N820 Pharmacology-Ashton Fox Case Study 2 Ashton Fox Loyola University New Orleans School of Nursing NURS 820 Pharmacology Case Study Submission 2 December 1, 2020 0 0 N820 Pharmacology-Ashton Fox Case Study 2 Pregnancy generally does not increase an individual's risk for contracting severe acute respiratory syndrome coronavirus 2, also known as SARS-CoV-2 infection or Covid-19, but has been shown to complicate the clinical course of COVID-19 in comparison with the non-pregnant and same-age individuals. Luckily, more than 90 percent of pregnant women infected with Covid-19 successfully recover without requiring delivery of the fetus (Berghella & Hughes, 2019). Certain factors should be considered when diagnosing and treating the pregnant person with suspected Covid-19 infection. Some COVID-19 related abnormal laboratory findings, such as elevated liver protein levels and thrombocytopenia are indistinguishable from those that occur with preeclampsia and HELLP syndrome. Laboratory delayed prothrombin time; raised D-dimer, procalcitonin, and Cresponsive protein (CRP) levels; positive lupus anticoagulant screen; and low fibrinogen levels may likewise be seen in confounded COVID-19 cases. Therefore, it is also very important to note that the typical reference ranges for D-dimer, CRP, and fibrinogen levels are higher in the pregnant patient. The American College of Obstetricians and Gynecologists (ACOG) and the Society for MaternalFetal Medicine (SMFM) recommend modifications for prenatal care that is cognizant of the risk level of each pregnancy (low versus high risk) to reduce the incidence of Covid-19 amongst the pregnant population. Some of these modifications include telehealth and reducing the number of face to face visits, grouping tests and screenings to minimize maternal contact, restriction of additional individuals accompanying the pregnant patient to visits and timing of indicated obstetric ultrasound, nonstress tests and biophysical profiles (Berghella & Hughes, 2019). Pregnant patients who are appropriate for utilization of glucocorticoids for maternal treatment of COVID-19 can safely receive the standard dose of dexamethasone for treatment of Covid-19 which is 6 mg orally or intravenously daily for 10 days. For the individuals who likewise meet standards for utilization of antenatal corticosteroids for fetal lung development, ACOG, WHO, and the European Medicines Agency recommend the typical dosages of dexamethasone to prompt fetal lung development and proceeding with dexamethasone to finish the standard course of treatment for maternal COVID-19. Nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen can be utilized for treatment of fever and other symptoms during pregnancy. During antepartum the lowest effective NSAID dose is utilized, preferably for under 48 hours. In patients with abnormal or diminished liver function auxiliary to COVID19, an expected concern of acetaminophen use is hepatic damage. Bamlanivimab is a neutralizing monoclonal antibody drug that has recently been authorized by the FDA for the treatment of nonhospitalized patients with mild to moderate cases of COVID-19 who are at high risk for progression to severe disease (Cohen & Blau, 2019). Monoclonal antibodies are man made proteins that mimic the human body’s immune response to antigens and viruses. Bamlanivimab is specifically directed against SARS-CoV-2 to block the virus’ attachment and entry into human cells (FDA, 2020). In regards to placental transfer of Bamlanivimab, it can be expected due to the ability of human immunoglobulin G1 to gross the placental barrier (Berghella & Hughes, 2019). Patient education is very important for this special population. Patient education could include the following: Specialists don't yet know a ton about COVID-19 and pregnancy. From what they know up until now, pregnant individuals are not at a higher risk in regards to COVID-19 infection than others of comparative age. You will be checked for fever and different manifestations of COVID-19 when you get to the emergency clinic or birth center. You may be required to quarantine for 2 weeks before your scheduled c-section or due date. On the off chance that you have COVID-19 when you start giving birth, 0 0 N820 Pharmacology-Ashton Fox Case Study 2 the specialists and medical attendants will find a way to ensure others around you. For instance, you should wear a clinical cover if possible. You will likely still have the option to have a vaginal birth, if that is the thing that you arranged. 0 0 N820 Pharmacology-Ashton Fox Case Study 2 References Blumberg DA, Underwood MA, Hedriana HL, Lakshminrusimha S. Vertical Transmission of SARS-CoV-2: What is the Optimal Definition? Am J Perinatol 2020; 37:769. Hecht JL, Quade B, Deshpande V, et al. SARS-CoV-2 can infect the placenta and is not associated with specific placental histopathology: a series of 19 placentas from COVID-19-positive mothers. Mod Pathol 2020; 33:2092. Patanè L, Morotti D, Giunta MR, et al. Vertical transmission of coronavirus disease 2019: severe acute respiratory syndrome coronavirus 2 RNA on the fetal side of the placenta in pregnancies with coronavirus disease 2019-positive mothers and neonates at birth. Am J Obstet Gynecol MFM 2020; 2:100145. Penfield CA, Brubaker SG, Limaye MA, et al. Detection of severe acute respiratory syndrome coronavirus 2 in placental and fetal membrane samples. Am J Obstet Gynecol MFM 2020; 2:100133. Pique-Regi R, Romero R, Tarca AL, et al. Does the human placenta express the canonical cell entry mediators for SARS-CoV-2? Elife 2020; 9. Shah PS, Diambomba Y, Acharya G, et al. Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand 2020; 99:565. 0 0
