP management; 35:40 – Surgical clipping v. Endovascular coiling; 42:51 – Cerebral vasospasms and delayed cerebral ischemia; 55:07 – Nimodipine in aSAH; 68:20 – DVT prophylaxis; 73:48 – Seizure prophylaxis; 76:30 – Augmented renal clearance; 83:56 – Take-home points
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Acute Liver Failure
Special Guest: Stephanie Bass, PharmD, BCPS, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2020/05/acute-liver-failure-show-notes.pdf
Reference List: https://pharmacytodose.files.wordpress.com/2020/05/acute-liver-failure-references.pdf
03:05 – Stephanie’s interest in the liver; 05:54 – Diagnosing ALF; 07:20 – Does having liver disease increase ALF risk?; 09:00 – Ultimate goal when treating ALF; 10:07 – Patient presentation; 11:58 – Common causes of ALF; 13:30 – ICP and cerebral edema management in ALF; 15:50 – PAD management in ALF; 18:55 – Acute hepatic encephalopathy management; 21:00 – Trending ammonia levels?; 22:25 – NAC for APAP overdose ALF; 27:11 – NAC for non-APAP overdose ALF; 30:23 – Albumin for ALF fluid resuscitation; 34:33 – Vasopressor use; 36:53 – Blood pressure goals; 40:00 – TEG for bleeding risk assessment; 43:45 – Hemostatic agents for coagulopathy; 46:18 – Anticoagulant of choice; 47:59 – Hepatic dose adjustments; 52:12 – Medication dosing with MARS/RRT; 54:00 – Medications to avoid; 56:02 – Transplant considerations; 58:24 – Take-home points
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Critical Care Management of COVID-19
Special Guests: Drayton Hammond, PharmD, MBA, MSc, BCPS, BCCCP, FCCM
Peter Nikolos, PharmD
Show Notes: https://pharmacytodose.files.wordpress.com/2020/04/covid-19-complications-show-notes.pdf
Mechanical Ventilation (Drayton)
08:00 – Non-COVID-19 PAD management; 11:16 – COVID-19 PAD management; 18:22 – Managing PAD drug shortages; 22:38 – Opioid conservation strategies; 26:08 – Propofol conservation strategies; 29:08 – Hypertriglyceridemia with propofol; 32:10 – Risk of PRIS; 34:30 – Ketamine; 41:05 – NMBA use and shortage; 46:00 – PPE conservation; 49:00 – Bronchodilator use for COVID-19; 50:28 – Inhaled anticoagulants; 52:46 – Inhaled pulmonary vasodilators; 54:17 – Advice for COVID-19 management
Cardiovascular (Peter)
67:20 – Current shortages; 71:05 – First-line vasopressor; 73:25 – Vasopressor compounding and utilization changes; 74:50 – Smart pump management; 77:15 – Vasopressor shortage management; 79:45 – Anticoagulation treatment strategy; 85:30 – Anticoagulation monitoring; 86:28 – Anticoagulation in ECMO/CRRT; 88:20 – PE causing rapid decompensation?; 90:25 – Alternate anticoagulants; 92:52 – Thrombolytics in ACS; 98:13 – Code response changes; 100:05 – ACE-I/ARB use in COVID-19; 103:41 – NSAID use in COVID-19; 105:15 – Statin use in COVID-19; 107:25 – Challenges from virtual rounding; 110:20 – Key points on COVID-19 management
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Research Principles for COVID-19
Special Guest: Todd Miano, PharmD, PhD
Show Notes: https://pharmacytodose.files.wordpress.com/2020/04/research-principles-show-notes.pdf
05:19 – Todd’s interest in research/statistics; 09:18 – How Todd analyzes a research article; 24:22 – Why so much low-quality research for COVID-19?; 28:18 – In vitro v. in vivo; 32:34 – Risk of study errors in low-quality research; 45:43 – Publication bias; 51:50 – Interpreting outcome-based studies when patients are still critically ill; 54:46 – Ideal primary outcome for COVID-19 trials; 57:50 – Applying information from international data to US patients; 61:02 – What is the risk of using experimental drug treatments?; 68:54 – Effect of COVID-19 on non-COVID research; 70:33 – Advice for starting COVID-19 research; 73:43 – Research red flags; 75:46 – Keeping up with COVID-19 literature; 79:09 – Quarantine entertainment recommendations
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Cerebral Edema Treatment
Special Guest: Aaron Cook, PharmD, BCCCP, BCPS, FCCP, FKSHP, FNCS
Show Notes: https://pharmacytodose.files.wordpress.com/2020/04/treatment-of-cerebral-edema-show-notes.pdf
Guideline Development
06:18 – How did the content and the chairs for this guideline get chosen?; 08:40 – How long were you working on these guidelines?; 09:40 – How are panel members chosen for the guidelines?; 11:20 – Is the research librarian underrated?; 13:31 – GRADE methodology and PICO formatting; 17:24 – Has this changed your research habits or ideas?; 21:40 – Challenges from meeting virtually when developing the guidelines; 23:53 – How were disagreements settled within the working group?
