Jessica
@jyu17.bsky.social
I’m a hospital pharmacist. I am here to learn :) Views are my own.
I learned a fast way of determining if the acidosis/alkalosis is metabolic or respiratory:
Look at the pCO2 and pH, if both are going up/down in the same direction, then it’s primarily metabolic, and if they are going in the opposite direction, it’s primarily respiratory.
#medsky #pharmsky
Look at the pCO2 and pH, if both are going up/down in the same direction, then it’s primarily metabolic, and if they are going in the opposite direction, it’s primarily respiratory.
#medsky #pharmsky
August 28, 2025 at 9:15 PM
Reposted by Jessica
The American College of Cardiology (ACC) and the American Heart Association (AHA) have published a new guideline for managing patients with acute coronary syndromes (ACS), the first update since 3 related guidelines were released from 2013 to 2015.
What to Know About the Updated Acute Coronary Syndromes Guideline
This Medical News article discusses new recommendations from the American College of Cardiology and the American Heart Association for managing patients for a year and beyond after they’ve experienced...
ja.ma
March 28, 2025 at 8:21 PM
The American College of Cardiology (ACC) and the American Heart Association (AHA) have published a new guideline for managing patients with acute coronary syndromes (ACS), the first update since 3 related guidelines were released from 2013 to 2015.
Just learned about NIPHS - non-insulinoma pancreatogenous hypoglycemia syndrome - where patients become hypoglycemic after eating. #medsky #pharmsky
a close up of a man 's face with a beard making a funny face .
ALT: a close up of a man 's face with a beard making a funny face .
media.tenor.com
March 28, 2025 at 10:34 PM
Reposted by Jessica
New in the March 6, 2025, issue of NEJM:
Male-Partner Treatment and Bacterial Vaginosis (StepUp trial) nej.md/3QJIVKn
Tirzepatide for Obesity Treatment and Diabetes Prevention (SURMOUNT-1 trial) nej.md/48VdDZp
AAV9.LAMP2B Gene Therapy in Danon Disease (phase 1 study) nej.md/40IBJVh
#MedSky
Male-Partner Treatment and Bacterial Vaginosis (StepUp trial) nej.md/3QJIVKn
Tirzepatide for Obesity Treatment and Diabetes Prevention (SURMOUNT-1 trial) nej.md/48VdDZp
AAV9.LAMP2B Gene Therapy in Danon Disease (phase 1 study) nej.md/40IBJVh
#MedSky
March 6, 2025 at 2:06 PM
New in the March 6, 2025, issue of NEJM:
Male-Partner Treatment and Bacterial Vaginosis (StepUp trial) nej.md/3QJIVKn
Tirzepatide for Obesity Treatment and Diabetes Prevention (SURMOUNT-1 trial) nej.md/48VdDZp
AAV9.LAMP2B Gene Therapy in Danon Disease (phase 1 study) nej.md/40IBJVh
#MedSky
Male-Partner Treatment and Bacterial Vaginosis (StepUp trial) nej.md/3QJIVKn
Tirzepatide for Obesity Treatment and Diabetes Prevention (SURMOUNT-1 trial) nej.md/48VdDZp
AAV9.LAMP2B Gene Therapy in Danon Disease (phase 1 study) nej.md/40IBJVh
#MedSky
Beta-hydroxybutyrate measures the degree of ketosis in patients with diabetic ketoacidosis #medsky
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
Plasma Beta-Hydroxybutyrate for the Diagnosis of Diabetic Ketoacidosis in the Emergency Department
Diabetic ketoacidosis (DKA) is a common emergency department (ED) presentation of both new-onset and established diabetes mellitus (DM). β-hydroxybutyrate (BOHB) provides a direct measure of the patho...
pmc.ncbi.nlm.nih.gov
January 18, 2025 at 7:31 AM
Beta-hydroxybutyrate measures the degree of ketosis in patients with diabetic ketoacidosis #medsky
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
Reposted by Jessica
any thoughts on overlapping IV & oral amiodarone?
no solid evidence
pharmacokinetics of amio is complex:
- PO takes ~3-7 days for antiarrhythmic effects
- IV works faster but via different mechanisms
- Half-life initially short (2/2 redistribution) but eventually huge
emcrit.org/ibcc/antiarr...
no solid evidence
pharmacokinetics of amio is complex:
- PO takes ~3-7 days for antiarrhythmic effects
- IV works faster but via different mechanisms
- Half-life initially short (2/2 redistribution) but eventually huge
emcrit.org/ibcc/antiarr...
