COVID - Block 3

Question 1

What is the primary method of transmission of SARs?

Answer 1

Direct person-to-person respiratory trasmission of infected particles

Question 2

What is the most common clinical presentation of COVID?

Answer 2

Asymptomatic
Flu-like
Loss in taste and smell
SOB
No sneezing

Question 3

Describe the progression of sx?

Answer 3

1. Exposure
2. Initial sx within 4-5 days up to 14
3. Sx can persist for weeks to months

Question 4

What are the phases of COVID?

Answer 4

1. Early infection
2. Pulmonary phase
3. Hyperinflammation

Question 5

RF of COVID?

Answer 5

1. ≥65YO
2. Smoker
3. Medical comorbiiites/conditions

Question 6

What is the most common diagnostic tool for COVID?

Answer 6

1. NAAT -> RT-PCR
2. Chest radiograph

Question 7

Do asymptomatic infection test positive?

Answer 7

Yes

Question 8

When are false negative most common?

Answer 8

Early infection

Question 9

Chest radiograph findings in patients with COVID?

Answer 9

Ground glass opacties

Question 10

What is the goal for outpatient tx?

Answer 10

1. Prevent progession
2. Hasten sx resolution

Question 11

What is the goal of inpatient tx?

Answer 11

1. Survival
2. To prevent med vent
3. Shorten hospital stay

Question 12

Tx for mild-moderate outpatient?

Answer 12

Symptom management with:
First line: Nirmatrelvir/ritonavir (Paxlovid)
Remdesivir
Second: Molnupiravir

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Question 13

Paxlovid

MOA, 0DDI, Duration of tx, ADR, Dosing adj0

Answer 13

Nirmatrelvir/ritonavir: PIs
DDI: Ritonavir is a CYP3A4 inhibitor
Duration: 5 days
ADR: taste disorder, diarrhea, COVID19-rebound (within 2-8 days after initial recovery)
Adj: GFR≤60

Question 14

Remdesivir

MOA, Indication, Duration of tx

Answer 14

MOA: delayed chain terminator
Indication: Used within 7 days of sx onset
Duration: 3 days IV

Question 15

ADR of remdesivir?

Answer 15

1. Elevated LFTs
2. Infusion rx
3. Bradycardia
4. Hypotension
5. GI sx
6. AKI
7. Rash

Question 16

MOA of molnupiravir?

Answer 16

Oral prodrug that is metabolized to a cytidine nucleoside analogue

Question 17

Duration of Molnupiravir use? When is it authorized to be used?

Answer 17

5 days

Within 7 days of sx onset

Question 18

What medications should not be used for outpatient?

Answer 18

1. Ivermectin
2. Hydroxychloroquin/chloroquine
3. Azithromycin
4. FLuvoxamine

Question 19

Medication course used in inpatient recieving supplemental O2?

Answer 19

1. Remdesivir
2. Dexamethasone
3. Prophylactic anticoagulation

Question 20

Why is dexamethasone used?

Answer 20

Patient who have rapidly increasing O2 needs and systemic inflammation:
* Requirements for an immunomodulator (baricitinib, tocilizumab)

Question 21

Counseling for conventional O2?

Answer 21

Non pregnant with D-dimer >ULN w/o increased bleeding risk -> therapeutic heparin

Question 22

Medications used for High Flow Nasal Canula (HFNC) or NIV?

Answer 22

Dexamethasone + immunomodulator baricitinib (preferred) or tocilizumab (alternate)

Consider adding remdesivir IF immunocompromised or symptom onset w/in 10 days

Question 23

Medications for MV or ECHO?

Answer 23

Dexamethasone plus either baricitinib or tocilizumab

Remdesivir is not recommended

Question 24

Clinical duration of remdesivir tx?

Answer 24

No difference between 5 and 10 course

Question 25

Indications for dexamethasone?

Answer 25

Those on O2 support: * 6mg for up to 0 days * **Not** recommended if patients don't require supplemental O2 due to potential harm

Question 26

When is tocilizumab recommended to be used? What is the other the drug that can be used as well?

Answer 26

In addition to dexamethsone in pateints with rapid requirements for O2 and increased inflammatory markers * **Same goes for baricitinib**

Question 27

COVID19 prothrombic abnormalities?

Answer 27

1. Elevated D-dimer, D-dimer, fibrinogen, facotr VIII 2. Decreased protein C, 2, and antithrombin levels 3. Virus binds to ACE2 -> endothelial injury and thrombosis

Question 28

What is recommned for anticoagulation? Prophylaxisis?

Answer 28

Therapeutic heparin or LMW heparin **Pro:** heparin **only**

Question 29

Nonpharm/OTC tx or COVID?

Answer 29

1. Isolate home for at least 5 days 2. Adequate sleep 3. Fluid intake 4. Low levels of activity 5. COugh/throat 6. Warm tea 7. Soup 8. NSAIDs antipyretics/Tylenol | 0

Question 30

Sx to montitor for in regards to resolution?

Answer 30

1. Hypoxia 2. FeverCoug 3. SOB 4. ADR

Question 31

Vaccination for COVID prevention?

Answer 31

**mRNA tech:** Pfizer, Moderna **recombinant spike protein platform:** Novovax

Question 32

Who should get COVID vax?

Answer 32

≥6 months

Question 33

Dosing rec for vax?

Answer 33

**≥5 YO:** 1 dose of updated vax **6M-4Y:** multiple doses including 1 dose of updated vax **IC:** additional doses of updated vax

Question 34

MOA of mRNA vaccines?

Answer 34

Encode the SARS-CoV-2 spike protein, allowing ribosomes within antigen presenting cells to translate the genetic material and present it to the immune system to stimulate an immune response

Question 35

Types of mRNA vaccines? Who can get them?

Answer 35

**Pfizer:** 6 mo-11YO **COMIRNATY:** ≥12 YO **Moderna:** 6 mo-11YO **SPIKEVAX:** ≥12YO

Question 36

MOA of protin subunit vaccine?

Answer 36

Contains a purified recombinant spike (S) antigen of the SARS-Co-V-2 virus * The vaccine then elicits an immune response to the S antigen, which contributes to protection against COVID-19 disease * Adjuvanted with Matrix-M to boost immune response to the spike protein

Question 37

TYpes of protein subunit vax?

Answer 37

1. Norvax adj

Question 38

ADRs of vax?

Answer 38

1. Inj site pain 2. Fatigue 3. HA 4. Myalgia 5. Chills 6. Fever