The Elective Rotation: Recent Episodes
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The Elective Rotation - the #1 Hospital Pharmacy podcast - is created for YOU Pharmacy Nation! If you are a Pharmacy Student, Resident, Pharmacist, Nurse, Physician, or Critical Care Practitioner in a hospital, intensive care unit (ICU) or emergency department looking to improve your practice, The Elective Rotation delivers expert critical care and hospital pharmacy content from a Board Certified Pharmacotherapy Specialist. Episodes are published every Monday and Thursday at 3AM EST. Find the show notes at pharmacyjoe.com.
Show notes at pharmacyjoe.com/episode193. In this episode I’ll: 1. Discuss an article about allometric dosing of vancomycin. 2. Answer the drug information question “How long should steroids be given for severe alcoholic hepatitis?" 3. Share a resourc
Show notes at pharmacyjoe.com/episode 111 In this episode I’ll: 1. Discuss an article about the risk and severity of Clostridium difficile Infection with PPIs. 2. Answer the drug information question “Will IV fat emulsion work for cardiac toxicity c
Show notes at pharmacyjoe.com/episode110 In this episode I'll discuss the treatment of coagulase-negative staphylococci infection.
Show notes at pharmacyjoe.com/episode109 In this episode I’ll: 1. Discuss an article about using high dose heparin for VTE prophylaxis in obese patients. 2. Answer the drug information question “Do the new FDA quinolone warnings for mild infections
Show notes at pharmacyjoe.com/episode108 In this episode, I’ll discuss the treatment of drug-induced Torsades. When responding to code blue, rapid response calls, and other medical emergencies, take the stairs instead of the elevator whenever possible
Show notes at pharmacyjoe.com/episode107 In this episode, I'll: 1. Discuss an article about the use of banana bags in ICU patients. 2. Answer the drug information question "If a pharmacist programs an IV pump for infusion, does that count as administrati
Show notes at pharmacyjoe.com/episode106 IIn this episode I'll discuss how pharmacists can improve their working relationships with physicians. Thank you so much for helping to make my book A Pharmacist’s Guide to Inpatient Medical Emergencies the #1
Show notes at pharmacyjoe.com/episode105 In this episode I'll: 1. Discuss an article about therapeutic drug monitoring of voriconazole. 2. Answer the drug information question "When alteplase is given for massive PE in a patient undergoing cardiopulmonar
Show notes at pharmacyjoe.com/episode104 I’ve ordered the proof copy for my book, A Pharmacist’s Guide to Inpatient Medical Emergencies and I look forward to hitting the final publish button very soon! To see the cover you can go to: clinicalpharmac
Show notes at pharmacyjoe.com/episode103 In this episode I'll: 1. Discuss an article about increased mortality from epinephrine in cardiogenic shock. 2. Answer the drug information question "Can phenytoin cause hypothermia" 3. Share two resources for st
Show notes at pharmacyjoe.com/episode102 In this episode I'll discuss how to transition from dexmedetomidine to clonidine. Dexmedetomidine is an IV alpha-2A adrenergic agonist. It has sedative effects and is used for the management of pain, agitation, a
Show notes at pharmacyjoe.com/episode101 In this episode I'll: 1. Discuss an article about using propofol for toxin-related seizures. 2. Answer the drug information question "Should SSRIs be stopped in a patient with GI bleeding?" 3. Share a resource fo
Show notes at pharmacyjoe.com/episode100 In this episode I’ll discuss my ICU workflow as a critical care pharmacist. I'll also share how I orient PGY-1 pharmacy residents to my critical care pharmacy rotation. Workflow There is a basic workflow to t
Show notes at pharmacyjoe.com/episode99 In this episode I’ll: 1. Discuss a new guideline on Acute kidney injury in ICU patients. 2. Answer the drug information question “What do you think about IV push antibiotics in sepsis?" 3. Share a resource for
Show notes at pharmacyjoe.com/episode98 In this episode I'll discuss whether there is a pro-ketamine bias in the #FOAMed community. Click here if you'd like to help me pick the title for my new book about inpatient medical emergencies for pharmacists.
