COVID-19 Therapies
Diese Karteikarten lernenKostenlos · Spaced Repetition · iPhone, Android, Mac & Web
Alle Karten
1
US death rates -- highest in what populations
≥85 yo
Native Americans, Hispanics
males
Native Americans, Hispanics
males
2
Preferred dx test
nucleic acid amplification test (PCR) from URT
- highly sensitive and specific
- highly sensitive and specific
3
What populations are at highest risk of severe COVID-19
≥65 yo
CVD
T2DM
chronic respiratory disease
cancer
kidney disease
BMI > 40
Sickle cell
pregnancy
transplant / immunosuppression
CVD
T2DM
chronic respiratory disease
cancer
kidney disease
BMI > 40
Sickle cell
pregnancy
transplant / immunosuppression
4
Classify -- test (+), but no sx
ASx or presymptomatic
5
Classify -- various s/s without SOB, dyspnea, abnormal imaging
mild
6
Classify -- evidence of lower respiratory disease by clinical assessment or imaging and O2sat ≥94% on room air
moderate
7
Classify -- >30 breaths / min, *O2sat <94%* on room air, PaO2/FiO2 < 300, or lung infiltrates>50%
severe
8
Classify -- respiratory failure, septic shock, +/- multiple organ dysfxn
critical
9
Classify -- common persistent sx
persistent sx or organ dysfxn
10
Pharm recommendation -- who gets dexamethasone
everyone hospitalized + oxygen
6 mg qd x 10 days (or discharge)
- no role of outpatient steroids in COVID
6 mg qd x 10 days (or discharge)
- no role of outpatient steroids in COVID
11
Pharm recommendation -- who gets remdesivir
hospitalized + oxygen
- not mech ventilation though
- not mech ventilation though
12
FDA approved pharm tx -- and indication
remdesivir -- for those who need O2 but not for mechanical ventilation
-for hospitalized ≥12 and >40 kg
- EUA: 3.5-40kg and <12 yo
-for hospitalized ≥12 and >40 kg
- EUA: 3.5-40kg and <12 yo
13
Remdesivir -- moa
nucleotide analog RNA polymerase inhibitor
14
Remdesivir -- dosing
day 1: 200 mg
2: 100 mg q24h x 4 days (until discharge)
- admin over 30-120 mins
2: 100 mg q24h x 4 days (until discharge)
- admin over 30-120 mins
15
Remdesivir -- monitoring
HSN during infusion
PT and LFTs at baseline and as indicated
CYP3a4, OAT, PGP DDIs
most common ADRS: N, inc LFTs
- CI: CrCl < 30 ml/min
PT and LFTs at baseline and as indicated
CYP3a4, OAT, PGP DDIs
most common ADRS: N, inc LFTs
- CI: CrCl < 30 ml/min
16
(3) meds not recommended currently -- only used in clinical trials
chloroquine/hydroxychloroquine +/- azithromycin
ivermectin
lopinavir / ritonavir
ivermectin
lopinavir / ritonavir
17
IDSA -- if steroids are CI, remdesivir + _________ is recommended
baricitinib
18
Steroid -- monitoring
hyperBG
secondary infxns
psychiatric effects
avascular necrosis
secondary infxns
psychiatric effects
avascular necrosis
19
Tocilizumab -- in trials for what patients
rapid respiratory decompensation
- ICU within 24 hours + ventilation or high flow nasal cannula
- ICU within 24 hours + ventilation or high flow nasal cannula
20
Tocilizumab -- do not use if...
immunosuppressed significantly
ALT > 5ULN
high risk GI perforation
uncontrolled non-covid infection
ANC < 500
PLT < 50K
ALT > 5ULN
high risk GI perforation
uncontrolled non-covid infection
ANC < 500
PLT < 50K
21
Tocilizumab -- how admin
over 60 mins IV with dexamethasone for 10 days or discharge
22
(2) mAbs
bamlanivimab 700 mg + etesevimab 1400 mg
casirivimab 1200 mg + imdevimab 1200 mg
casirivimab 1200 mg + imdevimab 1200 mg
23
Why are mAbs used
prevent progression to severe COVID19
24
Do not use mAbs if..
hospitalized or oxygen requirement
25
Bamlanivimab monotherapy?
NO
26
Convalescent plasma -- recommendation
not enough data for or against
- IDSA recommends against plasma unless in clinical trials
- IDSA recommends against plasma unless in clinical trials
27
Who gets mAbs
outpatient with mild-mod COVID19 at risk of clinical progression
- not hospitalized or requiring oxygen
- not hospitalized or requiring oxygen
28
If use convalescent plasma -- (3)
high titer product
use early in hospital course
use before critical illness
use early in hospital course
use before critical illness
29
FDA -- plasma
authorized use for hospitalized pts with COVID
30
Risk factors (other than COVID19) for VTE
hospitalization / critical illness
high BMI
lab abnormalities
high score on risk assessments (PADUA, etc)
high BMI
lab abnormalities
high score on risk assessments (PADUA, etc)
31
VTE prophylaxis
- all hospitalized pts
- continue home anticoag / antiPLT
- do not routinely discharge pts on prophylactic abx
- consider if sudden deterioration in pulmonary, cardiac, or neuro fxn
- continue home anticoag / antiPLT
- do not routinely discharge pts on prophylactic abx
- consider if sudden deterioration in pulmonary, cardiac, or neuro fxn
32
What about continuing ACE, ARB, statin, steroids, NSAIDs
continue from home
33
Pregnancy -- COVID (+) and need for hospitalization
need facility that can also monitor baby
34
Remdesivir -- age
12+
- EUA for < 12 yo
- EUA for < 12 yo
35
Multisystem inflammatory syndrome in children (MIS-C) -- clinical dx
- fever, labs = inflammation, severe illness req. hospital, multiorgan involvement
AND
- no alternate dx
AND
- recent COVID19 dx or exposure
AND
- no alternate dx
AND
- recent COVID19 dx or exposure
36
MIS-C is a ______ phenomenon rather than a direct viral process
post-infectious inflammatory
Mehr Karteikarten: Medizin und Gesundheit
Pathology Chapter 11Medizin und Gesundheit · EnglischMadiPregnancy Hypertension: Medications and CareMedizin und Gesundheit · EnglischAlaa.m.Immunology: PRRs, PAMPs, and DAMPsMedizin und Gesundheit · EnglischDanielaThe Lower Body: Advanced Anatomy & InjuriesMedizin und Gesundheit · EnglischAristotelisBegriffe Orthoptik Medizin und Gesundheit · DeutschLindaLEC 12 BIOL 431Medizin und Gesundheit · EnglischDDFLCHealthCare VocabMedizin und Gesundheit · EnglischBogaBlood Vessels and Blood Pressure Chapter 10 Pt. 2Medizin und Gesundheit · EnglischEmanSystème lymphatiqueMedizin und Gesundheit · FranzösischMevludeExam 6: Part 2 Review Medizin und Gesundheit · EnglischABiology: Homeostasis, Brain, and EyeMedizin und Gesundheit · EnglischAmélieRenal and Metabolic DiseaseMedizin und Gesundheit · Englischkarebear
Alle Decks: Medizin und Gesundheit
Lerne diese Decks in der App
Kostenlos auf iPhone, Android, Mac und im Web. Füge jedes Deck mit einem Tipp zu deinem Konto hinzu.
