Pharmacy to Dose: The Critical Care Podcast

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   PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

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   PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

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    PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

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   PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

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   PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

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   PharmacyToDose.Com   @PharmacyToDose on Twitter/Instagram   PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

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 PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

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. PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

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   Email: PharmacyToDose@Gmail.com Social Media: @PharmacyToDose Website: PharmacyToDose.Com Learn more about your ad choices. Visit megaphone.fm/adchoices

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 Social Media: @PharmacyToDose Website: PharmacyToDose.Com Learn more about your ad choices. Visit megaphone.fm/adchoices