Andy Webb
@ajwpharm.bsky.social
Neurocritical Care Clinical Pharmacist MGH NeuroICU | BCCCP | Alum OHSU, Mayo, URI Pharmacy | #rstats | He/him | http://neurowiserx.com | #SkyRx | #MedSky | #PharmSky
Found this nifty RCT cited in the guidelines which addresses a question we often face - a patient comes in on an ASM and is dx with PNES. What do you do with the ASM, immediately dc or taper?
Immediate d/c seems better than "delayed withdrawal" (DW)
pubmed.ncbi.nlm.nih.gov/20726877/
Immediate d/c seems better than "delayed withdrawal" (DW)
pubmed.ncbi.nlm.nih.gov/20726877/
December 17, 2025 at 2:24 AM
Found this nifty RCT cited in the guidelines which addresses a question we often face - a patient comes in on an ASM and is dx with PNES. What do you do with the ASM, immediately dc or taper?
Immediate d/c seems better than "delayed withdrawal" (DW)
pubmed.ncbi.nlm.nih.gov/20726877/
Immediate d/c seems better than "delayed withdrawal" (DW)
pubmed.ncbi.nlm.nih.gov/20726877/
AAN guidelines for functional seizure/PNES were just published, which covers a small group who end up in the unit
Key takeaways:
1️⃣ Median time to dx is 7-8 YEARS!
2️⃣ Pts can have both PNES & epilepsy
3️⃣ Psych/therapy can reduce PNES freq
4️⃣ Meds don't work for PNES
www.neurology.org/doi/10.1212/...
Key takeaways:
1️⃣ Median time to dx is 7-8 YEARS!
2️⃣ Pts can have both PNES & epilepsy
3️⃣ Psych/therapy can reduce PNES freq
4️⃣ Meds don't work for PNES
www.neurology.org/doi/10.1212/...
December 17, 2025 at 2:22 AM
AAN guidelines for functional seizure/PNES were just published, which covers a small group who end up in the unit
Key takeaways:
1️⃣ Median time to dx is 7-8 YEARS!
2️⃣ Pts can have both PNES & epilepsy
3️⃣ Psych/therapy can reduce PNES freq
4️⃣ Meds don't work for PNES
www.neurology.org/doi/10.1212/...
Key takeaways:
1️⃣ Median time to dx is 7-8 YEARS!
2️⃣ Pts can have both PNES & epilepsy
3️⃣ Psych/therapy can reduce PNES freq
4️⃣ Meds don't work for PNES
www.neurology.org/doi/10.1212/...
Thanks for at least serving as conference pro-con debate fodder for almost 10 years
Andexanet alfa, 2018-2025
Andexanet alfa, 2018-2025
December 11, 2025 at 2:12 PM
Thanks for at least serving as conference pro-con debate fodder for almost 10 years
Andexanet alfa, 2018-2025
Andexanet alfa, 2018-2025
End of an era, you will not be missed
December 11, 2025 at 1:49 AM
End of an era, you will not be missed
Found on the same MAR
Which one will win!
Which one will win!
November 24, 2025 at 1:52 PM
Found on the same MAR
Which one will win!
Which one will win!
Putting together a presentation on aSAH and I am always amazed re-reading the nimodipine trials just how different aSAH care is from how it was then
Mean time to azm clipping in British Aneurysm Trial was ~11 DAYS and they simply stopped tx if no azm was found
Best data we have 🤷
Mean time to azm clipping in British Aneurysm Trial was ~11 DAYS and they simply stopped tx if no azm was found
Best data we have 🤷
November 18, 2025 at 12:31 PM
Putting together a presentation on aSAH and I am always amazed re-reading the nimodipine trials just how different aSAH care is from how it was then
Mean time to azm clipping in British Aneurysm Trial was ~11 DAYS and they simply stopped tx if no azm was found
Best data we have 🤷
Mean time to azm clipping in British Aneurysm Trial was ~11 DAYS and they simply stopped tx if no azm was found
Best data we have 🤷
Excited to share our newest work on free VPA: improving ability to predict levels with the Fraser equation. We reveal that the orig eq. is modestly accurate in an external cohort and make improvements to the eq, but confirm measurement remains ideal
@cbthepharmd.bsky.social
doi.org/10.1002/phar...
@cbthepharmd.bsky.social
doi.org/10.1002/phar...
November 17, 2025 at 11:27 AM
Excited to share our newest work on free VPA: improving ability to predict levels with the Fraser equation. We reveal that the orig eq. is modestly accurate in an external cohort and make improvements to the eq, but confirm measurement remains ideal
@cbthepharmd.bsky.social
doi.org/10.1002/phar...
@cbthepharmd.bsky.social
doi.org/10.1002/phar...