show notes at pharmacyjoe.com/episode24 I’m excited to have my first guest here on The Elective Rotation Podcast. In this episode we’ll be talking with the one of the most talented and patient focused respiratory therapists I know. He is also a treme
Show notes at pharmacyjoe.com/episode23 In this episode, I’ll give real world patient care examples of how to remember and apply the concepts of sensitivity, specificity and predictive value as they relate to medical tests. I struggled with rememberin
Show notes at pharacyjoe.com/episode22 Methemoglobinemia is a potentially life-threatening form of functional anemia. There are two types of methemoglobinemia - congenital and acquired. In this episode I’ll discuss the recognition and treatment of acqu
Show notes at pharmacyjoe.com/episode21 In episode 20, I discussed how I prepare for ICU rounds. In this episode I’ll be talking about how ICU rounds are structured and how I participate in ICU rounds, including when and how I present my recommendations
Show notes at pharmacyjoe.com/episode20 Most of my pharmacy students are surprised that I look at medications last in my pre-rounding review of ICU patients. I am constantly tweaking and improving my method for pre-rounding on ICU patients. Here is my c
show notes at pharmacyjoe.com/episode19 In this episode I’ll share the decision making process I use to decide when and how to write a pharmacy progress note. When to write a pharmacy progress note? Not all communication is appropriate for a progress
show notes at pharmacyjoe.com/episdoe18 The methods I am going to discuss in this episode are not first line or even second line therapies for controlling acute agitation. I use them rarely - as in a few times per year or less. But in some difficult si
Show notes at pharmacyjoe.com/episode17 Have you already joined the Pharmacy Nation slack group to collaborate and communicate with other pharmacists in real time? If not, send yourself an invite at pharmacynation.org! In this episode I’ll cover when
Show notes at http://www.pharmacyjoe.com/episode16 There is a lot of buzz around the use of ketamine in the critical care setting, and for good reason. But a lot of providers are unfamiliar with and hesitant to use the drug. In this episode I’ll high
Show notes at pharmacyjoe.com/episode15 If one of us is not already at the bedside, pharmacists at my institution are frequently called by critical care providers to assist with intubation procedures in critically ill patients. This episode will provide
Show notes at pharmacyjoe.com/episode14 The Debate For over a decade there has been a debate on whether it is better to use succinylcholine (Sux) or rocuronium (Roc) for rapid sequence intubation (RSI) in emergency settings. I'm surprised when reading
In today's episode we will discuss three topics regarding antibiotic dosing in CRRT (continuous renal replacement therapy). 1. Review CRRT antibiotic dosing rules 2. Review CRRT antibiotic dosing exceptions 3. Discuss the prevelance of antibiotic underdo
Evaluating QTc drug interactions Prolonged QTc interval leading to torsades. It is the adverse medication event that keeps pharmacists awake at night. In this episode I will explain how, as a hospital-based pharmacist, I evaluate drug interactions that c
Why Is My Patient In the ICU and How Sick Are They? The topic for today’s show is PharmacyJoe-ism #7: making patient focused risk benefit assessments. My ability to do this greatly improved when I started to explicitly and on a basic level think about
As the expert in drug therapy, you need to know how different drugs exert their effects on the electrical system of the heart. Pharmacist review of the ECG is relatively straight forward compared to other professions. We should be able to identify the rh
Today I’m going to pull the curtain back and show you how I trained myself to have successful verbal communications with physicians, and get my interventions accepted. We’ll go over: Expected acceptance rates First impressions of your conversation
Show notes at pharmacyjoe.com/episode97 In this episode I'll: 1. Discuss an article about sedation choice and infection risk. 2. Answer the drug information question "Is phentolamine superior to terbutaline for treatment of extravasation?" 3. Share a re
