PikesPeakAg said:

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2020 COVID QTC Guidance is an exceptional guide from mayo Clinic EP. Our network is using the algorithm, shown as Figure 1 Page 19, as a reference to our providers. (If I knew how to pull that figure out to post it separately I would.) Our PDF version is the bottom half of diagram that has to do with QT prolongation only for non trial eligible patients.

Regardless, it's worth printing.

Good Luck!

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Very cool, thanks!

fig96 said:

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I feel like this goes without saying, but please don't use Dr Oz as your basis for medical advice for everyone's sake.

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Deepak Chopra is much better.

Think we ever get to the point of early/frequent testing so we can get folks on these meds before end up hospitalized?

I've had three PUI in the last seven days, borderline O2 requirement, who I am all but sure have it, only one got their Rx filled because of difficulty at the pharmacy.

Quote:

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Got a similar protocol for my state other day.

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Can you tell us more about this?

Doctor, I note that Wiki says that retinal toxicity happens after extended periods of treatment. Would the suggested regimen for COVID 19 approach that sort of dosage?

OldArmy71 said:

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Doctor, I note that Wiki says that retinal toxicity happens after extended periods of treatment. Would the suggested regimen for COVID 19 approach that sort of dosage?

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Doubtful! I think the main thing to watch for is QT prolongation so an EKG prior to use is something to consider.

Do you feel the zinc supplement is important?

The theoretical whiteboard explanation is the hydroxychloroquin is simply the mechanism to get the zinc into the cell.

Keegan99 said:

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Do you feel the zinc supplement is important?

The theoretical whiteboard explanation is the hydroxychloroquin is simply the mechanism to get the zinc into the cell.

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Not really most people if they eat a balanced diet have plenty of zinc. However, I am taking zinc because I sure don't want to be zinc deficient if I get sick!

Revellie. What are your thoughts re azithro plus HCQ. Re QTc intervals. Amazing our ID docs DCing azithro for this reason. Talking about hypoxic sick COVID pts. I am ordering daily EKGs and trying not to consult ID but hospitalist are doing it.

What is the current thinking about using ibuprofen while sick?

I just got a text stating how dangerous it is.

I realize I should ask my retina doctor this, but I don't want to sit through four waiting areas to see him and their online presence is not very helpful.

What sorts of issues in the retina make use of this drug problematic? I have had a Branch Retinal Vein Occlusion (seven years ago) and an aneurysm that bled (three years ago), both in the left retina. Is that the sort of thing that means I should not use the drug?

I found this journal article.


The manufacturers of HCQ suggest that pre-existing maculopathy is a contraindication to treatment,12 and the AAO criteria state it as a risk factor for the development of HCQ retinopathy.24, 25 There are no specific data to demonstrate that patients with pre-existing macular disease are more susceptible to HCQ retinopathy, although subtle parafoveal structural and functional abnormalities secondary to HCQ may be difficult or impossible to detect with SD-OCT, AF or mfERG in the context of pre-existing macular disease. Macular disorders should be identified at baseline by Ophthalmologists as part of AAO (2011) guidelines24 and baseline examination within the first year of treatment is advised in the 2016 guidelines.25 This will only be identified, according to RCOphth joint guidelines (2009) if the patient has visual symptoms at baseline and is then encouraged to see an Optometrist to determine whether the macula is affected, with an onward referral to an ophthalmologist if so.22 The authors of RCOphth joint guidelines advocate Amsler's screening from Rheumatology clinics by the prescribing physician.22 Interestingly this has been omitted from the more recently published AAO guidelines (2011 and 2016).24, 25 Isolated drusen with good photoreceptor function should not be considered a contraindication to HCQ treatment: a baseline SD-OCT, and AF imaging with a visual field test should be carried out in this context.25

Player To Be Named Later said:

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Just thinking outside of the box right now....

With our testing numbers/protocols being a complete Charlie Foxtrot at the moment, and just sending tons of people home with fairly clear signs of this virus.... what are the abilities of doctors to prescribe Hydroxychloroquine/azithro to people without a confirmed test?

You would think if someone has high fever, body aches, and somewhat short of breath that getting these drugs into them before they go downhill and a burden on an ER would be a good plan.

I realize you'd have to be cautious about the folks who would want it just because they feel a "little bad" and that we'd need to get the supply side into over drive, but is this feasible to start doing?

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That's what I want to know.

Is the testing improving? We live in Rockport and would have to be tested in Corpus Christi. Is it widespread enough that if needed. we could obtain fast testing?