Listening to Richard Ferrer, a Spanish microbiologist, discuss AMR and I am just stunned by this antibiogram from Barcelona
<2/3 of PsA isolates are cefepime sensitive 🤯
#SOCHIMI2025
<2/3 of PsA isolates are cefepime sensitive 🤯
#SOCHIMI2025
November 12, 2025 at 1:11 PM
Listening to Richard Ferrer, a Spanish microbiologist, discuss AMR and I am just stunned by this antibiogram from Barcelona
<2/3 of PsA isolates are cefepime sensitive 🤯
#SOCHIMI2025
<2/3 of PsA isolates are cefepime sensitive 🤯
#SOCHIMI2025
Kicking off SOCHIMI 2025 in beautiful Pucon, Chile listening to Jason Roberts discuss PK/PD of antibiotics in the ICU
November 12, 2025 at 12:25 PM
Kicking off SOCHIMI 2025 in beautiful Pucon, Chile listening to Jason Roberts discuss PK/PD of antibiotics in the ICU
Do you use vasopression for MAP augmentation in your SCI patients?
In our newly published series, we describe significant hyponatremia frequently develops when used just to push up the MAP - quite literally induced SIADH
pubmed.ncbi.nlm.nih.gov/41051384/
In our newly published series, we describe significant hyponatremia frequently develops when used just to push up the MAP - quite literally induced SIADH
pubmed.ncbi.nlm.nih.gov/41051384/
October 7, 2025 at 6:42 PM
Do you use vasopression for MAP augmentation in your SCI patients?
In our newly published series, we describe significant hyponatremia frequently develops when used just to push up the MAP - quite literally induced SIADH
pubmed.ncbi.nlm.nih.gov/41051384/
In our newly published series, we describe significant hyponatremia frequently develops when used just to push up the MAP - quite literally induced SIADH
pubmed.ncbi.nlm.nih.gov/41051384/
Excited for #NCS2025! If you're attending, be sure to participate in the @neurocritical.bsky.social Social Media Contest to potential win some great prizes - see more below
www.neurocriticalcare.org/Events/Annua...
www.neurocriticalcare.org/Events/Annua...
September 16, 2025 at 12:49 PM
Excited for #NCS2025! If you're attending, be sure to participate in the @neurocritical.bsky.social Social Media Contest to potential win some great prizes - see more below
www.neurocriticalcare.org/Events/Annua...
www.neurocriticalcare.org/Events/Annua...
Have you seen the new package insert tenecteplase dosing for stroke? It uses broad-stroke dose rounding that we think may put patients at risk of harm - a 40 kg patient will get a dose 50% higher than intended! See our editorial published today in Cerebrovascular Diseases
karger.com/ced/article/...
karger.com/ced/article/...
August 28, 2025 at 7:03 PM
Have you seen the new package insert tenecteplase dosing for stroke? It uses broad-stroke dose rounding that we think may put patients at risk of harm - a 40 kg patient will get a dose 50% higher than intended! See our editorial published today in Cerebrovascular Diseases
karger.com/ced/article/...
karger.com/ced/article/...
Excited to be speaking for @neurocritical.bsky.social on the treatment of SE with some phenomenal co-presenters. The Masterclass will have an interactive portion where participants can ask questions and join in discussion about treatment controversies!
www.neurocriticalcare.org/NCS-Learning...
www.neurocriticalcare.org/NCS-Learning...
June 11, 2025 at 4:09 PM
Excited to be speaking for @neurocritical.bsky.social on the treatment of SE with some phenomenal co-presenters. The Masterclass will have an interactive portion where participants can ask questions and join in discussion about treatment controversies!
www.neurocriticalcare.org/NCS-Learning...
www.neurocriticalcare.org/NCS-Learning...
Results of an important study
June 8, 2025 at 2:44 PM
Results of an important study
A great summary table of the available literature for neurostimulant use after stroke - lots of small, underpowered trials leave a lot to be desired when deciding whether starting a stimulant is worthwhile after stroke
www.ahajournals.org/doi/abs/10.1...
www.ahajournals.org/doi/abs/10.1...
April 30, 2025 at 1:47 PM
A great summary table of the available literature for neurostimulant use after stroke - lots of small, underpowered trials leave a lot to be desired when deciding whether starting a stimulant is worthwhile after stroke
www.ahajournals.org/doi/abs/10.1...
www.ahajournals.org/doi/abs/10.1...
EXPECTS trial published revealing significant benefit of tPA given up to 24 hours after symptom onset in posterior stroke. Most strokes were minor and patients going for IAT were excluded, but very interesting data!
www.nejm.org/doi/10.1056/...
www.nejm.org/doi/10.1056/...
