The Pharm So Hard Emergency Medicine & Hospital Pharmacy Podcast

Episode 122. SGLT2 Inhibitors in the ICU - Are We Missing an Opportunity?

In this episode of The Pharm So Hard Emergency Medicine Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, explores the potential of SGLT2 inhibitors in critically ill patients with guest Daniella Abi Kheir, PharmD. Traditionally viewed as diabetes medications, SGLT2 inhibitors are now gaining attention for their pleiotropic effects, including cardiovascular, renal, and anti-inflammatory benefits.
Together, Jimmy and Daniella dive into the DEFENDER trial, the first study to evaluate SGLT2 inhibitors in ICU patients with acute organ dysfunction. They break down the study design, key findings, and practical implications for managing critically ill patients. Could these drugs help prevent renal replacement therapy or improve outcomes in septic patients?
The episode also tackles potential safety concerns, including DKA and altered absorption in critically ill populations, while offering actionable insights for clinicians considering SGLT2 inhibitors in the ICU. Tune in for an evidence-based discussion packed with clinical pearls and takeaways.

Episode 121. Journavix: A New Era in Non-Opioid Pain Management?

In this episode of The Pharm So Hard Emergency Medicine Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by William Amarquaye, PharmD, to discuss Journavix, the first non-opioid pill approved for moderate to severe acute pain in over 20 years. They break down its mechanism as a NAV1.8 sodium channel blocker, compare it to existing analgesics, and analyze clinical trial data on its efficacy and safety. The conversation also tackles key considerations like side effects, drug interactions, and cost implications for real-world use.

Episode 120. Ketamine for Benzodiazepine-Resistant Status Epilepticus – A Game-Changer?

Episode 120. Ketamine for Benzodiazepine-Resistant Status Epilepticus – A Game-Changer?
In this episode of The Pharm So Hard Emergency Medicine Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP dives deep into an exciting new study exploring ketamine as a rescue agent for benzodiazepine-resistant status epilepticus. Traditionally, managing refractory seizures often requires intubation, high-dose propofol, or other antiepileptics. But could ketamine provide rapid and effective seizure control in these critical moments?
Jimmy discusses key findings from the study, practical implications for the ED, and how this data could influence your choice of induction agents during intubation. Plus, he shares valuable clinical pearls and caveats when considering ketamine use in different patient populations.
 
00:00 Introduction
02:16 The Clinical Dilemma: Benzodiazepine-Resistant Status Epilepticus
03:39 Introducing the Study: Ketamine as a Rescue Drug
05:16 Key Findings: Rapid Seizure Termination
06:05 Safety and Dosing Insights
06:42 Clinical Implications: Ketamine in ED Practice
07:05 Caveats and Patient Populations
07:55 Conclusion

Episode 119. Cephalosporins for Pyelonephritis: Insights from the COPY-ED Study

In Episode 119 of The Pharm So Hard Emergency Medicine Podcast, Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, dives into the COPY-ED study, which explores cephalosporins as a viable option for treating outpatient pyelonephritis. Jimmy challenges the fluoroquinolone-dominant narrative, breaks down the study’s methods and results, and highlights the implications for emergency medicine pharmacists.
 

Episode 118. Does Roc Rock and Succs Really Suck? Paralyzing Agents in RSI

In this episode of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, and guest Rosa Malloy-Post, MD, delve into the debate over the most suitable paralyzing agent for rapid sequence intubation (RSI). They weigh the advantages and disadvantages of Succinylcholine ("Succ") and Rocuronium ("Roc") by comparing their pharmacologic properties, onset, duration, side effects, and clinical use cases. Listen for expert perspectives, practical insights, and essential factors to consider when choosing the right agent in emergency settings, and find out if "Roc truly rocks" or if "Succs really suck.

