#pharmacology #nclex #nclexprep

Sepsis AlertπŸ’‰πŸ¦ Vanco

β€’ @theedtraumacist Vancomycin is a tricyclic glycopeptide antibiotic used to cover gramβž•bacteria such as methicillin resistant Staphylococcus aureus. πŸ’‰

Vancomycin works by inhibiting bacterial cell wall synthesis by binding to D-alanyl-D-alanine cell wall precursors, inhibiting polymerization and preventing linkage to the glycopeptide polymer located within the bacteria’s cell wall.

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When dosing vancomycin a couple of factors should be considered including the patient’s weight, renal function, and presenting disease state. It is normally

dosed at 15-20 mg/kg, and even higher for more severe infections (25-30 mg/kg in patients with sepsis, infective endocarditis, meningitis, etc. with a max dose depending on your hospital protocol).

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In a study by Fuller and colleagues that reviewed vancomycin management in the ED, they reviewed 4441 doses of vancomycin given to patients with a weight measurement available. Vancomycin was dosed correctly in only 22.1% of patients 😧 with 71 % of patients being dosed below the recommended dose of 15-20 mg/kg 😱. Vancomycin dosing is not one size fits all and patient specific characteristics should be considered when dosing this medication. πŸ’‰

#theedtraumacist #trauma #traumaninjas #miamitrauma #traumiami #emergencymedicine #emergencydepartment #pharmacy #pharmacylife #pharmlife #pharmvida #pharmsohard #pharmacystudent #pharmacyresident #pharmer

AEIOUTIPS Mnemonic DDx for Altered Mental Status

Have you ever taken care of a pt who had an altered mental status (AMS)? Patients with an altered mental status (or ALOC)are among the toughest to assess since there is no classic, “one size fits all” presentation.

The clinical presentation is often obscure, which makes recognizing changes in mental status a challenging endeavor. There are certain underlying pathophysiological conditions that can cause AMS. This is one of the largest differential diagnoses you may encounter in the ED, EMS or hospital setting. 

1-START WITH THE ABCS, IV, O2, βœ”οΈskins & 12 lead πŸ–€πŸ’™πŸ–€

2-ASSESS the pt & extrapolate info from the family (i.e. med list) πŸ’Š

3-GET labs: ISTATs, & venous blood gas (VBG) πŸ’‰

4-Use AEIOUTIPS mnemonic to help w/DDx

5-Listen to emergency trauma mama’s new podcast to review a super interesting case study 😲πŸ’ͺπŸ»πŸ’―πŸ€—

Benzodiazepines & Flumazenil

Remember that the reversal agent for benzodiazepines (Xanax, Ativan, Valium)=Romazicon (flumazenil) πŸ‘‡πŸ½πŸ‘‡πŸ½πŸ‘‡πŸ½ Narcan-CAN reverse NARCOTICS (morphine, heroin etc.). πŸ‘‡πŸ½πŸ‘‡πŸ½πŸ‘‡πŸ½
Always have the reversal agents on hand for every drug that you are using, especially when performing a moderate sedation or any other type of procedure. 
In addition, have an Ambu bag, & an 
NP/OPA handy. Airway adjuncts are appropriate in the event the patient suffers from unanticipated respiratory issues, which are the most known side effect of the majority of these drugs. πŸ‘‡πŸ½πŸ‘‡πŸ½πŸ‘‡πŸ½
Use your nasal cannula w/ETCO2 monitoring so you can ensure your patients oxygenation & ventilation status. 
Maintain 35-45 and watch the waveform. πŸ‘‡πŸ½πŸ‘‡πŸ½πŸ‘‡πŸ½
Senior RN tip: I usually bring the crash cart in the room and then I feel more prepared for any potential complications.

DOTD-Ceftriaxone (rocephin)

Ceftriaxone (Rocephin) is an intravenous/intramuscular third generation cephalosporin that provides decent aerobic gram positive coverage (ie, pneumococcus although bacterial resistance is growing) but wonderful gram negative coverage against organisms like E. coli, Klebsiella, H. flu, and Proteus. Anaerobic bacteria and Pseudomonas are NOT covered by ceftriaxone. πŸ€“πŸ’‰
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As an intensivist, I use this antibiotic in a myriad of clinical situations ranging from spontaneous bacterial peritonitis (SBP) prophylaxis and community acquired pneumonia to genitourinary infections and meningitis (even late Lyme disease involving the central nervous system as ceftriaxone as penetrates the cerebrospinal fluid very well). 😷🧠
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Similar to cefepime, ceftriaxone can also cause encephalopathy and altered mentation. Additionally, one must be aware of possible hepatobiliary impairment due to biliary sludging and cholecystitis. πŸ‘¨πŸ½β€βš•οΈπŸ₯
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My favorite aspect of using ceftriaxone is that it can usually be dosed once-a-day (a key exception being meningeal dosing which is twice daily). 😊

DOTD (drug of the day) #dotd KeppraπŸ’‰

Regram @rishimd

Levetiracetam (Keppra) is an oral and intravenous antiepileptic drug (AED) indicated as adjunctive therapy for partial onset seizures, myoclonic seizures, and generalized tonic-clonic (β€œgrand mal”) seizures in adults. The medication is used in the pediatric population as well for various reasons beyond my scope of practice. Most AEDs either enhance the release or limit the uptake of GABA – the primary inhibitory neurotransmitter in the central nervous system. Levetiracetam’s activity is thought to center around SV2A, a ubiquitous synaptic vesicle protein involved in regulating the exocytosis of neurotransmitters from vesicles. πŸ’‰πŸ€“
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Post-traumatic seizures (PTSs) are fairly common in patients who sustain traumatic brain injuries (TBIs), and the early initiation of AEDs like phenytoin help decrease early PTS in severe TBI; however NO AED prophylaxis I’m aware of helps prevent late TBIs. Lower levels of data suggest that newer AEDs like levetiracetam may be a safer alternative to phenytoin for early PTS prophylaxis. πŸ‘πŸ₯
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As an anesthesiologist, I can’t remember when I last administered levetiracetam intraoperatively (general anesthesia tends to be a pretty good antiepileptic itself), but as an intensivist, I’ve written for this many times at the recommendation of my colleagues in neurology. Interestingly, the oral formulation of levetiracetam is ~100% bioavailable, and its renally-excreted metabolites have no activity. 😷
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Regardless of why it’s given, levetiracetam can increase the risk of suicidal ideations (even within a week), so providers must remain vigilant about any unusual changes in mood or behavior in patients initiated on therapy. πŸ‘¨πŸ½β€βš•οΈ
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Drug of the Day (DOTD) ~Amiodarone

Amio YT

What is the Generic Name for Cordarone?

Amiodarone

What is the Trade Name for Amiodarone?

Cordarone

What are the Indications of Amiodarone (Cordarone) Nursing Pharmacology Considerations?

Primarily ventricular arrhythmias (VF & pulseless VT),

Occasionally can be used for SVT or a-fib

What are the Actions of Amiodarone (Cordarone) Nursing Pharmacology Considerations?

prolongs phase 3 of the action potential, makes the heart more tolerant to arrythmias, inhibits
adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation

What is the Therapeutic Class of Amiodarone (Cordarone) Nursing Pharmacology Considerations?

antiarrhythmic class III, potassium channel blocker