Mind Your MedsThe Neuro Pharm

Neurology · Neurocritical Care Pharmacy

Welcome to the Neuro Pharm.

Mind Your Meds is a working clinical reference for neurocritical care — structured drug cards, time-critical management pathways, and guideline distillations — built alongside original research in reversal, resuscitation, and seizure management.

PharmD, BCCCP Neurocritical Care 3 First-Author Studies Clinical Educator
Explore the drug library → See the research
01Drug LibraryAEDs, ICH reversal, drips & more 02Management PathwaysStatus epilepticus, ICH, MG crisis, migraine 03ResearchReversal, vasopressor timing, AED dosing 04PresentationsTalks, teaching & conference work

01 — Reference

Clinical Drug Library

Structured, scannable cards for the agents that matter at the bedside. Filter by category or search by drug. Open any card for mechanism, neuro-specific dosing, monitoring, and pearls.

02 — Disease States

Management Pathways

Time-critical, stepwise approaches to the core neurocritical care emergencies. Sequence carries clinical meaning here — each step maps to a decision point in escalation.

Emergency Status Epilepticus

1
0–5 min · Stabilization

ABCs, glucose, IV access, start the clock

Airway, oxygen, hemodynamics. Point-of-care glucose (dextrose + thiamine if low), labs and AED levels. Document seizure onset time — it drives every subsequent decision.

2
5–20 min · First line

Benzodiazepine at an adequate dose

IV lorazepam, IM midazolam, or IV diazepam. Under-dosing is the most common error — give a full weight-based dose before declaring failure.

3
20–40 min · Second line

IV antiseizure agent at a therapeutic load

Levetiracetam 60 mg/kg, fosphenytoin 20 mg PE/kg, or valproate 40 mg/kg — ESETT found roughly equivalent efficacy. Choose by patient factors; dose to the full target.

4
40+ min · Refractory

Continuous infusion + cEEG

Anesthetic infusion (midazolam, propofol, or pentobarbital) titrated to seizure suppression or burst-suppression on continuous EEG, with the airway secured.

Emergency Intracranial Hemorrhage & Anticoagulant Reversal

1
Immediate

Identify the anticoagulant and last dose

Reversal is agent-specific, so this determines everything downstream. Establish drug, dose, timing, and renal function before selecting a strategy.

2
Immediate

Blood pressure control

Titratable IV agent (nicardipine, clevidipine) to a guideline-directed target. Avoid large, abrupt drops; aim for smooth, sustained control.

3
Immediate

Reversal agent selection

4F-PCC + vitamin K for warfarin; idarucizumab for dabigatran; andexanet alfa (Class IIa) or 4F-PCC (Class IIb) for factor Xa inhibitors per 2022 AHA/ASA.

4
Ongoing

ICP management & stable imaging

Hyperosmolar therapy, head-of-bed elevation, neurosurgical consultation. Repeat CT to document hemorrhage stability — the gateway to reassessing anticoagulation.

5
Days 1–7

Reassess anticoagulation reinitiation

Once bleeding is stable, weigh thrombotic risk against rebleeding. Prolonged interruption carries its own hazard — see the reversal study below.

Emergency Myasthenic Crisis

1
Immediate

Respiratory monitoring

Serial NIF and vital capacity; low threshold for ICU and airway support. Avoid medications known to worsen neuromuscular transmission.

2
Acute

Rapid immunotherapy

IVIG or plasma exchange as first-line crisis therapy, with corticosteroids (watch for early transient worsening).

3
Ongoing

Trigger identification & symptomatic care

Identify and treat precipitants (infection, offending drugs). Symptomatic pyridostigmine as tolerated; manage secretions.

Ambulatory Migraine

1
Acute

Abortive therapy

NSAIDs/acetaminophen for mild attacks; triptans as first-line migraine-specific therapy; gepants or ditans and antiemetic adjuncts where triptans are contraindicated or ineffective.

2
Preventive

When to prevent

Consider prophylaxis with frequent or disabling attacks. Options include CGRP monoclonal antibodies, topiramate, and beta-blockers — matched to comorbidities.

3
Refractory

Status migrainosus

For prolonged, refractory attacks: IV approaches (DHE protocols, antiemetics, hydration) and specialist referral.

03 — Evidence

Guideline Distillations

The society guidelines behind each pathway, curated and summarized. We'll confirm the current edition of each and add your annotations.

Evaluation & Management of Status Epilepticus

Neurocritical Care Society

Definitions, treatment timeline, and refractory escalation. Source of the loading-dose targets used in the AED study.

Spontaneous Intracerebral Hemorrhage

AHA / ASA · 2022

Blood pressure targets and reversal class recommendations — andexanet alfa IIa, 4F-PCC IIb for Xa inhibitors.

