Pharmacy to Dose: The Critical Care Podcast

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

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

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

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

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

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

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

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

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

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