Pharmwyze solutions

Pharmwyze solutions Emergency Medicine Pharmacist. | | www.pharmwyze.com | Follow

I've waited my whole life for these blessings. Ready to be the best mommy and daddy for our baby boy. 🍼
07/22/2025

I've waited my whole life for these blessings. Ready to be the best mommy and daddy for our baby boy. 🍼

🤢 Influenza Virus: Antivirals - 👋 Acute respiratory infectionNegative-strand RNA of Orthomyxoviridae familyThree types ...
12/19/2024

🤢 Influenza Virus: Antivirals -

👋 Acute respiratory infection
Negative-strand RNA of Orthomyxoviridae family
Three types of influenza
Influenza A - Humans, swines, equines, birds, Higher susceptibility to antigen variant; pandemics
Influenza B
Influenza C

🤧 Signs and Symptoms
Cough
Fever
Myalgias
Chills/sweats
Malaise

💉 Prevention
CDC and AAFP recommend annual influenza vaccine (> 6 months). Emphasis on high-risk, immunocompromised, and healthcare professionals.

💊 Treatment (outpatient)
Primarily supportive care
Antivirals may be considered depending on severity and onset of symptoms
Antiviral agents only reduce severity of symptoms when taken < 48 hours of onset

🤖 Treatment (inpatient)
Hospitalized and those at high-risk of influenza-associated complications
CDC and IDSA recommend antiviral therapy regardless of symptom duration
Antivirals only reduce severity of symptoms

💊 Tamiflu (oseltamivir) - enteral
Neuraminidase inhibitor, decreases release of viral particles
Treatment: 75 mg po BID x 5 days, may consider longer in high risk
Px: 75 mg po daily (areas of outbreak)
Renally metabolized

💕 Rapivab (peramivir) - IV
Neuraminidase inhibitor, decreases release of viral particles
Treatment (hospitalized): 600 mg IV daily x 5 - 10 days
Reserved for patients unable to tolerate enteral oseltamivir
Renally metabolized

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Not medical advice. Educational purposes only. No relationships to report.

References
Gaitonde DY, Moore FC, & Morgan MK. Am Fam Physician. 2019 Dec 15;100(12):751-758.
Uyeki TM, Bernstein HH, Bradley JS, et al. Clin Infect Dis. 2019 Mar 5;68(6):e1-e47.

👀 Patient Case CC: Unresponsive After Collapsing (ACLS) - 82F (NKMA) presents unresponsive after collapsing. Actively r...
12/18/2024

👀 Patient Case CC: Unresponsive After Collapsing (ACLS) -

82F (NKMA) presents unresponsive after collapsing. Actively receiving CPR. EMS reports initial rhythm ventricular fibrillation. Defibrillation x 3 shocks, epinephrine 1 mg IV x 3 doses have been completed. Patient remains in ventricular fibrillation during pulse check. Team is preparing to deliver another defibrillation.

Which medication should be given?

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🤧 Asthma Exacerbation - 🚨 All patients presenting with an asthma exacerbation should be given oxygen to maintain O2 abo...
12/17/2024

🤧 Asthma Exacerbation -

🚨 All patients presenting with an asthma exacerbation should be given oxygen to maintain O2 above 92%. Management of asthma exacerbations are similar for pregnant women

Empiric antibiotics are not recommended, most respiratory infections are viral compared to bacterial. Optimize pharmacologic management while inpatient to transition into outpatient regimen. Chest XR more to rule out other etiologies

🔍Inhaled Beta-2 agonists
Short acting beta-2 agonists bind to beta receptors in lungs, resulting in bronchodilation
Albuterol 2.5 - 5 mg nebulized every 20 minutes x 3 doses
Caution with tachycardia, transient hypokalemia

✨Inhaled anticholinergics
Short acting antimuscurinics block acetylcholine in smooth muscle, leads to bronchodilation
Ipratropium 500 mcg nebulized every 20 minutes x 3 doses
Consider giving as combination albuterol-ipratropium

😱 Corticosteroids
Refractory to aggressive bronchodilator management
Prednisone 40 - 50 mg equivalent by mouth daily
Reduces need for hospitalization and incidence of relapse
Earlier administration (< 1 hour) associated with better outcomes

🐍 Magnesium sulfate
Bronchodilator properties via Mg effects on inhibition of calcium influx into bronchial smooth muscles
MgSO4 2 gm IV over 20 minutes
May possibly decrease need for hospitalization
Routine administration questionable given available evidence

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📝 ABOUT ME🫠 Welcome Pharmers and Friends! Here is a bit about me as you peruse my page. I thought it would be good to ha...
12/13/2024

📝 ABOUT ME

🫠 Welcome Pharmers and Friends! Here is a bit about me as you peruse my page. I thought it would be good to have an infographic on PHARMWYZE content for those interested.

