Pharmacy to Dose: The Critical Care Podcast

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

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

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

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

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

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. Learn more about your ad choices. Visit megaphone.fm/adchoices