PK
Patient is 59 YOM weighing 80kg (height: 160cm) with a CrCl of 24. ID wants to initiate Daptomycin to cover an enterococcus SSTI. What is an appropriate dose and frequency and what lab value do we monitor?
use Adjusted BW. 10-12mg/kg q 48hrs. CK
Patient currently being treated empirically with vancomycin and cefepime for a simple cellulitis. Renal function is stable and very good. How often do we need to get a level.
We do not need to monitor levels for Fixed Dosing!!!
You are treating anaphylaxis. Which epinephrine concentration do you use? What is the dose, volume and administration?
Epinephrine 1 mg/mL (1:1,000)
0.3-0.5 mg IM in lateral thigh (0.3-0.5 ml)
72 yo M found in the lobby dizzy, lethargic, and with right-sided facial droop. HR 82, BP 114/72, RR 14, O2 97% on RA, FS 32
A 3-year-old has a heart rate of 115 bpm, respiratory rate of 24 breaths/min, and systolic BP of 92 mmHg.
Are these normal vitals?
Yes
Patient is a 55 YOM being treated with digoxin 250mcg PO daily for afib. CrCl: 75ml/min. Team wants to add an additional agent: Amiodarone. What intervention should be made?
30-50% reduction in the Digoxin dose
ID wants to initiate Ertapenem for empiric UTI coverage. Which 3 organisms is Ertapenem known to not cover?
Acinetobacter
Pseudomonas
Enterococcus
A patient presents with sudden severe dyspnea, hypoxemia, and BP 240/140 mmHg. They are in acute pulmonary edema from SCAPE. What is the initial pharmacologic strategy, including drug, route, and dosing?
Nitroglycerin IV 100-400 mcg/min +/- 0.5-2 mg bolus
64 yo M complaining of chest pain radiating to back and provider asking for medications. What do you have available to administer?
Nitroglycerin 0.4mg SL, aspirin 81mg chewable, clopidogrel 300mg tablet, ticagrelor 90mg tablet
4-year-old child arrives lethargic and SOB. The patient has a pulse but the HR is 48 bpm, BP is 62/38, and extremities are cool with delayed capillary refill?
What do you do now?
Start CPR!
58 YOF currently on heparin infusion for DVT treatment. Team wants to transition patient from heparin to apixaban or enoxaparin. after discontinuing the heparin drip, when can the team initiate apixaban or enoxaparin?
2 hours after discontinuation of heparin infusion
46 YOF has a positive MRSA sputum culture. The IM team is requesting antibiotic recommendations? which of the following medications are preferred and why?
Vancomycin MIC 1.5 Susc; Daptomycin MIC:1 Susc; Linezolid MIC: 2 Susc
Linezolid
A patient has K⁺ 7.4 with peaked T waves. What is your immediate medication cocktail? medication, dose, route, and rationale
Calcium → stabilizes cardiac membrane
Regular insulin 10 units IV + dextrose 25 g IV → shifts K⁺ intracellularly
Albuterol 10–20 mg nebulized → shifts K⁺ intracellularly
Consider sodium bicarbonate if significant metabolic acidosis
46 yo M on 8W complaining of heart palpitations and K+ of 7.6. Provider asking for 1 amp of sodium bicarbonate, where do you get it from?
Pyxis or code box
According to our PK manual, which are the 3 infections that require trough based dosing? What are the goals?
Meningitis (15-20mg/L); necrotizing fasciitis (15-20mg/L); non-cutaneous abscess/ deep seeded ascess (10-15mg/L)
56 YOF being treated by the ID team with Vancomycin and zosyn for a wound growing Enterococcus spp. and pseudomonas. If the CrCl is 45ml/min, what is the dose and frequency of zosyn? What is the dosing strategy of Vancomycin and the target goal?
Zosyn 4.5g IVPB every 8 hours
Vancomycin dosed by trough (10-15mg/L)
This novel β-lactam combines a carbapenem with a cyclic boronic acid β-lactamase inhibitor and is preferred for KPC-producing CRE
What is meropenem-vaborbactam?
Patient has polymorphic VT with a prolonged QT. What is the rhythm? What do you give?
Torsades de Pointes
Magnesium 2 g IV
Rapid response in the ICU for 12 yo F with PMH asthma complaining of SOB while visiting her grandmother. What do you have in the bag to help?
Albuterol with pediatric spacer
How would you assess a pediatric patient's renal function?
Urine output (normal is 0.5-1.5 cc/kg/hr)
Team wants to initiate patient on warfarin for Afib as patient is "allergic" to DOACs. patient has normal renal function. Is bridging needed? Why or Why not? What is the point of bridging?
Bridging is not needed. Low risk.
Warfarin initially lowers natural clot-preventing proteins (Protein C and S) faster than clotting factors, creating a temporary high-risk state for dangerous blood clots
55 YOM is growing VRE Faecalis, MRSA, ESBL Kleb pneumo and acinetobacter baumanii. Is this patient covered with Eravacycline? Which organisms does Eravacycline not cover?
Proteus, providencia, pseudomonas
Your septic patient has been intubated and now has BP 64/48 and the providers ask for norepinephrine, but a central line has not yet been placed. What is your recommendation?
Start norepinephrine 8mg/250mL peripherally with plans to place a central line as soon as possible
64 yo F found unresponsive in the lobby with no pulse. Provider asking for epinephrine, what do you do?
Epinephrine 1mg/mL available in the bag, dilute in a 10 mL NS flush to make a cardiac epinephrine and administer after access has been obtained
46 yo M (76 kg) presents to ED for status asthmaticus and was treated appropriately but can no longer protect airway and team wants to intubate. What is the most appropriate regimen (induction agent and paralytic) and dosing? How would you draw it up?
Ketamine 100 mg (draw up 2 mL at Pyxis and immediately place back in drawer) then Rocuronium 80 mg (draw up 8 mL)