Monthly Archives: May 2016

Dr Huecker Stayin’ Healthy

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As I was catching up on my weekly EM/pharmacology blogs, I stumbled across an article featuring our very own Dr Martin Huecker on the Academic Life in Emergency Medicine (ALiEM) website.  It is a great article about staying healthy and balancing life in EM. I’ve attached the link for your viewing pleasure.

https://www.aliem.com/2016/martin-huecker-healthy-in-em/

Valsartan/sacubitril use likely to increase significantly

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So I just came across that the Valsartan/sacubitril (Entresto) was given a strong class 1 recommendation by the American College of Cardiology for heart failure.  I haven’t seen much of it in med-recs yet, so I just wanted to post a couple of high points that I think we need to know from the ER side. From what I’m reading this drug will start to replace ACE-Inhibitors in the treatment of Class II-IV heart failure. It’s also prescribed in slightly odd dosing in the combination (51 mg/49 mg or 26 mg/24 mg).

Sacubitril is a prodrug that converts to sacubitrilat. Sacubitrilat is responsible for the benefits of this drug as it inhibits the enzyme neprilysin and stops it from degrading atrial/brain natriuretic peptide.

Ultimately the main thing you need to know are the contraindications with other drugs. Basically there are 3: Lithium, ACE-Is, and Aliskiren. Lithium levels have the potential to increase with this drug, while the other 2 can lead to significant hypotension in combination with Valsartan/sacubitril.

Here’s the ACC release: http://www.acc.org/latest-in-cardiology/articles/2016/05/20/11/30/societies-release-focused-update-for-hf-management?wt.mc_id=fb

Would be appreciate if someone with a stronger background in pharmacy or cardiology than I can chime in.

Urine Drug Screen

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So while on my ICU months this year, I had upper levels that were very insistent that we needed to get a urine drug screen on everyone.  I would try to make the point that it most likely was not going to change our management of the patient at all.  My point was often ignored and after countless urine drug screens obtained during those months, most if not all proved to be of no utility.

Interestingly, Foamcast just put out a podcast about false positives and false negatives on the UDS.  What I found most interesting was that ibuprofen can cause a false positive for just about anything under the sun including cocaine, PCP, THC, and barbiturates.  Also, the benzos tested on this really only test for oxazepam which is a metabolite of diazepam.  So Ativan, Klonopin, and Xanax won’t show up.

Here is the link if you want to read the whole thing.   https://foamcast.org/2016/04/26/episode-48-urine-drug-screen-cocaine-and-pcp/