Rachel Khuc, PharmD

Boba-powered EM pharmacist🧋PGY2 EM @scvmcpgy1_2 || PGY1 @renownhealth || @uopacific c/o 2021 || thoughts are my own || she/her

[The Pharm So Hard Podcast Network @pharmsohardnet]

Make sure you don’t think that Academic medical center equals great program for YOU. Community shops with great preceptors are better than a big name with preceptors that use to care. Talk to ppl and realize what you want!

[Courtney Makowski @courtskipharmd]

You were calling a pharmacist & were upset they were being called upon in so many facets they were unable to help you …. the ultimate testament that pharmacists are vital. You needed one, you were calling one! Lift up professions other than your own, THAT is true patient care

[Josh Trebach, MD @jtrebach]

one time in med school I cried after one of my patients died

I felt embarrassed for crying and ashamed for showing emotion…until I saw that my attending was crying too.

it’s ok to have feelings in medicine

[gabaghoul ♡ @gabby_frost]

for all the medicated barbies out there

[Brittani James, MD @DrBrittaniJ]

I woke up yesterday morning, looked out my window and saw the neighbors had hung this flag on their children’s playground.

Pull up a seat, and join me, friends, for The Chronicles of Being Black in a Rich, White suburb

A thread 💀

[Elliot Tapper @ebtapper]

An older man comes to the ED with abrupt onset nausea, & diarrhea

He is joined by her daughter whom he is visiting from abroad

Testing is below
The diagnosis is unclear
Until his daughter got just as sick too
🧵
#livertwitter #liverstory #MedTwitter

[Jimmy Turner, MD @TPP_MD]

Overgeneralization is the process of taking one moment and making it determine your identity.

Instead of saying “That was a mistake” I made it mean “I am a mistake”

How do we defeat this?

The antidote to overgeneralization and imposter syndrome is self-compassion.

3/

[Josh Trebach, MD @jtrebach]

if I was in charge of naming drugs I would give them easy names like SeizeNoMore instead of levetiracetam

[Nick Mark MD @nickmmark]

Meta-analysis of 11 RCTs finds an increased risk of mortality when etomidate is used for induction: RR = 1.16 (95% CI 1.01–1.33), NNH = 31.

This justifies my practice; I’ve basically stopped using etomidate altogether for the last few years (ketamine instead).

[Sergey Motov @painfreeED]

Sarangarm et al 2023-UpdatED: The emergency medicine pharmacotherapy literature of 2022. https://t.co/0mKXV4Bhtf #FOAMed #MedED Thank you, #EMpharmacists for all you do!

[Raechel White @RaechelTWhite]

I heard if you chant charlatan three times to yourself in front of a mirror a pharmacist will appear and cancel your Vanco

[Rachel Khuc, PharmD @rkhucpharmd]

📚: Lange Poisoning and Drug Overdose; PMIDs 16382383, 32310561 📄 (🧵6/6)

[Rachel Khuc, PharmD @rkhucpharmd]

🫀Tax Tidbit Week 2🪴
Cardiac glycosides inhibit Na+/K+/ATPase, causing ⬆️ extracellular calcium and resulting in increased cardiac contractility. Digoxin and digitoxin are two cardiac glycosides prescribed for treatment of several cardiac conditions such as CHF and Afib (🧵1/?)

[Rachel Khuc, PharmD @rkhucpharmd]

The digoxin-DigiFab complex is renally excreted, but elimination is delayed 🦥 in patients with renal dysfunction. After giving DigiFab, save your patient a poke 🩸 levels on conventional assays reflect free+bound digoxin and will be falsely elevated. (🧵5/?)

[Rachel Khuc, PharmD @rkhucpharmd]

Today’s tox adventure: antidote tasting 🤩 trying plain NAC really made me appreciate that apple juice dilution 🧃

[Rachel Khuc, PharmD @rkhucpharmd]

If given early enough, fomepizole can 🛑 inhibit or ⬇️ decrease NAPQI formation and limit toxicity. Data is limited at this time, so optimal dosing has not been established. Call Poison Control ☎️ at 1-800-222-1222 for additional recs!

📚PMID 34785186, 34709101, 31785980 (🧵5/5)

[Rachel Khuc, PharmD @rkhucpharmd]

💊Tox Tidbit Week 1💊
Acetaminophen (APAP) is mostly metabolized to nontoxic molecules, but ~15% are metabolized by CYP2E1 → NAPQI☠️
NAPQI is conjugated with glutathione, but if glutathione is depleted (like in APAP OD!) can lead to hepatic/renal injury 😬 (🧵1/?)

[Rachel Khuc, PharmD @rkhucpharmd]

Patients with massive APAP OD may be considered for adjunct dialysis or fomepizole administration! We all know and love fomepizole as an alcohol dehydrogenase inhibitor 🙅‍♀️🍾, but it is also a potent inhibitor of CYP2E1 🤯 (🧵4/?)