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Therapy: year 3 > COVID > Flashcards

COVID Flashcards

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1
Q

What are the gerena of COVID and is the one we are most concerned about?

A

Alpha coronavirus
Beta coronavirus (mots concern)
Delta coronavirus
Gamma coronavirus

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2
Q

How is COVID transmiteed

A
  • inhalation
  • deposition of virus particles on exposed mucous membranes
  • touching mucous membrane with soiled hands
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3
Q

Epidmelogy- survelinnace

A

waste water survellance

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4
Q

What are typer of vaccines?

A
  1. mRNA
  2. Viral vector
  3. protein subunit
  4. virus-like particle (not available in Canada)
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5
Q

mRNA vax names

A

modern and pfizer

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6
Q

Viral vector vax names

A

johnson johnson and AstraZeneca

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7
Q

protein subunit vax names

A

novavax

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8
Q

wha are the XBB 1.5 monvalent vaxs?

A

moderna
pzifer

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9
Q

At what age can you be vaccinated? and what dose?

A

5 and over be vaccinated with 1 dose moderna or pzifer

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10
Q

when can you get a vaccine 6 months to 5 years old and what dose?

A

high risk for severe illness

2 doses of moderna or 3 doses of pfizer with 8 week interval betwen doses

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11
Q

if immuncomprised how does the vx schulde for doisng cahnge

A

need an additional dose with a 4-8 week intervla

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12
Q

when are you eligible for a booster?

A

6 months are an active covid infection or your last booster

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13
Q

in what patienst groups is immunization especially important?

A
  • 65 plus
  • long term care home or congregated living
  • underlying med conidtion
    -prego
  • members of racilaized and equity deserving communiites
  • people who provide essetial community servicecs
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14
Q

s/ e of mRNA vax

A

common: pain fever malagias, chills, fatigue muscle

Rare: myocarditis

Pfizer: balls palsey

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15
Q

s/ e of viral vector vax

A

Rare: blood clots due to thrombocytopeni, guille barre syndrom, capillary leakage syndrome

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16
Q

s/ e of proetin sub unit vax

A

just common ones

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17
Q

when do we need pre-exposure prophylaxis?

A

when vax is not an option or when immunocompromised (will lack an insufficient response to virus)

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18
Q

what is pre- exposure prophylaxis

A

tixagevimab/cilgavimab

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19
Q

what dose and how are tixagevimab/cilgavimab given?

A

150 mg IM each

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20
Q

when is. ahigher dose of tixagevimab/cilgavimab indicated

A

maybe 600mg depedning on efficacy of strain

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21
Q

tixagevimab/cilgavimab caution point

A

doesn’t work against all variants - omicron

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22
Q

Covid risk factors

A
  • old age
    -chronic medical condition
  • immuncomprismed
  • obesity BMI of 40 or higher
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23
Q

when can we experince COVID symptoms

A

1-14 days after exposure

usualy at day 3-7

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24
Q

COVID Red flags

A
  • tourble breathing
  • persistent pressure on chest
  • inability to stay awake
  • new confusion
  • bluish lips or face
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25
Covid illness catgeories and key features of categori
asymptomatic or presymptomatic mild illness - sym but no respiratory problems moderate illness - oxygen levels are effected severe illness - oxygen and respiration affected critical illness - sepsis, mult organs failure, respiratoyr failure
26
illness categories for tx
non- severe : outptaient severe: signs of pneumonia, severe respiratory distress and oxygen saturation of less than 90% critical: requires life sustaining tx, acute respiratoyr distress syndrom, sepsis, septic shock
27
COVID complications for those under 21
multisystem inflammatory syndrom - median age 8 - multple organ involvment (>2), inflmmation, fialure, no alterntaive disgnoses, cardiac
28
treatment for MIS-C or MIS-A
unsure, IVIG 2gm/kg or methylprednisone, or low dose ASA
29
COvid tests
Molecular - NAAT, PCR Antigen - Rapid
30
Recommendation of therpy for non-servere
nirmatrelvir and ritonavir remdesivir
31
recommendation of therpay for severe
CS IL-6 receptor blockers baricitinib remdesirvir
32
recommendation for therpoay of critical
CS IL-6 receptor blocker Baricitinib
33
nirmatrelvir/ ritonivir indication/ other name
confirmed symptomatic covid at risk for progressing to seriour severe disease paxlovid
34
nirmatrelvir / ritonavir MOA
nirmatrelvir: proetase inhibitor ritonavir: protease inhibtor and booster for hepatic met of nirmatrelvir
35
nirmatrelvir and ritonavir dose, frequncy duration
nirmatrelvir 300 mg(2 150mg tab) and ritonavir 100 mg (1 100mg tab) - bid po for 5 days
36
nirmatrelvir and ritonavir food consideration
with or without food, don;t crush
37
nirmatrelvir and ritonavir interactions
CYP 3A4 inhibitor
38
nirmatrelvir and ritonavir dose adjustment in renal?
if eGFR is over 60: normal dose 30-60: one tab of nirvatrelvir and one tab of riotnavir po BID for 5 days if below 30: not recommended
39
Remdessivir indication and biggest limiting factor
confirmed Covid and at risk of severe illness that could cause hospitalization - given IV
40
Remdesivir dosing for non-severe
200mg IV loading dose then 100 mg Iv daily for 2 days
41
Remdesivir for mod to severe
200mg IV loading dose then 100 mg daily for 4-9 days * can extend to 10 days if no improvement on day 5
42
remdesivir duration of therpay if on ecmo/mechanical ventilation
10 days
43
remdesivir renal adjustment
if below 30 avoid unless benifit outweight risk
44
remdesirvir ADR
infusion reactions
45
remdesirvir monitoring
LFT dont use if ASL are 5 times normal levels
46
remdesivir interations
is a CYP 3A4 inhibtor
47
remdesirvir duration if unvax with eraly COVD symptoms
3 days with PCR positive within last 4 to 7 days
48
remdesirvir caustion point
be careful with liver or renal disease
49
Corticoststoird recommendation?
dexamethasone
50
Dexamthsome dose and duration of therapy
6 mg IV or PO for 10 days
51
dexamethasone adverse effects
suppreses immune systme so maybe falre of latent disease - secodnary infections
52
IL-6 receptor blockers recommendation
Tociliczumab
53
Tocilizumab dose and duration
8 mg/kg with max of 800 mg in 1 hour
54
tocilizumab adverse effects
infection, hepatoxicity, HTN, infusion reactions, neutropenia, bowel perforation
55
What is the JAK inhibtor recommended
Baricitinib
56
baricitinib dose and duration
4 mg (2 2mg tab) po daily for 14 days
57
baricitinib food?
with or without food
58
baricitinib renal adjustment
30-60: 2mg po daily 15-30: 1 mg po daily below 15: not recommended
59
drugs with adjustment ofr renal
Paxlovid 30-60: 1 nirmatrelvir and 1 ritoniavir po BID for 5 days Remdesivir below 30 avoid Barticinib 30-60: 2 mg 15-30: 1 mg below 15; avoid
60
What drugs shoudl we be cautious about CYP 3A4
remdesivir is metabolized by Cyp 3A4 and also inhitis it ritonavir only inhibits it

Therapy: year 3 (14 decks)

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