Author: Nick Hatch, M.D. Educational Pearls Tramadol acts at multiple receptors and is a partial agonist at the mu opioid receptor, but also blocks reuptake of serotonin and norepinephrine throughout the body among others. One major side effect to be aware of is that it lowers the seizure threshold. Useful in setting of pain…
Read MoreAuthor: Aaron Lessen, M.D. Educational Pearls A “stuffer” is a term for someone who hastily and conceals a bag of drugs orally/rectally/vaginally in an unplanned situation. A “packer” is someone who is planning to smuggle drugs, and does so in a similar manner. “Stuffers”are more likely to have the drug container open up in…
Read MoreAuthor: Peter Bakes, M.D. Educational Pearls Probiotics are living bacteria that are taken as an oral supplement. Most of the data to support their use is in the prevention of antibiotic-related diarrhea and the reduction of the symptoms of ulcerative colitis (UC). Some studies have some a reduction of the incidence of antibiotic-related diarrhea in…
Read MoreEducational Pearls Truvada (Emtricitabine/tenofovir) is a combination nucleotide reverse transcriptase inhibitor that can be used as pre-exposure prophylaxis (PrEP) for HIV. It has been shown to dramatically reduce the risk of contracting HIV. It is used in high-risk patients, like the MSM community or those who are in a relationship with someone with HIV. Side…
Read MoreAuthor: Rachael Duncan, PharmD Educational Pearls A NEJM study report in July 2016 discussed a situation in New York during which 30 people became “zombie-like” after ingesting synthetic cannabinoids (aka “Spice). The ER managed to coordinate with the CDC to evaluate blood samples from 18 patients who were transported to the hospital. Of those who…
Read MoreAuthor: Dylan Luyten, M.D. Educational Pearls Cannabinoid Hyperemesis syndrome is a relatively new diagnosis that presents with vomiting and abdominal pain without a clear etiology in the setting of daily marijuana use. The pathophysiology is not well-understood well, but may involve cannabinoid receptors in the gut. Treatment is abstinence from marijuana, fluids, dextrose, and antiemetics…
Read MoreAuthor: Rachel Beham, PharmD, Advanced Clinical Pharmacist – Emergency Medicine Educational Pearls CDC recommends using the inactivated, injectable flu vaccine in those 6 months and older. The live attenuated vaccine is not used because of low efficacy. Pregnant women should be vaccinated, and can receive the vaccine at any stage of their pregnancy. The vaccine…
Read MoreAuthor: JP Brewer, M.D. Educational Pearls After the first hour, every 1 hour delay in antibiotics in a patient with septic shock patient is associated with a 4% increase in mortality. In patients with high suspicion for septic shock (fever and hypotension), antibiotics should be initiated ASAP. Rocephin (ceftriaxone) should be used for those with community-acquired…
Read MoreAuthor: Aaron Lessen, M.D. Educational Pearls Icatibant was introduced to treat ACE-inhibitor induced angioendema. This type of angioedema is refractory to epinephrine and antihistamines, and is likely mediated by elevated bradykinin.(which is inactivated by ATII and ACE). Icatibant initially was shown to reduce facial swelling and airway obstruction in the setting of ACE-I angioedema, but…
Read MoreAuthors: Don Stader, M.D & Rachael Duncan, PharmD BCPS BCCCP Educational Pearls Fentanyl patches may be abused in many ways, including changing the patches more frequently, chewing them, extracting the fentanyl in a tea, and administering them rectally. Fentanyl is very lipophilic and has a fast onset, but it has a very low bioavailability when given…
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