January 16, 2025 at 12:30 AM
any thoughts on overlapping IV & oral amiodarone?
no solid evidence
pharmacokinetics of amio is complex:
- PO takes ~3-7 days for antiarrhythmic effects
- IV works faster but via different mechanisms
- Half-life initially short (2/2 redistribution) but eventually huge
emcrit.org/ibcc/antiarr...
no solid evidence
pharmacokinetics of amio is complex:
- PO takes ~3-7 days for antiarrhythmic effects
- IV works faster but via different mechanisms
- Half-life initially short (2/2 redistribution) but eventually huge
emcrit.org/ibcc/antiarr...
Reposted by Jessica
January 13, 2025 at 6:58 PM
Reposted by Jessica
Not all carbapenems are made equal!
I keep the following in my backpocket to tailor Abx to pts.
for gram + aerobes, imipenem is ~2-4X more active than meropenem (esp E. faecalis)
meropenem ~2-16X more active against Gram - aerobes (esp enterobacteriacae)
#medsky #pharmsky #MedEd #antibiotics
I keep the following in my backpocket to tailor Abx to pts.
for gram + aerobes, imipenem is ~2-4X more active than meropenem (esp E. faecalis)
meropenem ~2-16X more active against Gram - aerobes (esp enterobacteriacae)
#medsky #pharmsky #MedEd #antibiotics
January 14, 2025 at 1:59 AM
Not all carbapenems are made equal!
I keep the following in my backpocket to tailor Abx to pts.
for gram + aerobes, imipenem is ~2-4X more active than meropenem (esp E. faecalis)
meropenem ~2-16X more active against Gram - aerobes (esp enterobacteriacae)
#medsky #pharmsky #MedEd #antibiotics
I keep the following in my backpocket to tailor Abx to pts.
for gram + aerobes, imipenem is ~2-4X more active than meropenem (esp E. faecalis)
meropenem ~2-16X more active against Gram - aerobes (esp enterobacteriacae)
#medsky #pharmsky #MedEd #antibiotics
Reposted by Jessica
Give FFP in angioedema?
-FFP contains ACE (breaks down bradykinin)
-FFP also contains bradykinin; may be adding fuel to fire
-Case reports not enough to support FFP; cases of failure don't get published
-Based on current data, FFP should not be given
#MedSky #EMIMCC
youtube.com/shorts/0zuvK...
-FFP contains ACE (breaks down bradykinin)
-FFP also contains bradykinin; may be adding fuel to fire
-Case reports not enough to support FFP; cases of failure don't get published
-Based on current data, FFP should not be given
#MedSky #EMIMCC
youtube.com/shorts/0zuvK...
FFP in Angioedema #emergencymed #medicalemergency #criticalcare #resuscitation
YouTube video by EMSwami
youtube.com
January 14, 2025 at 2:58 PM
Give FFP in angioedema?
-FFP contains ACE (breaks down bradykinin)
-FFP also contains bradykinin; may be adding fuel to fire
-Case reports not enough to support FFP; cases of failure don't get published
-Based on current data, FFP should not be given
#MedSky #EMIMCC
youtube.com/shorts/0zuvK...
-FFP contains ACE (breaks down bradykinin)
-FFP also contains bradykinin; may be adding fuel to fire
-Case reports not enough to support FFP; cases of failure don't get published
-Based on current data, FFP should not be given
#MedSky #EMIMCC
youtube.com/shorts/0zuvK...