Show notes at pharmacyjoe.com/episode96 In this episode I’ll discuss the use of magnesium sulfate in critical care. Shout out to listener “Pharmacy Alex” for suggesting this topic! When I think of magnesium in critical care, 3 uses come to mind:
Show notes at pharmacyjoe.com/episode95 In this episode I'll: 1. Discuss evidence on the efficacy of ketamine IM for acute behavioral emergencies. 2. Answer the drug information question "Can a patient with an allergy to contrast media receive amiodaron
Show notes at pharmacyjoe.com/episode92 In this episode I’ll discuss how I provide analgesia & sedation to critically ill patients who have taken buprenorphine. Buprenorphine is an opioid partial agonist. It is used to treat acute & chronic pain, op
Show notes at pharmacyjoe.com/episode93 In this episode I'll: 1. Discuss an article about high dose heparin for VTE prophylaxis in obese patients. 2. Answer a drug information question about vitamin K. 3. Share a resource for lab assay interference by n
So much of antibiotic selection has to do with local resistance patterns, and it cannot be protocolized or generalized without that knowledge. That said I believe there are some principles of antibiotic selection in the ICU that are worth discussing in g
Here are my 7 tips for how to stay current with medical literature: Pharmacist Letter / Subscriber's Letter Pubmed Alerts on saved searches Electronic delivery of journal table of contents Utilize your medical librarian Listen to a podcast Discuss new ar
Phentolamine is no longer manufactured. Phentolamine has now made ASHP's list of drugs no longer available. This information is critical to communicate to emergency medicine and critical care practitioners, as the risk:benefit of peripheral vasopressor
Shock is the syndrome that results when the cardiovascular system fails to maintain adequate tissue perfusion. The goal is to maintain hemodynamics while the cause of shock can be addressed. Fluids, vasopressors, and inotropes are the essential parts of
Push Dose Pressors, They're Not Just For Anesthesia Anymore! I like preventing the complications of profound hypotension as much as anyone. Really, I do. It's why I suggest you focus so much on anticipating patient and provider needs during an emergenc
Show notes at pharmacyjoe.com/episode92 In this episode I’ll discuss how I provide analgesia & sedation to critically ill patients who have taken buprenorphine. Buprenorphine is an opioid partial agonist. It is used to treat acute & chronic pain, op
Show notes at pharmacyjoe.com/episode91 In this episode I'll: 1. Review an article about using imatinib for bleomycin interstitial pneumonitis. 2. Answer the drug information question "Should daptomycin or linezolid be used for VRE bacteremia?" 3. Share
Show notes at pharmacyjoe.com/episode90 In this episode I’ll discuss 6 tips for pharmacists responding to medical emergencies. After years of working in the central pharmacy, an opportunity arose to go to the floors for code blue and rapid response ca
Show notes at pharmacyjoe.com/episode89 In this episode I'll: 1. Discuss an article about bloodless treatment of anemia. 2. Answer the drug information question "Which antibiotics should be given to a patient with necrotizing pancreatitis?" 3. Share a r
Show notes at pharmacyjoe.com/episode88 In this episode, I’ll discuss the treatment of loperamide toxicity. Loperamide is often referred to as “the poor man’s methadone”. It has been used as both a drug of abuse and as a way of self-treating opi
Show notes at pharmacyjoe.com/episode87 In this episode I'll: 1. Discuss an article about using platelet infusions to treat intracerebral hemorrhage (ICH) from antiplatelet medications. 2. Answer the drug information question "Why were the contraindicat
Show notes at pharmacyjoe.com/episode86 In this episode I’ll discuss updated toxicology guidelines when using intravenous lipid emulsion (ILE) for drug toxicity. In episode 30 I discussed the use of ILE for drug toxicity. In April the American Colle
Show notes at pharmacyjoe.com/episode85 In this episode I'll: 1. Share an article about using earplugs to reduce ICU delirium. 2. Answer the drug information question: "Should dextrose containing solutions be avoided in ischemic stroke patients?" 3. Sha