April 6, 2025 at 2:33 PM
EXPECTS trial published revealing significant benefit of tPA given up to 24 hours after symptom onset in posterior stroke. Most strokes were minor and patients going for IAT were excluded, but very interesting data!
www.nejm.org/doi/10.1056/...
www.nejm.org/doi/10.1056/...
FIX-ICH compared the effect of andexanet alfa vs PCC retrospectively across numerous centers. Big picture is that FIX-ICH found generally similar results to ANNEXA-I, where AA had better hemostatic efficacy but more thrombosis to PCC
April 6, 2025 at 12:34 PM
FIX-ICH compared the effect of andexanet alfa vs PCC retrospectively across numerous centers. Big picture is that FIX-ICH found generally similar results to ANNEXA-I, where AA had better hemostatic efficacy but more thrombosis to PCC
Excited to share our work on disproportionate free VPA in the ICU, revealing that a) unexpected free VPA levels are extremely common, b) unchecked elevation is associated with ADE, and c) common factors like propofol use lead to these elevations
link.springer.com/epdf/10.1007...
link.springer.com/epdf/10.1007...
March 26, 2025 at 9:53 AM
Excited to share our work on disproportionate free VPA in the ICU, revealing that a) unexpected free VPA levels are extremely common, b) unchecked elevation is associated with ADE, and c) common factors like propofol use lead to these elevations
link.springer.com/epdf/10.1007...
link.springer.com/epdf/10.1007...
After years of work, our report on the link between hypertension in the NeuroICU and long-term poorly controlled BP is out!
After adjusting for confounders, we found that inadequate BP control at NeuroICU tx was associated with ⬆️BP up to 2yrs post-discharge.
www.neurology.org/doi/10.1212/...
After adjusting for confounders, we found that inadequate BP control at NeuroICU tx was associated with ⬆️BP up to 2yrs post-discharge.
www.neurology.org/doi/10.1212/...
March 21, 2025 at 12:19 PM
After years of work, our report on the link between hypertension in the NeuroICU and long-term poorly controlled BP is out!
After adjusting for confounders, we found that inadequate BP control at NeuroICU tx was associated with ⬆️BP up to 2yrs post-discharge.
www.neurology.org/doi/10.1212/...
After adjusting for confounders, we found that inadequate BP control at NeuroICU tx was associated with ⬆️BP up to 2yrs post-discharge.
www.neurology.org/doi/10.1212/...
In severe ARDS, sedation with inhaled sevoflurane led to fewer vent-free days and higher mortality than sedation with propofol in the French SESAR trial
Will be interesting to compare the INSPiRE-ICU1 trial which was the just-finished US-based isoflurane study
jamanetwork.com/journals/jam...
Will be interesting to compare the INSPiRE-ICU1 trial which was the just-finished US-based isoflurane study
jamanetwork.com/journals/jam...
March 18, 2025 at 5:33 PM
In severe ARDS, sedation with inhaled sevoflurane led to fewer vent-free days and higher mortality than sedation with propofol in the French SESAR trial
Will be interesting to compare the INSPiRE-ICU1 trial which was the just-finished US-based isoflurane study
jamanetwork.com/journals/jam...
Will be interesting to compare the INSPiRE-ICU1 trial which was the just-finished US-based isoflurane study
jamanetwork.com/journals/jam...
You love to see it
Board prep CEs done until 2028 😎
Board prep CEs done until 2028 😎
March 18, 2025 at 5:29 PM
You love to see it
Board prep CEs done until 2028 😎
Board prep CEs done until 2028 😎
More data on the safety of AC resumption after ICH - shocking news, patients had fewer strokes but more recurrent ICHs
Median time from ICH to enrollment was 49 days!
www.thelancet.com/journals/lan...
Median time from ICH to enrollment was 49 days!
www.thelancet.com/journals/lan...
March 6, 2025 at 2:49 AM
More data on the safety of AC resumption after ICH - shocking news, patients had fewer strokes but more recurrent ICHs
Median time from ICH to enrollment was 49 days!
www.thelancet.com/journals/lan...
Median time from ICH to enrollment was 49 days!
www.thelancet.com/journals/lan...
The real value of conferences is reconnecting with pals at a piano bar that has a bubble machine at 1:30am
February 25, 2025 at 6:23 AM
The real value of conferences is reconnecting with pals at a piano bar that has a bubble machine at 1:30am
More MGH pharmacy research - pharmacokinetics of phenobarbital in ECMO presented by MICU extraordinaire Natasha Lopez and TCD response to milrinone in aSAH by our PGY2 Julie Jeong #SCCM2025
February 24, 2025 at 3:57 PM
More MGH pharmacy research - pharmacokinetics of phenobarbital in ECMO presented by MICU extraordinaire Natasha Lopez and TCD response to milrinone in aSAH by our PGY2 Julie Jeong #SCCM2025