Episode 117. Early Subcutaneous Basal Insulin in Mild to Moderate DKA: A Discussion with Tessa and Brian

In this episode, host Jimmy L. Pruitt III, PharmD, BCPS, BCCCP, BCEMP, welcomes Tessa R. Cox, PharmD, BCCCP, and Brian W. Gilbert, PharmD, MBA, FCCM, FNCS, BCCCP, to discuss their study on the early administration of subcutaneous (SQ) basal insulin in mild to moderate diabetic ketoacidosis (DKA). The episode covers the definition and treatment of DKA, the role of insulin therapy, and the design and results of the retrospective study, which found no significant difference in hospital length of stay between early and non-early SQ basal insulin groups. The discussion includes an analysis of the study outcomes, clinical implications, and the need for further research. Tessa R. Cox and Brian W. Gilbert share their expert insights on DKA management and the relevance of the study findings to emergency medicine.

Episode 116. Writing and Living InteGREAT with Andrea Sikora, Anthony Hawkins, and Susan Smith

Amazon Link: https://www.amazon.com/InteGREAT-Guidebook-Creating-Healthcare-Teams/dp/1946665706In this episode, Jimmy Pruitt engages with the C3 Group authors, Andrea Sikora, Anthony Hawkins, and Susan Smith from the University of Georgia College of Pharmacy. They delve into their collaborative journey of writing the book InteGREAT: A Guidebook for Creating Great Healthcare Teams. The discussion covers the challenges, milestones, and pivotal moments experienced during the book's creation. They explore the vision and goals behind the book, its structure, and how it aids in building and optimizing healthcare teams. The authors share insights on the importance of team development, building relationships, leveraging individual strengths, and achieving alignment within the team. The episode also highlights how the book impacts clinical teams and the authors' professional activities.Show notes: https://pharm-so-hard.com/2024/07/02/episode-116-collaborative-insights-on-creating-great-healthcare-teams-with-c3-group-authors/

Episode 115. Impact of EM CPP-driven sepsis antibiotic interventions with Taylor Cason

This episode of the Pharm So Hard podcast discusses the use of clinical pharmacy practitioners in the emergency room and their impact on sepsis antibiotic interventions author by Aubrie Hammond, Regan Porter, Taylor Cason, et al. The study found that the involvement of EMCPPs significantly improved the selection and timing of antibiotic administration in septic patients. The pharmacist-driven protocol improved the rate of appropriate antibiotic selection from 57% to 86% and reduced the time to administration by 64 minutes. The study also highlighted areas where antibiotic selection could be further improved, such as UTIs and intra-abdominal infections. The role of pharmacists in optimizing treatment time and expanding the pharmacist-driven sepsis management model was also discussed.

Episode 114. PharmD Lit Highlight: Risk of Arrhythmia in post-resuscitative shock after OHCA with Epi vs Norepi

In this episode of the Pharm So Hard Podcast's PharmD Literature Highlight Series, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP discusses the study "Risk of arrhythmia in post-resuscitative shock after out-of-hospital cardiac arrest with epinephrine versus norepinephrine" by Sarah Normand, Pharm.D., Courtney Matthews, Pharm.D., Caitlin S. Brown, Pharm.D., Alicia E. Mattson, Pharm.D., Kristin C. Mara, M.S., Fernanda Bellolio, M.D., M.S., and Erin D. Wieruszewski, Pharm.D.

Episode 113. Timing Matters: Delving into Prothrombin Complex Concentrate with Authors Townsend and Gilbert

Full TextPubMedIn this episode of the Pharm So Hard podcast, host Jimmy Pruitt interviews Brock Townsend and Brian Gilbert about their study on the impact of time to administration of four-factor PCC for patients with warfarin-associated intracranial hemorrhage. The study was a retrospective observational single-center study performed at a large community teaching hospital. The authors stratified patients into three groups based on time from diagnosis to administration of four-factor PCC. The study found no significant differences in outcomes, such as hemostasis achievement, hospital mortality, length of stay, and adverse effects. The authors emphasize the need for more data and personalized protocols for anticoagulation-related ICH.
Takeaways
The study found no significant differences in outcomes based on time to administration of four-factor PCC for patients with warfarin-associated intracranial hemorrhage. More data is needed to determine the optimal time to administer four-factor PCC and develop personalized protocols for anticoagulation-related ICH.
Standardization of radiologists' interpretations and reporting of CT scans is important for future studies in this area.
The study highlights the importance of resident research in answering important clinical questions.
Pharmacists and healthcare professionals should continue to strive for personalized medicine and individualized care for patients with anticoagulation-related ICH.