Medication Therapy Management - MTM

Up to April 25th, 2022, 169 cases had been reported worldwide, 17 cases require liver transplants , and one death; this unknown etiology hepatitis could be vaccine-induced autoimmune (CD-8 T-cell dominant) hepatitis (liver inflammation) and will be an example of antibody dependent enhancement reaction after vaccines.
This might be one of the reason for chronic fatigue after the vaccines. Glucocorticoids, such as prednisone, could be an effective treatment.
https://t.me/dailyexpose/7116

The Exposé News New Study confirming COVID Vaccine causes Severe Autoimmune-Hepatitis is published days after W.H.O issued ‘Global Alert’ about new Severe Hepatitis among Children “A new scientific study published 21st April 2022, has concluded that Covid-19 vaccination can elicit a distinct T cell-dominant i...

https://www.researchgate.net/publication/356842201_Myths_of_Ivermectin_Treatment_on_COVID-19/stats
Recent study of ivermectin on treatment and prophylaxis of Covid-19.

www.researchgate.net

IVM efficacy study in prophylaxis and treatment-Review.

https://journals.lww.com/americantherapeutics/fulltext/2021/06000/review_of_the_emerging_evidence_demonstrating_the.4.aspx

Review of the Emerging Evidence Demonstrating the Efficacy... : American Journal of Therapeutics ed within clinical trials. Areas of Uncertainty: The majority of trialed agents have failed to provide reproducible, definitive proof of efficacy in reducing the mortality of COVID-19 with the exception of corticosteroids in moderate to severe disease. Recently, evidence has emerged that the oral an...

Q&A of ivermectin
1. "Is Ivermectin for animal or human?
Ivermectin is used to kill parasites of humans for over 30 years, and around 3.7 billion doses have been distributed to humans for parasites infections (Yagisawa M et al., Global trends in clinical studies of ivermectin in Covid-19, The Japanese Journal of Antibiotics 2021;44(44):44-95). http://jja-contents.wdc-jp.com/pdf/JJA74/74-1-open/74-1_44-95.pdf

jja-contents.wdc-jp.com

The Recommended off-label Use of Ivermectin to Treat Covid-19, Mild-Moderate Cases and After Acute-Infection symptoms
By Susan Chen, RPh, PharmD, MS, BCGP. Medication Therapy Management Inc. PC.
9/23/2021

The criteria of FDA off-label drugs:
Questions and concerns that a healthcare provider considers using an approved drug for an unapproved use (off-label use)( https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label). The author answers these question in ( ).

· What is the drug approved for? (Ivermectin is approved for anthelmintic use in humans).
· Are there other drugs or therapies that are approved to treat my disease or medical condition? (Currently, no drugs are approved for Covid-19 treatment, except under EAU).
· What scientific studies are available to support the use of this drug to treat my disease or medical condition? (Please see the table and article below)( https://c19hcq.com/?from=groupmessage&isappinstalled=0)
· Is it likely that this drug will work better to treat my disease or medical condition than using an approved treatment? (Sufficiency amounts of clinical studies and meta-analysis conducted by multiple countries/institutions to treat Covid-19-positive patients have shown strongly proof of the effectiveness of ivermectin in the early stage of Covid-19 treatment.)
· What are the potential benefits and risks of treating my disease or medical condition with this drug? (Ivermectin has been used as humans anthelmintic for over 30 years and dispensed over 3.7 billion worldwide. Reported severe adverse drug reactions and death is considerably low. Based on the studies on its pharmacokinetics, post-market safety, drug-drug interactions, and drug-disease interaction profile, clinicians shall be able to use it safely and effectively to prevent overdose and toxicities).
· Will my health insurance cover treatment of my disease or medical condition with this drug? (Ivermectin is an oral drug with a very affordable price; insurance coverage is not an issue to approve it).
· Are there any clinical trials studying the use of this drug for my disease or medical condition that I could enroll in? (Currently, there are 197 trials of using ivermectin to treat Covid-19 on clinicaltrials.gov).

In summary, the successful use of ivermectin to treat Coivd-19 cases has been seen in many lawsuits, news, and public resources. However, there is no legal way to get it. As a result, consumers risk purchasing it from many under-table trades, animal dosage forms and formulas, and foreign pharmacy websites. If the clinicians know how to monitor the side effects, avoid the drug-drug/drug-disease interactions, use at the right dose and indication in the appropriate population, the clinicians can prevent many potential adverse reactions and failed clinical studies. The author strongly recommended prescribing healthcare providers to treat mild-moderate Covid-19 with off-label ivermectin for the above reasons.

