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Pharmacy Geniuses at Your Service

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First Dose: EM Pharmacy Insights

Start each month with a shot of pharmacy wisdom.

Sept

• ED Pharmacy Insights regarding ceftriaxone dosing 1g vs 2g

Aug

• How do I know if the antibiotics I am prescribing need to be renally adjusted?

TL;DR:

1 Almost all antibiotics require adjustment for impaired renal function. Exceptions: Ceftriaxone, azithromycin, doxycycline, linezolid, clindamycin, nafcillin.

2 Creatinine Clearance (rather than GFR) is still used to determine the need for dose adjustment for most medications. In general, estimated Creatinine Clearance < 60 mL/min is a good cutoff to start considering dose adjustment (exact cutoffs vary depending on specific agent).

3 Consult SHC’s Antimicrobial Dosing Guide (or your ED pharmacist) for drug-specific dosing recommendations.

July

• Should I really be prescribing metronidazole twice daily instead of three times a day for intra-abdominal infections?

TL;DR:

1. Metronidazole 500 mg Q12H is preferred over Q8H for most intra-abdominal infections to decrease pill burden and to minimize side effects.

2. C. difficile infections that are being treated with metronidazole should continue utilizing 500 mg Q8H dosing (Note: metronidazole is NOT first line)

3. H. pylori treatment should utilize 500 mg Q6-8H due to resistance

June

• Is Diphenhydramine needed for all patients who receive metoclopramide or prochlorperazine?

TL;DR:

1 Prochlorperazine was shown to be more effective for relieving migraine headache than metoclopramide when both are dosed at 10 mg IV

2 Diphenhydramine prevented akathisia when metoclopramide 20 mg IV or prochlorperazine 10 mg IV was administered for acute migraines

3 Diphenhydramine should NOT be given to prevent akathisia with metoclopramide 10 mg IV due to lack of proven clinical efficacy

May

GLP-1 agonists and the side effects you might see

• Quick Facts for SLP.1s

TL;DR:

1 Understanding the common side effects of GLP-1 agonists and their risk factors is necessary as the number of patients taking them increase.

2 The most common side effects are the GI side effects, many of which will dissipate after the first couple of months of treatment or by decreasing the dose.

3 Half-lives vary from hours to over a week for the different agents and formulations.

April

Uncomplicated UTI (uUTI) Updates

• UTI in Males

TL;DR:

1 IDSA has updated the definition for uUTI. The same antibiotics and duration should be used in men and in women.

2 Nitrofurantoin is the preferred agent for uUTI.  Alternatively, consider prescribing cephalexin 500 mg BID instead of QID.