Shock and Awe
This medication is the first-line treatment for asystole/pulseless electrical activity (PEA) during ACLS.
What is epinephrine?
This antidote replenishes glutathione stores to prevent hepatic damage after acetaminophen overdose.
What is N-acetylcysteine (Acetadote)?
This pneumonia develops more than 48 hours after endotracheal intubation and is a major concern in the ICU.
What is ventilator-associated pneumonia (VAP)?
Your patient is a 62-year-old male taking a corticosteroid who is prescribed a fluoroquinolone for pneumonia. He tells you that he swims or rides his bike at least 5 days a week. You should counsel him about this serious potential adverse effect, for which he is at increased risk.
What is tendon rupture (particularly the Achilles tendon)?
These two juices (all forms) must be avoided with transplant medications.
What are grapefruit and pomegranate juices?
This anticholinergic medication is the first-line treatment for symptomatic bradycardia, given at 1 mg IV every 3–5 minutes, up to 3 mg total.
What is atropine?
This benzodiazepine receptor antagonist can reverse the sedative effects of benzodiazepines but must be used cautiously due to seizure risk in chronic users.
What is flumazenil (Romazicon)?
In ICU patients with severe pneumonia and risk factors for multidrug resistance, this pathogen is sometimes empirically treated with dual antibiotic coverage to ensure adequate therapy.
What is Pseudomonas aeruginosa?
A 64-year-old man taking atorvastatin for high cholesterol complains of new-onset muscle pain and dark urine. You should warn him this could be a sign of this serious adverse effect.
What is rhabdomyolysis?
This medication is the most commonly used agent for “induction” in our transplant patients (usually 2-4 doses given).
What is Thymoglobulin?
If atropine is ineffective for symptomatic bradycardia, these two medications may be used as continuous infusions to increase heart rate and support blood pressure.
What are dopamine and epinephrine infusions?
This skeletal muscle relaxant is used as the antidote for malignant hyperthermia triggered by succinylcholine or volatile anesthetics.
What is dantrolene?
This class of antibiotics is commonly used to cover atypical pathogens such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella species.
What are macrolides (e.g., azithromycin, clarithromycin)?
A 40-year-old woman just started levothyroxine for hypothyroidism. You counsel her to take the medication on an empty stomach in the morning and separate it from these two supplements, which reduce absorption.
What are calcium and iron supplements?
This medication’s dosage must be halved when converting from PO to SL dosing.
What is tacrolimus?
These two antiarrhythmics can be given after the third shock in refractory ventricular fibrillation or pulseless VT.
What is amiodarone or lidocaine?
In calcium channel blocker overdose, this electrolyte can be given intravenously to help improve myocardial contractility and blood pressure.
What is calcium (calcium chloride or calcium gluconate)?
This IV corticosteroid may be considered in ICU patients with severe pneumonia and septic shock requiring vasopressors.
What is hydrocortisone? Typical dosing 200 mg per day (often as 50 mg IV q6h or continuous infusion).
Patients taking this cardiac glycoside should be counseled to report nausea, vomiting, or visual halos, as these may indicate toxicity.
What is digoxin?
Thymoglobulin targets and depletes THESE types of cells to suppress the immune system.
What is T-Cells or T-lymphocytes?
This medication is used in ventricular fibrillation/pulseless ventricular tachycardia associated with torsades de pointes (prolonged QT interval).
What is magnesium sulfate? Give 2g IV or IO over 1-2 minutes, diluted.
This antidote is used to treat severe beta-blocker overdose by increasing intracellular cAMP, improving heart rate and contractility.
What is glucagon?
Name 3 medications from different pharmaceutical classes that cover pseudomonas aeruginosa.
1. Penicillins
Piperacillin/tazobactam (Zosyn)
2. Cephalosporins
Cefepime (4th generation)
Ceftazidime (3rd generation, antipseudomonal)
Ceftolozane/tazobactam (Zerbaxa)
Ceftazidime/avibactam (Avycaz)
3. Carbapenems
Meropenem
Imipenem/cilastatin
Doripenem
(Note: Ertapenem does not cover Pseudomonas!)
4. Monobactam
Aztreonam (useful in beta-lactam allergy, but resistance may occur)
5. Fluoroquinolones
Ciprofloxacin
Levofloxacin
(Moxifloxacin does not cover Pseudomonas)
6. Aminoglycosides
Tobramycin
Amikacin
Gentamicin - resistance!!!
(Often used for double coverage, not monotherapy due to poor lung penetration)
Other Options (Resistant Strains / Last-Line)
Polymyxins (Colistin, Polymyxin B)
Cefiderocol (newer siderophore cephalosporin active against MDR Pseudomonas)
Imipenem/cilastatin/relebactam (Recarbrio)
Meropenem/vaborbactam (Vabomere) – limited activity for some resistant strains
A 35-year-old patient recently started clozapine and calls the pharmacy about a fever and sore throat. You should advise immediate medical evaluation because this may indicate this dangerous adverse effect.
What is agranulocytosis (severe neutropenia)?
This medication is sometimes used to CREATE a drug interaction to help augment tacrolimus levels.
What is Fluconazole (low dose)?