Management of Cerebral Edema
27:45 – Cerebral edema and elevated ICP; 29:22 – Refractory cerebral edema management; 31:59 – How long was the initial question list?; 35:03 – Quality of evidence; 37:58 – Patient subgroup with the most evidence; 40:10 – Should we be driving up patients’ sodium levels?; 44:56 – Is there a preferred hyperosmolar agent?; 47:45 – Mannitol in acute ischemic stroke; 49:00 – Osmolar therapy and neurologic outcomes; 51:16 – HTS administration; 54:30 – HTS ADE and monitoring; 57:10 – Mannitol osmolality monitoring; 58:20 – Hyperosmolar therapy ADE prevention; 61:00 – Guideline key take-aways; 62:20 – Common research issues
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COVID-19
Special Guest: Andrew Barnes, PharmD
Dr. Andrew Barnes joins the podcast to discuss the effects of COVID-19. We talk about what Seattle and the University of Washington are doing to help treat this national pandemic. Plus there are plenty of tips throughout the episode for ways you can adapt to COVID-19 in your hospital or health system.
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Part 3 Critical Care Medication March Madness Bracket
Downloadable bracket and more available here: https://pharmacytodose.com/2020/03/15/2020-critical-care-medication-march-madness-bracket-and-info/
03:01 – Final Four analysis with Matt Rubertus, PharmD, BCCCP
09:11 – Final Four analysis with Josiah Smith, PharmD, BCCCP
17:35 – Final Four analysis with Brian Gilbert, PharmD, BCPS, BCCCP
29:18 – Final Four analysis with Melanie Smith, PharmD, BCPS, BCCCP
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Website: PharmacyToDose.Com
Part 2 Critical Care Medication March Madness Bracket
Downloadable bracket and more available here: https://pharmacytodose.com/2020/03/15/2020-critical-care-medication-march-madness-bracket-and-info/
00:50 – Introduction; 03:23 – Potpourri region analysis with Brian Gilbert, PharmD, BCPS, BCCCP; 43:43 – PAD region analysis with Melanie Smith, PharmD, BCPS, BCCCP
Email: PharmacyToDose@Gmail.com
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Website: PharmacyToDose.Com
Part 1: Critical Care Medication March Madness Bracket
Downloadable bracket and more available here: https://pharmacytodose.com/2020/03/15/2020-critical-care-medication-march-madness-bracket-and-info/
00:58 – Bracket announcement, background, rules, and how you can participate!; 10:15 – Cardiac region analysis with Matt Rubertus, PharmD, BCCCP; 40:37 – Infectious Diseases region analysis with Josiah Smith, PharmD, BCCCP
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Immunotherapy Toxicity in the ICU Special Guest: Heather May, PharmD, FCCM, BCPS, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2020/03/immunotherapy-toxicity-in-the-icu-show-notes.pdf
Show References: https://pharmacytodose.files.wordpress.com/2020/03/immunotherapy-references.pdf
00:52 – Show updates!; 10:50 – Immune system primer; 13:30 – How does CART therapy work?; 16:35 – CART Side effects that lead to the ICU; 17:40 – When does CRS occur and how acute is the presentation?; 20:50 – CRS risk factors; 23:26 – Biomarkers for CRS identification; 25:25 – CRS treatment; 32:30 – CART neurotoxicity; 37:00 – Mechanism of ICANS; 38:00 – ICANS risk factors; 39:30 – ICANS treatment; 42:45 – Where do patients go post-CART?; 47:15 – Examples of immune checkpoint inhibitors; 49:27 – ICI mechanism of action; 51:05 – Immune-related adverse events (irAEs); 55:20 – Which irAEs grades will present to the hospital/ICU?; 57:30 – When do irAEs occur?; 59:28 – irAEs treatment; 64:55 – Downside to treating irAEs?; 68:22 – Do irAEs mean the treatment is working?; 73:12 – Take-home points for immunotherapy toxicity
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2020 SCCM Congress Recap
Special Guest and Official Conference Correspondent: Anthony Hawkins, PharmD, BCCCP
Anthony and I recap the 2020 SCCM Congress discussing everything from the convention center, research presentations, educational sessions, receptions, things we would change, and much more! This episode was recorded live in Orlando, FL.