Show notes at pharmacyjoe.com/episode84 In this episode I'll discuss chemical sedation for acute agitation. Chemical sedation is part of the array of options to treat acute agitation. Prevention strategies, verbal de-escalation techniques, and physical
Show notes at http://pharmacyjoe.com/episode25 When it comes to direct antidotes for drug toxicity, there are only a handful. In this episode I’ll talk about when to give a lot of naloxone (Narcan), and when to give just a little bit. Naloxone is a pu
Show notes at pharmacyjoe.com/episode26 The American Heart Association cardiopulmonary resuscitation guidelines have been updated for 2015! There are some interesting changes to the guidelines that pharmacists should know about, and I'll summarize them
Show notes at pharmacyjoe.com/episode27 In this episode I will: 1. Review an article about the choice of IV fluids in ICU patients 2. Answer a drug information question: "Can dexmedetomidine cause a fever?" 3. Share a free resource I use to stay updated
Show notes at pharmacyjoe.com/episode28 In this episode I'll share how I approach a "Pharmacy Pain Consult" at my hospital. I'll discuss how I titrate opioid doses when the patient has risk factors for respiratory depression. I'll also share the 4 most
Show notes at pharmacyjoe.com/episode29 In this episode I will: 1. Review an article about idarucizumab for dabigatran reversal 2. Answer a drug information question: "Can I use rivaroxaban to treat a pulmonary embolism (PE) in a patient with active can
Show notes at pharmacyjoe.com/episode30 If you haven’t already joined the Pharmacy Nation slack group where pharmacists collaborate about patient care in real-time, sign up at pharmacynation.org. I hope you join me and the over 70 other Pharmacy Natio
Show notes at pharmacyjoe.com/episode31 In this episode, I will: Review an article about monitoring vancomycin by trough levels Answer a drug information question: Why do some of my trauma patients get heparin and some enoxaparin for DVT prophylaxis? S
Show notes at pharmacyjoe.com/episode32 II’ve got to thank a critical care doc I work with - Pulmonology Tony - for taking the time to teach me about hyponatremia from SIADH several years ago. In this episode I’ll share with you what he taught me an
Show notes at pharmacyjoe.com/episode33 In this episode I'll: 1. Review the FDA briefing documents for sugammadex 2. Answer a drug information question about dabigatran 3. Share a great resource I use for evaluating drug interactions Before we get to th
Show notes at pharmacyjoe.com/episode34 In this episode I’ll: 1. Review how to recognize severe hyperkalemia 2. Review the 3 categories of hyperkalemia treatments and the order which they should be used 3. Discuss the nuances of each treatment Recogni
Show notes at pharmacyjoe.com/episode35 In this episode I'll: 1. Review an article on propofol related infusion syndrome 2. Answer a drug information question about surgical antibiotic prophylaxis 3. Share a great resource I use for investigating drug i
Show notes at pharmacyjoe.com/episode36 In this episode I’ll review the definition, recognition, causes & pharmacotherapy treatments of stridor in critically ill adult patients. Defintion Stridor is an abnormal inspiratory sound, and a sign of upper
Show notes at pharmacyjoe.com/episode37 In this episode I'll: 1. Discuss an article about prolonged empiric antibiotic therapy in adult ICUs 2. Answer a drug information question about eosinophilic nephritis 3. Share a 4T score calculator Article A Mul
Show notes at pharmacyjoe.com/episode38 Today’s episode topic is being presented at the request of another "Pharmacy Joe” who left this message on pharmacyjoe.com about using clonidine for hypertensive emergencies. If you’d like to call in a topic
Show notes at pharmacyjoe.com/episode39 In this episode I'll: 1. Discuss an article about evidence based medicine 2. Answer a drug information question about IV compatibility 3. Share a resource for calculating a patient's Candida Score Article Parach
Show notes at pharmacyjoe.com/episode40 In this episode, I’ll discuss the recognition and treatment of serotonin syndrome (SS), malignant hyperthermia (MH), and neuroleptic malignant syndrome (NMS). Muscular rigidity, significant hyperthermia, and aut
