Andy Webb @AJWPharm Twitter profile

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Andy Webb

2 years

I've made a number of infographics since joining Twitter and many are buried in my timeline I figured I'd start a thread of all the infographics I've made over the years so they are more readily available! 👇 🖼️

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Andy Webb

@AJWPharm

5 years

Can we start a drug name story thread? I'll start Ambien got its name from a little bit of crappy Spanish - after your night's sleep, you should have an AM that is bien

CounterSideCartoons

@CartoonsSide

5 years

VICODIN'S NAME comes from the fact that it is 6 times stronger than codeine so, they used VI (the roman numeral for 6) + CODeINe (dropped the e's from codeine)= VICODIN

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Andy Webb

@AJWPharm

4 years

What law of physics dictates that your badge will always flip to its back side no matter how many times you flip it the right way

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Andy Webb

@AJWPharm

1 year

Attention📢📢 : New aneurysmal subarachnoid hemorrhage guidelines just dropped! Lots of new updates to the last guidelines published in 2012, lets check them out below 👇

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Andy Webb

@AJWPharm

4 years

The ECMO circuit causes a number of changes to how medications distribute throughout the body - here's a quick guide to some of the most common clinically relevant considerations!

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Andy Webb

@AJWPharm

3 years

Big life announcement! After a trial of westward expansion, I'm coming home - I am elated to announce I accepted a position as a neurosciences clinical pharmacist at Mass Gen! I can't wait to move to Boston and start the job I've been dreaming of since pharmacy school 🧠

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Andy Webb

@AJWPharm

5 years

Did you see @NEJM recently released new guidelines for the use of P values in clinical trials? I thought I'd put together a little guide to understand how they are misused/misinterpreted for PGY1s (or anyone who wants a refresher!)

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Andy Webb

@AJWPharm

3 years

How to summon a pharmacist

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Andy Webb

@AJWPharm

3 years

Sci-Hub added a button to collapse the giant left panel in the PDF reader A perfect tool got even more perfect

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Andy Webb

@AJWPharm

2 years

The unspoken perk of fabric posters is their second life as a blanket

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Andy Webb

@AJWPharm

2 years

Imposter syndrome is often billed as a feeling that you made it into your position because of a mistake, but my special brand of evolved imposter syndrome™ is not that I feel like I'm unqualified; it's that I feel like I am constantly underperforming despite my qualifications

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Andy Webb

@AJWPharm

2 years

We've had a few patients with mitochondrial diseases recently and I've had to refresh myself on the details of the ol powerhouses of the cell. While each disease is unique, there is a common set of meds to avoid. I put together a 1-pager for common ones! #NeuroCritCare

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Andy Webb

@AJWPharm

3 years

Day 3 of toxicology rotation and I am officially afraid to eat food

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Andy Webb

@AJWPharm

4 years

My team after I tell them not to order ceftriaxone on a susceptible Kleb aerogenes for the 9th time

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Andy Webb

@AJWPharm

2 years

Just a reminder that anticoagulants do not thin your blood and a stroke is not an accident

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Andy Webb

@AJWPharm

3 years

Trying to remember even the names all of the available antiepileptic drugs can be challenging, let alone their place in therapy. One way I like to think about them is by their "spectrum of activity," just like how we think about antibiotics! 🧠 #NeuroPharm

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Andy Webb

@AJWPharm

4 years

Remind me again why the hell pharmacists are the only healthcare professional (that I know of) that needs to take a separate licensing exam for state laws? If I read one more shall, may, should, or must my head is going to explode

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Andy Webb

@AJWPharm

5 years

Warfarin is a classic, a coumARIN discovered at the Wisconsin Agricultural Research Foundation (WARF) after investigating why so many cows were hemorrhaging after eating moldy sweet clover

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Andy Webb

@AJWPharm

1 year

As a resident, I loved the rabbit holes I was sent down trying answer to a question. I post many of them here, but I can't capture nuance in 280 characters Introducing Neu℞oWise - a place to share some deep dives and thoughts on pharmacotherapy in NCC!

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Andy Webb

@AJWPharm

2 years

Oh my GOD 🙌🙌🙌🙌

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Andy Webb

@AJWPharm

7 months

New CSVT Scientific Statement - LMWH officially preferred over heparin and official endorsement of DOACs!