Thanks for stopping by!

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Not medical advice. Educational purposes only. No relationships to report.


🤯Traumatic Brain Injury Seizure Prophylaxis - Seizure prophylaxis is crucial since having an episode post TBI increases...
12/12/2024

🤯Traumatic Brain Injury Seizure Prophylaxis -

Seizure prophylaxis is crucial since having an episode post TBI increases the risk for developing epilepsy. About half of patients with a severe TBI will have a seizure within 24 hours.

Risk factors include decreased GCS, skull fractures, penetrating injuries, and retained material. Increased metabolic demands, increased intracranial pressure, compromised cerebral oxygen delivery, and excess neurotransmitter release.

Post traumatic seizures are classified under two categories; early is within seven days, and late is after. Seizure prophylaxis is not beneficial and may do harm in late post traumatic seizures. There isn’t a preference on guideline recommended options, but fosphenyoin 17-20 mg/kg and levetiracetem 500 to 1000 mg or weight-based are reasonable treatments.

Levetiracetem seems more practical with most trauma patients since it can be given as an IV push and without concerns for DDI in the setting of limited information.

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Not medical advice. Educational purposes only. No relationships to report.

References
Carney et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017 Jan 1;80(1):6-15.
Lucke-Wold et al. Traumatic brain injury and epilepsy: Underlying mechanisms leading to seizure. Seizure. 2015 Dec;33:13-23.
Temkin, N. Risk factors for posttraumatic seizures in adults. Epilepsia. 2003;44(s10):18-20.

🐛 Patient Case CC: Pain with Urination 🚀 22yoF (sulfa, penicillin - anaphylaxis) complains of pain with urination. No fl...
12/11/2024

🐛 Patient Case CC: Pain with Urination

🚀 22yoF (sulfa, penicillin - anaphylaxis) complains of pain with urination. No flank pain, fevers. Diagnosis: Uncomplicated urinary traction infection. Which antibiotic should be initiated outpatient?

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Not medical advice. Educational purposes only. No relationships to report.

Patient Case CC: Generalized Weakness, Hyperkalemia - 💊 54yoM (NKMA) presents with generalized weakness. Hx of ESRD, on...
07/25/2024

Patient Case CC: Generalized Weakness, Hyperkalemia -

💊 54yoM (NKMA) presents with generalized weakness. Hx of ESRD, on hemodialysis. Potassium 7.2 mEq/L (high). Calcium gluconate, insulin/dextrose, sodium bicarbonate, and furosemide ordered. Which medication eliminates potassium?

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💥 Cardiac Arrest: Reversible Hs and Ts - 📋 To increase the chances of a successful resuscitation for non-shockable rhyt...
07/24/2024

💥 Cardiac Arrest: Reversible Hs and Ts -

📋 To increase the chances of a successful resuscitation for non-shockable rhythms (PEA and asystole), it is important to address the H's and T's. The H's cover Hypovolemia (fluids, blood), Hypoxia (oxygenation, ventilation), Hydrogen ions (acidosis correction), Hypo-Hyperkalemia (replacement, hyperkalemia treatment), and Hypothermia (management during resuscitation).

📢 The T's include Toxins (antidotes, elimination), Thrombosis Cardiac/Pulmonary (thrombolytics), Tension pneumothorax (needle decompression), and Cardiac tamponade (pericardiocentesis).

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Not medical advice. Educational purposes only. No relationships to report.

Reference
Van den Bempt S, Wauters L, Dewold P. Med Princ Pract. 2021 Jun; 30(3): 212–222.

Advanced Cardiac Life Support: Medications - 🤕 The ACLS algorithm recommends high-quality CPR throughout and epinephrin...
07/22/2024

Advanced Cardiac Life Support: Medications -

🤕 The ACLS algorithm recommends high-quality CPR throughout and epinephrine every 3 to 5 minutes for PEA and asysole.

