Treatment options for COVID19

Treatment Options for COVID-19 🦠

- Remdesivir
- Lopinavir/Ritonavir
- Ribavirin
- Tocilizumab
- Anakinra
- Chloroquine & Hydroxychloroquine
- Favipiravir
- Convalescent Plasma

𝐑𝐞𝐟: 𝐓𝐡𝐞 𝐬𝐨𝐜𝐢𝐞𝐭𝐲 𝐨𝐟 𝐈𝐧𝐟𝐞𝐜𝐭𝐢𝐨𝐮𝐬 𝐃𝐢𝐬𝐞𝐚𝐬𝐞 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐬𝐭𝐬.


💢 Remdesivir

Is an investigational antiviral drug works by interfering with viral RNA-dependent RNA polymerase leading to premature termination of viral transcription.

First indicated for Ebola virus disease .


 💢Lopinavir/Ritonavir    (kaletra ®)🦠

Is an Antiviral agent for HIV works by inhibiting HIV-1 protease leading to form immature non infectious viral particals.

It’s Potential MOA in COVID-19:
Inhibition of Chymotrypsin-like protease (3CLpro) to give the same effect in HIV.



💢 Ribavirin 🦠

Is a broad spectrum Antiviral agent (Guanosine analogue) works by direct inhibition of RNA polymerase leads to chain termination or indirect inhibition of inosine monophosphate dehydrogenase leads to GTP depletion.

It’s FDA approved  for Chronic Hepatitis C.


💢 Tocilizumab 💊

Is a humanized monoclonal antibody IL-6 antagonist. Inhibiting binding of IL-6 to IL-6 receptor leads to inhibiting signal transduction and diminish the inflammatory response of the body.

FDA indications: Rheumatoid Arthritis, Giant Cell Arteritis, PJIA & CRS.



💢 Anakinra (Kineret ®)💊

Is a Recombinant human interleukin-1 receptor antagonist

FDA indications:
- Rheumatoid Arthritis
- Cryopyrin-Associated Periodic Syndromes



💢 Chloroquine 🦠

Is an antimalarial agent active against 𝑷𝒍𝒂𝒔𝒎𝒐𝒅𝒊𝒖𝒎 𝒗𝒊𝒗𝒂𝒙, 𝑷𝒍𝒂𝒔𝒎𝒐𝒅𝒊𝒖𝒎 𝒎𝒂𝒍𝒂𝒓𝒊𝒆𝒂 and strains of 𝑷𝒍𝒂𝒔𝒎𝒐𝒅𝒊𝒖𝒎 𝒇𝒂𝒍𝒄𝒊𝒑𝒂𝒓𝒖𝒎.

FDA indication:
- Malaria
- Extraintestinal amebiasis


💢 Hydroxychloroquine 💊

Is an antimalarial agent. Its MOA against 𝑷𝒍𝒂𝒔𝒎𝒐𝒅𝒊𝒖𝒎 is unknown yet. It has also anti-inflammatory and immunomodulatory effects so it is FDA approved for Rheumatoid Arthritis and Lupus Erythematosus.



💢 Favipiravir 🦠

Is a nucleoside analog prodrug. It is RNA-dependent RNA polymerase inhibitor.
It’s approved in Japan for tratment of Influenza A,B and C.
It’s currently under investigation for use in the management of SARS-CoV-2.


💢 Convalescent Plasma 💊

Convalescent Plasma Therapy 🩸 

It’s a procedure of administration of the passive antibodies (in plasma) of recovered patients to Severe COVID19 patients that leads to adaptive immune transfer resulting in passive immunity.

How Epilepsy is treated

Medications are used to treat epilepsy are called anti-epileptic drugs.

About 30 anti-seizure medications are currently approved to treat epilepsy.

About 6 in 10 people may control their seizures with the first or second medicine.

Yet a survey of adults in the community found that 56% still have seizures.

Neurologists are specialized doctors in treating epilepsy.

If the seizures are not controlled with 2 or more medications, one will be evaluated at an epilepsy center where options beyond medications are possible.

Epilepsy surgery, Vagus Nerve Stimulations and Ketogenic diet are other methods of treatment.

UNIT CONVERSIONS FOR SUSPENSION FORM MEDICATIONS

UNIT CONVERSIONS FOR SUSPENSION FORM MEDICATIONS

If the medicine comes in suspension form, shake well before using.
DO NOT use flatware spoons used for eating for giving medicine. They are not all the same size. For example, a flatware teaspoon could be as small as one half teaspoon (2.5 mL) or as large as 2 teaspoons (10 mL).
Measuring spoons used for cooking are accurate, but they spill easily.
Oral syringes have some advantages for giving liquid medicines: They are accurate, they are easy to use and you can take a capped syringe containing a dose of medicine to your child's daycare or school. 
Dosing cups are also a handy way to give liquid medicines. Liquid medicines often do not taste good, but many flavors are now available and can be added to any liquid medicine. Ask your pharmacist.

