Pharm & Cheese: A Case of Intractable Emesis

May 10, 2026

We start this Wednesday’s Pharm and Cheese off with something unappetizing: emesis. You’re rounding on Red Team and meet a patient with a history of cholangiocarcinoma on chemotherapy who isn’t tolerating PO pending a CT scan. He has normal vitals and a benign exam, but he tells you that for the past two weeks he’s had intractable emesis, even when not eating or drinking. He initially thought it was just from chemo, but his last round was 3 weeks ago and he hasn’t improved.

Samson Frendo MD and Eric Leser MD

Figure 1. Action potential with QT prolongation

Pharm & Cheese: Antipsychotic Selection and Risk of QTc Prolongation

April 22, 2026

Hey Doc, Mr. Jones in R4 is starting to sundown and keeps trying to get out of bed, do you have anything to sedate him? You look into R4 and Mr. Jones is pulling off his pulse ox and yelling at the tech, he definitely needs something to calm him down. However, Mr. Jones is 83 and is being admitted for CHF exacerbation on 5L NC, you also remember his ECG looking funny so you pull it up again. Oh yeah, he has a QTc of 509…that makes sedating him a bit more difficult. You think through your go-to list of medications…he is already on oxygen and hypoxic so you want to be careful about causing too much CNS depression with benzos, and his QTc is long so can you safely give him an antipsychotic? You vaguely remember that haldol seemed to be safe-ish, but haven’t we all heard a horror story of someone going into torsades? Are there any other options?

Taylor Wahrenbrock MD, Joanne Rutsolias PharmD, & Eric Leser MD

Pharm & Cheese: How to Give Medications "Sick Days Off"

January 31, 2026

In time for the season! Have you ever wondered about how acute illness impacts chronic medication usage? What do we tell our "sick" patients upon discharge?

Joanne Routsolias PharmD

the County Consult