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The Pharm So Hard Podcast is a show focused primarily on emergency medicine and hospital pharmacy related topics. Episodes range from 5-30 minutes depending on the topic and guest speakers. The goal is to disseminate information in bite-sized episodes from experts in the field of acute care and hospital pharmacy sub-specialties.
130 Episodes
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In Episode 129 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by Oscar Santalo, PharmD, MBA, MHA, BCPS, to discuss his recently published study in the Journal of Acute Care Pharmacotherapy (JACP) examining prescription abandonment after emergency department discharge. Jimmy and Oscar walk through the motivation behind the research and explore how automated pharmacy kiosks may serve as a practical solution to improve medication access at the point of discharge. The conversation focuses on why prescription abandonment remains a persistent challenge in emergency care and how pharmacy-led innovations can help bridge gaps during transitions from the ED to home. This episode also takes a broader look at the role of clinical pharmacy in emergency medicine, highlighting how system-level approaches can support adherence, continuity of care, and better patient experiences. If you’re interested in how evidence published in JACP can inform real-world practice, this episode offers thoughtful insight from the study’s author himself.
In Episode 128 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, takes on one of the most common—and most consequential—errors in emergency care: how we give IM epinephrine for anaphylaxis. Spoiler alert: if you’re giving it in the arm, you may be giving your patient little more than saline. Using real EMS-to-ED scenarios and landmark pharmacokinetic data, Jimmy breaks down why IM epinephrine in the deltoid fails, how thigh administration delivers up to 10-fold higher plasma concentrations, and why many adults are being significantly underdosed with the standard 0.3 mg approach. This episode dives into absorption physiology, weight-based dosing, needle length, and the dangerous downstream consequences that occur when inadequate IM therapy pushes teams toward risky IV epinephrine boluses. If you manage anaphylaxis in the ED, ICU, or prehospital setting, this episode will fundamentally change how you think about epinephrine. The takeaway is simple—and non-negotiable: don’t try to outsmart physiology. Don’t ask why. Give it in the thigh.
In Episode 127 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, breaks down the long-awaited RSI Trial comparing ketamine versus etomidate for rapid sequence intubation in critically ill patients. Challenging more than two decades of dogma, Jimmy explores why ketamine was associated with more early cardiovascular collapse—including higher rates of vasopressor escalation and significant blood pressure drops—despite its reputation as the “safer” agent in shock. Using real-world scenarios from the ED and ICU, this episode unpacks the concept of the ketamine hemodynamic paradox, catecholamine depletion, dosing considerations, and how these findings should change your airway preparation strategy. If you care about making intubations as boring—and as safe—as possible, this is a must-listen.
Picking up right where Part 1 left off, this episode zeroes in on the practical, high-stakes side of inpatient heart failure management. Dr. Cait Kulig returns to unpack key adverse effects of diuresis, strategies to overcome diuretic resistance, and how to approach add-ons, IV vasoactive agents, and inotropes.
Jimmy and Cait also dive into the impact of acute decompensated heart failure on pharmacokinetics, diuretic selection, and guideline-directed therapy across HFrEF and HFpEF—including tips for transitioning to ARNIs and remembering what really matters during inpatient optimization.
Whether you're adjusting diuretics or making big-picture decisions, this episode will help you level up your heart failure confidence.
In Part 1 of this two-part masterclass on acute heart failure, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, teams up with Cait E. Kulig, PharmD, HF-Cert, clinical cardiology expert and creator of CAR Rx Explain, to unpack the fundamentals of heart failure in a way that finally clicks.
From defining heart failure and understanding ejection fraction to breaking down volume status and the Forrester plot, this episode delivers clear, memorable teaching pearls for any pharmacist working with cardiac patients. Learn when to hold GDMT, how to think through diuretic strategies, and what questions you should be asking your patients on admission. This is heart failure demystified—through the lens of real-world clinical decision-making.
💡 Up next in Part 2: We pick up with the adverse reactions of diuresis, dive into overcoming diuretic resistance, and discuss IV vasoactives, GDMT classes, and more.
In Episode 124 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, explores the ongoing debate around anticoagulation reversal in patients with minor traumatic intracranial hemorrhage (TICH). Highlighting a recent multicenter study, Jimmy breaks down the data, challenges current guideline-driven practices, and raises critical questions about risk, patient selection, and clinical judgment. Tune in for a nuanced discussion that could reshape how we approach minor TICH in the emergency department.