Show references: https://pharmacytodose.files.wordpress.com/2020/02/2020-sccm-congress-references.pdf
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Acute Kidney Injury (AKI) Special Guest: Erin Barreto, PharmD, MSc, BCPS, BCCCP, FCCM
Show Notes: https://pharmacytodose.files.wordpress.com/2020/02/aki-show-notes.pdf
Show References: https://pharmacytodose.files.wordpress.com/2020/02/aki-references.pdf
1:10 – Show updates!; 9:15 – Define and classify AKI; 14:45 – Subspecifying the type of AKI; 18:22 – Prevalence of AKI in the ICU; 20:45 – Identification of high-risk patients; 24:43 – Preferred risk prediction tools; 26:12 – Ideal kidney biomarker; 28:28 – Ideal v. current biomarkers; 32:13 – Structural biomarkers; 39:40 – AKI prevention; 44:08 – Kidney/drug dosing equations; 53:49 – Equations in AKI/renal recovery; 56:43 – Cystatin C; 72:19 – What if you don’t use novel biomarkers?; 75:33 – Favorite calculator for AKI clinical risk predictor tool; 77:43 – AKI potpourri; 85:05 – Take-home points
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Life After the ICU: A Personal Experience Special Guest: G. Morgan Jones, PharmD, BCCCP, FCCM
Show Notes: https://pharmacytodose.files.wordpress.com/2020/01/life-after-the-icu-show-notes.pdf
Morgan details his incredible journey after a personal experience with PICS and PICS-F.
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Post-Intensive Care Syndrome (PICS) Special Guest: Jimmi Hatton Kolpek, PharmD, BSPharm, FCCP, FCCM, FNAP
Show Notes: https://pharmacytodose.files.wordpress.com/2020/01/pics-show-notes.pdf
Show References: https://pharmacytodose.files.wordpress.com/2020/01/pics-references.pdf
00:25 - #PharmacyToRead Update; 10:07 – Why Jimmi is interested in PICS; 12:36 – When did PICS become an ICU focus?; 13:56 – How did PICS get thrust into the spotlight?; 15:40 – Definition of PICS; 16:27 – When does PICS occur?; 19:38 – How common is PICS?; 21:30 – PICS risk factors; 25:35 – How long does PICS last and how does it affect recovery?; 28:55 – Role of peer support; 31:20 – PICS prevention; 38:17 – Medications that can treat/prevent PICS; 41:50 – When to seek help for PICS?; 44:25 – Process for patients being referred to ICU Recovery Clinic; 48:12 – Who makes up the team and what problems are addressed?; 51:18 – What PICS resources are available for patients/families?; 54:35 – Do we prepare patients for what happens after the ICU?; 56:58 – How can we improve?; 59:53 – Take-home points on PICS
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Extracorporeal Membrane Oxygenation (ECMO) Special Guest: Amy Dzierba, PharmD, FCCM, FCCP, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2020/01/ecmo-show-notes.pdf Show References: https://pharmacytodose.files.wordpress.com/2020/01/ecmo-references.pdf
00:25 - #PharmacyToRead Announcement!; 07:50 – Why is Amy interested in ECMO?; 11:48 – What is ECMO and when did we start using ECMO in the US?; 13:45 – ECLS v. ECMO; 15:52 – Why are we talking about ECMO today?; 19:40– What does ECMO do?; 21:05 – ECMO modalities; 22:59 – ECMO equipment; 27:30 – What should be tried before ECMO?; 30:56 – ECLS effect on PK/PD; 40:05 – Tips/tricks on ECMO anticoagulation, infection, and sedation protocols; 40:45 – Anticoagulation protocols; 47:30 – Infection protocols; 53:15 – Sedation protocols; 58:18 – ECMO complications; 60:40 – Tips when creating or modifying ECMO protocols; 63:27 – Future areas of ECMO research; 65:00 – Take-home points
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Acute Respiratory Distress Syndrome (ARDS) Special Guest: Andrea Sikora Newsome, PharmD, BCPS, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2019/12/ards-show-notes.pdf Show References: https://pharmacytodose.files.wordpress.com/2019/12/ards-references.pdf
