EXAM 1- REIDY

Covid-19 is an infection cause by ________________, which is a betacoronavirus.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

How do new sublineages of COVID-19, like Omicron, compared to SARS-CoV-2?

• more transmissible

• not suscpetible to anti-SARS-CoV-2 mAbs

There are 5 clinical manifestations of Covid-19. Describe the s/sx of each:

• asymptomatic/presymptomatic

• mild illness

• moderate illness

• severe illness

• critical illness

• asymptomatic/presymptomatic: test positive, but no symptoms

• mild illness: s/sx of covid, but NO SOB or DYPSNEA

• moderate illness: oxygen saturation (SpO2) ≥94%

• severe illness (idk how important): oxygen saturation (SpO2) <94%, PaO2/FiO2 <300mmHg, RR >30, or lung infiltrates >50%

• critical illness: respiratory failure, sepsis, multi organ dysfunction

Transmission of covid occurs primarily via _____________________________.

exposure to respiratory droplets

How can transmission of covid be reduced?

• face coverings

• cover when cough/sneeze

• isolate

• frequent handwashing

what is the 1st line approach and MOST EFFECTIVE WAY to prevent covid-19 infection?

vaccination

The covid-19 vaccination is recommended for all persons ≥ _________ months or years?

≥ 6 months

How many vaccines are currently available for covid?

What kind of vaccine are they? (mRNA or Adjuvanted)

• 3 vaccines available

  • 2 mRNA vaccines

    • Moderna

    • Pfizer

  • 1 adjuvanted recombinant protein vaccine

    • Novavax

mRNA vaccines are approved for use in those _________ and older.

6 months

Adjuvanted recombinant protein vaccines are approved for use in those _____________ and older.

12 years

What are some rare, but serious adverse effects of covid vaccines?

myocarditis and pericarditis

What are the vaccine recommendations in pregnancy/lactation?

CDC and ACOG recommended GETTING VACCINATED!!!!!!

What type of drug is Pemivibrant?

What is its indication?

When is it dosed?

Pemivibrant

• mAb

• indication:

  • for PRE-EXPOSURE prophylaxis in individuals ≥ 12 yrs of age and ≥ 40 kg in pts. who:

    • not currently infected with covid AND

    • no recent exposure AND

    • who are moderate-severely immune compromised

• dosed every 3 months

What are the different tx options for Covid-19?

• antivirals

  • Remdesivir

  • Nirmatrelvir/Ritonavir

  • Molnupipiravir

• mAb

  • Tocilizumab

  • Sarilumab

  • Vilobelimab

• antirheumatics

  • Tofacitinib

  • Baricitinib

• corticosteroids

  • dexamethasone

What is the indication for Remdesivir?

adult and pediatric pts. (aged ≥28 days and ≥3kg), who have mild-moderate covid-19 AND are at high risk of progression to severe covid-19

The duration of tx for Remdesivir depends on hospitalization status.

What’s the duration for hospitalized and non-hospitalized patients?

• hospitalized: 5 days or until discharge

• non-hospitalized: 3 days

  • make sure to initiate within 7 days

What drugs interact with Remdesivir?

warfarin—> increases INR

For Paxlovid, what is the MOA of Ritonavir?

STRONG CYP3A4 INHIBITOR!!!!!!!!! (in order to boost Nirmatrelvir)

What is the indication for Paxlovid?

treatment of mild-moderate covid-19 in adults at high risk for progression to severe covid-19 (EUA for pediatric pts. ≥12 and ≥40kg)

Paxlovid should be initiated within ___ days of symptoms onset.

5

What is an ADR of Paxlovid?

dysgeusia (distortion of sense of taste)

When is the standard versus reduce dose pack of Paxlovid used?

• standard: normal renal fxn

• reduced: renal impairment (eGFR ≥30 to <60 ml/min)

What is the BBW on PAXLOVID or Nirmatrelvir/Ritonavir?

significant drug interactions

• ex: amiodarone, clopidogrel, clozapine, statins, rivaroxaban

What is the indication for Molnupiravir?

• tx of adults with mild-moderate covid-19 who are at high risk for progression to severe covid-19

• AND

• alternative covid-19 options are not accessible (like paxlovid)

Molnupiravir should be initiated within __ days of symptoms onset.

5

Use of Molnupiravir is STRONGLY recommended AGAINST in what group of people?

pregnancy!!!!!!!!!!!!!! (unless no other options)

What is the indication for Tocilizumab, Sarilumab, and Vilobelimab?

• Tocilizumab:

  • for use in HOSPITALIZED PTS. who are receiving systemic corticosteroids AND require supplemental oxygen (mechanical vent, ECMO)

• Sarilumab:

  • may be used if tocilizumab is NOT available

• Vilobelimab

  • for use in HOSPITALIZED PTS. specifically when administered within 48 hrs of mechanical ventilation or EMCO (extracorporeal membrane oxygenation)

SYSTEMIC CORTICOSTEROIDS ARE ONLY USED IN WHAT KIND OF PTS.?

• ONLY IF HOSPITALIZED AND ON SUPPLEMENTAL OXYGEN!!!!!!!!

• NOT IN OUTPATIENT!!!!!!!!!

What is the preferred systemic corticosteroid for tx of covid?

• dexamethasone

  • can also use prednisone, methylpred, hydrocortisone

What are some adverse effects of steroids? Can you take steroids while pregnant/breast feeding?

• ADRs: hyperglycemia, secondary infections, psychiatric effects

• yes can use while pregnant, lactating

REVIEW:

For therapeutic management of non-hospitalized adults…

• is systemic corticosteroids recommended for symptom management?

• pts. who are at high risk of progressing to severe covid-19 should be txed with what?

IDK HOW IMP

• RECOMMEND AGAINST DEXAMETHASONE USE

• pts. who are mild-mod and high risk of progressing to severe

  • PAXLOVID- start within 5 day sym onset

  • REMDESIVIR- start within 7 days sym onset

  • alternative: Molnupiravair- start within 5 day sym onset

REVIEW:

For therapeutic management of hospitalized adults:

• hospitalized BUT not requiring supplemental oxygen

• hospitalized AND requiring supplemental oxygen

• hospitalized AND required HFNC or HIV

• hospitalized AND requiring mechanical ventilation or ECMO

IDK HOW IMP

• hospitalized BUT not requiring supplemental oxygen

  • remdesivir

• hospitalized AND requiring supplemental oxygen

  • requiring minimal oxygen—> remdesivir

  • most pts. dexamethasone + remdesivir

  • can add one of the following immunomodulators: PO baricitinib or IV tocilizumab

• hospitalized AND required HFNC or HIV

  • dexamethasone in ALL pts.

  • if not already initiated add 1 of the following mAb

    • PO baricitinib (preferred), IV tocilizumab

• hospitalized AND requiring mechanical ventilation or ECMO

  • dexamethasone in ALL pts.

  • if pt. has not received a second immunomodulator, add one of the following mAb

    • PO baricitinib (preferred), IV tocilizumab