In this episode of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, introduces the Society of Emergency Medicine Pharmacists (SEMP), a newly established organization dedicated to advancing the practice of emergency medicine pharmacy. Jimmy discusses SEMP's mission to optimize pharmacotherapeutic care in emergency departments through practice improvement, education, advocacy, research, and international collaboration. He highlights the importance of creating a unified global community for emergency medicine pharmacists and explores how SEMP aims to provide tailored support and resources for practitioners in this dynamic field. Tune in to learn how SEMP plans to shape the future of emergency medicine pharmacy and how you can get involved.
In this episode of The Pharm So Hard Emergency Medicine Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, explores the potential of SGLT2 inhibitors in critically ill patients with guest Daniella Abi Kheir, PharmD. Traditionally viewed as diabetes medications, SGLT2 inhibitors are now gaining attention for their pleiotropic effects, including cardiovascular, renal, and anti-inflammatory benefits.
Together, Jimmy and Daniella dive into the DEFENDER trial, the first study to evaluate SGLT2 inhibitors in ICU patients with acute organ dysfunction. They break down the study design, key findings, and practical implications for managing critically ill patients. Could these drugs help prevent renal replacement therapy or improve outcomes in septic patients?
The episode also tackles potential safety concerns, including DKA and altered absorption in critically ill populations, while offering actionable insights for clinicians considering SGLT2 inhibitors in the ICU. Tune in for an evidence-based discussion packed with clinical pearls and takeaways.
In this episode of The Pharm So Hard Emergency Medicine Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by William Amarquaye, PharmD, to discuss Journavix, the first non-opioid pill approved for moderate to severe acute pain in over 20 years. They break down its mechanism as a NAV1.8 sodium channel blocker, compare it to existing analgesics, and analyze clinical trial data on its efficacy and safety. The conversation also tackles key considerations like side effects, drug interactions, and cost implications for real-world use.
Episode 120. Ketamine for Benzodiazepine-Resistant Status Epilepticus – A Game-Changer?
In this episode of The Pharm So Hard Emergency Medicine Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP dives deep into an exciting new study exploring ketamine as a rescue agent for benzodiazepine-resistant status epilepticus. Traditionally, managing refractory seizures often requires intubation, high-dose propofol, or other antiepileptics. But could ketamine provide rapid and effective seizure control in these critical moments?
Jimmy discusses key findings from the study, practical implications for the ED, and how this data could influence your choice of induction agents during intubation. Plus, he shares valuable clinical pearls and caveats when considering ketamine use in different patient populations.
00:00 Introduction
02:16 The Clinical Dilemma: Benzodiazepine-Resistant Status Epilepticus
03:39 Introducing the Study: Ketamine as a Rescue Drug
05:16 Key Findings: Rapid Seizure Termination
06:05 Safety and Dosing Insights
06:42 Clinical Implications: Ketamine in ED Practice
07:05 Caveats and Patient Populations
07:55 Conclusion
In Episode 119 of The Pharm So Hard Emergency Medicine Podcast, Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, dives into the COPY-ED study, which explores cephalosporins as a viable option for treating outpatient pyelonephritis. Jimmy challenges the fluoroquinolone-dominant narrative, breaks down the study’s methods and results, and highlights the implications for emergency medicine pharmacists.
In this episode of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, and guest Rosa Malloy-Post, MD, delve into the debate over the most suitable paralyzing agent for rapid sequence intubation (RSI). They weigh the advantages and disadvantages of Succinylcholine ("Succ") and Rocuronium ("Roc") by comparing their pharmacologic properties, onset, duration, side effects, and clinical use cases. Listen for expert perspectives, practical insights, and essential factors to consider when choosing the right agent in emergency settings, and find out if "Roc truly rocks" or if "Succs really suck.
In this episode, host Jimmy L. Pruitt III, PharmD, BCPS, BCCCP, BCEMP, welcomes Tessa R. Cox, PharmD, BCCCP, and Brian W. Gilbert, PharmD, MBA, FCCM, FNCS, BCCCP, to discuss their study on the early administration of subcutaneous (SQ) basal insulin in mild to moderate diabetic ketoacidosis (DKA). The episode covers the definition and treatment of DKA, the role of insulin therapy, and the design and results of the retrospective study, which found no significant difference in hospital length of stay between early and non-early SQ basal insulin groups. The discussion includes an analysis of the study outcomes, clinical implications, and the need for further research. Tessa R. Cox and Brian W. Gilbert share their expert insights on DKA management and the relevance of the study findings to emergency medicine.
