COVID-19 Flashcards
Complications of COVID-19: CV
History of CVD puts a patient at 5x higher risk of mortality
Complications of COVID-19: Diabetes
More likely to lead to ARDS
Other complications of COVID-19
Hepatobiliary, GI, renal, neurological, thyrotoxicosis, musculocutaneous, hemotologic
Remdesivir MoA
Delayed termination of RNA transcription
Only approved COVID drug
Remdesivir
Guidelines for use of remdesivir
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)
Duration of treatment of remdesivir
5 days
Corticosteroids for COVID
Dexamethasone 6mg IV/PO QD x10 days or until hospital discharge
Dexamethasone ADEs
Hyperglycemia, agitation/confusion, adrenal suppression, risk of bacterial and fungal infection
Remdesivir dosing
200mg IV loading dose, 100mg MD x5-10 days
Outpatient dosing is 200mg IV x1, 100mg MD x2 days
Tocilizumab MoA
binds to membrane-bound and soluble forms of IL-6R
Tocilizumab dosing
8mg/kg IV x1 dose
Tocilizumab ADEs
Elevated liver enzymes, neutropenia or thrombocytopenia, general infection, serious infections like TB, bacterial/fungal infections
Baricitinib MoA
Modulates signaling pathway of JAK, preventing phosphorylation and activation of STATs
Baricitinib drug class
Kinase inhibitor
Baricitinib dosing
4mg PO x14 days or until hospital discharge
Baricitinib guidelines: IDSA
It’s better than nothing in hospitalized patients with severe COVID-19 with elevated inflammatory markers
Baricitnib guidelines: NIH
For hospitalized patients on dexamethasone and supplemental oxygen with rapidly increased oxygen needs and systemic inflammation
Tocilizumab drug class
IL-6 antagonist
Tocilizumab guidelines
Hospitalized patients who are receiving systemic corticosteroids and require any kind of supplemental oxygen
Sotrovimab drug class
Neutralizing monoclonal antibody
Sotrovimab MoA
Bind to receptor binding domain of spike protein and blocks entry into host cells
Sotrovimab dosing
500mg IV x1 ASAP (within 7 days of Sx onset)
Sotrovimab indication: IDSA
Patients with mild-moderate COVID-19 at high risk of severe disease
High-risk patients for sotrovimab
Old people, obesity, pregnancy, CKD, DM, immunosuppression, CVD, chronic lung disease, sickle cell disease, neurodevelopmental disorders, medical-related technological dependency
Sotrovimab indication: NIH
Second-line if ritonavir-boosted nirmatrelvir isn’t an option (Paxlovid)
Molnupiravir MoA
Inhibits viral reproduction by promoting widespread mutations in the replication of viral RNA by RNA-dependent RNA polymerase
Molnupiravir dosing
800mg PO q12h x5 days
Molnupiravir indication
Adults with mild-moderate COVID-19 with at least 1 risk factor for developing severe illness (NOT hospitalized)
Nirmatrelvir/ritonavir (Paxlovid) MoA
inhibits COVID-19’s main protease to prevent viral replication
Paxlovid dosing
Nirmatrelvir 300mg/ritonavir 100mg PO BID x5 days
Paxlovid indication
Patients with COVID with at least 1 risk factor for developing severe illness (NOT hospitalized)
ABX and COVID-19
Not recommended
Anticoagulation and COVID-19
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
