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Archive for April, 2020

What Are We Doing to Fight COVID-19? By Our Student Pharmacist, Ryan Peterson.

We are currently living in times of great uncertainty and the ideal approach to treating COVID-19 has been hotly debated. Although several therapies have been touted in the media, none have been proven effective.  The decision to use a drug is based principally on observational and anecdotal reports or extrapolated from indirect evidence. Most patients who test positive can be treated at home with rest and management of symptoms. Several experimental therapies have been tried on patients with moderate or severe disease.

Below, I will outline several of the drugs that appear to be the most promising.

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Remdesivir.  Remdesivir is a recently developed antiviral medication. Administered by injection, remdesivir prevents the virus from replicating.It has shown to be effective in treating viruses similar to COVID-19 including SARS and Middle East Respiratory Syndrome (MERS-COV). Remdesivir appears to prevent  COVID-19 from replicating in a laboratory setting. However, the activity of remdesivir against COVID-19 in sick patients has yet to be determined.2 Several small case studies show promise of remdesivir as an agent against COVID-19.3,4  The cases studies are limited in that they cannot compare remdesivir to no treatment or other possible treatments. Multiple larger randomized trials are currently underway to determine if remdesivir can be used as an agent against COVID-19.

What is the risk of using remdesivir before its effects are proven? Remdesivir can cause nausea, vomiting, liver and kidney damage, and potentially organ failure. In patients with kidney disease, remdesivir can build up in the body causing the side effects to last longer than normal.1

Hydroxychloroquine/chloroquine. Much speculation exists about whether hydroxychloroquine and chloroquine, either alone or in combination with azithromycin, may help treat patients with COVID-19. Please refer to my previous post (see “What is up with hydroxychloroquine?“)  where I discussed hydroxychloroquine in detail. Currently, there is not enough data to say if hydroxychloroquine or chloroquine has a role in treatment of COVID-19.2 The most recent research(published mid April 2020) indicates that hydroxychloroquine, either alone or with azithromycin, does not reduce the severity of the disease. In fact, patients who were given hydroxychloroquine were more than twice as likely to die and more likely to require a mechanical ventilator to breathe compared to those who did not receive  hydroxychloroquine.

Convalescent plasma. Researchers are investigating convalescent plasma as a potential therapy in patients with severe or life-threatening COVID-19. After a person recovers from COVID-19 they have antibodies to the disease in their blood. Within their blood, the plasma, a golden fluid that contains nutrients, can be separated from the red blood cells. There is hope that convalescent plasma can be given to people with severe COVID-19 to provide them with the antibodies needed to fight the virus and increase their chances of recovery.6

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The Food and Drug Administration (FDA) has recently expanded access and approved convalescent plasma for emergency individual use.7 Several patients in case studies showed substantial improvement after they were administered convalescent plasma. This, however, does not establish a causal effect, and whether plasma is useful in therapy remains largely unknown. Additionally, hospitals face logistical challenges finding appropriate donors and establishing testing to confirm the antibodies in the plasma have activity against COVID-19. 2,6

Tocilizumab. Tocilizumab inhibits the activity of Interleukin 6, a protein that affects the body’s response to infection and inflammation. Tocilizumab is approved by the FDA to treat rheumatoid arthritis and cytokine release syndrome.8  The basis for the use of tocilizumab to combat COVID-19 stems from reports of elevated Interleukin levels in patients with severe COVID-19. As with the other potential therapies, several cases indicate the positive impact of tocilizumab, but its place in therapy is still uncertain. Other Interleukin 6 inhibitors such as sarilumab and siltuximab, are also being evaluated in clinical trials.2