✨ Shockable rhythms are more likely to be survive as ACS is often the cause. Survival is less associated with nonshockable rhythms.

🔍 Going through the H's and T's allows you the maximize the likelihood of a successful resuscitation. H's include Hypovolemia (fluids, blood), Hypoxia (oxygenate, ventilate), Hydrogen ions (underlying acidosis), Hypo-Hyperkalemia (replace, hyperK c**ktail), and Hypothermia (prolonged resuscitation). T's consists of Toxins (antidotes, elimination), Thrombosis Cardiac/Pulmonary (systemic thrombolytics), Tension pneumonthorax (needle decompression), and Cardiac tamponade (pericardiocentesis).

🤕 CPR is the mainstay of therapy for both shockable and nonshockable rhythms. Ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) are shockable rhythms.

✨ Defibrillation is the definitive treatment. High-quality CPR throughout and assessing for pulse/shockable rhythm every 2 minutes maximizes our chances for a successful resuscitation and maintains organ perfusion.

🔍 Medications are only associated with improved rates of ROSC. Epinephrine 1 mg IV/IO every 3 to 5 minutes is given. Antiarryhtmics include amiodarone 300 mg, then 150 mg IV/IO OR lidocaine 1 - 1.5 mg/kg, then 0.5 - 0.75 mg/kg.

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Not medical advice. Educational purposes only. No relationships to report.

References
Panchal AR, Bartos JA, Cabanas JG, et al. Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468.

💢Supraventricular Tachycardia (SVT): Adenosine - 📢 Adenosine is used for the treatment of supraventricular tachycardia ...
07/18/2024

💢Supraventricular Tachycardia (SVT): Adenosine -

📢 Adenosine is used for the treatment of supraventricular tachycardia (SVT). It does this by "resetting" the heart by inhibiting AV node conduction, as well as prolongation of cAMP-mediated inhibition of calcium influx.

💉 Guideline recommendations list adenosine 6 mg IV/IO for the initial dose, then 12 mg IV/IO for the repeat doses. Given the short half life, which is less than 30 seconds, administration of adenosine must be rapid. Smaller scale trials indicate that standard dosing may be insufficient in obese patients and dilution into a single syringe offers a safe, rapid method of administration with equivalent SVT termination vs 3-way stop c**k.

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References
Layland J, Carrick D, Lee M, et al. JACC Cardiovasc Interv. 2014 Jun;7(6):581-91.
Miyawaki IA, Gomes C, Morira VC, et al. Am J Cardiovasc Drugs. 2023 Jul;23(4):341-353.
Deck CM, Dang B, Ashenburg N, et al. Cureus. 2023 Mar; 15(3): e35995.
Not medical advice. Educational purposes only. No relationships to report.

🤢 Community-Acquired Pneumonia - Risk factors for MRSA and PsA are prior isolation, and hospitalization with antibiotic...
07/16/2024

🤢 Community-Acquired Pneumonia -

Risk factors for MRSA and PsA are prior isolation, and hospitalization with antibiotics in past 90 days. Targets of empiric CAP therapy include S. pneumonia, H. influenzae, M. catarrahlis, L. pneumophila, and C. pneumoniae. Legionella and Chlamydia are considered atypical since they’re not easily detected on standard assays. Here’s a quick review of the ATS/IDSA 2019 CAP Guideline antibiotic recomendations.

High dose amoxicillin, thats 1000 mg po TID, has shown to be effective even without coverage for atypical pathogens. Doxycycline and macrolides cover common CAP pathogens, including atypicals. Monotherapy with one of these three can be considered in patients without comorbidities.

Patients with comborbidities are at higher risk for broader and emerging resistant organisms. These would include those with chronic organ disease, alcoholism, malignancy, and asplenia. Combination therapy is recommended with amoxicillin/cluvanate acid or a cephalsporin like cefuroxime and cefpodoxime, in addition to atypical coverage with doxycline or macrolide is recommended.

Patients requiring admission with CAP are treated initially with IV antibiotics. Beta-lactams and macrolide combination therapy is recommended. You’ll likely come across ceftriaxone and azithromycin.

Patients with risk factors for MRSA or Pseudomonas should add vancomycin and change the beta-lactam to piperacillin-tazobactam or cefepime, where appropriate.

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