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Therapeutics IV > COVID - Block 3 > Flashcards

COVID - Block 3 Flashcards

1
Q

What is the primary method of transmission of SARs?

A

Direct person-to-person respiratory trasmission of infected particles

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2
Q

What is the most common clinical presentation of COVID?

A

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

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3
Q

Describe the progression of sx?

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

What are the phases of COVID?

A
  1. Early infection
  2. Pulmonary phase
  3. Hyperinflammation
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5
Q

RF of COVID?

A
  1. ≥65YO
  2. Smoker
  3. Medical comorbiiites/conditions
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6
Q

What is the most common diagnostic tool for COVID?

A
  1. NAAT -> RT-PCR
  2. Chest radiograph
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7
Q

Do asymptomatic infection test positive?

A

Yes

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8
Q

When are false negative most common?

A

Early infection

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9
Q

Chest radiograph findings in patients with COVID?

A

Ground glass opacties

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10
Q

What is the goal for outpatient tx?

A
  1. Prevent progession
  2. Hasten sx resolution
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11
Q

What is the goal of inpatient tx?

A
  1. Survival
  2. To prevent med vent
  3. Shorten hospital stay
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12
Q

Tx for mild-moderate outpatient?

A

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

00

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13
Q

Paxlovid

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

A

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

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14
Q

Remdesivir

MOA, Indication, Duration of tx

A

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

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15
Q

ADR of remdesivir?

A
  1. Elevated LFTs
  2. Infusion rx
  3. Bradycardia
  4. Hypotension
  5. GI sx
  6. AKI
  7. Rash
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16
Q

MOA of molnupiravir?

A

Oral prodrug that is metabolized to a cytidine nucleoside analogue

17
Q

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

A

5 days

Within 7 days of sx onset

18
Q

What medications should not be used for outpatient?

A
  1. Ivermectin
  2. Hydroxychloroquin/chloroquine
  3. Azithromycin
  4. FLuvoxamine
19
Q

Medication course used in inpatient recieving supplemental O2?

A
  1. Remdesivir
  2. Dexamethasone
  3. Prophylactic anticoagulation
20
Q

Why is dexamethasone used?

A

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

21
Q

Counseling for conventional O2?

A

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

22
Q

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

A

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

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

23
Q

Medications for MV or ECHO?

A

Dexamethasone plus either baricitinib or tocilizumab

Remdesivir is not recommended

24
Q

Clinical duration of remdesivir tx?

A

No difference between 5 and 10 course

25
Q

Indications for dexamethasone?

A

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

26
Q

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

A

In addition to dexamethsone in pateints with rapid requirements for O2 and increased inflammatory markers

  • Same goes for baricitinib
27
Q

COVID19 prothrombic abnormalities?

A
  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
28
Q

What is recommned for anticoagulation? Prophylaxisis?

A

Therapeutic heparin or LMW heparin

Pro: heparin only

29
Q

Nonpharm/OTC tx or COVID?

A
  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

30
Q

Sx to montitor for in regards to resolution?

A
  1. Hypoxia
  2. FeverCoug
  3. SOB
  4. ADR
31
Q

Vaccination for COVID prevention?

A

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

32
Q

Who should get COVID vax?

A

≥6 months

33
Q

Dosing rec for vax?

A

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

34
Q

MOA of mRNA vaccines?

A

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

35
Q

Types of mRNA vaccines? Who can get them?

A

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

36
Q

MOA of protin subunit vaccine?

A

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

37
Q

TYpes of protein subunit vax?

A
  1. Norvax adj
38
Q

ADRs of vax?

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

Therapeutics IV (39 decks)

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