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Andy Webb

@AJWPharm

2 years

This tweet serves as a reminder that sometimes, they really do just need the vanc to be q18

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Andy Webb

@AJWPharm

3 years

When the patient is on nimodipine, nicardipine, and amlodipine

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Andy Webb

@AJWPharm

4 years

Do you ever get over the feeling of overwhelming guilt when you're not constantly doing something productive asking for a friend

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Andy Webb

@AJWPharm

5 years

I am SO excited to announce my first publication finally hit press today! Learned a lot through this process (including...patience) and I'm thrilled to share our workflow for pharmacists to evaluate renal clearance/IBW in transgender patients.

Implications for medication dosing for transgender patients: A review of the literature and...

AbstractPurpose. Transgender patients face considerable healthcare disparities. Improved means of recognizing transgender patients and understanding their

academic.oup.com

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Andy Webb

@AJWPharm

3 years

Officially have more letters after my name than before Andrew Webb, PharmD, BCCCP Thanks to all the preceptors and mentors who got me here!

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Andy Webb

@AJWPharm

4 years

Guess I should join the party - this season I had to decide between two specialties I loved and knew I would grow so much in: crit care and ID. I ultimately landed right where I wanted. I'm so excited to announce I will be continuing on for a PGY2 in critical care @OHSUNews !

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Andy Webb

@AJWPharm

1 month

When you write "expect vanc trough to be 15 after dose adjustment" in your note and it comes back at 15.0

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Andy Webb

@AJWPharm

4 years

Does anyone else get oddly uncomfortable when you see the bottom half of someone's face for the first time after having met them wearing a mask or just me

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Andy Webb

@AJWPharm

7 months

*arrives at patient room out of breath* I heard there were intestinal cholesterol uptake transporters that were uninhibited and I got here as fast as I could!

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Andy Webb

@AJWPharm

8 months

Free VPA levels are unpredictable in the ICU, but an equation was just validated to estimate free VPA levels in ICU patients - the Fraser equation @CBthePHARMD To make it more user-friendly, I made an app and am hosting it on Neurxowise, check it out!

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Andy Webb

@AJWPharm

1 year

A key point in ACLS is that in shockable rhythms, the ⚡ is key to improving outcomes A knee-jerk reaction in a code is to give epi, but epi before shock in a shockable rhythm WORSENS outcomes ⚡once, then ⚡ again, THEN give epi

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Andy Webb

@AJWPharm

2 years

Another day, another patient on an oral onc drug I've never heard of

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Andy Webb

@AJWPharm

3 years

Ok maybe orgo is useless for everyday practice but how else would my team have appreciated my rounds-stopping med chem fun facts like how Onfi (clobazam) got its name because it's a ONe-FIve nitrogen substituted benzo rather than a 1,4 giving it higher GABA α-2 subunit affinity

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Andy Webb

@AJWPharm

1 year

@amyfaithho For someone who says they value pharmacists you really love dunking on pharmacists huh

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Andy Webb

@AJWPharm

4 years

Continuing my ampC adventures in the MICU Me: Hafnia is ampC Team: well it's not that virulent so continue Zosyn Hafina then now

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Andy Webb

@AJWPharm

4 years

I have an entire CE to put together this weekend so naturally my apartment is immaculate

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Andy Webb

@AJWPharm

4 years

Walked out of Mayo for the last time today; what a surreal experience While this year was... Unorthodox, I still experienced immense personal and professional growth and had a ton of fun doing it. I can't thank my preceptors and mentors enough for their guidance! On to PGY2!

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Andy Webb

@AJWPharm

2 years

@MeganARech @JACCPJournal @gmjones09 @beaverspharmd "working with difficult physician colleagues did not influence rate of burnout; however, working with difficult pharmacist colleagues increased the odds of burnout by 110%." We are truly our own worst enemy... Awesome, much needed article! Great work!