What a cluster ****! Sure we have meds to help you, but unfortunately you may be dead by the time your test results are back! I live on the Texas/Louisiana border, I wonder if like Texas, Louisiana requires a positive test first as well? May determine where I go for treatment, if needed.

Cayman Chemical in Michigan research link might be interesting for the Doctors and researchers on this board

https://www.caymanchem.com/news/using-existing-therapeutics-against-sars-cov-2

Note: The products listed in this article are for biomedical research only. They are not for human or veterinary use.

Currently, there are no approved drugs to treat the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that causes coronavirus disease 2019 (COVID-19). Existing FDA-approved drugs that have a known favorable safety profile are being examined for strategies to treat the disease and fast-track a treatment plan. The influenza drug favilavir (favipiravir;... Ebola virus drug remdesivir ...This virus shares 79.5% sequence identity with SARS-CoV and uses the same angiotensin converting enzyme 2 (ACE2) receptor as SARS-CoV as a mechanism of cell entry. ACE2 is highly concentrated in airway epithelial cells...

Various potential targets for development of COVID-19 therapeutics exist along the stages from when a positive-sense, single-stranded RNA virus infects host cells and replicates.

Abl Kinase Inhibitors
Virus-Host Fusion Inhibitors
Protease Inhibitors
RNA-Dependent RNA Polymerase Inhibitors
RdRp Inhibitors
Oxysterol-Binding Protein Inhibitors
Endosomal pH Regulators
Endosomal Acidification Inhibitors
Uncovering the Role of BRD2 in COVID-19

Marcus Aurelius said:

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The assay is now 10-14 day turnaround for me. The COVID ARDS pts I'm seeing are too far along in the disease process for HCQ to be effective at that point. These rapid assays have got be implemented. There was news of a 45 min one a week or so ago, now the 5 min one.

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I wouldn't hold my breat on the rapid tests being a game changer anytime soon. The production volumes are just not there.

Reveille said:

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Tabasco said:

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Player To Be Named Later said:

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Just thinking outside of the box right now....

With our testing numbers/protocols being a complete Charlie Foxtrot at the moment, and just sending tons of people home with fairly clear signs of this virus.... what are the abilities of doctors to prescribe Hydroxychloroquine/azithro to people without a confirmed test?

You would think if someone has high fever, body aches, and somewhat short of breath that getting these drugs into them before they go downhill and a burden on an ER would be a good plan.

I realize you'd have to be cautious about the folks who would want it just because they feel a "little bad" and that we'd need to get the supply side into over drive, but is this feasible to start doing?

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That's what I want to know.

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Unfortunately that is not an option at this point. The State of Texas Medical Board has specifically said in order to prevent at run on these medications they are requiring a confirmed positive before they will dispense this combination of medications. I have located a couple of compounding pharmacies for my patient's who have been on hydroxycholoroquine for years for autoimmune diseases as it has become difficult to obtain now. Some pharmacies are even wanting a code of bronchitis or pneumonia prior to dispensing Zithromax now.

This is where the new fast Abbott test will come in to play. They diagnosis can be made earlier and than you can discuss with the patient if they wish to try this or not. If they have had a normal EKG recently I think it is worth trying. I am sure many other physicians will feel the same. Some will want to wait till we have more data or FDA approval. As we other treatments as we start using it more and studies are released we will find out if it is truly effective or not.

My personal opinion based on what I have read and heard from other doctors who have been using it. Is that seems to be effective if started early in the clinical process. However, much like Tamiflu if you start it later in the disease process it seems to have a minimal effect. So here is where early detection appears to be key and should give us a much better understanding of the effectiveness of this combination.

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Given the high % of tests are coming back negative, even with the most likely patients, prescribing the drugs to anyone with the symptoms would be a terrible approach if you wanted the drugs available to the patients that need it. Far too many things have flu like symptoms.

Marcus Aurelius said:

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The assay is now 10-14 day turnaround for me. The COVID ARDS pts I'm seeing are too far along in the disease process for HCQ to be effective at that point. These rapid assays have got be implemented. There was news of a 45 min one a week or so ago, now the 5 min one.

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Out of curiosity, where are you and where are you sending the samples?

So I'm really getting the vibe that we shouldn't get too encouraged by this treatment protocol, given the fact that it's going to be difficult to even get it to people while it's still effective.

What a kick in the nuts.

https://www.google.com/amp/s/amp.usatoday.com/amp/2934583001

I see Remdesivir is back online. How hard will it be for doctors to actually get it for their patients now?