Show notes at pharmacyjoe.com/episode41 In this episode I'll: 1. Review an article on monitoring enoxaparin with antifactor Xa levels in morbidly obese patients 2. Answer a drug information question about using morphine in a patient on dialysis 3. Share
Show notes at pharmacyjoe.com/episode42 In this episode I’ll talk about tips for the pharmacist in the initial treatment of severe sepsis / septic shock. Introduction Severe sepsis is sepsis with organ dysfunction, and septic shock is sepsis induced
Show notes at pharmacyjoe.com/episode43 In this episode I’ll: 1. Review an article I used to answer the drug information question “Can olanzapine be given IV?" 2. Share a resource for finding free open access medical education content Article Intr
Show notes at pharmacyjoe.com/episode44 In this episode I'll discuss the management priorities for a hospital pharmacist when caring for a patient with status epilepticus. Seizure Whenever I encounter a hospital inpatient with an acute seizure, I make
Show notes at pharmacyjoe.com/episode45 In this episode I'll: 1. Review an article about using melatonin to decrease the need for sedation in the ICU 2. Answer the drug information question "How long can I take NSAIDs before I need to take GI prophylaxi
Show notes at pharmacyjoe.com/episode46 In this episode I'll review the pharmacologic treatments for anaphylaxis. Definition Anaphylaxis is a potentially fatal allergic reaction with a rapid onset. Immunoglobulin E (IgE)-mediated allergic reactions to
Show notes at pharmacyjoe.com/episode47 In this episode I'll: 1. Review an article about augmented renal clearance of antibiotics in critically ill patients 2. Answer the drug information question "For a patient with rash to penicillin that is 5 months
Show notes at pharmacyjoe.com/episode48 In this episode I’ll review the medications used to support the treatment of shock from 12 different etiologies. During the treatment of shock, the patient’s life hangs in the balance while the care team quick
Show notes at pharmacyjoe.com/episode49 In this episode I'll: 1. Review an article about fixed dosing of 4-factor prothrombin complex concentrate for emergent warfarin reversal 2. Answer the drug information question: What is the dose of subcutaneous h
Show notes at pharmacyjoe.com/episode50 In this episode I’ll focus on 2 examples of medication overdose that require more than supportive care to treat effectively: 1. Acetaminophen poisoning 2. Methanol & ethylene glycol poisoning A special shout ou
Show notes at pharmacyjoe.com/episode51 In this episode I’ll: 1. Discuss an article recommending DDAVP for intracranial hemorrhage from anti-platelet agents 2. Answer the drug information question: “What should I use to treat a DVT in a patient on C
Show notes at pharmacyjoe.com/episode52 In this episode I’ll review the inpatient treatment of hypoglycemia. Hypoglycemia is a medical emergency To help myself remember and apply medical concepts, I break them down into the most simple terms I can. W
Show notes at pharmacyjoe.com/episode53 In this episode I’ll: 1. Discuss an article about evaluating the presence of pain in patients with ICU delirium 2. Answer the drug information question: “Does quetiapine reduce the duration of ICU delirium?" 3
Show notes at pharmacyjoe.com/episode54 In this episode I'll discuss the use of daptomycin in the context of adult critically ill patients. Mechanism of action Daptomycin demonstrates concentration-dependent bactericidal activity against essentially al
Show notes at pharmacyjoe.com/episode55 In this episode I’ll: 1. Discuss an article that found an increase in mortality when succinylcholine was used for rapid sequence intubation in patients with traumatic brain injury. 2. Answer the drug informati
Show notes at pharmacyjoe.com/episode56 In this episode I’ll discuss a long time pet peeve of mine - the Cockcroft Gault formula can be used to predict - not calculate - creatinine clearance. 40 years after it’s publication, the Cockcroft Gault form
Show notes at pharmacyjoe.com/episode57 Shout out to Pharmacy Nation member Noha for suggesting this article for review! In this episode I'll: 1. Review the updated CHEST guidelines on Antithrombotic Therapy for VTE Disease 2. Answer the drug informati
