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Chapter 24 Coordinating Care for Patients With Infectious Respiratory Disorders
Table 24.6 Medications Used in the Outpatient Treatment of COVID-19
Medication Classification
Mechanism of Action Cleves the two viral polyproteins inhibiting viral replication. Shows antiviral activity against current known cir- culating corona- viruses that infect humans.
Exemplars
Nursing Implications
Protease inhibitor + CYP3A inhibitor
Nirmatrelvir with ritonavir (Paxlovid) Oral tablets every 12 hours for 5 days
Indicated for mild-moderate COVID-19 illness not requiring hospitali- zation for individuals >12 years weighing at least 88 lb (40 kg) at high risk for developing severe illness. Drug therapy should begin within 5 days of symptom onset. Administer both tablets together. Do not crush or chew tablets. Educate patients about: l Completing entire course of therapy even if they begin to feel better l Monitoring for side effects such as hypertension, muscle aches, vomiting, bad taste in the mouth (dysgeusia) l Significant drug-to-drug interactions. Must share ALL medications currently taking with care provider. Ensure that a negative pregnancy test is obtained before initiating drug therapy. Educate patients about: l Use of reliable birth control during treatment as safe use during pregnancy has not been established. l Avoiding breastfeeding as details about secretion in breast milk are insufficient. Indicated for mild-moderate COVID-19 illness not requiring hospitali- zation for individuals >12 years weighing at least 88 lb (40 kg) at high risk for developing severe illness. Used as alternative when Paxlovid or remdesivir not available. Treatment should be initiated within 7 days of symptom onset. Observe patients for 1 hour after administration for: Anaphylaxis, hypersensitivity, and infusion-related reactions, (e.g., fever, chills, headache, dizziness, bronchospasm, hypotension, angioedema, cardiac arrhythmias, rash, pruritus diarrhea, nausea, vomiting). Treatment should begin within 10 days of symptom onset. Obtain baseline and daily laboratory studies: complete blood count, chemistries, liver function panel, coagulation Monitor for hypersensitivity and infusion-related reactions (e.g., fever, chills, headache, dizziness, bronchospasm, hypotension, angioedema, cardiac arrhythmias, rash, pruritus diarrhea, nausea, vomiting). Stop infusion and notify provider. Utilize a dedicated IV line for infusion. Flush with at least 30 mL normal saline after infusion. syndrome (ARDS). This can manifest quickly after onset of dyspnea, and clinicians should be on high alert for the development of ARDS in patients with increasing oxygen requirements and increased work of breathing. Other inflammatory complications include Guillain-Barré syn- drome, septic shock, multiple organ failure, and throm- botic sequelae.
Protease inhibitor
Molnupiravir (Lagevrio)
Facilitates uptake into the viral RNA, where it promotes lethal muta- tions in the viral genome
Monoclonal antibody (Anti SARS-CoV-2 mAbs)
Bebtelovimab IV injection at an outpatient health- care facility for 3 consecutive days
Target spike pro- tein preventing viral attachment to host cell
Nucleotide analog
Remdesivir (Veklury) IV infusion at an outpatient health- care facility for 3 consecutive days
Direct inhibition of SARS-CoV-2– dependent RNA polymerase (RdRp) preventing viral replication
and endothelial injury, which combine to increase hyper- coagulability (Virchow’s triad). Prophylactic or therapeutic anticoagulation is recommended for hospitalized patients. Complications The immediate major complication in patients with severe COVID-19 infection is acute respiratory distress
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