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Therapy: year 3 > COVID > Flashcards

COVID Flashcards

1
Q

What are the gerena of COVID and is the one we are most concerned about?

A

Alpha coronavirus
Beta coronavirus (mots concern)
Delta coronavirus
Gamma coronavirus

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2
Q

How is COVID transmiteed

A
  • inhalation
  • deposition of virus particles on exposed mucous membranes
  • touching mucous membrane with soiled hands
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3
Q

Epidmelogy- survelinnace

A

waste water survellance

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4
Q

What are typer of vaccines?

A
  1. mRNA
  2. Viral vector
  3. protein subunit
  4. virus-like particle (not available in Canada)
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5
Q

mRNA vax names

A

modern and pfizer

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6
Q

Viral vector vax names

A

johnson johnson and AstraZeneca

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7
Q

protein subunit vax names

A

novavax

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8
Q

wha are the XBB 1.5 monvalent vaxs?

A

moderna
pzifer

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9
Q

At what age can you be vaccinated? and what dose?

A

5 and over be vaccinated with 1 dose moderna or pzifer

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10
Q

when can you get a vaccine 6 months to 5 years old and what dose?

A

high risk for severe illness

2 doses of moderna or 3 doses of pfizer with 8 week interval betwen doses

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11
Q

if immuncomprised how does the vx schulde for doisng cahnge

A

need an additional dose with a 4-8 week intervla

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12
Q

when are you eligible for a booster?

A

6 months are an active covid infection or your last booster

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13
Q

in what patienst groups is immunization especially important?

A
  • 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
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14
Q

s/ e of mRNA vax

A

common: pain fever malagias, chills, fatigue muscle

Rare: myocarditis

Pfizer: balls palsey

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15
Q

s/ e of viral vector vax

A

Rare: blood clots due to thrombocytopeni, guille barre syndrom, capillary leakage syndrome

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16
Q

s/ e of proetin sub unit vax

A

just common ones

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17
Q

when do we need pre-exposure prophylaxis?

A

when vax is not an option or when immunocompromised (will lack an insufficient response to virus)

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18
Q

what is pre- exposure prophylaxis

A

tixagevimab/cilgavimab

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19
Q

what dose and how are tixagevimab/cilgavimab given?

A

150 mg IM each

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20
Q

when is. ahigher dose of tixagevimab/cilgavimab indicated

A

maybe 600mg depedning on efficacy of strain

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21
Q

tixagevimab/cilgavimab caution point

A

doesn’t work against all variants - omicron

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22
Q

Covid risk factors

A
  • old age
    -chronic medical condition
  • immuncomprismed
  • obesity BMI of 40 or higher
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23
Q

when can we experince COVID symptoms

A

1-14 days after exposure

usualy at day 3-7

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24
Q

COVID Red flags

A
  • tourble breathing
  • persistent pressure on chest
  • inability to stay awake
  • new confusion
  • bluish lips or face
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25
Q

Covid illness catgeories and key features of categori

A

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

26
Q

illness categories for tx

A

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

27
Q

COVID complications for those under 21

A

multisystem inflammatory syndrom

  • median age 8
  • multple organ involvment (>2), inflmmation, fialure, no alterntaive disgnoses, cardiac
28
Q

treatment for MIS-C or MIS-A

A

unsure, IVIG 2gm/kg or methylprednisone, or low dose ASA

29
Q

COvid tests

A

Molecular - NAAT, PCR

Antigen - Rapid

30
Q

Recommendation of therpy for non-servere

A

nirmatrelvir and ritonavir

remdesivir

31
Q

recommendation of therpay for severe

A

CS
IL-6 receptor blockers
baricitinib

remdesirvir

32
Q

recommendation for therpoay of critical

A

CS
IL-6 receptor blocker
Baricitinib

33
Q

nirmatrelvir/ ritonivir indication/ other name

A

confirmed symptomatic covid at risk for progressing to seriour severe disease

paxlovid

34
Q

nirmatrelvir / ritonavir MOA

A

nirmatrelvir: proetase inhibitor

ritonavir: protease inhibtor and booster for hepatic met of nirmatrelvir

35
Q

nirmatrelvir and ritonavir dose, frequncy duration

A

nirmatrelvir 300 mg(2 150mg tab) and ritonavir 100 mg (1 100mg tab)

  • bid po for 5 days
36
Q

nirmatrelvir and ritonavir food consideration

A

with or without food, don;t crush

37
Q

nirmatrelvir and ritonavir interactions

A

CYP 3A4 inhibitor

38
Q

nirmatrelvir and ritonavir dose adjustment in renal?

A

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

39
Q

Remdessivir indication and biggest limiting factor

A

confirmed Covid and at risk of severe illness that could cause hospitalization

  • given IV
40
Q

Remdesivir dosing for non-severe

A

200mg IV loading dose then 100 mg Iv daily for 2 days

41
Q

Remdesivir for mod to severe

A

200mg IV loading dose then 100 mg daily for 4-9 days

  • can extend to 10 days if no improvement on day 5
42
Q

remdesivir duration of therpay if on ecmo/mechanical ventilation

A

10 days

43
Q

remdesivir renal adjustment

A

if below 30 avoid unless benifit outweight risk

44
Q

remdesirvir ADR

A

infusion reactions

45
Q

remdesirvir monitoring

A

LFT

dont use if ASL are 5 times normal levels

46
Q

remdesivir interations

A

is a CYP 3A4 inhibtor

47
Q

remdesirvir duration if unvax with eraly COVD symptoms

A

3 days with PCR positive within last 4 to 7 days

48
Q

remdesirvir caustion point

A

be careful with liver or renal disease

49
Q

Corticoststoird recommendation?

A

dexamethasone

50
Q

Dexamthsome dose and duration of therapy

A

6 mg IV or PO for 10 days

51
Q

dexamethasone adverse effects

A

suppreses immune systme so maybe falre of latent disease - secodnary infections

52
Q

IL-6 receptor blockers recommendation

A

Tociliczumab

53
Q

Tocilizumab dose and duration

A

8 mg/kg with max of 800 mg in 1 hour

54
Q

tocilizumab adverse effects

A

infection, hepatoxicity, HTN, infusion reactions, neutropenia, bowel perforation

55
Q

What is the JAK inhibtor recommended

A

Baricitinib

56
Q

baricitinib dose and duration

A

4 mg (2 2mg tab) po daily for 14 days

57
Q

baricitinib food?

A

with or without food

58
Q

baricitinib renal adjustment

A

30-60: 2mg po daily
15-30: 1 mg po daily
below 15: not recommended

59
Q

drugs with adjustment ofr renal

A

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

60
Q

What drugs shoudl we be cautious about CYP 3A4

A

remdesivir is metabolized by Cyp 3A4 and also inhitis it

ritonavir only inhibits it

Therapy: year 3 (14 decks)

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