Reposted by Jessica
𝐍𝐨𝐭𝐚𝐛𝐥𝐞 𝐀𝐫𝐭𝐢𝐜𝐥𝐞𝐬 𝐨𝐟 𝟐𝟎𝟐𝟒: Omalizumab for Multiple Food Allergies
In a trial involving 180 persons with food allergies, omalizumab was effective in increasing the reaction threshold for peanut & other common food allergens. Read more: nej.md/4bLW7aS
#MedSky
In a trial involving 180 persons with food allergies, omalizumab was effective in increasing the reaction threshold for peanut & other common food allergens. Read more: nej.md/4bLW7aS
#MedSky
January 12, 2025 at 2:42 PM
𝐍𝐨𝐭𝐚𝐛𝐥𝐞 𝐀𝐫𝐭𝐢𝐜𝐥𝐞𝐬 𝐨𝐟 𝟐𝟎𝟐𝟒: Omalizumab for Multiple Food Allergies
In a trial involving 180 persons with food allergies, omalizumab was effective in increasing the reaction threshold for peanut & other common food allergens. Read more: nej.md/4bLW7aS
#MedSky
In a trial involving 180 persons with food allergies, omalizumab was effective in increasing the reaction threshold for peanut & other common food allergens. Read more: nej.md/4bLW7aS
#MedSky
Reposted by Jessica
Lipophilic drugs (e.g. ketamine, midazolam, propofol) distribute into tissues, including adipose. In obesity, use actual body weight (ABW) for calculating loading dose 4/
January 7, 2025 at 3:19 AM
Lipophilic drugs (e.g. ketamine, midazolam, propofol) distribute into tissues, including adipose. In obesity, use actual body weight (ABW) for calculating loading dose 4/
Reposted by Jessica
Hydrophilic drugs (e.g. vancomycin, gentamicin, acyclovir, daptomycin, rocuronium) stay mainly in the blood. In obesity, use adjusted/ideal body weight to avoid potential overdosing 3/
January 7, 2025 at 3:19 AM
Hydrophilic drugs (e.g. vancomycin, gentamicin, acyclovir, daptomycin, rocuronium) stay mainly in the blood. In obesity, use adjusted/ideal body weight to avoid potential overdosing 3/
Reposted by Jessica
𝐍𝐨𝐭𝐚𝐛𝐥𝐞 𝐀𝐫𝐭𝐢𝐜𝐥𝐞𝐬 𝐨𝐟 𝟐𝟎𝟐𝟒
In the FINEARTS-HF trial, finerenone resulted in a lower rate of total worsening heart failure events and death from cardiovascular causes than placebo, marking a notable benefit with respect to its primary end point.
Full trial results: nej.md/470x4ix
#MedSky
In the FINEARTS-HF trial, finerenone resulted in a lower rate of total worsening heart failure events and death from cardiovascular causes than placebo, marking a notable benefit with respect to its primary end point.
Full trial results: nej.md/470x4ix
#MedSky
January 7, 2025 at 5:13 PM
𝐍𝐨𝐭𝐚𝐛𝐥𝐞 𝐀𝐫𝐭𝐢𝐜𝐥𝐞𝐬 𝐨𝐟 𝟐𝟎𝟐𝟒
In the FINEARTS-HF trial, finerenone resulted in a lower rate of total worsening heart failure events and death from cardiovascular causes than placebo, marking a notable benefit with respect to its primary end point.
Full trial results: nej.md/470x4ix
#MedSky
In the FINEARTS-HF trial, finerenone resulted in a lower rate of total worsening heart failure events and death from cardiovascular causes than placebo, marking a notable benefit with respect to its primary end point.
