COVID-19

Question 1

Complications of COVID-19: CV

Answer 1

History of CVD puts a patient at 5x higher risk of mortality

Question 2

Complications of COVID-19: Diabetes

Answer 2

More likely to lead to ARDS

Question 3

Other complications of COVID-19

Answer 3

Hepatobiliary, GI, renal, neurological, thyrotoxicosis, musculocutaneous, hemotologic

Question 4

Remdesivir MoA

Answer 4

Delayed termination of RNA transcription

Question 5

Only approved COVID drug

Answer 5

Remdesivir

Question 6

Guidelines for use of remdesivir

Answer 6

Use when the patient is hospitalized and require minimal supplemental oxygen

Also for ambulatory patients with mild-moderate COVID at high risk for progression to severe disease (initiate within 7 days of symptom onset)

Question 7

Duration of treatment of remdesivir

Answer 7

5 days

Question 8

Corticosteroids for COVID

Answer 8

Dexamethasone 6mg IV/PO QD x10 days or until hospital discharge

Question 9

Dexamethasone ADEs

Answer 9

Hyperglycemia, agitation/confusion, adrenal suppression, risk of bacterial and fungal infection

Question 10

Remdesivir dosing

Answer 10

200mg IV loading dose, 100mg MD x5-10 days

Outpatient dosing is 200mg IV x1, 100mg MD x2 days

Question 11

Tocilizumab MoA

Answer 11

binds to membrane-bound and soluble forms of IL-6R

Question 12

Tocilizumab dosing

Answer 12

8mg/kg IV x1 dose

Question 13

Tocilizumab ADEs

Answer 13

Elevated liver enzymes, neutropenia or thrombocytopenia, general infection, serious infections like TB, bacterial/fungal infections

Question 14

Baricitinib MoA

Answer 14

Modulates signaling pathway of JAK, preventing phosphorylation and activation of STATs

Question 15

Baricitinib drug class

Answer 15

Kinase inhibitor

Question 16

Baricitinib dosing

Answer 16

4mg PO x14 days or until hospital discharge

Question 17

Baricitinib guidelines: IDSA

Answer 17

It’s better than nothing in hospitalized patients with severe COVID-19 with elevated inflammatory markers

Question 18

Baricitnib guidelines: NIH

Answer 18

For hospitalized patients on dexamethasone and supplemental oxygen with rapidly increased oxygen needs and systemic inflammation

Question 19

Tocilizumab drug class

Answer 19

IL-6 antagonist

Question 20

Tocilizumab guidelines

Answer 20

Hospitalized patients who are receiving systemic corticosteroids and require any kind of supplemental oxygen

Question 21

Sotrovimab drug class

Answer 21

Neutralizing monoclonal antibody

Question 22

Sotrovimab MoA

Answer 22

Bind to receptor binding domain of spike protein and blocks entry into host cells

Question 23

Sotrovimab dosing

Answer 23

500mg IV x1 ASAP (within 7 days of Sx onset)

Question 24

Sotrovimab indication: IDSA

Answer 24

Patients with mild-moderate COVID-19 at high risk of severe disease

Question 25

High-risk patients for sotrovimab

Answer 25

Old people, obesity, pregnancy, CKD, DM, immunosuppression, CVD, chronic lung disease, sickle cell disease, neurodevelopmental disorders, medical-related technological dependency

Question 26

Sotrovimab indication: NIH

Answer 26

Second-line if ritonavir-boosted nirmatrelvir isn’t an option (Paxlovid)

Question 27

Molnupiravir MoA

Answer 27

Inhibits viral reproduction by promoting widespread mutations in the replication of viral RNA by RNA-dependent RNA polymerase

Question 28

Molnupiravir dosing

Answer 28

800mg PO q12h x5 days

Question 29

Molnupiravir indication

Answer 29

Adults with mild-moderate COVID-19 with at least 1 risk factor for developing severe illness (NOT hospitalized)

Question 30

Nirmatrelvir/ritonavir (Paxlovid) MoA

Answer 30

inhibits COVID-19’s main protease to prevent viral replication

Question 31

Paxlovid dosing

Answer 31

Nirmatrelvir 300mg/ritonavir 100mg PO BID x5 days

Question 32

Paxlovid indication

Answer 32

Patients with COVID with at least 1 risk factor for developing severe illness (NOT hospitalized)

Question 33

ABX and COVID-19

Answer 33

Not recommended

Question 34

Anticoagulation and COVID-19

Answer 34

ICU patients shouldn’t receive it, but consider Lovenox in non-ICU patients whose D-dimer is ≥4 ULN

All patients should receive VTE trophy where possible