Pharmacy to Dose: The Critical Care Podcast

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 PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Cerebral Edema Treatment Special Guest: Aaron Cook, PharmD, BCCCP, BCPS, FCCP, FKSHP, FNCS Show Notes: https://pharmacytodose.files.wordpress.com/2020/04/treatment-of-cerebral-edema-show-notes.pdf Guideline Development 06:18 – How did the content and the chairs for this guideline get chosen?; 08:40 – How long were you working on these guidelines?; 09:40 – How are panel members chosen for the guidelines?; 11:20 – Is the research librarian underrated?; 13:31 – GRADE methodology and PICO formatting; 17:24 – Has this changed your research habits or ideas?; 21:40 – Challenges from meeting virtually when developing the guidelines; 23:53 – How were disagreements settled within the working group? Management of Cerebral Edema 27:45 – Cerebral edema and elevated ICP; 29:22 – Refractory cerebral edema management; 31:59 – How long was the initial question list?; 35:03 – Quality of evidence; 37:58 – Patient subgroup with the most evidence; 40:10 – Should we be driving up patients’ sodium levels?; 44:56 – Is there a preferred hyperosmolar agent?; 47:45 – Mannitol in acute ischemic stroke; 49:00 – Osmolar therapy and neurologic outcomes; 51:16 – HTS administration; 54:30 – HTS ADE and monitoring; 57:10 – Mannitol osmolality monitoring; 58:20 – Hyperosmolar therapy ADE prevention; 61:00 – Guideline key take-aways; 62:20 – Common research issues PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

COVID-19 Special Guest: Andrew Barnes, PharmD Dr. Andrew Barnes joins the podcast to discuss the effects of COVID-19. We talk about what Seattle and the University of Washington are doing to help treat this national pandemic. Plus there are plenty of tips throughout the episode for ways you can adapt to COVID-19 in your hospital or health system. PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Part 3 Critical Care Medication March Madness Bracket Downloadable bracket and more available here: https://pharmacytodose.com/2020/03/15/2020-critical-care-medication-march-madness-bracket-and-info/ 03:01 – Final Four analysis with Matt Rubertus, PharmD, BCCCP 09:11 – Final Four analysis with Josiah Smith, PharmD, BCCCP 17:35 – Final Four analysis with Brian Gilbert, PharmD, BCPS, BCCCP 29:18 – Final Four analysis with Melanie Smith, PharmD, BCPS, BCCCP Email: [email protected] Social Media: @PharmacyToDose Website: PharmacyToDose.Com Learn more about your ad choices. Visit megaphone.fm/adchoices

Part 2 Critical Care Medication March Madness Bracket Downloadable bracket and more available here: https://pharmacytodose.com/2020/03/15/2020-critical-care-medication-march-madness-bracket-and-info/ 00:50 – Introduction; 03:23 – Potpourri region analysis with Brian Gilbert, PharmD, BCPS, BCCCP; 43:43 – PAD region analysis with Melanie Smith, PharmD, BCPS, BCCCP Email: [email protected] Social Media: @PharmacyToDose Website: PharmacyToDose.Com Learn more about your ad choices. Visit megaphone.fm/adchoices

Part 1: Critical Care Medication March Madness Bracket Downloadable bracket and more available here: https://pharmacytodose.com/2020/03/15/2020-critical-care-medication-march-madness-bracket-and-info/ 00:58 – Bracket announcement, background, rules, and how you can participate!; 10:15 – Cardiac region analysis with Matt Rubertus, PharmD, BCCCP; 40:37 – Infectious Diseases region analysis with Josiah Smith, PharmD, BCCCP PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Immunotherapy Toxicity in the ICU Special Guest: Heather May, PharmD, FCCM, BCPS, BCCCP Show Notes: https://pharmacytodose.files.wordpress.com/2020/03/immunotherapy-toxicity-in-the-icu-show-notes.pdf Show References: https://pharmacytodose.files.wordpress.com/2020/03/immunotherapy-references.pdf 00:52 – Show updates!; 10:50 – Immune system primer; 13:30 – How does CART therapy work?; 16:35 – CART Side effects that lead to the ICU; 17:40 – When does CRS occur and how acute is the presentation?; 20:50 – CRS risk factors; 23:26 – Biomarkers for CRS identification; 25:25 – CRS treatment; 32:30 – CART neurotoxicity; 37:00 – Mechanism of ICANS; 38:00 – ICANS risk factors; 39:30 – ICANS treatment; 42:45 – Where do patients go post-CART?; 47:15 – Examples of immune checkpoint inhibitors; 49:27 – ICI mechanism of action; 51:05 – Immune-related adverse events (irAEs); 55:20 – Which irAEs grades will present to the hospital/ICU?; 57:30 – When do irAEs occur?; 59:28 – irAEs treatment; 64:55 – Downside to treating irAEs?; 68:22 – Do irAEs mean the treatment is working?; 73:12 – Take-home points for immunotherapy toxicity PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

