208.3 🩺 內科專科考前版

208.3.0.1 1⃣ Paxlovid Rebound

  • 5-10% post-treatment rebound (return of viral shedding + sx)
  • Managed conservatively
  • Retreatment not routinely recommended
  • Continue isolation until resolution

208.3.0.2 2⃣ Drug Interaction Severity

  • Liverpool COVID-19 interaction tool (online resource)
  • Pharmacist review for transplant + complex regimens
  • Some require switch to remdesivir or molnupiravir

208.3.0.3 3⃣ Immunocompromise Pre-Exposure Prophylaxis

  • Pemivibart (Pemgarda) 2024 FDA — replaces tixagevimab-cilgavimab
  • Single IV q3 mo
  • For severely immunocompromise patients (HSCT, CLL, BMT, anti-CD20, etc.)
  • Variant-resistance evolving — monitoring efficacy

208.3.0.4 4⃣ Anti-IL-6 vs JAK Inhibitor

  • Both reduce mortality in severe COVID
  • Choice based on availability + comorbidities + center preference
  • Tocilizumab: single IV dose
  • Baricitinib: oral × 14d
  • Don’t combine

208.3.0.5 5⃣ ATTACC + REMAP-CAP Anticoagulation Findings

  • Severe non-ICU: therapeutic anticoagulation reduces mortality
  • ICU patients: harm signal with therapeutic anticoagulation
  • Standard: prophylactic dose for hospitalized; therapeutic in select severe non-ICU
  • D-dimer guided some centers

208.3.0.6 6⃣ MIS-C Treatment Algorithm

  • IVIG 2 g/kg over 12 hr
  • Methylprednisolone 1-2 mg/kg
  • Anakinra (IL-1 inhibitor) for refractory
  • Tocilizumab + biologic for resistant
  • Cardiac monitoring (myocarditis frequent)

208.3.0.7 7⃣ Long COVID Approach

  • Symptom-driven, multidisciplinary
  • Brain fog: cognitive rehab, neurology
  • POTS: salt, fluid, midodrine, ivabradine
  • Fatigue: pacing, graded activity, CBT
  • