YAFI Online Programming // Disease State Management and Drug Therapy
UConn Update #1
SARS-CoV-2 and COVID-19
After participating in this activity, pharmacists will be able to:
- Describe emerging information about the COVID-19 pandemic
- Use this information to answer patients’ questions
Release Date: March 28, 2020
Expiration Date: December 31, 2021
$3 for pharmacists
$3 for technicians
20YC38-FTC42 Pharmacy Technician
1.0 hours of CE
UConn faculty assembled this homestudy in response for a high demand to reliable education on coronavirus. It answers questions proposed by our learners.
|The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.|
Pharmacists and pharmacy technicians are eligible to participate in this application-based activity and will receive up to 0.2 CEU (2 contact hours) for completing the activity, passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor on- line system and your participation will be recorded with CPE Monitor within 72 hours of submission
Grant funding: None
Cost: $3 for pharmacists $3 for technicians
Initial Release Date: March 28, 2020
Expiration Date: December 31, 2021
To obtain CPE credit, visit the UConn Online CE Center
Use your NABP E-profile ID and the session code 20YC38-WXF49 for pharmacists or 20YC38-FTC42 for pharmacy technicians to access the online quiz and evaluation.
First- time users must pre-register in the Online CE Center. Test results will be displayed immediately and your participation will be recorded with CPE Monitor within 72 hours of completing the requirements.
For questions concerning the online CPE activities, email firstname.lastname@example.org
Jeffrey R. Aeschlimann, Pharm.D. Is an Associate Professor, UConn School of Pharmacy, Adjunct Associate Professor, UConn School of Medicine, UConn Health, Division of Infectious Diseases.
Kelsey Giara, Pharm.D. is a community pharmacist and freelance medical writer based in New Hampshire.
C. Michael White, Pharm.D., FCP, FCCP; Professor and Chair, Pharmacy Practice, UConn School of Pharmacy, Storrs, CT and Director, HOPES Collaborative Group, University of Connecticut and Hartford Hospital, Hartford, CT.
All faculty have no actual or potential conflicts of interest associated with this article.
Disclosure of Discussions of Off-label and Investigational Drug Use
This activity may contain discussion of off label/unapproved use of drugs. The content and views presented in this educational program are those of the faculty and do not necessarily represent those of the University of Connecticut School of Pharmacy. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
This is an update to the University of Connecticut School of Pharmacy’s continuing education (CE) activity on coronavirus. Interested individuals can find the original activity here: https://pharmacy.uconn.edu/wpcontent/uploads/sites/2740/2020/03/CORONAVIRUS-MAR2020-FINAL.pdf. Please feel free to share it with others.
As the SARS-CoV-2 virus spreads and the number of infections with and deaths from this virus grows, new questions emerge daily. Many pharmacists and pharmacy technicians who took the CE activity mentioned above have sent additional questions and asked for periodic updates. This update answers five of the questions we hear most often. We hope that it will provide the information you need to educate patients and answer questions.
We are aware that misinformation flourishes at a time like this. We believe something we read on a tee shirt today: Science doesn’t care what you think. We hope you believe this too–that science is about facts, not beliefs–and will find value in the evidence we present below.
Full List of References
1. The International Pharmaceutical Federation. CORONAVIRUSSARSCoV-2/COVID-19 PANDEMIC: Information and Interim Guidelines for Pharmacists and the Pharmacy Workforce. Available at https://www.fip.org/files/content/priorityareas/coronavirus/Coronavirus-guidance-updateENGLISH.pdf?fbclid=IwAR3bnHU2CpiQyCBogDTU_- AqACl_Lu2HKJ9iPVMSl7D7TlNJ0GTNzeBRjbA. Accessed March 26, 2020.
2. [No author.] WHO clarifies guidance on ibuprofen, says there's no evidence it can worsen COVID-19. Available at https://www.cbc.ca/news/health/ibuprofen-covid-19-novelcoronavirus-1.5501496. Accessed March 26, 2020.
3. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020 Mar 11. pii: S2213-2600(20)30116-8. doi: 10.1016/S2213-2600(20)30116-8. [Epub ahead of print]
4. Acetaminophen. MedlinePlus. U.S. National Library of Medicine. Available at https://www.nlm.nih.gov/medlineplus/druginfo/meds/a681004.html. Accessed March 26, 2020.
5. U.S. Food and Drug Administration. FDA warns of rare acetaminophen risk. August 1, 2013. Available at http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm363010.h tm. Accessed March 26, 2020.
6. Centers for Disease Control and Prevention. Pregnancy & breastfeeding. Available at https://www.cdc.gov/coronavirus/2019- ncov/prepare/pregnancy-breastfeeding.html. Accessed March 26, 2020.
7. Miller K. 9 Resources for women preparing to give birth during the coronavirus outbreak. Available at https://www.whattoexpect.com/news/pregnancy/giving-birthcoronavirus-resources/. Accessed March 26, 2020.
8. Dong L, Tian J, He S. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. March 26, 2020. Available at https://jamanetwork.com/journals/jama/fullarticle/2763853?guestAcc essKey=21538ef3-f864-42db-8fd8- 47c4c89245df&utm_source=silverchair&utm_medium=email&utm_ca mpaign=article_alert-jama&utm_content=olf&utm_term=032620. Accessed March 27, 2020.
9. Bian B, Kelton CM, Guo JJ, Wigle PR. ACE Inhibitor and ARB utilization and expenditures in the Medicaid fee-for-service program from 1991 to 2008. J Manag Care Pharm. 2010;16(9):671-9.
10. Sommerstin R, Grani C. Rapid Response: Re: Preventing a covid-19 pandemic: ACE inhibitors as a potential risk factor for fatal Covid-19. Available at https://www.bmj.com/content/368/bmj.m810/rr-2. Accessed March 26, 2020.
11. Coronavirus and ACE inhibitors: Do not stop taking your blood pressure medication. Available at https://theskepticalcardiologist.com/2020/03/14/coronavirus-and-aceinhibitors-do-not-stop-taking-your-blood-pressure-medication/. Accessed March 26, 2020.
12. Council on Hypertension of the European Society of Cardiology. GPs should continue with ACE inhibitors and ARBs. Available at http://www.pulsetoday.co.uk/clinical/clinicalspecialties/cardiovascular/gps-should-continue-with-ace-inhibitorsand-arbs/20040353.article). Accessed March 26, 2020.
13. Baker WL, Coleman CI, Kluger J, et al. Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers for ischemic heart disease. Ann Intern Med. 2009;151(12):861-871.
14. White CM. Comparative effectiveness of renin-angiotensin system inhibitors in hypertension. J Comp Eff Res. 2012;1(2):125-7. doi: 10.2217/cer.12.2.
15. Piccoli GB, Anania P, Biancone L, et al. Hypertensive rebound after angiotensin converting enzyme inhibitor withdrawal in diabetic patients with chronic renal failure. Nephrol Dial Transplant. 2001;16(5):1084-1085.
16. Walther CP, Richardson P, Winkelmayer WC, et al. ACEi/ARB discontinuation and adverse outcomes in CKD. Presented during a November 7, 2019 oral session at the American Society of Nephrology's 2019 Kidney Week conference in Washington, DC. Abstract TH-OR057.
17. White CM. Angiotensin-converting-enzyme inhibition in heart failure or after myocardial infarction. Am J Health Syst Pharm. 2000;57 Suppl 1:S18-S25.
18. Gilstrap LG, Fonarow GC, Desai AS, et al. Initiation, continuation, or withdrawal of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and outcomes in patients hospitalized with heart failure with reduced ejection fraction. J Am Heart Assoc. 2017;6(2). pii: e004675. doi: 10.1161/JAHA.116.004675.
19. Song JC, White CM. Clinical pharmacokinetics and selective pharmacodynamics of new angiotensin converting enzyme inhibitors: an update. Clin Pharmacokinet. 2002;41(3):207-224.
20. Gurwitz D. Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics. Drug Dev Res. 2020 Mar 4. doi: 10.1002/ddr.21656. [Epub ahead of print]
21. Zisman LS. ACE and ACE2: a tale of two enzymes. Eur Heart J. 2005;26(4):322-324.
22. American College of Cardiology. COVID-19 clinical guidance for the cardiovascular care team. ACC Clin Bull. Available at https://www.acc.org/~/media/665AFA1E710B4B3293138D14BE8D121 3.pdf. Accessed March 26, 2020.
23. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 Feb 7. doi: 10.1001/jama.2020.1585. [Epub ahead of print]
24. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020 Mar 5. doi: 10.1038/s41569-020-0360-5. [Epub ahead of print]
25. Kuba K, Imai Y, Rao S, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med. 2005;11(8):875-879.
26. Itoyama S, Keicho N, Quy T, et al. ACE1 polymorphism and progression of SARS. Biochem Biophys Res Commun. 2004;323(3):1124-1129.
27. Liu Y, Huang F, Xu J, et al. Anti-hypertensive angiotensin II receptor blockers associated to mitigation of disease severity in elderly COVID19 patients. March 27, 2020. Available at https://www.medrxiv.org/content/10.1101/2020.03.20.20039586v1. Accessed March 27, 2020.
28. Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Bioscience Trends. Available at https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_2020.01047 /_pdf/-char/en. Accessed March 27, 2020.
29. Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. 2020 Mar 10. pii: S0883-9441(20)30390-7. doi: 10.1016/j.jcrc.2020.03.005. [Epub ahead of print]
30. Gautret P, Lagier JC, Parola P, et al. Hydroxyquine and azithromycin as a treatment for COVID-19: results of an open label non-randomized trial. Int J Antimicrob Agents. March 20, 2020. Avaiable at https://pubpeer.com/publications/E09AC9D25125B0AB077971FBA6DD 7B. Accessed March 27, 2020.
31. ChenJ, Liu D, Liu L, et al. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID19). Available at http://www.zjujournals.com/med/article/2020/1008- 9292/20200108.shtml. Accessed March 27, 2020.
32 Boulware D. Available at https://twitter.com/boulware_dr. Accessed March 27, 2020.
33. Clinicaltrials.gov. Corona virus + hydroxychloroquine. Available at https://clinicaltrials.gov/ct2/results?cond=Corona+Virus+Infection&ter m=hydroxychloroquine&cntry=&state=&city=&dist=. Accessed March 26, 2020.
34. Center for Infectious Disease Research and Policy. US agents seize shipments of fake Tamiflu. Available at http://www.cidrap.umn.edu/news-perspective/2005/12/us-agentsseize-shipments-fake-tamiflu. Accessed March 26, 2020.
35. MPR. FDA warns of counterfeit Tamiflu products. June 18, 2010. Available at https://www.empr.com/uncategorized/fda-warns-ofcounterfeit-tamiflu-product/. Accessed March 26, 2020.
36. National Associations of Boards of Pharmacy. Internet drug outlet identification program: progress report for state and federal regulators. August 2017. Available at: https://nabp.pharmacy/wpcontent/uploads/2016/08/Internet-Drug-Outlet-Report-August2017.pdf. Accessed March 26, 2020.
37. Mackey TK, Liang BA. The global counterfeit drug trade: patient safety and public health risks. J Pharm Sci 2011;100:4571-4579. doi 10.1002/jps.22679.
38. Waldrop T, Alsup D, McLaughlin ED. Fearing coronavirus, Arizona man dies after taking a form of chloroquine used to treat aquariums. CNN Health. Available at https://www.cnn.com/2020/03/23/health/arizona-coronaviruschloroquine-death/index.html. Accessed March 27, 2020.