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Andy Webb

@AJWPharm

1 year

European Stroke Organization released an expedited recommendation for TNK: expert consensus recommends tenecteplase OVER alteplase given potential safety benefits and ease of administration! Highlights from committee meta analysis below 👇

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Andy Webb

@AJWPharm

1 year

Please no, we are all so tired

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Andy Webb

@AJWPharm

1 year

Fun pharmacy catch today - Patient had rapidly rising phos but normal Cr and normal Ca and had not received any phos repletion during stay (and RN confirmed lab drawn off A line) The culprit? The A-line had heparinized saline running which is buffered with sodium phos

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Andy Webb

@AJWPharm

2 years

Dropping everything for this

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Andy Webb

@AJWPharm

2 years

While not typically considered to contribute to seizures, high-dose chronic levodopa can lead to refractory pyridoxine deficiency seizures Levodopa needs B6 as a cofactor in its metabolism to dopamine, leading to depletion, ⬇️GABA production, and seizure

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Andy Webb

@AJWPharm

2 years

Always inspired by the grit and perseverance of providers who soldier through every duplicate order warning when they put in an entire 20-order order set twice

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Andy Webb

@AJWPharm

2 years

Every look at a vasopressor receptor affinity table and think... but why? Some minor structural differences between agents can greatly change how pressors interact with α and β receptors. (This doesn't work with dobutamine whose pesky (+) and (-) enantiomers act differently)

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Andy Webb

@AJWPharm

3 years

"They fevered through oral tylenol"

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Andy Webb

@AJWPharm

1 year

Putting through the 5th vanc/cefepime of the morning

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Andy Webb

@AJWPharm

2 years

The ANNEXA-4 statistician running the 37th post-hoc adjusted model of the trial data in a desperate attempt to squeeze every p<0.05 out of the trial data set

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Andy Webb

@AJWPharm

2 years

I'm giving a talk on manuscript writing for our residents in a few weeks - the last section is "quality of life" tips for making writing easier. Some are obvious (citation software, etc), but what are some QoL things you have discovered that improve your writing experience?

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Andy Webb

@AJWPharm

4 years

Finds interesting fact in review article Citation is another review article Review article cites textbook Textbook cites another textbook Older textbook has no citation

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Andy Webb

@AJWPharm

3 years

When the trough for the vanc you dosed isn't exactly in range

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Andy Webb

@AJWPharm

4 years

There's nothing quite like the feeling when a seasoned MICU attending is gearing up to teach the team something on rounds but then turns to you and says "correct me if I'm wrong"

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Andy Webb

@AJWPharm

4 years

Honored to have won this award and can't wait to continue my research career!

Critical Care Pharmacists

@CCPharmacists

4 years

Congratulations to these @SCCM CPP section award/scholarship winners!👏👏👏 ⭐️Distinguished Service Award - Joe Dasta ⭐️Congress Scholarship - @SESmithPharmD ⭐️Innovations in Patient and Medication Safety - Alexa Nardone ⭐️Young Pharmacist Investigator - @AJWPharm #PharmICU

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Andy Webb

@AJWPharm

4 years

VFib in the field: ⚡, 5 epis, amio AND lido. More ⚡⚡& epi in resus with no luck Esmolol 500mcg/kg bolus then infusion and they sail to ROSC and the cath lab Probably the mix of it all but this will forever be my "one time we used esmolol" story Ok ED is kinda cool

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Andy Webb

@AJWPharm

11 months

My favorite story of this myth in action was when vanc/cefepime was ordered for UTI - I called asking why they needed vanc & the response was to cover enterococcus When I suggested pip/tazo monotherapy, they pushed back, d/t concern for nephrotoxicity But they were ok with vanc

𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊

@PulmCrit

11 months

PIPERACILLIN-TAZOBACTAM IS NOT NEPHROTOXIC: exploring the arc of a myth over time this was clearly a myth in 2016: blog from 2022 exploring the evolution of this myth: fresh RCT to finally settle this:

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Andy Webb

@AJWPharm

28 days

We know IV push Keppra is safe, but status-sized loading doses remain unexplored vs piggyback I'm excited to share former PGY2 EM @MadisonKoons1 's work on IVP LEV loads (vs IVPB): - Faster time to admin - No incr in ADEs - Potential ⬇️ICU admits in SE!

