DISORDERS OF THE RESPIRATORY SYSTEM PART 3.2 (based on T) Flashcards
What is the indication for corticosteroids in COVID-19?
Patients classified as severe & critical COVID-19.
What is the dosing regimen for IV dexamethasone in COVID-19?
0.15 mg/kg IV once daily (max dose: 6mg) for up to 10 days or until discharge.
What are the alternative IV corticosteroids if dexamethasone is unavailable?
Methylprednisolone: 0.8 mg/kg IV once daily (max dose: 32mg) OR Hydrocortisone based on age-specific dosing.
What is the dosing regimen for oral corticosteroids in COVID-19?
Dexamethasone PO: 0.15 mg/kg orally once daily (max dose: 6mg) OR Prednisolone: 1 mg/kg orally once daily (max dose: 40mg).
What are the contraindications for corticosteroids?
Systemic fungal infection, systemic infection unless treated, hypersensitivity to the active ingredient or any component.
What are the adverse effects of corticosteroids?
Adrenal suppression, immunosuppression, hyperglycemia, psychiatric disturbances, hypertension, edema, myopathy, hypernatremia, avascular necrosis, adrenal insufficiency.
What is the indication for Tocilizumab in COVID-19?
Patients with rapid respiratory deterioration requiring high oxygen and with elevated inflammation markers.
What is the dosing regimen for Tocilizumab in COVID-19?
8 mg/kg (≥30 kg) or 12 mg/kg (<30 kg) as a single dose (max: 800 mg). A second dose may be given ≥8 hours after if no improvement.
What are the contraindications for Tocilizumab?
Hypersensitivity to Tocilizumab or any component of the formulation.
What are precautions for Tocilizumab use?
Immunocompromised patients, ALT >5x ULN, high GI perforation risk, uncontrolled serious infections, ANC <500, platelets <50,000.
What are the adverse effects of Tocilizumab?
Serious infections (TB, opportunistic), increased cholesterol, constipation, neutropenia, elevated AST/ALT, injection/infusion site reactions.
What is the indication for Bamlanivimab + Etesevimab in COVID-19?
Child, non-hospitalized, lab-confirmed SARS-CoV-2, mild-moderate COVID-19, within 10 days of symptoms, high risk for severe disease.
What is the dosing regimen for Bamlanivimab + Etesevimab?
IV infusion based on weight: 1-12 kg: 12 mg/kg Bamlanivimab + 24 mg/kg Etesevimab, ≥40 kg: 700 mg Bamlanivimab + 1400 mg Etesevimab.
What are the contraindications for Bamlanivimab + Etesevimab?
Severe hypersensitivity (e.g., anaphylaxis) to Bamlanivimab, Etesevimab, or any component.
What are the adverse effects of Bamlanivimab + Etesevimab?
Fever, chills, dizziness, dyspnea, urticaria, pruritus, flushing, nausea, vomiting.
What is the indication for Casirivimab + Imdevimab in COVID-19?
Child/adolescent >12 years, >40 kg, non-hospitalized, lab-confirmed SARS-CoV-2, mild-moderate COVID-19, within 10 days of symptoms, high risk for severe disease.
What is the dosing regimen for Casirivimab + Imdevimab?
600 mg Casirivimab + 600 mg Imdevimab as a single IV infusion over ≥60 minutes.
What are the contraindications for Casirivimab + Imdevimab?
Severe hypersensitivity (e.g., anaphylaxis) to Casirivimab, Imdevimab, or any component.
What are the adverse effects of Casirivimab + Imdevimab?
Fever, chills, dizziness, dyspnea, urticaria, pruritus, flushing, nausea, vomiting.
What is the US NIH recommendation for mAb therapy in regions with Omicron VOC?
If Delta VOC is still prevalent, Bamlanivimab + Etesevimab or Casirivimab + Imdevimab may be used, but they are ineffective against Omicron.
What is the recommended monoclonal antibody for Omicron VOC?
Sotrovimab should be administered within 10 days of symptom onset in patients ≥12 years and ≥40 kg.
Is Sotrovimab available in the Philippines?
No, Sotrovimab is not yet available in the Philippines.
What is the recommended dosing regimen for methylprednisolone in MIS-C?
1-2 mg/kg/dose (max: 30 mg/dose) IV q12h initially, then shift to oral corticosteroids once defervescence occurs or after 3-5 days, tapered off over 3-4 weeks.
When is high-dose pulse glucocorticoids recommended in MIS-C?
In patients who do not respond to IVIG and low-dose corticosteroids, especially those on high-dose multiple inotropes.