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  • LexiDrugs. Hydroxychloroquine. Updated March 2020. Accessed on 21 April 2020
  • Coronavirus disease 2019 (COVID-19). Updated April 2020. Available at Uptodate.com. Accessedon 21 April 2020
  • Lescure, F.X. et al. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. doi: https://doi.org/10.1016/S1473-3099(20)30200-0•
  • Grein, J. et al. Compassionate Use of Remdesivir for Patients with Severe Covid-19.N Engl J Med.doi: 10.1056/NEJMoa2007016
  • Magagnoli, J. et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. (In Press) medRxiv preprint. April 2020.doi: https://doi.org/10.1101/2020.04.16.20065920
  • Mayo Clinic. Convalescent plasma: Possible treatment for COVID-19? 2020. Available at: https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/convalescent-plasma/faq-20484383. Accessed on 21 April 2020.
  • US Food and Drug Administration. Recommendations for Investigational COVID-19 Convalescent Plasma. Available at: https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/recommendations-investigational-covid-19-convalescent-plasma. Accessed on 21 April 2020.
  • LexiDrugs. Tocilizumab. Updated March 2020. Accessed on 21 April 2020.
  • Michot, J.M. et al. Tocilizumab, an anti-IL6 receptor antibody, to treat Covid-19-related respiratory failure: a case report. Ann Onco 2020. doi: 10.1016/j.annonc.2020.03.300.

Taking Care of Your Emotional Health During COVID-19. By Our Student Pharmacist, Alison Samsel.

It is very normal to feel overwhelmed, anxious, stressed, and grief during a global outbreak. Everyone has different reactions to stress and even your own feelings can change throughout this time.


Ways to cope with stress:

  • Take care of your body.
  • Connect with others.
    • Maintain relationships with friends and family. Virtually have get togethers or game nights with Skype or Google hangouts.
    • Let your loved ones know how you are feeling.
    • Email or send cards if phone or video chats are not available.
  • Take breaks.
    • Make time to unwind.
    • Try meditation. Use apps like Calm and Headspace which offer free meditations.
    • Try to do activities you usually enjoy and explore new hobbies.
  • Stay informed.
    • Watch, listen to, or read the news for updates from officials.
    • Be aware that there may be rumors during a crisis, especially on social media.
    • Get information from a trusted source: coronavirus.ohio.gov
  • Avoid too much exposure to news.
  • Continue seeking treatment for ongoing health needs and continue treatment regimens.
  • Seek help when needed.
    • If distress impacts activities of your daily life for several days or weeks, talk to a clergy member, counselor, or doctor.
    • Madison County – Mental Health & Alcohol/Drug Services:
    • Franklin County Youth (17 years old and under) Psychiatric Crisis Line: 614-722-1800
    • Franklin County Mental Health and Substance Abuse Crisis Hotline: 614-276-2273
    • Ohio Mental Health and Addiction Services Hotline: 1-877-275-6364
    • Ohio Crisis Text Line – Text keyword “4HOPE” to 741 741
    • Contact the National Disaster Distress helpline at 1-800-985-5990

Common signs of distress to look out for:

  • Feelings of numbness, disbelief, anxiety, or fear.
  • Changes in appetite, energy, and activity levels.
  • Difficulty concentrating.
  • Difficulty sleeping or nightmares and upsetting thoughts and images.
  • Physical reactions, such as headaches, body pains, stomach problems, and skin rashes.
  • Worsening of chronic health problems.
  • Anger or short-temper.
  • Increased use of alcohol, tobacco, or other drugs.

For Parents:

Children and teens react, in part, to what they see from the adults around them. When parents and caregivers deal with the COVID-19 virus calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.

What Health Providers Can Do:

  • Help connect people with family and loved ones to help lower distress and feelings of social isolation.
  • Let older adults and people with disabilities know it is common for people to feel distressed during a crisis. Remind them that asking for and accepting help is a sign of strength.
  • Have a procedure and referrals ready.

Remember: “Every day begins with an act of courage and hope: getting out of bed.” Mason Cooley







What is Up with Hydroxychloroquine? By Our Student Pharmacist, Ryan Peterson.


With the ongoing COVID-19 pandemic, there has been much speculation about the use of hydroxychloroquine from public officials and in the media. Therefore, with all the information floating around, it is important to separate fact from speculation.

What is hydroxychloroquine?

First approved for medical use in the United States in 1955, hydroxychloroquine is used for the short-term treatment of malaria and the long-term treatment of various autoimmune diseases such as lupus, rheumatoid arthritis, and dermatomyositis. Hydroxychloroquine is marketed under the trade name Plaquenil.

Does hydroxychloroquine work against COVID-19?

The short answer is possibly.  Hydroxycholoroquine has been shown to have direct antiviral activity against SARS-CoV-2 (COVID-19) in a petri dish in a laboratory under controlled conditions. Several small clinical trials looking at whether hydroxycholorquine works have led to conflicting results.  Two small studies1,2 in China found that hydroxychloroquine either aloneor in combination with azithromycinappeared to be associated with a more rapid decline in viral RNA.  However, another small observational studyin patients with more severe illness did not suggest rapid viral RNA clearance after treatment with hydroxychloroquine and azithromycin. Multiple trials evaluating hydroxychloroquine for COVID-19 treatment are underway.


Has hydroxychloroquine been shown to prevent COVID-19?

No medication including hydroxychloroquine is known to be effective for preventing COVID-19.  Clinical trials are ongoing to determine whether hydroxychloroquine should be used in post-exposure prophylaxis for household contact and in healthcare workers. It has been suggested that neither hydroxychloroquine nor any other medication be used for COVID-19 prophylaxis outside of clinical trials. 4

Why is there hesitation among clinicians to use hydroxychloroquine?

There are three main reasons physicians are hesitant about the use of hydroxycholoroquine in COVID -19 patients: 5

  1. Hydroxychloroquine is associated with significant side effects. In many patients, the potential side effects outweigh the benefits of the medication which is a major reason why the drug has not been used.
  2. Hydroxychloroquine is a critical drug used for the treatment of malaria and other diseases throughout in the world. A surge in the use of hydroxychloroquine or use in unapproved indications (including COVID-19) can create major drug shortages.
  3. While clinicians are hopeful that hydroxychloroquine will work to treat COVID-19, they do not have enough evidence at this time to say whether it does or not. Asking a patient to take a medication that can cause significant side effects and has yet to be proven beneficial is very difficult except in extreme cases.

What side effects are associated with hydroxychloroquine?

Patients taking hydroxychloroquine have reported numerous side effects.

These include:

  • dizziness
  • fatigue
  • headache
  • anxiety
  • weight loss
  • diarrhea
  • hair and skin discoloration
  • hair loss
  • nausea and vomiting

Additionally, hydroxychloroquine has been associated with heart problems that make it harder to pump blood to the rest of the body and can lead to heart failure. 6

It is often recommended that before patients take hydroxychloroquine they receive genetic testing.  Patients taking hydroxychloroquine with a mutation leading to a particular enzyme, G6PD, being deficient are at a higher risk to develop a condition called hemolytic anemia where the body destroys red blood cells faster than they are made.

Can I get hydroxychloroquine?

Hydroxychloroquine is a prescription only medication.  The Food and Drug Administration (FDA) issued an emergency use authorization to allow the use of hydroxychloroquine and other agents in adolescents or adults hospitalized for COVID-19.7 Additionally, the Ohio Board of Pharmacy issued an emergency rule8  regarding the dispensing of hydroxychloroquine. According to the rule, new prescriptions of hydroxychloroquine are limited to a 14 day supply and must contain the patient’s diagnosis. Prescriptions written for a COVID-19 diagnosis must have documented a positive test result on the prescription. Additionally, prescriptions for either patients believed to be positive with COVID-19 or prophylactic use is strictly prohibited.

coronavirus symptoms


  • Gautret et al. Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 DOI:10.1016/j.ijantimicag.2020.105949.
  • Molina JM,et al. No Evidence of Rapid Antiviral Clearance or Clinical Benefit with the Combination of Hydroxychloroquine and Azithromycin in Patients with Severe COVID-19 Infection. Medecine et Maladies Infectieuses,
  • Chen J,et al. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19). Journal of Zhejiang University, 2020.
  • Coronavirus disease 2019 (COVID-19). Updated April 2020. Available at Uptodate.com. Accessed April 7, 2020.
  • Cortegiani, A. et al. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19, Journal of Critical Care, In Press 2020. https://doi.org/10.1016/j.jcrc.2020.03.005
  • LexiDrugs. Hydroxychloroquine. Updated March 2020. Accessed on April 7, 2020
  • US Food and Drug Administration. https://www-fda-gov.proxy.lib.ohio-state.edu/media/136534/-download. Accessed on April 7, 2020
  • State of Ohio Board of Pharmacy. ORC 4729-5-30.2 – Prescription requirements for chloroquine or hydroxychloroquine. Updated March 26, 2020.


Please Welcome Ryan Peterson Our Student Pharmacist for April at Happy Druggist on Karl Road.

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This month at Happy Druggist on Karl Road, Kristie and the gang are joined by Ryan Peterson, a fourth-year pharmacy student from The Ohio State University’s College of Pharmacy.

Ryan will graduate in May 2020 and will then take the test to become a registered pharmacist.  Ryan will be at Karl Road throughout April, so please stop by and meet him while he is in the store.

Here is what Ryan tells us about himself:

My name is Ryan Peterson. I am a fourth-year pharmacy student at The Ohio State University’s College of Pharmacy.  I have the opportunity of completing my last APPE rotation at Happy Druggist on Karl Road.

I am originally from Springfield, Illinois.  I completed my undergraduate work at Illinois Wesleyan University majoring in psychology. I then moved to Bowling Green, Ohio to work on my Masters’ in behavioral neuroscience. My work primarily focused on the neurobiological substrates of spatial working memory in homing pigeons. I was originally planning on completing my PHD and going into academia, but I came to realize that while I immensely enjoyed much of the work I was doing, it would have almost no impact on those around me, and few could even understand what I was doing.

Seeking to do work that directly affected people, I decided to pursue pharmacy in a large part because of my fascination with how drugs interact with receptors within the brain. I think that it is amazing that by changing how neurons fire (or work) with a drug can vastly change how an individual’s mind works.  I took a few prerequisite courses at the University of Toledo and then transferred to OSU for my formal work.

Currently, I work at both Meijer pharmacy in Delaware and at Mount Carmel in Grove City. 

Over the course of my pharmacy education I have begun to appreciate how much of an effect a pharmacist can have on people’s lives in simple day to day interactions.  For example, I remember in my second year of pharmacy school when a patient came into my pharmacy looking for a medication to help with his cough that had been bothering him for over a month.  It was a week after our class had learned about the direct blood pressure medications. When I asked him what medications he was taking or anything he had tried, he told me one of the medications that he took was lisinopril. Lisinopril is a commonly prescribed medication used to treat high blood pressure, but it can cause the patient to develop a dry hacking cough that can only be treated by discontinuing the medication. When I asked the patient to describe his symptoms he told me that he had a dry cough and a tickle in the back of his throat.  I immediately put two and two together and told him that his cough was probably a side effect of the lisinopril that he was taking and then I told him that he should talk to his doctor about changing to a different medication instead of taking a cough suppressant.  He was incredibly grateful that I was able to explain to him what was causing him to cough so much and I found it incredibly rewarding that I could use what I have learned to make a simple but important effect on a patient’s life.

As I am rapping at the door of graduation within a month, my heart is pounding trying to figure out what I will do for future employment.  I hope my time at Happy Druggist might provide some insight into what type of pharmacy I’d like to eventually pursue.

In my free time, I enjoy biking as well as playing cards and games with friends and trying new beers. I love to watch Buckeye football and try to get to as many games as I can. Whenever I get a chance I love to go skiing.