Show notes at pharmacyjoe.com/episode58 In this episode I'll discuss using patient controlled analgesia in ICU patients. What is PCA? Patient controlled analgesia (PCA) is when a patient self-administers opioid medication through the use of a programma
Show notes at pharmacyjoe.com/episode59 In this episode I’ll: 1. Discuss an article about vasopressors and pressure ulcers in critical care. 2. Answer the drug information question: "How long should I hold etanercept before surgery?" 3. Share a reso
Show notes at pharmacyjoe.com/episode60 In this episode, I’ll discuss the treatment of ACE inhibitor induced angioedema. Angioedema due to Angiotensin-converting enzyme (ACE) inhibitors is a rare event. Because of the high frequency of ACE inhibitor u
Show notes at pharmacyjoe.com/episode61 In this episode I'll: 1. Discuss an article about the toxicology of rivaroxaban and apixaban. 2. Answer the drug information question "Is vancomycin compatible with piperacillin-tazobactam at Y-site?" 3. Share a r
Show notes at pharmacyjoe.com/episode62 In this episode I’ll share my top 6 tips to incorporate precepting advanced pharmacy practice experience (APPE) students into your workflow. I look at precepting as providing a student the opportunity to develop
Show notes at pharmacyjoe.com/episode63 In this episode I’ll: 1. Discuss an article about identifying patients at risk of death from sepsis outside of the ICU. 2. Answer the drug information question: What are the new definitions and clinical criteria
Show notes at pharmacyjoe.com/episode64 In this episode I'll discuss how I identify drug fever. Background Drug fever is a common condition that coincides temporally with the administration of a drug and disappears after discontinuation of the medicati
Show notes at pharmacyjoe.com/episode83 / / In this episode I'll: / / 1. Discuss an article on the pharmacodynamics of a fluid challenge. / 2. Answer the drug information question "Why is epinephrine added to lidocaine for injection?" / 3. Share a resou
Show notes at pharmacyjoe.com/episode64 / / IIn this episode I'll: / / 1. Discuss an article that evaluates continuous vs intermittent dosing of cefazolin during CABG surgery / 2. Answer the drug information question "Can I give heparin subcutaneously f
Show notes at pharmacyjoe.com/episode66 / / In this episode I'll discuss diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). / / Definition / / Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most seri
Show notes at pharmacyjoe.com/episode67 / / In this episode I?ll: / / 1. Discuss an article about using dexmedetomidine for agitated delirium when haloperidol doesn?t work / 2. Answer the drug information question ?Should I use a loading dose when initi
Show notes at pharmacyjoe.com/episode68 / / In this episode I'll discuss whether sugammadex can rescue your patient from a ?can?t intubate, can?t oxygenate? scenario. / / Now that sugammadex has made it to the US market, the push to add it to formulary
Show notes at pharmacyjoe.com/episode69 / / In this episode I'll: / / 1. Discuss and article about whether aspirin affects mortality in staph aureus bloodstream infection / 2. Answer the drug information question "Why is phenylephrine such a bad vasopre
Show notes at pharmacyjoe.com/episode70 / / In this episode I?ll discuss the treatment of severe alcohol withdrawal. / / Symptoms / / Symptoms of alcohol withdrawal are the result of an increase in autonomic activity and sympathetic outflow, as well as
Show notes at pharmacyjoe.com/episode72 / / If a patient has been on a continuous fentanyl infusion for 7 or more days, they are likely to have physical signs of opioid withdrawal if the infusion is suddenly stopped. / / This is a fairly regular problem
Show notes at pharmacyjoe.com/episode71 / / In this episode I'll: / 1. Discuss an article about predicting the need for critical care resources after receiving IV thromblysis for ischemic stroke. / 2. Answer the drug information question "Should a pregna
Show notes at pharmacyjoe.com/episode73 / / In this episode I'll: / / 1. Discuss an article about calcium correction in the ICU / 2. Answer the drug information question "What weight should be used to calculate an initial dose of IV immune globulin (IVI