Full trial results: nej.md/470x4ix
#MedSky
Reposted by Jessica
Time to Staphylococcus aureus blood culture positivity is a useful marker for infective endocarditis
This retrospective cohort study of >1700 cases of SAB suggests that if TTP > 13 hrs, the patient is unlikely to have endocarditis (NPV 96%, 95%CI 95-97)
academic.oup.com/cid/advance-... #IDSky
This retrospective cohort study of >1700 cases of SAB suggests that if TTP > 13 hrs, the patient is unlikely to have endocarditis (NPV 96%, 95%CI 95-97)
academic.oup.com/cid/advance-... #IDSky
December 21, 2024 at 4:07 PM
Time to Staphylococcus aureus blood culture positivity is a useful marker for infective endocarditis
This retrospective cohort study of >1700 cases of SAB suggests that if TTP > 13 hrs, the patient is unlikely to have endocarditis (NPV 96%, 95%CI 95-97)
academic.oup.com/cid/advance-... #IDSky
This retrospective cohort study of >1700 cases of SAB suggests that if TTP > 13 hrs, the patient is unlikely to have endocarditis (NPV 96%, 95%CI 95-97)
academic.oup.com/cid/advance-... #IDSky
why is it for certain surgeries such as major spinal surgeries, ASA should be stopped ~1 week pre-op, despite that half-life of ASA is only 20min? It’s because ASA is a COX inhibitor and the effect lasts for the lifespan of the platelet (~10 days). #medsky
www.ahajournals.org/doi/10.1161/....
www.ahajournals.org/doi/10.1161/....
Aspirin | Circulation
www.ahajournals.org
December 22, 2024 at 4:30 AM
why is it for certain surgeries such as major spinal surgeries, ASA should be stopped ~1 week pre-op, despite that half-life of ASA is only 20min? It’s because ASA is a COX inhibitor and the effect lasts for the lifespan of the platelet (~10 days). #medsky
www.ahajournals.org/doi/10.1161/....
www.ahajournals.org/doi/10.1161/....
Cardiac output = heart rate ❎ stroke volume.
For a patient who is hypoperfused, the stroke volume is low, so to maintain the cardiac output, the patient’s heart rate would increase.
Thus tachycardia is a sign of early shock.
#medsky
For a patient who is hypoperfused, the stroke volume is low, so to maintain the cardiac output, the patient’s heart rate would increase.
Thus tachycardia is a sign of early shock.
#medsky
a woman is holding a cell phone in her hand and asking why is my heart beating so fast .
ALT: a woman is holding a cell phone in her hand and asking why is my heart beating so fast .
media.tenor.com
December 20, 2024 at 4:40 AM
Cardiac output = heart rate ❎ stroke volume.
For a patient who is hypoperfused, the stroke volume is low, so to maintain the cardiac output, the patient’s heart rate would increase.
Thus tachycardia is a sign of early shock.
#medsky
For a patient who is hypoperfused, the stroke volume is low, so to maintain the cardiac output, the patient’s heart rate would increase.
Thus tachycardia is a sign of early shock.
#medsky
Patients with spinal cord injuries are susceptible to experience autonomic dysreflexia, a syndrome characterized by severe hypertension due to sympathetic discharges below the injured spinal cord. This mostly applies to injuries above the sympathetic outflow at T6.
December 20, 2024 at 4:26 AM
Patients with spinal cord injuries are susceptible to experience autonomic dysreflexia, a syndrome characterized by severe hypertension due to sympathetic discharges below the injured spinal cord. This mostly applies to injuries above the sympathetic outflow at T6.