4:42 – #PharmacyToRead Book Club Announcement!; 7:24 – History of ARDS; 10:17 – Current ARDS definition; 11:25 – Criticisms to Berlin definition; 13:54 – ARDS Causes/Risk factors; 15:33 – Typical ARDS time course; 18:58 – ARDS treatment goals; 21:04 – Brief primer on mechanical ventilation; 30:50 – Prone positioning; 35:17 – NMBA for ARDS; 42:15 – Prone, paralyze, or both?; 43:34 – FACTT study and fluid stewardship in ARDS; 46:00 – Corticosteroids in ARDS; 49:45 – ARDS failed drugs; 53:55 – ECMO for severe ARDS; 58:25 – Future research areas; 60:10 – Role of PharmD in ARDS
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Prothrombin Complex Concentrates (PCCs) for PharmDs Special Guest: Scott Dietrich, PharmD, BCCCP
Show Notes: https://pharmacytodose.files.wordpress.com/2019/12/pccs-for-pharmds-show-notes.pdf
Show References: https://pharmacytodose.files.wordpress.com/2019/12/pccs-for-pharmds-references.pdf
3:05 – Anticoagulation reversal pre-PCC 5:18 – Brief history of PCC 6:45 – Current role for 3-factor PCC 7:56 – When should we be using PCC? 10:00 – Role of PCC for non-reversal indications 13:20 – Weight-based v. Fixed-dose Kcentra 15:39 – Why fixed-dose Kcentra? 17:33 – When to re-dose Kcentra? 18:50 – Kcentra when INR < 2 20:20 – Guideline-recommended anticoagulation reversal 22:30 – How does Kcentra differ from FEIBA? 23:48 – FEIBA dosing strategy 24:15 – Kcentra for DOAC reversal 28:22 – FEIBA for DOAC reversal 30:02 – FEIBA v. Kcentra for DOAC reversal 30:25 – FEIBA v. KCentra for warfarin reversal 33:32 – Should we have Kcentra and FEIBA on formulary? 34:26 – Weight-based v. Fixed-dose FEIBA for DOAC reversal 35:20 – Pros/Cons of Andexxa 37:14 – PCC v. Andexxa 37:45 – Andexxa’s cost 40:10 – How would Scott reverse his AC? 43:20 – Pharmacist’s role 45:54 – PCC take home points
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Fluid Stewardship
Special Guest: Anthony Hawkins, PharmD, BCCCP
Show notes: https://pharmacytodose.files.wordpress.com/2019/11/fluid-stewardship-show-notes.pdf
Show references: https://pharmacytodose.files.wordpress.com/2019/11/fluid-stewardship-references.pdf
5:45 – Defining fluid overload; 7:12 – Complications of being fluid overloaded; 10:45 – Why does fluid overload still happen?; 13:40 – Solutions to help fix mIVF; 15:30 – Patients at risk of becoming fluid overloaded; 18:28 – Determining if patients are fluid responsive; 24:38 – Does fluid responsiveness mean always give fluid?; 26:40 – What does fluid stewardship mean?; 28:45 – Four D’s; 31:30 – ROSE model; 39:39 – Applying ROSE model to non-sepsis patients; 42:20 – 4 rights of Medication Administration for Fluid Stewardship; 53:48 – Interventions that Pharmacists can make; 59:49 – Questions that still need answered; 61:30 – Future research to watch for; 63:33 – Take-home points
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Value & Importance of ICU Pharmacists with Special Guest: Chris Droege, PharmD, BCCCP, FCCM, FASHP
Show notes: https://pharmacytodose.files.wordpress.com/2019/10/icu-pharmacist-show-notes.pdf
References: https://pharmacytodose.files.wordpress.com/2019/10/icu-pharmacist-references-1.pdf
8:02 – History of Critical Care Pharmacy; 13:40 – Why are Pharmacists needed as multidisciplinary team members?; 15:45 – Why do Pharmacists still need to justify our value?; 18:45 – Historical perception of Pharmacists play a part?; 21:51 – Overview of the White Paper; 26:52 – How relevant are most of these recommendations now?; 30:40 – How should time be spent within the different pillars?; 36:49 – Avoiding “The Sheriff” mentality; 41:55 – Examples of Pharmacists demonstrating value; 45:30 – How do we continue creating research studies demonstrating Pharmacists’ value?; 49:50 – The future of Clinical Pharmacy; 55:45 – Tips/Tricks for Pharmacists to demonstrate value to the ICU team
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Status Epilepticus with Special Guest: Karen Berger, PharmD, FCCM, BCPS, BCCCP
Show notes: https://pharmacytodose.files.wordpress.com/2019/10/status-epilepticus-show-notes-1.pdf
References: https://pharmacytodose.files.wordpress.com/2019/10/status-epilepticus-references.pdf