Professor Christian Perronne, a former head at the World Health Organization’s (WHO) European Advisory Group of Experts in Immunisation said that vaccinated people are dangerous for others. https://theexpose.uk/2021/09/24/immunisation-expert-warns-that-vaccinated-people-are-the-real-threat-dangerous-to-others/

The US Supreme Court’s final decision about why mandates booster vaccines are not necessary.https://www.supremecourt.gov/DocketPDF/21/21A15/187103/20210810123328658_PIC%20Amicus%20Brief%20for%20SCOTUS%20in%20Klaassen%20case%20--%20FINAL.pdf

The RT-PCR tests were used in all the vaccine clinical trials. Since we have more evidence that the test results are manipulatable via the CT value of each test and the test results rely on Covid disease stages, the whole vaccine efficacy results could be misleading / mistake. I am not surprised if there were false death rates and new cases rates reported later on.
https://theexpose.uk/2021/09/23/f-o-i-reveals-the-uk-medicine-regulator-never-inspected-the-pfizer-covid-19-vaccine-trial-data-prior-to-its-emergency-use-authorisation/

The FDA released presentation about the debate of booster vaccine. In order to save one person, the vaccine adverse effects will kill two persons! Please share the information to others. Watch and read the article here. You can choose to listen to the article or choose to translate into the other language to read. https://theexpose.uk/2021/09/18/fda-experts-reveal-the-covid-19-vaccines-are-killing-2-people-for-every-1-life-saved/

FDA experts reveal the Covid-19 Vaccines are killing at least 2 people for every 1 life they save as they vote 16 – 2 against the approval of booster shots FDA experts have unexpectedly voted against approving Covid-19 vaccination boosters for anyone over the age of 16 in the USA, citing a lack of long term data and stating that the risks do not outwe…

The home-based of Covid-19 treatment. https://faculty.utrgv.edu/eleftherios.gkioulekas/zelenko/aaps-Guide-to-Home-Based-Covid-Treatment.pdf

The state Supreme Court ordered the hospital to give Ivermectin to the patient? Read the story below.

https://www.thedesertreview.com/opinion/letters_to_editor/ivermectin-wins-in-court-again-for-human-rights/article_98d26958-a13a-11eb-a698-37c06f632875.html?from=groupmessage&isappinstalled=0

Ivermectin Wins in Court Again: For Human Rights One dose of Ivermectin was all it took to get 81-year-old John Swanson off the ventilator. John’s wife Sandra could not believe it. His story is remarkably similar to other

Vaccine or not? Please take a look this article and review the data online (downloaded from VERS). (Direction to view the data is to pull down all the way the bottom and view the highlighted section by the authors). Please feel free to join the discussion or send me a private email.
The access to the data, total 8 sheets
https://docs.google.com/spreadsheets/d/1wOqHveyD_ZHJ2BgkdhoqWpciaLjf2mClLz1c5D1pyqQ/edit?usp=sharing

The evidence of Covid-19 Central Nervous System (CNS) infection is presented in the following paragraph. Covid-19 CNS infection can explain why most common nasal swab PCR usually not accurate. Unfortunately, most of the Covid-19 vaccines clinical trials used this method plus symptoms identification to "confirm" infection. Without a reliable method to detect viral infection (especially asymptomatic infections), I doubt most clinical trial efficacy results.
"1). Infection of the CNS. If ACE2 is located in almost all human organs and tissues, why do the most accurate diagnostic tests, such as real-time polymerase chain reactions (RT-PCR), miss the diagnosis? Some cases repeatedly test negative before finally testing positive and confirming COVID-19 infection. What physiological effects cause this apparent lack of test reliability? The authors have proposed that the infected target organ of the SARS-CoV-2 is the brain because regular blood RT-PCR tests through nasopharyngeal swabs and blood could not detect the pathogen in the brain, except by using the lumbar puncture test to detect cerebrospinal fluid (CSF). This hypothesis provides a rationalization for the challenges of virus detection at some specific points in time in disease progression. For example, the virus can be detected when it returns to the bloodstream during the final stage, before it enters the brain in the latency/early stage, and during DA levels of activating alpha-adrenergic effects-immunosuppression. This hypothesis, supported by autopsy results, did not find viral inclusions in those COVID-19 patients with mucus plugging their airways [29,31]. However, autopsy studies of brains show acute hypoxic-ischemia and low virus levels [46]. Low levels of virus in the brain could be due to the beta-adrenergic effects of macrophage activation. Furthermore, the study of Moriguchi et al. found SARS-CoV-2 in CSF [47]. These findings support this hypothesis of CNS infection". (Quote from "Chen T, Tseng V, Techaarpornkul S. The Plausible COVID-19 Progression and Etiology-Perspectives of Endocrine, Neuroimmune, and Pharmacological Running title: Imbalance of dopamine/prolactin-induced inflammation and autoimmunity. Preprint, Research Gate. Dol:10.13140/RG.2.2.30227.91688")
References in the paragraph
29. LM. Barton, EJ. Duval, E. Stroberg, S. Ghosh, and S. Mukhopadhyay COVID-19 autopsies, Oklahoma, USA Am J Clin Pathol 153(6)(2020), pp. 725-733 doi:10.1093/ajcp/aqaa062
31. LM Buja, DA. Wolf, B. Zhao, et al. The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of three autopsies from Houston, Texas and review of autopsy findings from other united states cities Cardiovasc Pathol 48(2020) doi:10.1016/j.carpath.2020.107233
46. IH. Solomon, E. Normandin, S. Bhattacharyya, et al. Neuropathological features of COVID-19 N Engl J Med 383(10)(2020) pp.989-992 doi:10.1056/NEJMc2019373
47. T. Moriguchi, N. Harii, J. Goto, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2 Int. J Infect Dis 94(2020) pp.55-58, doi:10.1016/j.ijid.2020.03.062

Clinical presentation of corticosteriod-induced adrenal insufficiency.
Alexandraki KI, Grossman A. Adrenal Insufficiency. 2018 Aug 20. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.lm.nih.gov/books/NBK279122/

Minnesota Board of Pharmacy

The Board is forwarding the following e-mail so that any pharmacy that may have received this product can take action.

