Roles and challenges of a Swiss hospital pharmacy during the COVID-19 pandemic

Background: On March 16, 2020, because of the COVID-19 pandemic, the Swiss Federal Council declared an 'extraordinary situation' in terms of the Epidemics Act. Purpose(s): To assess the roles of an inter-hospital pharmacy in the fight against SARS-CoV-2. Method(s): All missions performed by our pharmacy were systematically collected and evaluated. They were also compared to its official duties. Result(s): Specific missions, which have been mainly managed by the crisis unit and the four departments of the pharmacy (Pharmaceutical Logistics, Drug Manufacturing, Clinical Pharmacy and Nursing Homes Supply), were: 1) human resources continuity;2) specific drug supply (for both hospitals and nursing homes;e.g. anaesthetics, sedatives, antiviral drugs, incl. for clinical trials);3) clinical assistance (especially in the ICU of the main acute hospital);4) individual drug manufacturing (e.g. hydroxychloroquine oral solution);5) on-site pharmacies management;6) own infrastructure securing (especially in term of hygiene);7) hand disinfectant production;and 8) hygienic masks supply for healthcare professionals in the area. The two last missions were out of the traditional duties of our pharmacy and have been achieved with the support of staff from the Swiss civil protection. A particular challenge was the management of the shortage of various products and the identification of alternative therapeutic options. Conclusion(s): Our pharmacy has faced various challenges during the acute pandemic situation. Some missions performed were even beyond our traditional ones. The disaster plan of our pharmacy has to be further developed, as well as the associated training of the staff, based on the lessons learned from this pandemic.

Influence of antihypertensive treatment on RAAS peptides in newly diagnosed hypertensive patients

Objective: Recently, the influence of antihypertensive treatment on the renin-angiotensin-aldosterone system (RAAS) gained increasing attention, especially since concerns were raised regarding a potential influence of RAAS inhibitors on Corona Virus Disease 2019 (COVID-19). Our objective was to study the effect of recently initiated antihypertensive drugs on Angiotensin (Ang) II (1-8) and Ang (1-7) as markers of the pro-inflammatory ACE/Ang II/Ang Type 1 receptor (AT1R) axis and the counteractive ACE2/Ang (1-7)/Mas R axis in patients with newly diagnosed hypertension. Design and method: Randomized, open-label trial investigating RAAS peptide profiles after initiation of antihypertensive treatment with either perindopril, olmesartan, amlodipine, or hydrochlorothiazide. Ang II and Ang (1-7) concentrations were measured at 8am and 12am at day of treatment initiation and after four weeks of treatment. Results: 80 patients were randomized in a 1:1:1:1 fashion. Between the four substances, we found significant differences for the concentrations of Ang II (p<0.0005 for 8 and 12am) and Ang (1-7) (p=0.019 for 8am and <0.0005 for 12am) four weeks after treatment start. Ang II was decreased by perindopril (p=0.002), and increased by olmesartan (p<0.0005) and amlodipine (p=0.012), and hydrochlorothiazide (p=0.001) (Figure panel A). Ang (1-7) was increased by perindopril and olmesartan (p=0.008 and 0.002), but not measurably altered by amlodipine and hydrochlorothiazide (p=0.317 and 0.109) (Figure panel B). Conclusions: Initiation of antihypertensive therapy causes early and distinct alterations of equilibrium angiotensin levels. Given the additional AT1R blocking action of olmesartan, RAAS peptide shifts upon initiation of perindopril and olmesartan appear to work in favor of the anti-inflammatory axis compared to amlodipine and hydrochlorothiazide.