Unit conversions

1 cm3 = 20 drop; 1 drop = 0.05 cc

1 mL = 1 cc (cm³)

2.5 mL = 1/2 teaspoon

5 mL = 1 teaspoon

15 mL = 1 tablespoon

3 teaspoons = 1 tablespoon

First guideline for the industry and research establishment on how to make such products on the basis of sound ethical, scientific and regulatory norms.

Nine months after the national drug regulator CDSCO recognised “gene therapy” as a new drug, Indian Council of Medical Research has come out with the first guideline for the industry and research establishment on how to make such products on the basis of sound ethical, scientific and regulatory norms.

The guidelines not only outlines the ethical and scientific requirements for gene therapy trials but also asks developers to keep the patient’s safety, efficacy and clinical rigour in mind while developing such therapies

Two other types of therapies involve knocking out a bad gene that triggers disease and introducing a new gene to fight disease. The first successful gene therapy clinical trial was conducted in 1989 in the USA, for severe combined immunodeficiency.

“In India, there is no gene therapy trials yet. Along with guideline, the ICMR has also sought proposals from researchers for funding opportunities for gene therapy projects targeting human disease,” Geeta Jotwani, programme coordinator for gene therapy and gene editing at the ICMR told DH.

The apex medical research council looks at gene therapy as a treatment option not only for inherited diseases and rare diseases but also for multi-factorial ailments like cancer, diabetes, lung diseases and neurological diseases. Several Indian pharmaceutical companies have shown interest in a particular gene-therapy for cancer known as Car-T cell therapy, in which one particular immune cell of a patient (T-cell) is tweaked using gene therapy in such a manner so that they attack and kill cancer cells.

“While gene therapy is used to look for treatments of rare diseases, the clinical trial procedure for such therapies should be different. The US Food and Drug Administration has a fast track process for such therapies. They are unconventional products for which the protocol should be slightly different,” commented Sridhar Sivasubbu, a scientist at the Institute of Genomics and Integrative Biology, Delhi, who works on rare diseases but wasn’t involved in the making of the guideline.

While products for common diseases like cancer and diabetes may go through the standard three-phase clinical trial, the CDSCO may opt for a different protocol for rare diseases. In the notification, the regulator has defined a rare disease drug as “a medicine intended to treat a condition which affects not more than five lakh persons in India”.

In the past three years, several gene therapy products received approval for patient use from US and EU regulators, paving the way for the development of therapies for previously untreatable disorders. Worldwide, the market for such treatments is predicted to increase at a compound annual growth rate of 11.3% from 2018 to 2024.

What you Need to know about Medical Coding

What is Medical Coding?

Medical coding is the transformation of the following in to universal Medical alphanumeric codes.

• Healthcare diagnosis
• Procedures
• Medical services
• Equipment

• The diagnosis and procedure codes are taken  from medical record documentation, such as transcription of physicians notes, laboratory and radiologic results, etc.

Career path Ahead

• If you are currently employed as a medical coder, it would perhaps make a sense to gain considerable work and domain related experience i.e. at least 1-2 years of experience. This coupled with the right certification should be give you a head-start on your  career progression.

• The US healthcare industry is in the middle of a shift from ICD 9 to ICD 10 and having experience in the later is valuable asset right now and for coming year.

• With increase in your expertise and experience, you can expect your pay scale to go up. Down the line, you can get into medical office  management or medical office operations. 

Opportunities in Medical Coding

• Over the past several years there has been increase in the number of coding audits performed by the government to look for fraudulent  coding practices.

• In addition, there has been an increase in the rules regarding the privacy of health information records.

• Due to these recent developments, qualified coder's are needed to fill jobs other than the traditional medical coding positions.

• Some additional job opportunities for medical coders includes outpatient coding, inpatient coding, HEDIS abstraction, medical billing, and Medical Coding instructor.

• There are also positions available in closely related areas such as Health information management including coding supervisor  and health information manager.

Practice Question

Correct answer= B.
Pyrimethamine is active against T. gondii and in combination with sulfadiazine is the
treatment of choice for toxoplasmosis. Metronidazole is active against amebiasis and giardiasis. Leucovorin can
be used during the treatment of toxoplasmosis; however, its actions are to protect against folate deficiency caused
by the treatment, and the drug itself does not have antiprotozoal activity. Miltefosine is used for leishmaniasis

Practice Question

Correct answer = B. Miltefosine is the only oral agent available for the treatment of visceral leishmaniasis. All the

other drugs are orally administered, but artemether/lumefantrine is used for the treatment of malaria, nitazoxanide

is used for the treatment of giardiasis or cryptosporidiosis, and tinidazole is effective for amebiasis or giardiasis.