Thread by @MedIQCME

1/16 See below for this #Tweetorial on guideline and management updates for COVID-19. It is contributed by @RishiDesaiMD.
#MedTwitter #MedEd

2/ In all outpatient settings in which patients with COVID-19 are seen, including long-term care facilities, testing and treatment must be done in a timely manner. It is also crucial to consider patient risk factors for progression to severe disease and death.

3/Conditions such as metabolic syndrome and obesity confer an increased risk of ICU admission, mechanical ventilation, acute respiratory distress, and death.

4/Time for our first poll. Which of the following are often recommended for nonhospitalized adults with mild-to-moderate COVID-19 who do not require supplemental oxygen: ritonavir-boosted nirmatrelvir (RBN), dexamethasone (DEX), remdesivir (RDV), and/or molnupiravir (MOV)?

5/The answer is B: ritonavir-boosted nirmatrelvir, remdesivir, or molnupiravir. According to the NIH COVID-19 guidelines, there are insufficient safety and efficacy data on the use of dexamethasone for COVID-19 in the outpatient setting.

6/Preferred therapies for outpatients with mild-to-moderate COVID-19 who do not require supplemental oxygen are ritonavir-boosted nirmatrelvir and remdesivir. If these treatments are unavailable or are not clinically appropriate, then molnupiravir should be considered.

7/Let’s move onto dosing. Nirmatrelvir 300 mg is given with ritonavir 100 mg orally twice daily for 5 days in nonhospitalized adults and pediatric patients aged ≥ 12 years and weighing ≥ 40 kg who have mild-to-moderate COVID-19 and a high risk of disease progression.

8/Ritonavir is coadministered with nirmatrelvir to increase the concentration of nirmatrelvir in the blood, which makes it effective against SARS-CoV-2.

9/Because nirmatrelvir and ritonavir are CYP3A4 substrates, ritonavir-boosted nirmatrelvir should not be administered within 2 weeks of taking a strong CYP3A4 inducer (eg, St. John’s wort, rifampin).

10/Time for another poll. Which of the following medications is/are NOT recommended for the management of nonhospitalized immunocompetent adults with mild-to-moderate COVID-19 who are not on supplemental oxygen?

11/The answer is D. For the management of nonhospitalized immunocompetent adults with mild-to-moderate COVID-19 who do not require supplemental oxygen, the use of COVID-19 plasma, ivermectin, and lopinavir/ritonavir is not recommended.

12/In nonhospitalized patients with COVID-19, anticoagulants and antiplatelet therapy (ie, aspirin, P2Y12 inhibitors) should not be routinely given for the prevention of VTE or arterial thrombosis, unless the patient has other indications for antithrombotic therapy.

13/Let’s discuss prophylaxis for COVID-19. SARS-CoV-2 omicron subvariants that are not susceptible to tixagevimab plus cilgavimab now account for more than 90% of infections in the US. Because of this, tixagevimab plus cilgavimab is NOT recommended as PrEP for COVID-19.

14/The long-term use of zinc supplementation for the prevention of COVID-19 is also NOT recommended. This can result in copper deficiency, which is associated with reversible hematologic and potentially irreversible neurologic issues.

15/Thank you for joining this #Tweetorial! This activity is supported by an educational grant from Pfizer Inc.

To view references and glossary: bit.ly/3WZzuJl

16/Share an interactive education tool with your patients!

COVID-19 Facts: Updated Information on Risk, Test Results, and Treatment Options is available in English (bit.ly/3JTdyuo) and Spanish (bit.ly/3Z9vzcs).