Contributor: Don Stader, MD Educational Pearls: Olanzapine (Zyprexa) is an atypical antipsychotic that can be used in a similar fashion to haloperidol for pain and nausea, including that with abdominal pain and headaches Olanzapine can be administered as an oral disolving tablets, intramuscular or intravenous injection Because Zyprexa is an atypical antipsychotic, it has a…
Read MoreContributor: Rachel Beham, PharmD Educational Pearls: Coricidin HBP Cough & Cold (dextromethorphan and chlorpheniramine) is one of the more commonly abused over-the-counter medications Dextromethorphan, binds to multiple receptors, particularly at high doses Opioid receptors, causing respiratory depression, CNS depression NMDA receptors, causing agitation and hallucinations Serotonin-reuptake inhibition, which may lead to serotonin syndrome, especially when…
Read MoreAuthor: Michael Hunt, MD Educational Pearls: Organophosphate “nerve agents” were developed in the 1930’s These agents have cholinergic effects, which can be remembered by the mnemonic “SLUDGE” Salivation Lacrimation Urination Defecation GI cramping Emesis The “SLUDGE” toxidrome is mediated through the muscarinic acetylcholine receptors. Nerve agents also affect the nicotinic acetylcholine receptors, which leads to…
Read MoreContributor: Don Stader, MD Educational Pearls: The classic migraine cocktail includes: Reglan (or other dopamine antagonist), Benadryl, Toradol, Decadron, and IV fluids. The most effective agent in the cocktail is a dopaminergic agent Routine IV fluids have not shown efficacy There is no evidence for pre-treatment of akathisia with diphenhydramine (Benadryl) Decadron reduces rebound headache …
Read MoreContributor: John Winkler Educational Pearls: There is increasing resistance to antimalarial drugs, especially in P. falciparum. This trend started with chloroquine, but is now spreading to the other first-line drugs. Resistant strains have been identified in Cambodia and Thailand 220 million people were infected last year The best treatment of malaria is prevention from bites…
Read MoreContributor: Erik Verzemnieks, MD Educational Pearls: Important to realize complications can occur in the post-opioid overdose patient regardless of cause Narcan administration has been associated with non-cardiogenic pulmonary edema, although the mechanism of this is not quite known Symptoms include progressive shortness of breath and hypoxia. Treatment is with positive-pressure ventilation and diuresis, similar to…
Read MoreAuthor: Don Stader, MD Educational Pearls: Suboxone, methadone, and naltrexone are commonly used as treatments for opiate use disorder. Naltrexone is a full mu-opiate receptor antagonist, making acute pain control difficult in patients taking it. Options for pain control in patients on naltrexone include nerve blocks, NSAIDS, ketamine, and high doses of opiates. Of the…
Read MoreAuthor: Rachel Beham, PharmD Educational Pearls: There are currently many Ebola vaccines that are being studied, and one (recombinant VZV-Ebola vaccine) is currently being used in Africa. This vaccine has so far shown good efficacy in reducing Ebola infections and mortality from Ebola in those who do become infected. There are antibody-based treatments that are…
Read MoreAuthor: Jared Scott, MD Educational Pearls: Study from Hennepin County EM studied the efficacy of different drugs for agitation, which included 737 patients Most patients in this study were male and *surprise* drunk Compared doses of common sedatives with primary outcome of sedation at 15 minutes (all intramuscular) haloperidol 5 mg ziprasidone 20 mg olanzapine…
Read MoreTreatment with buprenorphine is easier, less time consuming and far more effective for management of opioid withdrawal and OUD than standard care with clonidine, IVF, haldol and other symptomatic therapies. Induction with buprenorphine is easy, requires no IV or labs, and is usually accomplished in 1-2 hours. It requires a chair, not a hospital bed….
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