6:02 –Karen’s interest in SE; 7:35 – What is SE?; 9:32 – Further classifications of SE?; 10:37 – Patient presentation; 11:27 – Can the presentation change?; 13:35 – Any risk factors for SE?; 14:45 – Medication-induced SE; 15:40 – Prompt non-AED treatment for SE?; 17:06 – Empirically treat Wernicke’s?; 18:35 – Preferred BZD for initial treatment of SE?; 20:44 – If they don’t respond to an AED, do you avoid/discontinue using these agents?; 23:08 – Convincing providers to give larger BZD doses?; 26:53 – BZD dosing if a patient uses alcohol or BZD?; 27:37 – First-line AED for patients in SE?; 30:34 – Difficulty with high quality research in SE?; 31:46 – Are there specific patient populations or disease states where you prefer or avoid a specific AED?; 33:04 – Why is timely treatment so important?; 34:25 – General information on first-line AED agents; 47:20 – Where to find evidence-based dosing recommendations for SE?; 49:49 – Appropriate TDM of AED; 53:55 – Increase dose or add another AED?; 55:53 – How to improve time to AED administration for SE?; 59:04 – Review of IV anesthetic infusions for refractory SE; 64:27 – Tips/Tricks for Pharmacists treating SE; 65:40 – Take-home points
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Vasoactives in Septic Shock with Special Guest: Alex Flannery, PharmD, BCCCP, BCPS
3:35 – Why is Alex interested in sepsis?...5:49 – How do you teach sepsis with the recent changes?...8:35 – When to start vasopressors in a hypotensive patient?...11:58 – What do you consider high-dose norepinephrine?...13:40 – How do you add vasopressin and corticosteroids for patients in refractory septic shock?...15:15 – Do you use fludricortisone in combination with hydrocortisone?...16:49 – Utility of cortisol levels or ACTH stimulation testing...18:27 – Cost:benefit analysis of vasopressin...19:21 – Role of epinephrine in septic shock...21:15 – Dobutamine or Epinephrine?...22:57 – HAT cocktail...24:55 – Thiamine supplementation in sepsis and septic shock...28:35 – Use of Angiotensin II and its place in therapy...32:30 – Approach to using methylene blue...34:05 – Modify hemodynamic goals to assist with vasopressor weaning...36:07 – Managing adverse effects due to vasopressors...39:27 – Order of operations in weaning vasopressors and corticosteroids...44:35 – The use of midodrine to wean off IV vasopressors...49:25 – Take-away points for vasoactives and their use in septic shock...51:11– Future areas for research
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Sleep in the ICU with Special Guest: Mojdeh Heavner, PharmD, BCPS, BCCCP
4:55 – 10:00 – How did Mojdeh first become interested in sleep?; 10:00 – 13:40 – Why is sleep disruption so bad for ICU patients?; 14:11 – 15:31 – How does sleep deprivation affect clinical outcomes?; 15:35 – 19:13 – How do we know ICU patients have issues with sleep?; 19:45 – 24:38 – Is there a relationship between sleep deprivation and delirium; 24:50 – 30:30 – Risk factors for sleep deprivation; 30:48 – 32:35 – What do the PAD-IS guidelines recommend regarding sleep assessment?; 32:37 – 34:00 – What do we use for sleep assessment currently?; 34:00 – 37:12 – What options are available to assess sleep in ICU patients?; 37:20 – 38:30 – Can we rely on family to bring up sleep related issues?; 38:45 – 44:15 – Non-pharmacologic management of sleep disruption; 44:20 – 54:21 – Pharmacologic interventions for sleep promotion; 54:30 – 55:45 – What to do with the patient who has taken BZD chronically for sleep at home?; 55:45 – 58:10 – Does your approach for sleep management change for patients with chronic insomnia?; 58:12 – 60:09 – Importance of multi-disciplinary involvement with sleep; 60:10 – 63:20 – Role of Pharmacist in Sleep Promotion; 63:20 – 65:00 – Take-home points
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Introducing Pharmacy to Dose: The Critical Care Podcast with your host Nick Peters. Learn more about the podcast discussing critical care and its pharmacotherapy in a fun and entertaining manner.