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Unit V Promoting Health in Patients With Oxygenation Disorders
Table 24.7 Medications Used in the Inpatient Treatment of COVID-19
Medication Classification
Mechanism of Action
Exemplars
Nursing Implications
Nucleotide analogue
Obtain baseline and daily laboratory studies: CBC, 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. Obtain baseline and daily laboratory studies: CBC, chemistries, liver function panel, coagulation. Screen patients for tuberculosis, herpes virus, and hepatitis before initiating therapy. Monitor for: l Signs and symptoms of thrombotic events (PE, DVT, arterial thrombosis, myocardial infarction, and stroke) l Development of opportunistic infections while receiving therapy (bacterial, viral, and fungal) Utilize a dedicated IV line for infusion. Flush with at least 30 mL normal saline after infusion. Avoid administration of any “live” vaccines during therapy. Obtain baseline and daily laboratory studies: CBC, chemistries (including lipid panel), liver function panel, coagulation. Screen for tuberculosis, HIV, hepatitis before initiating therapy. Monitor for: l Hypersensitivity and infusion-related reactions (e.g., fever, chills, headache, dizziness, hypotension, bronchospasm, skin reactions) l Observe for at least 1 hour after infusion for reactions—can occur up to 24 hours after infusion. Obtain baseline and daily laboratory studies: CBC, chemistries, renal and liver function panels, thyroid studies. Monitor for: l Elevated serum blood sugars during course of therapy. Insulin adjustments may be necessary. l Development of GI events (stress ulcer formation, perforation, flare of irritable bowel syndrome) l Increased blood pressures during therapy l Daily intake/output and weight (indicating fluid retention) Ensure GI prophylaxis for duration of therapy. Obtain baseline and ongoing laboratory studies: CBC, chemistries, coagulation (APTT) (not required for Lovenox). Initiate bleeding precautions. Monitor for: l Abnormal bleeding l Decreasing hemoglobin/hematocrit
Remdesivir (Veklury) IV infusion, initial loading dose (200 mg), then 100 mg IV daily × 4 days
Direct inhibition of SARS-CoV-2– dependent RNA polymerase (RdRp) preventing viral replication
JAK inhibitor
Baricitinib (Olumiant)
Inhibits JAK pro- teins and mitigates cytokine response, diminishing the inflammatory response
Interlukin-6 (IL-6) receptor inhibitor
Inhibits IL-6 sig- naling, reducing cytokine release
Tocilizumab (Actemra)
Corticosteroid
Dexamethasone (Decadron)
Inhibition of inflammatory cells and suppression of expression of inflammatory mediators
Anticoagulant
Unfractionated hepa- rin (UFH) Enoxaparin (LMWH) Lovenox
Inhibition of factor Xa
Binds and accel- erates the activity of antithrombin III; inhibits coagulation factors Xa and IIa
APTT, Activated partial thromboplastin time; CBC, complete blood count; DVT, deep vein thrombosis; GI, gastrointestinal; LMWH, low-molecular-weight heparin; PE, pulmonary embolism.
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