Pharmacy to Dose: The Critical Care Podcast
Pulmonary Hypertension

Pulmonary Hypertension

September 14, 2020

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 & Anticoagulant Therapy with Cardiac Devices

Antithrombotic & Anticoagulant Therapy with Cardiac Devices

August 26, 2020

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

Pediatric Critical Care Part I

August 13, 2020

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

Ventricular Arrhythmias

July 26, 2020

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

White Coats for Black Lives

July 3, 2020

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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Medication Dosing in CRRT

Medication Dosing in CRRT

June 18, 2020

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

Aneurysmal Subarachnoid Hemorrhage

June 3, 2020

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

Acute Liver Failure

May 19, 2020

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

Critical Care Management of COVID-19

April 27, 2020

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

Research Principles for COVID-19

April 22, 2020

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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