Pharmacology Archives - Page 13 of 16 - The Emergency Medical Minute

Pharmacology

Podcast #412: tPa Mission Creep

Author: Aaron Lessen, MD Educational Pearls: Patients with “minor” strokes with NIHSS 0 to 5  can still end up having poor long-term outcomes Recent study compared use of alteplase vs. aspirin for these patients and saw no difference in regards to favorable neurologic outcome at 90 days Study was ended early due to patient recruitment…

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Podcast #408: Go the hell to sleep

Author: Don Stader, MD Educational Pearls: Recent study showed efficacy 5mg IM midazolam > 10mg IM olanzapine > 10mg IM haloperidol for quickly sedating an agitated patient If you have access, ketamine intravenous is the fastest Olanzapine should be used with caution in elderly patients because of its anticholinergic properties Ketamine can transiently worsen psychosis…

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Podcast #406: PO vs. IV Tylenol

Author: Don Stader, MD Educational Pearls:   Intravenous Tylenol currently is many times more expensive than oral Single ED study comparing the two has methodology flaws and there is a lack of additional evidence to support intravenous over oral formulations solely for pain control Oral Tylenol appears to be at least equally efficacious, though with…

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Podcast #395: Aspirin for everyone!

Author: Aaron Lessen, MD Educational Pearls: In patients without indications for aspirin, three recent studies looked at prevention of several end points in the elderly These showed no benefit in preventing cardiovascular events (stroke, MI, hear failure), disability, or death in elderly These studies also demonstrated higher mortality and increased bleeding risk in patients who…

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Podcast # 390: Haloperidol for Pain

Author: Gretchen Hinson, MD Educational Pearls: Reasonable approach of haloperidol 10 mg IM (or 5 mg IV) for pain relief in opioid-dependent patients; can repeat once. Chronic opioid use results in hyperalgesia and a narrow therapeutic window in the long-term so alternatives are essential. Consider the risk of QTc prolongation with haloperidol, particularly if the…

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Podcast #387: Fluoroquinolones are Perfectly Safe?

Author:  Don Stader, MD Educational Pearls: Fluoroquinolones can cause connective tissue disruption leading not only to tendon rupture but also aortic dissection. Retrospective study from Taiwan showed over a 2x higher rate of dissection when exposed to fluoroquinolones (1.6% vs 0.6%). Remember to think about aortic dissection when you have a patient with chest pain…

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Podcast # 372: The Latest on Epinephrine in Cardiac Arrest

Author:  Don Stader, MD Educational Pearls: 8014 patients with out-of-hospital cardiac arrest randomized to epinephrine vs placebo 30-day survival was not dramatically better between groups (3.2%in the epinephrine group and 2.4% in the placebo group) Functional neurological outcome was nearly identical at 2.2% and 1.9% of patients Adds to literature that epinephrine provides little important…

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Podcast #357: Local Anesthetic Toxicity

Author: Michael Hunt, MD Educational Pearls: Toxicity happens from local anesthetics being given too fast, too much, or in the unintended spot Systemic toxicity manifests first with neurologic symptoms like circumoral numbness, tinnitus, blurred vision, nausea, and even seizures. Severe toxicity can then progress to arrhythmias and cardiac arrest. Maximum doses of lidocaine: 4 mg/kg;…

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Podcast # 356: Babies can’t be born addicted

Author: Don Stader, MD. Educational Pearls: A baby can be born dependent on opioids but not addicted to them. Opioid addiction (Opioid Use Disorder) is a disease of mature brains and is characterized by compulsive drug use despite adverse consequences. Opioid addiction is a disease that affects the reward center of the brain Pregnant patients…

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Podcast # 341: Tenecteplase vs. Alteplase

Author: Rachel Beham, PharmD Educational Pearls: Tenecteplase is more specific for fibrin and has a longer half-life than alteplase. In setting of ischemic stroke, tenecteplase before thrombectomy was associated with a statistically higher incidence of reperfusion and better functional outcome than alteplase.   References Bruce C.V. Campbell B et al (2018). Tenecteplase versus Alteplase before…

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