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Andy Webb

@AJWPharm

2 years

Ahh precepting, a fulfilling experience of helping to develop the next generation of pharmacists made only sweeter by the requirement to fill out a 20 page, 47 item evaluation

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Andy Webb

@AJWPharm

2 years

The man himself #SCCM2023

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Andy Webb

@AJWPharm

3 years

Attending: "I think this patient needs some albumin" *Looks at me* "Sorry"

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Andy Webb

@AJWPharm

3 years

I finish residency in 19 days, and I just got an email that my password expires in 20 days

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Andy Webb

@AJWPharm

3 years

#BCCCP ✅

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Andy Webb

@AJWPharm

4 months

Oh my... The time has arrived! ANNEXA-I has been published Time to dig in...

Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage | NEJM

Patients with acute intracerebral hemorrhage who are receiving factor Xa inhibitors have a risk of hematoma expansion. The effect of andexanet alfa, an agent that reverses the effects of factor Xa ...

www.nejm.org

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Andy Webb

@AJWPharm

3 years

My Epic training just forced me to order clindamycin for pneumonia and I have never cringed so hard clicking sign and verify

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Andy Webb

@AJWPharm

2 years

If your patient with ESRD is bradycardic, please don't forget to check if atenolol is on their home med list They may have been in the hospital for a few days, but their last dose of atenolol is still along for the ride Oh, and if you see it - discontinue it

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Andy Webb

@AJWPharm

4 years

#OTILT is the saying "piss like a race horse" refers to horses being given a dose of furosemide prior to a race to reduce the risk of exercise induced pulmonary hemorrhage and improve race performance I'm not sure what to do with this information but there you go

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Andy Webb

@AJWPharm

5 months

Patience pays off - at long last, our final manuscript on bromocriptine for central fever has been published! We describe 30 pts where bromocriptine was used for central fever. It was modestly effective overall, although some patients (esp SAH patients) saw a dramatic response

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Andy Webb

@AJWPharm

3 years

Thrilled to see my PGY1 research in print today! TEG fans will be excited to see we found K time and a angle were significantly associated with hemorrhage expansion in patients with severe TBI Thanks to my team and mentors @Dre_pharmd @CBthePHARMD for helping this come to life!

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Andy Webb

@AJWPharm

3 years

I'm thinking we could use a "10 false beliefs of critical care pharmacotherapy" I'll start: resuming vanc in a decompensating patient without evidence of MRSA will not change the patient's outcome

Edgar V. Lerma 🇵🇭

@edgarvlermamd

3 years

The 10 False Beliefs in Adult Critical Care Nephrology #KidneyWk #Nephpearls

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Andy Webb

@AJWPharm

1 year

Time is brain shown once again 🧠 Delayed initiation of therapy in first time status epilepticus is associated with increased likelihood of recurrent unprovoked seizures in a large prospective registry Give that (full dose) benzo asap!

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Andy Webb

@AJWPharm

2 years

TRACE-2: Yet another win for TNK - if you haven't switched yet, why not?

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Andy Webb

@AJWPharm

4 years

This sentence is a first for me: "He was started on meropenem and nitrofurantoin."

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Andy Webb

@AJWPharm

2 years

Guidelines times! The presenters will report the results of their systematic reviews as the recommendations are undergoing vetting First up: Seizure prophylaxis

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Andy Webb

@AJWPharm

4 years

Do you ever have those days at work where despite all signs showing you're doing Just Fine and your team is grateful for your input but you just can't shake the feeling you're not doing well enough? Yea me too

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Andy Webb

@AJWPharm

3 years

When I round with the stroke team and we enter the room to examine the patient, I'm no help with the neuro exam so I give myself another job - open the blinds and update the date/day of the week on the whiteboard if it hasn't already been done No delirium on my watch ☀️

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Andy Webb

@AJWPharm

5 months

Well this is neat! Honored to have my @SCCM_CPP presentation at @SCCM 2024 selected as one of the Best of SCCM Congress

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Andy Webb

@AJWPharm

2 years

Every damn day

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Andy Webb

@AJWPharm

5 years

The past few weeks I saw lots of pictures of poster presentations which means I also saw lots of pictures of pie charts. Thought I'd throw together a little data viz 101 on how pie charts are usually a poorly efficient way visualize your data

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Andy Webb

@AJWPharm

4 months

I'll do a brief thread on my thoughts, mostly because much of what is reported is not new and others have shared similar thoughts ANNEXA-I randomized mostly sICH patients w GCS >7 w/i 15 h of last DOAC to AA vs usual care. Here is the treatment algo, from the protocol:

Andy Webb

@AJWPharm

4 months

Oh my... The time has arrived! ANNEXA-I has been published Time to dig in...