Just wanted to list some drugs that lowers seizure threshold:
1. Psychiatric meds (Bupropion, tricyclic antidepressants, lithium)
2. Antimicrobial (imipenem, quinolones, metronidazole, acyclovir, ganciclovir, isoniazid)
3. 1st-gen Antihistamines
4. Analgesics (tramadol, meperidine) …
#medsky
1. Psychiatric meds (Bupropion, tricyclic antidepressants, lithium)
2. Antimicrobial (imipenem, quinolones, metronidazole, acyclovir, ganciclovir, isoniazid)
3. 1st-gen Antihistamines
4. Analgesics (tramadol, meperidine) …
#medsky
December 11, 2024 at 12:34 AM
Just wanted to list some drugs that lowers seizure threshold:
1. Psychiatric meds (Bupropion, tricyclic antidepressants, lithium)
2. Antimicrobial (imipenem, quinolones, metronidazole, acyclovir, ganciclovir, isoniazid)
3. 1st-gen Antihistamines
4. Analgesics (tramadol, meperidine) …
#medsky
1. Psychiatric meds (Bupropion, tricyclic antidepressants, lithium)
2. Antimicrobial (imipenem, quinolones, metronidazole, acyclovir, ganciclovir, isoniazid)
3. 1st-gen Antihistamines
4. Analgesics (tramadol, meperidine) …
#medsky
Reposted by Jessica
1/ On the 6th day of Pharmacy Advent, let’s talk re: communication
Today, I’m sharing a💎I learned in palliative care that I carry into ED practice. This tool has profoundly shaped how I approach sensitive conversations w/ pts & peers. Let’s dive in👇 #medsky #pharmsky #nursesky #emimcc #HMsky #GPsky
Today, I’m sharing a💎I learned in palliative care that I carry into ED practice. This tool has profoundly shaped how I approach sensitive conversations w/ pts & peers. Let’s dive in👇 #medsky #pharmsky #nursesky #emimcc #HMsky #GPsky
December 6, 2024 at 9:02 PM
Reposted by Jessica
The other way to prevent NAGMA is to replete potassium with K-Citrate (PO) or K-Acetate (IV).
KCl causes hyperchloremic acidosis (like normal saline!), so giving tons of KCl will drive down the pH 😟
citrate or acetate are metabolized into bicarb, so they're alkalinizing and will *improve* pH 😛
KCl causes hyperchloremic acidosis (like normal saline!), so giving tons of KCl will drive down the pH 😟
citrate or acetate are metabolized into bicarb, so they're alkalinizing and will *improve* pH 😛
a little girl in a red jacket is looking up at something in the sky .
ALT: a little girl in a red jacket is looking up at something in the sky .
media.tenor.com
December 6, 2024 at 8:55 PM
The other way to prevent NAGMA is to replete potassium with K-Citrate (PO) or K-Acetate (IV).
KCl causes hyperchloremic acidosis (like normal saline!), so giving tons of KCl will drive down the pH 😟
citrate or acetate are metabolized into bicarb, so they're alkalinizing and will *improve* pH 😛
KCl causes hyperchloremic acidosis (like normal saline!), so giving tons of KCl will drive down the pH 😟
citrate or acetate are metabolized into bicarb, so they're alkalinizing and will *improve* pH 😛
Reposted by Jessica
So let's summarize:
- Initially, pH is super low, ketoacidosis is the driver, insulin tx is key, bicarb probably doesn't help much (give some if you want)
- When the gap closes, a residual NAGMA may increase the risk of ICU bounceback. Use IV bicarb to treat NAGMA & reduce ICU length of stay.
- Initially, pH is super low, ketoacidosis is the driver, insulin tx is key, bicarb probably doesn't help much (give some if you want)
- When the gap closes, a residual NAGMA may increase the risk of ICU bounceback. Use IV bicarb to treat NAGMA & reduce ICU length of stay.
a man says let 's break it down in front of a sign that says swimming
ALT: a man says let 's break it down in front of a sign that says swimming
media.tenor.com
December 6, 2024 at 8:55 PM
So let's summarize:
- Initially, pH is super low, ketoacidosis is the driver, insulin tx is key, bicarb probably doesn't help much (give some if you want)
- When the gap closes, a residual NAGMA may increase the risk of ICU bounceback. Use IV bicarb to treat NAGMA & reduce ICU length of stay.
- Initially, pH is super low, ketoacidosis is the driver, insulin tx is key, bicarb probably doesn't help much (give some if you want)
- When the gap closes, a residual NAGMA may increase the risk of ICU bounceback. Use IV bicarb to treat NAGMA & reduce ICU length of stay.