Target Audience:

Who should attend:

• Clinical faculty from the University of Pittsburgh School of Pharmacy
• Clinical staff pharmacists employed by the University of Pittsburgh Medical Center and deployed throughout the hospital campus in unit based roles and centrally in the department of pharmacy's main pharmacy
• Student pharmacy interns currently working within the department of pharmacy
• Certified Pharmacy Technicians

Abstract:
Droperidol is a first-generation antipsychotic that was commonly used in emergency departments for acute agitation. In 2001 the FDA issued a boxed warning for the risk of prolonged QTc and torsades de pointes. This resulted in a significant decline in the use of droperidol and it became widely unavailable in the United States. In recent years droperidol has returned, leaving many clinicians wondering whether it may be safely administered. In this presentation we will discuss the safety of droperidol for acute agitation in the emergency department.

Educational Objectives:

Upon successful completion of this continuing pharmacy education program, the participant should be able to:

• Identify pharmacologic options for management of acute agitation in the ED.
• Describe the safety concerns for the use of droperidol for acute agitation.
• Discuss available evidence for the use of droperidol in the ED.

Pharmacy Continuing Education Credits In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Pharmacy (ACPE): This knowledge-based activity provides 1.0 contact hours of continuing pharmacy education credit. The assigned universal program number(s) is JA4008223-0000-23-093-H04-P. Other Healthcare Professionals Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Suggested Additional Reading:

1. Catlette M. A descriptive study of the perceptions of workplace violence and safety strategies of nurses working in level I trauma centers. J Emerg Nurs. 2005 Dec;31(6):519-25. Calver L, Page CB, Downes MA. The Safety and Effectiveness of Droperidol for Sedation of Acute Behavioral Disturbance in the Emergency Department. Ann Emerg Med. 2015 Sep;66(3):230-238.e1.
2. Chan EW, Taylor DM, Knott JC. Intravenous droperidol or olanzapine as an adjunct to midazolam for the acutely agitated patient: a multicenter, randomized, double-blind, placebo-controlled clinical trial. Ann Emerg Med. 2013 Jan;61(1):72-81.
3. Droperidol [package insert]. Shirley, NY: American Regent, Inc.; 2019.
4. Horowitz BZ, Bizovi K, Moreno R. Droperidol-Behind the Black Box Warning. Academic Emergency Medicine. 2002;9(6):615–8.
5. Isbister GK, Calver LA, Page CB. Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Ann Emerg Med. 2010 Oct;56(4):392-401.
6. Knott JC, Taylor DM, Castle DJ. Randomized clinical trial comparing intravenous midazolam and droperidol for sedation of the acutely agitated patient in the emergency department. Ann Emerg Med. 2006 Jan;47(1):61-7.
7. Martel ML, Driver BE, Miner JR, Biros MH, Cole JB. Randomized Double‐blind Trial of Intramuscular Droperidol, Ziprasidone, and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. Academic Emergency Medicine. 2020;28(4):421–34.
8. Pich J, Hazelton M, Sundin D, Kable A. Patient-related violence against emergency department nurses. Nurs Health Sci. 2010 Jun;12(2):268-74.
9. Taylor DM, Yap CY, Knott JC, Taylor SE, Phillips GA, Karro J, et al. Midazolam-Droperidol, Droperidol, or Olanzapine for Acute Agitation: A Randomized Clinical Trial. Annals of Emergency Medicine. 2017;69(3).
10. Wilson M, Pepper D, Currier G, Holloman G, Feifel D. The Psychopharmacology of Agitation: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Psychopharmacology Workgroup. Western Journal of Emergency Medicine. 2012;13(1):26–34.
11. Ziaei M, Massoudifar A, Rajabpour-Sanati A. Management of Violence and Aggression in Emergency Environment; a Narrative Review of 200 Related Articles. Adv J Emerg Med. 2018 Nov 29;3(1):e7.