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Andy Webb

@AJWPharm

3 years

This is a PSA to please use the Page Break function in Word so you don't have to hammer the enter key to get things to a new page and ruin my beautiful formatting thank you for coming to my TED talk

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Andy Webb

@AJWPharm

5 years

*Team trying to figure out why a patient's wound keeps getting infected* Me: "Does he have any pets?" Team: "I have no idea" Patient: "Oh yea, I let my dogs lick my wounds all the time" Pharmacists: good for more than just drugs

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Andy Webb

@AJWPharm

4 years

Ok this might be insane for a resident but there's a real chance I might adopt this absolute nugget of a pupper

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Andy Webb

@AJWPharm

3 years

Evaluating your own CE to claim CE credit

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Andy Webb

@AJWPharm

3 years

ICU admission order sets really be like "Welcome to the ICU! Here's 3 laxatives"

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Andy Webb

@AJWPharm

1 year

I think we're safe for now

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Andy Webb

@AJWPharm

5 years

@AliRaja_MD Tacrolimus was named after the area in Japan it was discovered, Tsukuba Tsukuba mACROlide IMmUnoSuppresant

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Andy Webb

@AJWPharm

2 years

I am mostly only good for antibiotic dosing and med chem fun facts

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Andy Webb

@AJWPharm

1 month

Can droxidopa help patients get off pressors? As a norepi prodrug, it may have an edge over our traditional agent of choice, midodrine. In our new multicenter study, we our experience adding droxidopa in 30 persistently hypotensive patients on pressors

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Andy Webb

@AJWPharm

5 years

Excited to present my quality improvement project on shortening the duration of antibiotic prophylaxis after neurosurgical drain placement at @VizientInc ! Poster 240A - come by! #ASHP19

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Andy Webb

@AJWPharm

2 years

There are dozens of antibiotics out there to treat infections But few are quite as time-tested and reliable as vancomycin Here are 11 reasons why you might as well just go ahead and start your patient on vancomycin 👇

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Andy Webb

@AJWPharm

4 years

Honored that my first published article has made it on to the @AJHPOfficial Top 25 Articles of 2020! Important area of research deserving of more attention.

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Andy Webb

@AJWPharm

1 year

When the handoff is to watch the renal function closely

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Andy Webb

@AJWPharm

4 years

Buying a bag of chocolate chips: This will be great when I get the inspiration to bake Owning a bag of chocolate chip: This is a suitable replacement for all three meals and applicable snacks

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Andy Webb

@AJWPharm

3 years

Young patient started on vanc and 2-point PK shows calculated peak of ~120 & trough of ~4 w/ T1/2 of 1.5h and Vd of ~8L. Seems wrong. Repeat levels and same result. Change to continuous infusion of 3.5g/24h (145mg/h / Vd of 8L = Cpss of ~18 mg/L) First level on CI? 17.4

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Andy Webb

@AJWPharm

4 years

Call me extra but I'm pretty sure if a collect a few more I unlock the Infinity Patagonia and white coats will be banished forever

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Andy Webb

@AJWPharm

3 years

Taught my team about CysC today - CrCl >120 mL/min but vanc >20 with 15mg/kg q12? Cystatin C tells a different story. The attending's reaction - "why don't we use this more??" Thanks to @erin_barreto and co for teaching me there's more to renal function than just creatinine

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Andy Webb

@AJWPharm

2 years

See you all in San Francisco! @SCCM_CPP @SCCM_Neuro

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Andy Webb

@AJWPharm

5 years

The inventor of the selegiline patch named the product after his two kids Emily and Sam - Emsam!

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Andy Webb

@AJWPharm

4 years

Residency program Twitter accounts are all the rage these days - read about @JasonMordino , @DanielleTBurton , @garrett_schramm , and my strategy for success for running a successful account!

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