A syringe and bottle of COVID-19 vaccine on yellow background. 3d illustration

Hospice Pharmacy Insights January 2021

New This Month: New Year Wishes, What Clinicians Need to Know About the COVID-19 Vaccines, Editor's Note, & An Updated Drug Shortage List.
To our clients

New Year Wishes

To Our Clients,

2020 has been unusual and challenging to say the least. COVID-19 has impacted every aspect of our professional and personal lives. Despite the pandemic you managed to continue to provide quality end of life care to your patients and support their families. We are in awe of your selfless dedication to your communities and are grateful for your service. We look forward to serving you in the coming year. On behalf of all of us at Wise Hospice Options, I wish you a very happy, healthy and safe new year.

Kind Regards,

Grant Faubion, President

special edition

What Clinicians Need to Know About the COVID-19 Vaccines

It appears that 2020 is ending on a promising note. Two COVID-19 vaccines were given approval by the FDA; the Pfizer-BioNTech received emergency use authorization (EUA) on December 11th and the Moderna on December 18th. Both vaccines are messenger RNA (nRNA) and both have a reported effectiveness of 94-95% across age, racial and ethnic groups. Both vaccines rely on two doses give 21 days apart (Pfizer-BioNTech) and 28 days apart (Moderna). There are currently age restrictions with Pfizer-BioNTech approved for persons 16 years and older and Moderna for persons 18 years and older. It is recommended that those who receive either vaccine be observed for 15 to 30 minutes following injection as a precaution against potential severe allergic reactions. 

mRNA: What is it and how does it work?

The make-up of both vaccines is similar but not the same. Both contain mRNA, lipids and buffering salts and sugars. Messenger RNA is a single-stranded RNA molecule that is compatible with a gene’s DNA strand. It isn’t the same as DNA, and it does not combine with a person’s DNA to alter genetic code.

“The mRNA vaccine essentially provides instructions to the immune system by coding for the spike protein and producing an immune response that is similar to what would happen if a person were actually exposed, except the mRNA vaccines have no live virus and cannot interact with or integrate into the vaccinated person’s DNA. The spike protein mRNA and lipid particulate matter are the predominant ingredients in the vaccines along with buffering salts and sugars.

The lipid particles allow the vaccine’s mRNA to travel to the lymph system and enter antigen producing cells. The mRNA instructions are assimilated by the cell, and the spike protein is produced on the surface of the cell. Once that happens, the mRNA and lipids break down quickly. As the spike protein is produced on the surface of the antigen producing cell, a B cell neutralizing antibody response occurs. At the same time, CD4 and CD8 T cells are produced and create the response that establishes the body’s immune ‘memory.’ Thus, the mRNA vaccine works by enabling the body to mount a specific immune response to the virus through the creation of the B and T cells even though the virus itself is not present as a result of the vaccination.”

The most commonly reported side effects for both vaccines were pain at the injection site, headache, fatigue, chills, myalgia (generalized muscle pain) and arthralgia (joint pain). However, side effects for the Moderna vaccine also included nausea/vomiting, axillary swelling, and tenderness, swelling at the injection site, and erythema. Symptoms were usually mild and resolved within one to two days. Antipyretic or analgesic medications may be taken for the treatment of post-vaccination local or systemic symptoms, but prophylactic administration of such medications to prevent post-vaccination symptoms is not recommended.

It is notable with the Pfizer-BioNTech vaccine that side effects were more frequent and more severe following the second dose and among younger people, including those between the ages of 18 and 55. Patients should be encouraged to complete the series unless a significant contraindication develops.

Information about the degree to which the vaccine may reduce transmission in the general population and how long that protection will last is limited. As a result, vaccinated people should continue following all current CDC guidance to protect themselves and others including wearing a mask, social distancing, hand hygiene, and avoiding crowds.

Detailed information and guidance for the Pfizer-BioNTech vaccine is in the links below. At the time this newsletter was being published the guidance for the Moderna vaccine had not been published by the CDC.

Current CMS Emergencies

Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic

Wellsky CDC Update

from the author

Editor's Note

As we begin a new year, I would like to bring a couple of things to your attention. At Wise Hospice Options we do our best to provide the latest pharmaceutical, clinical, regulatory and practice information pertinent to the hospice and palliative care setting. Since we intentionally keep our newsletter to a length that is readable in 10 minutes, there are limitations to the amount of detail we can provide within this format. That is why we always provide references and/or links to give you the opportunity to explore in more depth those articles that have caught your interest.  Secondly, I want to assure you that the information we provide comes from the most reputable sources; NHPCO, NACH, CDC, CMS, FDA to name a few. In addition, research we cite is peer reviewed and comes from sources such as New England Journal of Medicine, National Institutes of Health, Journal of the American Medical Association, etc.

It is my hope as editor, that you find some value in the information provided in our newsletter. We not only welcome your questions, comments and suggestions but encourage them. You can contact me regarding the newsletter by email at dbougher@wiseop.com.

Happy New Year,

David Bougher, RN, BSN, Editor

Updated

Drug Shortage List

These shortages are due either from manufacturing delays or shortage of raw ingredients. This is not an inclusive list, but the listed drugs may be used for hospice patients, especially in the inpatient setting. For a complete list of drugs on shortage follow this link:

https://www.drugs.com/drug-shortages/

The FDA is warning that there may be an increase in drug shortages due to the effect the coronavirus is having on raw products coming out of China and India used in the manufacturing of drugs.

NOTE: Any items marked with a pill icon are new from the previous month’s newsletter

About the Author

David Bougher

Senior VP of Regulatory Affairs

David is a seasoned veteran of the hospice world and an essential member of the Wise Hospice Options clinical team. 

Education:

RN, BSN

Experience:

  • Former hospice COO
  • 20 Years of education & training experience
  • 10 Years of experience at Wise Hospice Options

Connect

Wise Clinical Team

Deanna Rice

PharmD
Vice President
Clinical Services

drice@wiseop.com

(800) 856-9757:
EXT. 216

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Tino Vilches

RPh
Senior Vice President
Clinical Services

tvilches@wiseop.com

(800) 856-9757:
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