COVID Flashcards
What are the gerena of COVID and is the one we are most concerned about?
Alpha coronavirus
Beta coronavirus (mots concern)
Delta coronavirus
Gamma coronavirus
How is COVID transmiteed
- inhalation
- deposition of virus particles on exposed mucous membranes
- touching mucous membrane with soiled hands
Epidmelogy- survelinnace
waste water survellance
What are typer of vaccines?
- mRNA
- Viral vector
- protein subunit
- virus-like particle (not available in Canada)
mRNA vax names
modern and pfizer
Viral vector vax names
johnson johnson and AstraZeneca
protein subunit vax names
novavax
wha are the XBB 1.5 monvalent vaxs?
moderna
pzifer
At what age can you be vaccinated? and what dose?
5 and over be vaccinated with 1 dose moderna or pzifer
when can you get a vaccine 6 months to 5 years old and what dose?
high risk for severe illness
2 doses of moderna or 3 doses of pfizer with 8 week interval betwen doses
if immuncomprised how does the vx schulde for doisng cahnge
need an additional dose with a 4-8 week intervla
when are you eligible for a booster?
6 months are an active covid infection or your last booster
in what patienst groups is immunization especially important?
- 65 plus
- long term care home or congregated living
- underlying med conidtion
-prego - members of racilaized and equity deserving communiites
- people who provide essetial community servicecs
s/ e of mRNA vax
common: pain fever malagias, chills, fatigue muscle
Rare: myocarditis
Pfizer: balls palsey
s/ e of viral vector vax
Rare: blood clots due to thrombocytopeni, guille barre syndrom, capillary leakage syndrome
s/ e of proetin sub unit vax
just common ones
when do we need pre-exposure prophylaxis?
when vax is not an option or when immunocompromised (will lack an insufficient response to virus)
what is pre- exposure prophylaxis
tixagevimab/cilgavimab
what dose and how are tixagevimab/cilgavimab given?
150 mg IM each
when is. ahigher dose of tixagevimab/cilgavimab indicated
maybe 600mg depedning on efficacy of strain
tixagevimab/cilgavimab caution point
doesn’t work against all variants - omicron
Covid risk factors
- old age
-chronic medical condition - immuncomprismed
- obesity BMI of 40 or higher
when can we experince COVID symptoms
1-14 days after exposure
usualy at day 3-7
COVID Red flags
- tourble breathing
- persistent pressure on chest
- inability to stay awake
- new confusion
- bluish lips or face
Covid illness catgeories and key features of categori
asymptomatic or presymptomatic
mild illness - sym but no respiratory problems
moderate illness - oxygen levels are effected
severe illness - oxygen and respiration affected
critical illness - sepsis, mult organs failure, respiratoyr failure
illness categories for tx
non- severe : outptaient
severe: signs of pneumonia, severe respiratory distress and oxygen saturation of less than 90%
critical: requires life sustaining tx, acute respiratoyr distress syndrom, sepsis, septic shock
COVID complications for those under 21
multisystem inflammatory syndrom
- median age 8
- multple organ involvment (>2), inflmmation, fialure, no alterntaive disgnoses, cardiac
treatment for MIS-C or MIS-A
unsure, IVIG 2gm/kg or methylprednisone, or low dose ASA
COvid tests
Molecular - NAAT, PCR
Antigen - Rapid
Recommendation of therpy for non-servere
nirmatrelvir and ritonavir
remdesivir
recommendation of therpay for severe
CS
IL-6 receptor blockers
baricitinib
remdesirvir
recommendation for therpoay of critical
CS
IL-6 receptor blocker
Baricitinib
nirmatrelvir/ ritonivir indication/ other name
confirmed symptomatic covid at risk for progressing to seriour severe disease
paxlovid
nirmatrelvir / ritonavir MOA
nirmatrelvir: proetase inhibitor
ritonavir: protease inhibtor and booster for hepatic met of nirmatrelvir
nirmatrelvir and ritonavir dose, frequncy duration
nirmatrelvir 300 mg(2 150mg tab) and ritonavir 100 mg (1 100mg tab)
- bid po for 5 days
nirmatrelvir and ritonavir food consideration
with or without food, don;t crush
nirmatrelvir and ritonavir interactions
CYP 3A4 inhibitor
nirmatrelvir and ritonavir dose adjustment in renal?
if eGFR is over 60: normal dose
30-60: one tab of nirvatrelvir and one tab of riotnavir po BID for 5 days
if below 30: not recommended
Remdessivir indication and biggest limiting factor
confirmed Covid and at risk of severe illness that could cause hospitalization
- given IV
Remdesivir dosing for non-severe
200mg IV loading dose then 100 mg Iv daily for 2 days
Remdesivir for mod to severe
200mg IV loading dose then 100 mg daily for 4-9 days
- can extend to 10 days if no improvement on day 5
remdesivir duration of therpay if on ecmo/mechanical ventilation
10 days
remdesivir renal adjustment
if below 30 avoid unless benifit outweight risk
remdesirvir ADR
infusion reactions
remdesirvir monitoring
LFT
dont use if ASL are 5 times normal levels
remdesivir interations
is a CYP 3A4 inhibtor
remdesirvir duration if unvax with eraly COVD symptoms
3 days with PCR positive within last 4 to 7 days
remdesirvir caustion point
be careful with liver or renal disease
Corticoststoird recommendation?
dexamethasone
Dexamthsome dose and duration of therapy
6 mg IV or PO for 10 days
dexamethasone adverse effects
suppreses immune systme so maybe falre of latent disease - secodnary infections
IL-6 receptor blockers recommendation
Tociliczumab
Tocilizumab dose and duration
8 mg/kg with max of 800 mg in 1 hour
tocilizumab adverse effects
infection, hepatoxicity, HTN, infusion reactions, neutropenia, bowel perforation
What is the JAK inhibtor recommended
Baricitinib
baricitinib dose and duration
4 mg (2 2mg tab) po daily for 14 days
baricitinib food?
with or without food
baricitinib renal adjustment
30-60: 2mg po daily
15-30: 1 mg po daily
below 15: not recommended
drugs with adjustment ofr renal
Paxlovid
30-60: 1 nirmatrelvir and 1 ritoniavir po BID for 5 days
Remdesivir
below 30 avoid
Barticinib
30-60: 2 mg
15-30: 1 mg
below 15; avoid
What drugs shoudl we be cautious about CYP 3A4
remdesivir is metabolized by Cyp 3A4 and also inhitis it
ritonavir only inhibits it
