Week 6: Alterations of Pulmonary Function

Question 1

***What part of the COVID-19 virus structure causes infection?

Answer 1

Spike Protein (S)

Question 2

***What makes the (S) Spike Protein so special?

Answer 2

It fuses into our cells, causing MASSIVE replication without recognition from our immune system.

Question 3

more review What is the patho of COVID-19?

Answer 3

• Hyperinflamm. response causes increased permeability of vascular & epithelial membranes, edema, & tissue necrosis (esp. lung tissue)
• Hypercoagulable state like Disseminated Intravascular Coagulation (DIC)

Question 4

***What are the non-respiratory symptoms of COVID-19?

Answer 4

• (heart) inflammation/immune changes in myocardium; cardiomyocyte death
• (brain) Neuro. inflammation.; brain damage @ parenchyma & cerebral vasculature
• (kidneys) Acute Kidney Injury (AKI); especially in critically ill patients…
  nephrology –> acute tubular necrosis (ATN) –> glomerulosclerosis

Question 5

What does ARDS stand for?

Answer 5

acute respiratory distress syndrome

Question 6

What is ARDS? (2)

Answer 6

• acute lung inflammation
• diffuse alveolocapillary injury
  …because of direct pulm. injury/severe sys. infection

Question 7

TRUE or FALSE: ARDS is potentially deadly

Answer 7

TRUE

Question 8

TRUE or FALSE: Since COVID-19 emerged, there has been a decrease in ARDS cases globally

Answer 8

FALSE

Question 8

What is seen in ARDS? (2)

Answer 8

• acute onset of BILATERAL INFILTRATES on chest x-ray (ex. pulmonary edema)
• persistent hypoxemia even though O2 is given :(

Question 8

What does PARDS stand for?

Answer 8

PEDIATRIC acute respiratory distress syndrome

Question 8

_______ & ________ cause direct lung injury in PARDS (?)

Answer 8

COVID-19 & pneumonia

Question 8

more review What is the patho of ARDS?

Answer 8

• Inflammatory response
  —–infiltration of macrophages…activation of complement/clotting system “cytokine storm”
  —— Results in diffuse alveolar & micro. vas. DAMAGE and THROMBOSIS
  ——- Fluid LEAKS into pulm. interstitium…so V/Q mismatch & hypoxemia

Question 8

What are the 3 stages of ARDS?

Answer 8

• Exudative (inflammatory)
• Proliferative
• Fibrotic

Question 8

**In ARDS, during the _________ stage, there is severe _____________.

Answer 8

Fibrotic stage, RIGHT to LEFT shunting

Question 9

What are the key clinical manifestations of ARDS? (5)

Answer 9

• Dyspnea, hypoxemia
• Initial hyperventilation & resp. Alkalosis
• Metabolic acidosis

Question 10

What is Glomerulosclerosis?

Answer 10

Glomerulosclerosis is scarring of the filtering part of the kidneys (glomerulus). This causes a loss of protein into the urine. These proteins help fluid stay within the blood vessels. Without them, fluid leaks into the nearby tissue causing swelling.

Question 11

COVID-19 transmission consists of:

Answer 11

Droplet (ex. cough, sneeze, talking)
Aerosol :0
**symptomatic = MOST infectious

Question 12

What is COVID-19’s incubation period?

Answer 12

up to 1 week

Question 13

**What is the key concept in COVID-19 in children?

Answer 13

It’s mild for kids usually, but some may develop serious illness…
- Multisystem inflammatory syndrome in children (MIS-C)*****

Question 14

What are the clinical manifestations of COVID-19? (6)

Answer 14

• myalgias (muscle ache/pain)
• fever
• cough
• fatigue
• SOB
• loss of smell/taste

Question 15

In COVID-19, what are the primary causes of mortality? (2)

Answer 15

Respiratory failure & septic shock

Question 16

Name the 2 monoclonal antibodies drugs

Answer 16

TixageviMAB & CilgaviMAB

Question 17

Which drug (s) does/do Ontario NOT recommend anymore for preventing COVID?

Answer 17

TixageviMAB & CilgaviMAB

Question 18

What is the use of TixageviMAB & CilgaviMAB?

Answer 18

• prevent COVID
• pre-exposure to COVID

Question 19

What is the mechanism of action of TixageviMAB & CilgaviMAB?

Answer 19

• attach to receptor-binding portion of COVID spike protein
  —> This combo of drugs BLOCKS virus’ interaction w/ HUMAN ACE 2 receptor req. for viral fusion w/ host cell

Question 20

What are the side effects of TixageviMAB & CilgaviMAB? (3)

Answer 20

• hypersensitivity
• anaphylaxis
• injection site reaction

Question 21

Name the 2 antiviral drugs to treat COVID:

Answer 21

Nirmatrelvir & Ritonavir

Question 22

What is the use of Nirmatrelvir & Ritonavir?

Answer 22

Treats mild/moderate COVID
—> (+) test
—> HIGH RISK of getting severe COVID…(hospital/death)

:) stops virus from multiplying
:) decreases severe outcomes

Question 23

*****What are the age groups that can take antivirals? (Nirmatrelvir & Ritonavir)?

Answer 23

• 60+
• 18+ immunocompromised
• 18-59 & HIGHER risk of severe COVID (1+ comorbidity; inadequate immunity; unvaxxed/incomplete series…OR had COVID/infection 6+ months ago)

Question 24

What is DIC stand for?

Answer 24

Disseminated Intravascular Coagulation (DIC)