COVID

Question 1

CP, sx

Answer 1

-Cough, SOB, difficulty breathing
-Fever, chills
-Muscle/body aches
-Loss of taste/smell

Question 2

Diagnosis

Answer 2

-Gold standard: NAAT
*detects RNA, RT PCR

-Antigen: less sensitive, similar specificity
*detects antigens, best when symptomatic

-Serology (antibody) testing not recommended

Question 3

Outpatient Treatment

Answer 3

All Patients
-Symptom management
-NO dexamethasone or CS in the absence of other indication (AIIb)

High Risk
-Paxlovid (ritonavir-nirmatrelvir)
-Remdesivir (Blla)
*Alternative tx
-Molnupiravir (Clla)

Question 4

High Risk Criteria

Answer 4

-65+
-Diabetes, obesity
-CKD, liver disease
-HIV
-Cancer
-Heart stuff
-Immunocompromised
-COPD, asthma
-Dementia
-TB, smoker
-Pregnancy

Question 5

Remdesivir

Answer 5

*Not hospitalized, high risk, not requiring oxygen
-Give within 5 days of onset, 200 mg IVPB then 100 mg

AE:
-Nausea
-Elevated transaminase
-Increased PT
-Bradycardia, low BP
-Hypersensitivity

DDI: hydroxy/chloroquine

Question 6

Paxlovid

Answer 6

*Not hospitalized, high risk, not requiring oxygen
-Give within 5 days of onset, 100-300

AE:
-Altered taste (metallic)
-HTN
-Diarrhea
-Myalgia
-Elevated transaminase

CI: severe renal/liver (GFR<30, child C) + DDIs (CYP)

Question 7

Inpatient Treatment

Answer 7

Non-Covid reasons
-outpatient tx with prophylactic heparin

Hospitalized but no oxygen
-All: no dexamethasone
-High risk: Remdesivir
*with heparin

Hospitalized and needs oxygen
-Minimal ox: Remdesivir
-Most pts: Dexa + Remdesivir
-Conventional ox needs: Dexa + Remdesivir + Baricitnib OR Tocilizumab (or abatacept or infliximab) (DR TABI)
-Needs NFNC/HIV ox: Dexa + BTAI (in order) + add remdesivir
-MV/ECMO: Dexa + add BorT
*all with heparin

Question 8

Molnupiravir

Answer 8

*Not hospitalized, high risk, not requiring oxygen
-Give within 5 days of onset, 800 mg bid

AE:
-Nausea, diarrhea
-Dizzy
-Bone/cartilage tox
-Embryo-fetal tox (test for preg)

Question 9

Dexamethasone

Answer 9

-Needs oxygen or ventilation support
*6 mg for 10 days

AE: cardio, cns, endocrine, immuno

DDI: CYPs

Question 10

Baricitinib

Answer 10

-Need ox with HFNC, NIV, MC, ECMO

-CI in GFR < 15, bacteria infection, other JAK/DMARD

-AE: elevated ALT/AST, VTE, thrombocytopenia, infection (BG TAVI)

Question 11

Tocilizumab

Answer 11

-Need ox with HFNC, NIV, MC, ECMO
*30+ kg: 8 mg/kg
*< 30 kg: 12 mg/kg

-CI: active bacteria infection or TB

-AE: elevated ALT/AST, VTE, thrombocytopenia, infection (TB TAVI)

Question 12

Abatacept

Answer 12

-Need ox, NIV, high flow, intolerance to other agents

10 mg/kg abw

AE:
-Fever, anemia
-HTN
-CMV infection
-Pneumonia
-Epistaxis
-AKI
(FAH PACE)

Question 13

Infliximab

Answer 13

-Need ox, NIV, high flow, intolerance to other agents

5 mg/kg

AE: infection, infusions, cytopenias, liver, (cerebal, CV are rare) - CILI

Question 14

The Vaccines

Answer 14

NOT immunocompromised
-New: 1 dose moderna, 2 doses novavax, 1 dose pfizer
-Vac: 1 dose of any

Mod/Sev immunocompromised
-New: 3 doses M, 2 doses N, 3 doses P
-1 dose M or P = 2 doses M or P
-2 doses M or P = 1 dose M or P
-3 ore more of any: 1 dose of any