2020 SCCM Congress Recap Special Guest and Official Conference Correspondent: Anthony Hawkins, PharmD, BCCCP Anthony and I recap the 2020 SCCM Congress discussing everything from the convention center, research presentations, educational sessions, receptions, things we would change, and much more! This episode was recorded live in Orlando, FL. Show references: https://pharmacytodose.files.wordpress.com/2020/02/2020-sccm-congress-references.pdf PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Acute Kidney Injury (AKI) Special Guest: Erin Barreto, PharmD, MSc, BCPS, BCCCP, FCCM Show Notes: https://pharmacytodose.files.wordpress.com/2020/02/aki-show-notes.pdf Show References: https://pharmacytodose.files.wordpress.com/2020/02/aki-references.pdf 1:10 – Show updates!; 9:15 – Define and classify AKI; 14:45 – Subspecifying the type of AKI; 18:22 – Prevalence of AKI in the ICU; 20:45 – Identification of high-risk patients; 24:43 – Preferred risk prediction tools; 26:12 – Ideal kidney biomarker; 28:28 – Ideal v. current biomarkers; 32:13 – Structural biomarkers; 39:40 – AKI prevention; 44:08 – Kidney/drug dosing equations; 53:49 – Equations in AKI/renal recovery; 56:43 – Cystatin C; 72:19 – What if you don’t use novel biomarkers?; 75:33 – Favorite calculator for AKI clinical risk predictor tool; 77:43 – AKI potpourri; 85:05 – Take-home points PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Life After the ICU: A Personal Experience Special Guest: G. Morgan Jones, PharmD, BCCCP, FCCM Show Notes: https://pharmacytodose.files.wordpress.com/2020/01/life-after-the-icu-show-notes.pdf Morgan details his incredible journey after a personal experience with PICS and PICS-F. PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Post-Intensive Care Syndrome (PICS) Special Guest: Jimmi Hatton Kolpek, PharmD, BSPharm, FCCP, FCCM, FNAP Show Notes: https://pharmacytodose.files.wordpress.com/2020/01/pics-show-notes.pdf Show References: https://pharmacytodose.files.wordpress.com/2020/01/pics-references.pdf 00:25 - #PharmacyToRead Update; 10:07 – Why Jimmi is interested in PICS; 12:36 – When did PICS become an ICU focus?; 13:56 – How did PICS get thrust into the spotlight?; 15:40 – Definition of PICS; 16:27 – When does PICS occur?; 19:38 – How common is PICS?; 21:30 – PICS risk factors; 25:35 – How long does PICS last and how does it affect recovery?; 28:55 – Role of peer support; 31:20 – PICS prevention; 38:17 – Medications that can treat/prevent PICS; 41:50 – When to seek help for PICS?; 44:25 – Process for patients being referred to ICU Recovery Clinic; 48:12 – Who makes up the team and what problems are addressed?; 51:18 – What PICS resources are available for patients/families?; 54:35 – Do we prepare patients for what happens after the ICU?; 56:58 – How can we improve?; 59:53 – Take-home points on PICS PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Extracorporeal Membrane Oxygenation (ECMO) Special Guest: Amy Dzierba, PharmD, FCCM, FCCP, BCCCP Show Notes: https://pharmacytodose.files.wordpress.com/2020/01/ecmo-show-notes.pdf Show References: https://pharmacytodose.files.wordpress.com/2020/01/ecmo-references.pdf 00:25 - #PharmacyToRead Announcement!; 07:50 – Why is Amy interested in ECMO?; 11:48 – What is ECMO and when did we start using ECMO in the US?; 13:45 – ECLS v. ECMO; 15:52 – Why are we talking about ECMO today?; 19:40– What does ECMO do?; 21:05 – ECMO modalities; 22:59 – ECMO equipment; 27:30 – What should be tried before ECMO?; 30:56 – ECLS effect on PK/PD; 40:05 – Tips/tricks on ECMO anticoagulation, infection, and sedation protocols; 40:45 – Anticoagulation protocols; 47:30 – Infection protocols; 53:15 – Sedation protocols; 58:18 – ECMO complications; 60:40 – Tips when creating or modifying ECMO protocols; 63:27 – Future areas of ECMO research; 65:00 – Take-home points PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Acute Respiratory Distress Syndrome (ARDS) Special