Amazon Link: https://www.amazon.com/InteGREAT-Guidebook-Creating-Healthcare-Teams/dp/1946665706
In this episode, Jimmy Pruitt engages with the C3 Group authors, Andrea Sikora, Anthony Hawkins, and Susan Smith from the University of Georgia College of Pharmacy. They delve into their collaborative journey of writing the book InteGREAT: A Guidebook for Creating Great Healthcare Teams. The discussion covers the challenges, milestones, and pivotal moments experienced during the book's creation. They explore the vision and goals behind the book, its structure, and how it aids in building and optimizing healthcare teams. The authors share insights on the importance of team development, building relationships, leveraging individual strengths, and achieving alignment within the team. The episode also highlights how the book impacts clinical teams and the authors' professional activities.
Show notes: https://pharm-so-hard.com/2024/07/02/episode-116-collaborative-insights-on-creating-great-healthcare-teams-with-c3-group-authors/
This episode of the Pharm So Hard podcast discusses the use of clinical pharmacy practitioners in the emergency room and their impact on sepsis antibiotic interventions author by Aubrie Hammond, Regan Porter, Taylor Cason, et al. The study found that the involvement of EMCPPs significantly improved the selection and timing of antibiotic administration in septic patients. The pharmacist-driven protocol improved the rate of appropriate antibiotic selection from 57% to 86% and reduced the time to administration by 64 minutes. The study also highlighted areas where antibiotic selection could be further improved, such as UTIs and intra-abdominal infections. The role of pharmacists in optimizing treatment time and expanding the pharmacist-driven sepsis management model was also discussed.
In this episode of the Pharm So Hard Podcast's PharmD Literature Highlight Series, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP discusses the study "Risk of arrhythmia in post-resuscitative shock after out-of-hospital cardiac arrest with epinephrine versus norepinephrine" by Sarah Normand, Pharm.D., Courtney Matthews, Pharm.D., Caitlin S. Brown, Pharm.D., Alicia E. Mattson, Pharm.D., Kristin C. Mara, M.S., Fernanda Bellolio, M.D., M.S., and Erin D. Wieruszewski, Pharm.D.
Full Text
PubMed
In this episode of the Pharm So Hard podcast, host Jimmy Pruitt interviews Brock Townsend and Brian Gilbert about their study on the impact of time to administration of four-factor PCC for patients with warfarin-associated intracranial hemorrhage. The study was a retrospective observational single-center study performed at a large community teaching hospital. The authors stratified patients into three groups based on time from diagnosis to administration of four-factor PCC. The study found no significant differences in outcomes, such as hemostasis achievement, hospital mortality, length of stay, and adverse effects. The authors emphasize the need for more data and personalized protocols for anticoagulation-related ICH.
Takeaways
The study found no significant differences in outcomes based on time to administration of four-factor PCC for patients with warfarin-associated intracranial hemorrhage. More data is needed to determine the optimal time to administer four-factor PCC and develop personalized protocols for anticoagulation-related ICH.
Standardization of radiologists' interpretations and reporting of CT scans is important for future studies in this area.
The study highlights the importance of resident research in answering important clinical questions.
Pharmacists and healthcare professionals should continue to strive for personalized medicine and individualized care for patients with anticoagulation-related ICH.
In this episode of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, alongside guests Robert O'Connell, PharmD, BCCCP, BCEMP, Louisa Sullivan, PharmD, BCPS, BCEMP, Mark Mixon, PharmD, BCPS, BCIDP, BCCCP, and Joshua Senn, PharmD, BCPS, share their experiences at last year's EMPoweRx conference. As they gear up for this year's conference, gain exclusive insights into their preparations and aspirations, offering a glimpse into their pursuit of excellence in pharmacy practice.
This Pharm So Hard episode titled "Pulse Check! Kyle Stupca's Study on Esmolol & Dose-Capped Epi" is a deep dive into the innovative research conducted by Kyle Stupca on emergency cardiac care. The episode hosted by Jimmy Pruitt aims to explore Stupca's groundbreaking study which focuses on the use of Esmolol and dose-capped epinephrine in treating life-threatening cardiac arrhythmias like ventricular fibrillation and pulseless ventricular tachycardia. The discussion covers Stupca's personal journey and motivations in emergency medicine research, delves into the specifics of his study's methodology, findings, and the challenges faced during research. A significant part of the episode is dedicated to discussing the practical implications of these findings for emergency cardiac care and envisaging the future of this field with unlimited research resources. This episode is designed to enlighten healthcare professionals, particularly pharmacists and physicians, about the evolving role of pharmacology in emergency medical scenarios, emphasizing the critical impact of research in this domain.
In this episode of the Pharm So Hard Podcast, Jimmy L. Pruitt III, PharmD, BCPS, BCCCP together with Alexandra Cruz Pabón, PharmD and Nicholas Servati, PharmD, BCCP discuss the STREAM-2 Study Journal Club.
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