Surviving Sepsis Campaign

SCCM / ESICM · 2021

Norepinephrine first-line; vasopressin as preferred adjunct, suggested at 0.25–0.5 mcg/kg/min.

Corticosteroids in Sepsis, ARDS & CAP

SCCM Focused Update · 2024

Revised corticosteroid recommendations — a documented confounder in the vasopressin timing analysis.

Myasthenia Gravis Management

International Consensus

Crisis therapy, chronic immunotherapy, and drugs to avoid.

Analgesia & Sedation in the ICU

SCCM (PADIS)

Sedation targets, agent selection, and light-sedation strategies.

04 — Original Research

Research

Three investigations across anticoagulation reversal, vasopressor sequencing, and guideline-concordant seizure management. Select any study for full background, methods, results, and clinical implications.

Manuscript First Author Multicenter · Retrospective

Evaluation of Thrombotic Outcomes Following Reversal of Direct Oral Anticoagulant-Associated Intracranial Hemorrhage

Abdallah Ali Salman, PharmD, BCCCP; Jonathan Kline, PharmD, BCCCP; Heidi Clarke, PharmD, BCCCP

10.0% vs 7.3%
Thrombotic events — andexanet alfa vs 4F-PCC (p=0.71)
8.3 vs 14.3 h
Time to stable brain CT — significantly faster with andexanet (p=0.03)
3.7 vs 6.8 d
Time to anticoagulation reinitiation (p=0.04)
81
Patients across seven acute care sites, 2019–2025
Read full study
Manuscript + Presentation First Author Retrospective Cohort

Impact of Norepinephrine Dose at Time of Vasopressin Initiation on Clinical Outcomes of Septic Shock

Abdallah Ali Salman, PharmD, BCCCP; Mahalia Sanon, PharmD, BCPS; Christian Gonzalez-Hernandez, PharmD, BCPS; Stanley Linder, DO

43.6% vs 48.9%
28-day mortality — early vs late vasopressin (p=0.21)
40.0% vs 49.4%
Renal replacement therapy requirement (p=0.10)
38.1% vs 47.3%
Need for additional vasopressors (p=0.09)
245
Patients included from 983 screened, 2019–2023
Read full study
Poster Co-First Author Quality Improvement

Retrospective Analysis of Antiepileptic Drug Loading Doses in Status Epilepticus

Katherine Fernandez, PharmD*; Abdallah Salman, PharmD, BCCCP*; Allison Vargas, PharmD, BCPS, BCCCP; Payal Patel, PharmD, BCCCP; Jonathan Kline, PharmD, BCCCP
*These authors contributed equally.

19.2%
Of patients received a therapeutic AED loading dose
94 min
Mean time from status epilepticus onset to AED administration
2.4 mg
Mean lorazepam dose given before AED loading
50%
Therapeutic loading dose rate after pharmacist intervention
Read full study

05 — Teaching

Presentations & Talks

Conference presentations, grand rounds, and educational lectures. Send the remaining decks and I'll clean them up for a consistent look and publish them here.

Conference

Vasopressin Timing in Septic Shock

Society of Critical Care Medicine

Full presentation of the norepinephrine-dose-at-initiation cohort, including landmark trial context (VASST, VANISH) and the corticosteroid confounder analysis.

Poster

AED Loading Doses in Status Epilepticus

Quality improvement poster

Retrospective evaluation of guideline concordance in AED loading, with pharmacist intervention as a driver of therapeutic dosing.

Slides

Presentation title

Venue · Year

Upload your next deck — I'll refine the design and add it with a summary.

06 — Profile

About

Abdallah Ali Salman, PharmD, BCCCP — a neurology and neurocritical care pharmacist focused on the pharmacologic management of time-critical neurologic and critical illness.

My work sits where deep drug knowledge meets the bedside decision: selecting and timing anticoagulant reversal in intracranial hemorrhage, sequencing vasopressors in shock, and closing the gap between guideline-recommended antiseizure dosing and what patients actually receive.

That last theme runs through all three of my studies. Each began as a question about whether real-world practice matches the evidence — and each produced findings that changed how I teach and how our teams practice. Translating evidence into practice is the throughline of my work.

I'm particularly interested in Medical Science Liaison roles, where scientific depth, clinical fluency, and the ability to communicate complex evidence to diverse audiences converge. If you're building an MSL team in neurology, critical care, or hematology, I'd welcome a conversation.

Abdallah Ali Salman, PharmD, BCCCP
Abdallah Ali Salman, PharmD, BCCCP
Neurology & Neurocritical Care Pharmacist

At a Glance

CredentialsPharmD, BCCCP
SpecialtyNeuro / Neurocritical Care
Research areasDOAC reversal · Vasopressors · SE
Original studies3 (all first / co-first)
InterestsMSL · Medical Affairs · Education
LocationMiami, FL
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