Guest: Andrea Sikora Newsome, PharmD, BCPS, BCCCP Show Notes: https://pharmacytodose.files.wordpress.com/2019/12/ards-show-notes.pdf Show References: https://pharmacytodose.files.wordpress.com/2019/12/ards-references.pdf 4:42 – #PharmacyToRead Book Club Announcement!; 7:24 – History of ARDS; 10:17 – Current ARDS definition; 11:25 – Criticisms to Berlin definition; 13:54 – ARDS Causes/Risk factors; 15:33 – Typical ARDS time course; 18:58 – ARDS treatment goals; 21:04 – Brief primer on mechanical ventilation; 30:50 – Prone positioning; 35:17 – NMBA for ARDS; 42:15 – Prone, paralyze, or both?; 43:34 – FACTT study and fluid stewardship in ARDS; 46:00 – Corticosteroids in ARDS; 49:45 – ARDS failed drugs; 53:55 – ECMO for severe ARDS; 58:25 – Future research areas; 60:10 – Role of PharmD in ARDS PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Prothrombin Complex Concentrates (PCCs) for PharmDs Special Guest: Scott Dietrich, PharmD, BCCCP Show Notes: https://pharmacytodose.files.wordpress.com/2019/12/pccs-for-pharmds-show-notes.pdf Show References: https://pharmacytodose.files.wordpress.com/2019/12/pccs-for-pharmds-references.pdf 3:05 – Anticoagulation reversal pre-PCC 5:18 – Brief history of PCC 6:45 – Current role for 3-factor PCC 7:56 – When should we be using PCC? 10:00 – Role of PCC for non-reversal indications 13:20 – Weight-based v. Fixed-dose Kcentra 15:39 – Why fixed-dose Kcentra? 17:33 – When to re-dose Kcentra? 18:50 – Kcentra when INR < 2 20:20 – Guideline-recommended anticoagulation reversal 22:30 – How does Kcentra differ from FEIBA? 23:48 – FEIBA dosing strategy 24:15 – Kcentra for DOAC reversal 28:22 – FEIBA for DOAC reversal 30:02 – FEIBA v. Kcentra for DOAC reversal 30:25 – FEIBA v. KCentra for warfarin reversal 33:32 – Should we have Kcentra and FEIBA on formulary? 34:26 – Weight-based v. Fixed-dose FEIBA for DOAC reversal 35:20 – Pros/Cons of Andexxa 37:14 – PCC v. Andexxa 37:45 – Andexxa’s cost 40:10 – How would Scott reverse his AC? 43:20 – Pharmacist’s role 45:54 – PCC take home points PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Fluid Stewardship Special Guest: Anthony Hawkins, PharmD, BCCCP Show notes: https://pharmacytodose.files.wordpress.com/2019/11/fluid-stewardship-show-notes.pdf Show references: https://pharmacytodose.files.wordpress.com/2019/11/fluid-stewardship-references.pdf 5:45 – Defining fluid overload; 7:12 – Complications of being fluid overloaded; 10:45 – Why does fluid overload still happen?; 13:40 – Solutions to help fix mIVF; 15:30 – Patients at risk of becoming fluid overloaded; 18:28 – Determining if patients are fluid responsive; 24:38 – Does fluid responsiveness mean always give fluid?; 26:40 – What does fluid stewardship mean?; 28:45 – Four D’s; 31:30 – ROSE model; 39:39 – Applying ROSE model to non-sepsis patients; 42:20 – 4 rights of Medication Administration for Fluid Stewardship; 53:48 – Interventions that Pharmacists can make; 59:49 – Questions that still need answered; 61:30 – Future research to watch for; 63:33 – Take-home points PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Value & Importance of ICU Pharmacists with Special Guest: Chris Droege, PharmD, BCCCP, FCCM, FASHP Show notes: https://pharmacytodose.files.wordpress.com/2019/10/icu-pharmacist-show-notes.pdf References: https://pharmacytodose.files.wordpress.com/2019/10/icu-pharmacist-references-1.pdf 8:02 – History of Critical Care Pharmacy; 13:40 – Why are Pharmacists needed as multidisciplinary team members?; 15:45 – Why do Pharmacists still need to justify our value?; 18:45 – Historical perception of Pharmacists play a part?; 21:51 – Overview of the White Paper; 26:52 – How relevant are most of these recommendations now?; 30:40 – How should time be spent within the different pillars?; 36:49 – Avoiding “The Sheriff” mentality; 41:55 – Examples of Pharmacists demonstrating value; 45:30 – How do we continue creating research studies demonstrating Pharmacists’ value?; 49:50 – The future of Clinical Pharmacy; 55:45 – Tips/Tricks for Pharmacists to demonstrate value to the ICU team PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Status Epilepticus with Special Guest: Karen Berger, PharmD, FCCM, BCPS, BCCCP Show notes: https://pharmacytodose.files.wordpress.com/2019/10/status-epilepticus-show-notes-1.pdf References: https://pharmacytodose.files.wordpress.com/2019/10/status-epilepticus-references.pdf 6:02 –Karen’s interest in SE; 7:35 – What is SE?; 9:32 – Further classifications of SE?; 10:37 – Patient presentation; 11:27 – Can the presentation change?; 13:35 – Any risk factors for SE?; 14:45 – Medication-induced SE; 15:40 – Prompt non-AED treatment for SE?; 17:06 – Empirically treat Wernicke’s?; 18:35 – Preferred BZD for initial treatment of SE?; 20:44 – If they don’t respond to an AED, do you avoid/discontinue using these agents?; 23:08 – Convincing providers to give larger BZD doses?; 26:53 – BZD dosing if a patient uses alcohol or BZD?; 27:37 – First-line AED for patients in SE?; 30:34 – Difficulty with high quality research in SE?; 31:46 – Are there specific patient populations or disease states where you prefer or avoid a specific AED?; 33:04 – Why is timely treatment so important?; 34:25 – General information on first-line AED agents; 47:20 – Where to find evidence-based dosing recommendations for SE?; 49:49 – Appropriate TDM of AED; 53:55 – Increase dose or add another AED?; 55:53 – How to improve time to AED administration for SE?; 59:04 – Review of IV anesthetic infusions for refractory SE; 64:27 – Tips/Tricks for Pharmacists treating SE; 65:40 – Take-home points PharmacyToDose.Com @PharmacyToDose on Twitter/Instragram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Vasoactives in Septic Shock with Special Guest: Alex Flannery, PharmD, BCCCP, BCPS 3:35 – Why is Alex interested in sepsis?...5:49 – How do you teach sepsis with the recent changes?...8:35 – When to start vasopressors in a hypotensive patient?...11:58 – What do you consider high-dose norepinephrine?...13:40 – How do you add vasopressin and corticosteroids for patients in refractory septic shock?...15:15 – Do you use fludricortisone in combination with hydrocortisone?...16:49 – Utility of cortisol levels or ACTH stimulation testing...18:27 – Cost:benefit analysis of vasopressin...19:21 – Role of epinephrine in septic shock...21:15 – Dobutamine or Epinephrine?...22:57 – HAT cocktail...24:55 – Thiamine supplementation in sepsis and septic shock...28:35 – Use of Angiotensin II and its place in therapy...32:30 – Approach to using methylene blue...34:05 – Modify hemodynamic goals to assist with vasopressor weaning...36:07 – Managing adverse effects due to vasopressors...39:27 – Order of operations in weaning vasopressors and corticosteroids...44:35 – The use of midodrine to wean off IV vasopressors...49:25 – Take-away points for vasoactives and their use in septic shock...51:11– Future areas for research PharmacyToDose.Com @PharmacyToDose on Twitter/Instragram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Sleep in the ICU with Special Guest: Mojdeh Heavner, PharmD, BCPS, BCCCP 4:55 – 10:00 – How did Mojdeh first become interested in sleep?; 10:00 – 13:40 – Why is sleep disruption so bad for ICU patients?; 14:11 – 15:31 – How does sleep deprivation affect clinical outcomes?; 15:35 – 19:13 – How do we know ICU patients have issues with sleep?; 19:45 – 24:38 – Is there a relationship between sleep deprivation and delirium; 24:50 – 30:30 – Risk factors for sleep deprivation; 30:48 – 32:35 – What do the PAD-IS guidelines recommend regarding sleep assessment?; 32:37 – 34:00 – What do we use for sleep assessment currently?; 34:00 – 37:12 – What options are available to assess sleep in ICU patients?; 37:20 – 38:30 – Can we rely on family to bring up sleep related issues?; 38:45 – 44:15 – Non-pharmacologic management of sleep disruption; 44:20 – 54:21 – Pharmacologic interventions for sleep promotion; 54:30 – 55:45 – What to do with the patient who has taken BZD chronically for sleep at home?; 55:45 – 58:10 – Does your approach for sleep management change for patients with chronic insomnia?; 58:12 – 60:09 – Importance of multi-disciplinary involvement with sleep; 60:10 – 63:20 – Role of Pharmacist in Sleep Promotion; 63:20 – 65:00 – Take-home points PharmacyToDose.Com @PharmacyToDose on Twitter/Instagram [email protected] Learn more about your ad choices. Visit megaphone.fm/adchoices

Introducing Pharmacy to Dose: The Critical Care Podcast with your host Nick Peters. Learn more about the podcast discussing critical care and its pharmacotherapy in a fun and entertaining manner. Learn more about your ad choices. Visit megaphone.fm/adchoices