Parenteral Nutrition
Debunking Hyperkalemia Myths: What Clinicians Need to Know
H yperkalemia is a life-threatening electrolyte disturbance with significant implications for patient care. Despite its seriousness, several myths persist in clinical practice. In this article, we'll address these myths and provide evidence-based recommendations. Introduction to hyperkalemia Hyperkalemia affects 2.6-2.7% of the U.…
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Ulcer
Do all ICU patients need Stress Ulcer Prophylaxis?
Introduction ㅡ Patients who are admitted to ICU may suffer from Stress Ulceration, which is the development of superficial ulcers in the upper gastrointestinal (GI) tract. This differs from the reactivation of chronic duodenal or gastric ulcers as it is caused by either hypersecretion of gastric acid or impaired mucosal protection. Thus, m…
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Sepsis
Update your SEPSIS protocols
As a critical care pharmacist, you will hear ongoing debate about MANAGING SEPSIS IN ADULTS. Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Update your protocols using the latest data... Fluids Verify your sepsis order set includes balanced fluids ( Lactated Ringer's, Plasma-Lyte, etc…
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Status Epilepticus
Assess the need for SEIZURE prophylaxis
As a critical care pharmacist, questions are still popping up about seizure prophylaxis after a neurological injury, trauma, intracranial hemorrhage, etc. Who should get it? Continue to use seizure prophylaxis after a SEVERE traumatic brain injury (TBI); Glasgow Coma Scale 3 to 8. About 1 in 10 TBI patients have seizures…
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Nutrition
Pharmacist's approach to manage acute HYPERkalemia
As a critical care pharmacist, both patiromer ( Veltassa ) and sodium zirconium cyclosilicate ( Lokelma ) can play a role in managing acute hyperkalemia, often in conjunction with other interventions. Both meds work similarly to sodium polystyrene sulfonate ( Kayexalate ), by binding potassium in the GI tract. Limited data suggest that potassium lowering is roughly c…
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Hematology and Oncology
Venous thromboembolism PROPHYLAXIS options
As a critical care pharmacist, it is crucial to identify patients who require venous thromboembolism (VTE) prophylaxis and those who should avoid it. According to the CHEST Guidelines, prophylaxis is recommended for acutely ill hospitalized medical patients at increased risk of thrombosis (hip replacement, obesity, cancer, advanced age, etc) , unless contraindicate…
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Infectious Diseases
Help manage Candida auris
As a critical care pharmacist, you should know how to manage the multidrug-resistant yeast and Candida auris . C. auris can be fatal in up to about 60% of patients. It spreads easily, contaminates surfaces and is tough to eliminate. Plus it’s difficult to identify C. auris . It can mistakenly be reported as another yeast, especially Candida haemulonii . …
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Total parenteral nutrition
Safe medication administration Via FEEDING Tubes
As a critical care pharmacist, questions often come up about giving medications via an enteral tube. Dosage form, Liquid medications are often the best option if available. But point out that hyperglycemia may occur if sugar content in liquid meds is high. Plus GI side effects are possible with hyperosmolar medications (acetaminophen, potassium, etc) or sorbitol abo…
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Critical Care
Compatibility of IV calcium and CEFtriaxone administration
As a hospital pharmacist, you should know that it's okay to give IV calcium and ceftriaxone immediately after one another in most patients. Health Canada originally warned NOT to give IV ceftriaxone and calcium solutions within 2 to 5 days of each other. Several babies died when these drugs were given together due…
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Loop Diuretics
Strategies to manage DIURETIC resistance
As a critical care pharmacist, you will hear debate about the best approach for managing "diuretic resistance" in acute decompensated heart failure . Continue to start IV furosemide at 1 to 2.5 times the TOTAL DAILY oral home dose. For example, if the home oral furosemide dose is 40 mg daily, multiply this by 1 to 2.5 for an …
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GIT and Liver
Appropriate treatment for acute variceal bleeding
As a clinical pharmacist, you must be kept up to date. One-third of patients with varices will have variceal bleeding , the most life-threatening complication of cirrhosis . Expect patients to be resuscitated with fluids and blood if needed, then to have an endoscopy within 12 hours for esophageal banding. Start an octreotide bolus f…
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Procalcitonin
Reevaluate protocols for ACUTE pancreatitis
As a clinical pharmacist, you must be kept up to date. New evidence will lead to questions about treating acute pancreatitis .. Fluids. The standard has been to give aggressive fluids in the first 24 hours. But this is based on limited evidence linking early hydration to lower mortality. Now stronger data show that aggressive f…
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Terlipressin
Assess TERLIpressin for Hepatorenal Syndrome
As a clinical pharmacist, you should evaluate the use of terlipressin for hepatorenal syndrome. Terlipressin ( Glypressin, Haemoxamine ) will be the first FDA-approved medication for hepatorenal syndrome with acute kidney injury (HRS-AKI). HRS-AKI typically occurs in patients with cirrhosis and ascites who develop splanchnic vasodilation. This causes decreased perf…
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Surgery
How to manage ANTIplatelets around surgery
As a clinical pharmacist, you will be asked how to manage dual antiplatelet therapy (DAPT) around surgery in patients with a recent coronary stent. It’s a balancing act between risk of thrombosis and bleeding. American College of Cardiology guidelines still prefer at least 6 to 12 months of DAPT after most stent placements, but suggest shorter durations as an opti…
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Critical Care
Guide Fluid De-Resuscitation in the ICU
As a critical care pharmacist, you will see more emphasis on using de-resuscitation as part of fluid stewardship in critically ill patients. Positive fluid balance in ICU patients is linked to poor outcomes, such as increased mortality and length of stay. Continue to promote judicious fluid use . For example, stop maintenance fluids that aren’t necessary and minimi…
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