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ice712

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May 24, 2013
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I will be doing my rotation at a hospital and my preceptor emailed me ahead of time, telling me to study about critical medications (drips, anticoagulation, rescue medications). Does anyone have a list of commonly used critical meds in hospitals? I have never worked in a hospital and don't know what they use.

Thank you very much in advance!! :)
 

sakigt

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Apr 19, 2006
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Google code blue tray contents and RSI contents then research the meds on that list

This pp looks pretty cool
http://cursa.ihmc.us/rid=1143301396187_1419700471_2402/code

Look up dosing for tpa, kcentra, crofab, heparin, lovenox, arixtra, xarelto, eliquis, pradaxa and warfarin drug interactions

Look up dosing for allergic reactions: epi (IM), benadryl, solumedrol and zantac

That should be good enough. Check out the podcast EMBasic and look for episodes that sound pharmacy related: ie: Anaphylaxis Check out the podcast EMCrit and find the one on Hyperkalemia. Finally, listen to HelixTalk and Pharmacy Joe podcasts in their entirety.
 

ice712

5+ Year Member
May 24, 2013
119
8
Status
Google code blue tray contents and RSI contents then research the meds on that list

This pp looks pretty cool
http://cursa.ihmc.us/rid=1143301396187_1419700471_2402/code

Look up dosing for tpa, kcentra, crofab, heparin, lovenox, arixtra, xarelto, eliquis, pradaxa and warfarin drug interactions

Look up dosing for allergic reactions: epi (IM), benadryl, solumedrol and zantac

That should be good enough. Check out the podcast EMBasic and look for episodes that sound pharmacy related: ie: Anaphylaxis Check out the podcast EMCrit and find the one on Hyperkalemia. Finally, listen to HelixTalk and Pharmacy Joe podcasts in their entirety.
:love: I will definitely take a good at these. Thank you very much!!!!!
 
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I am and have always been retail. My hospital rotation was the hardest for me because I knew I would never practice in that setting. My advice would be to know your Vancomycin dosing. Troughs and Peaks and know how to monitor correctly.
 

npage148

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Peaks and troughs? I thought we moved into the great future of constant vanco iv infusions to steady state
 
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Dred Pirate

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My per diem gig orders peaks.

They also aim for troughs of 5-10. And don't use extended interval aminoglycoside dosing. So yeah...




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we did that is school 12 years ago - actually wu did extended ag back then
 

njac

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we did that is school 12 years ago - actually wu did extended ag back then
Exactly. Extended AG is nothing new. AUC:MIC is getting attention again in obese patients, but I can promise you that that site isn't getting Vanco peaks doe that purpose!


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msweph

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My per diem gig orders peaks.

They also aim for troughs of 5-10. And don't use extended interval aminoglycoside dosing. So yeah...




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Wtf why a trough of 5-10 for vanco???!
 
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msweph

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Because they're practicing 20+ years ago.

I just go for the money. I tried talking to the director and he agrees with me while we talk but doesn't make any changes.




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Lol, I didn't know that was how it used to be done.... It's that out of date.
 

njac

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Lol, I didn't know that was how it used to be done.... It's that out of date.
You know, because Vanco is inherently nephrotoxic. It eats kidneys for dinner.

Their reasoning for the EI AG is "what if the RN gives it but doesn't chart it so the next RN gives it again and the patient gets 14 mg/kg"

Uhh, you train your RNs not to eff it up?


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gwarm01

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Peaks and troughs? I thought we moved into the great future of constant vanco iv infusions to steady state
Continuous vancomycin infusions? Tell me more! I've never worked anywhere that does this, but I'm in peds and we don't do much continuous antibiotics. That is an interesting idea.

My per diem gig orders peaks.

They also aim for troughs of 5-10. And don't use extended interval aminoglycoside dosing. So yeah...
Hah, trough of 5. At my last job we shot for 15 on the low end.

You know, because Vanco is inherently nephrotoxic. It eats kidneys for dinner.
I see this cautious attitude towards vanco in some older pharmacists. Even when I show them articles that explains vancomycin isn't really that nephrotoxic, and that the earlier reports were due to impurities in the older formula ("Mississippi mud"), they won't budge. I had someone give me crap about giving a pretty damn high dose of vanco to a septic patient. I was the first to admit that the dose was high, but the trough came back right where we wanted it. I was willing to take the very small risk of potentially causing temporary and reversibly kidney injury in the face of life-threatening sepsis, but I guess we don't all have the same priorities.
 
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njac

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Exactly. Older pharmacists with so much fear. I give 20-25 mg/kg loads (I cap at 2500mg/500ml because if you're that heavy I'm sure you've got some CHF component and don't need the extra fluid) every day.

I would be more aggressive about education, etc if I worked there more than once every other week. But yeah...


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npage148

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Continuous vancomycin infusions? Tell me more! I've never worked anywhere that does this, but I'm in peds and we don't do much continuous antibiotics. That is an interesting idea.
No. It was just some bs pie in the sky thing my school preceptors were all about.
 
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monkieez

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At my job we occasionally measure vanco peaks for to hard penentrate diseases such as osteomyelitis.

5 to 10 trough? Wow

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njac

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No. It was just some bs pie in the sky thing my school preceptors were all about.
They did them at the hospital I interned at during school. And occasionally in pediatrics where I did my PGY 1. But I haven't seen it since.


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msweph

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Continuous vancomycin infusions? Tell me more! I've never worked anywhere that does this, but I'm in peds and we don't do much continuous antibiotics. That is an interesting idea.



Hah, trough of 5. At my last job we shot for 15 on the low end.


I see this cautious attitude towards vanco in some older pharmacists. Even when I show them articles that explains vancomycin isn't really that nephrotoxic, and that the earlier reports were due to impurities in the older formula ("Mississippi mud"), they won't budge. I had someone give me crap about giving a pretty damn high dose of vanco to a septic patient. I was the first to admit that the dose was high, but the trough came back right where we wanted it. I was willing to take the very small risk of potentially causing temporary and reversibly kidney injury in the face of life-threatening sepsis, but I guess we don't all have the same priorities.
What was your empiric vanco dosing in kids? Just curios- where I work now is much less aggressive than my old job
 

gwarm01

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What was your empiric vanco dosing in kids? Just curios- where I work now is much less aggressive than my old job
Typically 20 mg/kg q8 or q6, I can't really remember. The reasoning was that anything less than 20 mg/kg isn't going to load the patient sufficiently. Trough before the third dose and revaluate from there.
 

BidingMyTime

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I don't think I've seen a vanco peak, since something like 1999. If pharmacy is dosing, we look at troughs, which is the majority of patients.
 
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