ISMP
URGENT - HAZARDOUS SITUATION - PLEASE REACH IMMEDIATELY
ISMP is aware of an extremely hazardous packaging error involving certain cisatracurium products from Meitheal Pharmaceuticals. While the outer carton identifies the vials inside as cisatracurium, the vials contained in the carton are labeled phenylephrine injection. A photograph appears below. The vials actually contain cisatracurium and have caps appropriate for a paralyzing agent. However, this cap warning may not be noticed, since the vial is labeled phenylephrine.

Due to the nature of this situation and the potential for death if the these vials are used as phenylephrine injection in patients who are not intubated and ventilated, we urge facilities to immediately examine any and all cartons of cisatracurium from Meitheal Pharmaceuticals for this serious packaging error. The possibility that any of these vials were actually distributed should also be considered. ISMP has confirmed that both the FDA and the manufacturer are aware of this situation and that a recall is imminent.

CiSTARACURUIM
Carton labeled properly as cisatracurium, but the vials within are mislabeled as phenylephrine but actually contain cisatracurium.

What medical conditions use corticosteroids?
a. Allergic conditions: asthma, rhinitis, hypersensitivity
b. Chemotherapy: antiemetic, brain tumors, multiple myeloma
c. Autoimmune: hepatitis, Lupus nephritis, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, immune thrombocytopenia, giant cell arteritis
d. Respiratory: COPD, acute respiratory distress syndrome, asthma
e. Rhematic/collagen disorders: dermatomyositis/polymyositis, bursitis, tenosynovitis, arthritis (acute gouty)
f. Genetics: Duchenne muscular dystrophy
g. Rare: multiple sclerosis, eosinophilic esophagitis, adrenal crisis, adrenal insufficiency, after Cushing’s syndrome treatment (e.g. surgical remove of ACTH-secreting pituitary adenoma), primary adrenal insufficiency, septic shock, spinal cord injury, bell’s palsy, pericarditis, and polymyalgia rheumatica, etc.
David Richfield (User:Slashme) and Mikael Häggström. Derived from previous version by Hoffmeier and Settersr. In external use, this diagram may be cited as: Häggström M, Richfield D (2014). "Diagram of the pathways of human steroidogenesis". Wikiversity Journal of Medicine 1 (1). DOI:10.15347/wjm/2014.005. ISSN 20018762. - Self-made using bkchem and inkscape

What are the central-nervous system hormones/axes?
a. HPA(Hypothalamic-Pituitary-Adrenal axis),
b. HPT (hypothalamic–pituitary–thyroid axis),
c. HPG (hypothalamic-pituitary-gonadal axis (HPG axis),
d. Hypothalamus (Dopamine)-pituitary (prolactin),
e. Hypothalamus (Growth hormone releasing hormone)-pituitary (Growth hormone)-Liver (insulin-like growth factor-I). (Puche JE, Castilla-Cortázar I. Human conditions of insulin-like growth factor-I (IGF-I) deficiency. J Transl Med. 2012;10:224. Published 2012 Nov 14. doi:10.1186/1479-5876-10-224.)

A plausible mechanism of Covid-19 disease progression, points of viral detection, prolactin alternations, and suggestion medications according to four stages of disease progressions.

Preprint at DOI: 10.13140/RG.2.2.30227.91688
Authors:
Tsuhua ChenTsuhua ChenVanessa TsengSunee Techaarpornkul
Copy right: LicenseCC BY-ND 4.0

Hormone can have the following function (s)
1. Metabolism (sugar, fat, etc)
2. Growth
3. Sexal (estrogen, testosterone)
4. Response to stressors (cortisol, glucocorticoids)
5. Vital signs (blood pressure, heart rate)
6. Electrolytes balance (potassium, sodium, calcium)
7. Gastroenterological function

This is a new publication published in The Senior Care Pharmacist Journal. I will introduce its application in the following posts. ( please follow me!). Corticosteroids is one of the few approved medication to reduce the 28-day death rate and the corticosteroids -induced adrenal insufficiency is very common undiagnosed condition. Here is the citation: Chen TS, Li SD. Adrenal Insufficiency Caused by Chronic Corticosteroid Use, Identified through Medication Therapy Management. Sr Care Pharm. 2021 Jan 1;36(1):22-33. doi: 10.4140/TCP.n.2021.22.. PMID: 33384031.

The ResearchGate has the full article doi: 10.4140/TCP.n.2021.22