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COVID Pharmacology
For Pharmacology NURS 422
| Term | Definition |
|---|---|
| Coronaviruses | 7 known. 4 mild/moderate, 3 may be fatal: MERS, SARS, COVID-19 Zoonotic Affecting respiratory tract - respiratory ailment is a common clinical manifestation |
| COVID-19 Symptoms | Wide range of symptoms and severity ranges from asymptomatic to fatal. 14 days incubation period Starts with cold-like symptoms Occasionally presents with rash, loss of taste/smell |
| COVID-19 Complications | Viral pneumonia Thromboembolic complications: DVT, PE, CVA CV Complications Encephalopathy Secondary Infections (Superimposed bacterial pneumonia) |
| COVID-19 Complications (Cont.) | CYTOKINE STORM: Inflammatory response triggered later in course of disease Starts days 8-10 Sepsis, worsening respiratory failure, acute renal injury/failure, elevated blood glucose levels & DKA, CV compromise, thrombi |
| Inpatient COVID-19 Considerations | - On supplemental oxygen - NOT on supplemental oxygen |
| Remdesivir (Veklury) | ANTIVIRAL - IN HOSPITAL/ON OXYGEN Used in early course of disease. 5 day course, IV only |
| Remdesivir MOA | Inhibits viral replication |
| Remdesivir Adverse Effects | Patients w/ CKD, toxicity as metabolites are renally excreted; avoid if GFR less than 30 Hepatotoxicity: monitor LFT Hypersensitivity Reactions: Watch for flushing airway compromise, hemodynamic instability |
| Dexamethasone | GLUCOCORTICOID - IN HOSPITAL/ON OXYGEN Can be used w/ remdesivir Reduces mortality and reduces in need for mechanical ventilation (meta-analysis) No benefit in patients who DONT need supplemental oxygen 10 day course, oral or IV push (over 5 mins) |
| Dexamethasone MOA | Long acting steroid; suppresses immune response Inflammatory response drives the severe presentations of COVID, dexamethasone shuts this down |
| Dexamethasone Adverse Effects | Hyperglycemia Hypertension Steroid Psychosis/Encephalopathy, esp. in the elderly Immune Suppression - Risk of superinfections Increased risk of ulcers/gastritis |
| Dexamethasone Adverse Effects (Cont.) | Unlikely to cause long-term steroid use side effects such as adrenal insufficiency, new DM, myopathy, osteoporosis, cataracts |
| Baracitinib | JANUS KINASE (JAK) INHIBITOR - IN HOSPITAL/ON OXYGEN Oral w/ or w/o food Adults and children over 9 years: 4 mg per say for 14 days or until discharge |
| Baracitinib Indications | Used in many autoimmune & inflammatory diseases COVID FDA approved to be used WITH remdesivir in patients needing supplemental oxygen, intubation/ventilation, or ECMO (extracorporeal membrane oxygenation) |
| Baracitinib MOA | Inhibits janus kinase - blocks inflammatory signaling Reduces time to recover, associated with improved outcomes, decease need for mechanical ventilation, decreased adverse effects & mortality |
| Baracitinib Adverse Effects | Suppresses BOTH innate and adaptive immune responses Increased risk of infectious diseases (UTI, including nasopharyngitis) RARE: May activate latent viruses (TB, Hep.B, Herpes...) Increased risk for CA-lymphoma and skin cancers Thrombosis |
| Baracitinib Considerations | Check liver functions Check CBC w/ differential (absolute lymphocytes & neutrophils) Avoid in patients with ACTIVE opportunistic infections Weigh benefits/risks w/ active infections other than COVID |
| Paxlovid | ANTIVIRAL - FOR NON-HOSPITALIZED PATIENTS 2 parts Nirmatrelvir, 1 part Ritonavir 3 tablets twice a day for 5 days |
| Paxlovid Indications | Approved in EUA on 12/21 For mild-moderate COVID Not used for pre/post exposure For adults & children over 12 years of age **Reduced hospitalization & death versus placebo |
| Paxlovid Adverse Effects | Lost of taste Diarrhea Hypertension Myalgias In people with uncontrolled/undiagnosed HIV, it can lead to drug resistance |
| Monoclonal Antibodies | Target spike proteins to interfere with membrane fusion and viral entry Treatment for COVID, PrEP, and post exposure after potential exposure. Should ONLY be used for those at high risk of disease progression (i.e: immunocompromised pts) |
| Monoclonal Antibodies (Cont.) | Bamlanivimab + Etesevimab (NOT for Omicron) Casirivimab + Imdevimab (NOT for Omicron) Sotrovimbab = 500 mg IV single dose Tixagevimab + Cilgavimab |
| Evusheld | NOT A SUBSTITUTE FOR THE VACCINE FOR PEOPLE WHO CANNOT GET VACCINATED Tixagevimab + Cilgavimab 2 consecutive IM injections |
| Evusheld Indications | Pre-exposure prophylaxes for those who can't get vaccinated 12 years & older Must weigh above 88 lbs. Moderate- severe compromised immune systems On immunosuppressive treatment H/O severe reaction to vaccines HIV pts can continue ART |
Created by:
mkeita2
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