Safety profile of the most ordered medications for breastfeeding patients in the emergency department.

BACKGROUND: Emergency Medicine (EM) physicians routinely treat breastfeeding patients. Physicians frequently recommend pumping and dumping milk for perceived safety risks. We hypothesized that the majority of the most commonly ordered medications in the emergency department (ED) are safe for breastfeeding patients. Accordingly, we performed a comprehensive safety analysis of the commonly ordered medications and provided an algorithm for EM physicians to utilize when treating breastfeeding patient in the ED. METHODS: We investigated the 90 most administered medications to female patients between the ages of 15 to 50 for common ED chief complaints at a tertiary care academic medical center from January 2018 to December 2022. A total of 145,960 doses were analyzed. We subsequently searched LactMed®, InfantRisk Application, and Pubmed® for all safety information on these medications and divided them by categories. Ultimately, we proposed a treatment algorithm for breastfeeding patients in the ED. RESULTS: Analgesics were the most commonly ordered medications in the ED, and importantly analgesics ranging from ibuprofen to morphine are safe in limited doses in the ED setting. Antibiotics and antifungals pose limited restrictions. All systems-based medications have a variety of safe options available. Lastly, supplements and electrolytes are safe. CONCLUSION: The majority of medications utilized in the acute setting are compatible with breastfeeding. There should be limited circumstances to advise pumping and dumping in the ED.

Emergency Department Management of Acute Venous Thromboembolism in Patients With Obesity With Intravenous Unfractionated Heparin and Anti-Xa Monitoring.

Background: Unfractionated heparin (UFH) remains a frequently utilized agent in the emergency department (ED) for management of acute venous thromboembolism (VTE). While various protocols of UFH dosing have been proposed for patients with obesity, the optimal dosing and monitoring strategy is unclear. Objective: This study aims to compare the time to the first therapeutic anti-Xa level in obese acute VTE patients following the use of either total body weight (TBW) or adjusted body weight-based (AdjBW) dosing of UFH in the ED, and to analyze the impact of different dosing strategies on patient outcomes. Methods: Inclusion criteria included adult patients with a BMI > 30 kg/m2, and suspected VTE managed with UFH per institutional protocol utilizing a bolus dose followed by maintenance infusion and anti-Xa monitoring. The primary outcome was time to the first therapeutic anti-Xa level in the group dosed per TBW compared with the group dosed per AdjBW. Safety outcomes included incidence of bleeding events, protamine administration, and mortality. Results: There were 32 patients included in the study. Patients dosed per TBW achieved a median time to first therapeutic anti-Xa level of 14.5 hours compared with 15 hours in the AdjBW group (P = .613). The median therapeutic UFH infusion rate was 16 units/kg/hr in the TBW group compared with 13.5 units/kg/hr in the AdjBW group (P < .001). Safety outcomes were not significantly different between groups. Conclusion: Patients presenting to the ED with acute VTE may be managed with UFH using either a TBW or AdjBW dosing strategy.

Ketamine for Pain Management: A Review of Literature and Clinical Application.

Ketamine is a dissociative anesthetic used increasingly as analgesia for different manifestations of pain, including acute, chronic, cancer and perioperative pain as well as pain in the critically ill patient population. Its distinctive pharmacologic properties may provide benefits to individuals suffering from pain, including increased pain control and reduction in opioid consumption and tolerance. Despite wide variability in proposed dosing and method of administration when used for analgesia, it is important all clinicians be familiar with the pharmacodynamics of ketamine in order to appropriately anticipate its therapeutic and adverse effects.

An Exploratory Survey of Incorporation of Gender- and Sex-related Differences in the PharmD Curricula.

INTRODUCTION: Clinical presentation and treatment in many disease states vary due to sex- and gender-differences. Sex-related pharmacokinetic differences are particularly important for pharmacists. The Accreditation Council for Pharmacy Education (ACPE) currently has no standard for the inclusion of gender- and sex-related differences in the didactic PharmD curriculum, but encourages advanced pharmacy practice experiences (APPEs) to include diverse populations related to gender. The purpose of this survey is to explore faculty incorporation of gender and sex differences within the PharmD didactic curriculum in preparation for a nation-wide survey. METHODS: A survey was created to determine how many clinical topics incorporated gender- and sex-related differences and to what extent this information was discussed in the classroom. The survey link was emailed to pharmacotherapeutics and pharmacokinetics faculty at Midwestern University Chicago College of Pharmacy, University of Illinois at Chicago, Roosevelt University, Rosalind Franklin University, and Chicago State University. Chi square analyses were performed to examine relationships across participant responses. RESULTS: A total of 56 faculty members participated in the survey, resulting in a 20% response rate. Of these, 30 (54.5%) faculty indicated that they discussed gender- and sex-related differences in the subject area in which they teach. Approximately 33% of respondents found gender- and sex-related differences very clinically important. Gender- and sex- related differences were taught in a variety of subject areas, including cardiology, diabetes, and chronic obstructive pulmonary disease (COPD). CONCLUSION: With no current standard, faculty members independently choose to include gender- and sex-related differences in their lecture topics and the extent of the discussion. Faculty should be aware of this lack of standardization and that they are independently responsible for including gender- and sex-related differences in their particular topics. Because the surveyed faculty find gender- and sex-related differences clinically important and literature suggests differences in medications depending on gender and sex, further research is planned to provide insight on a national level.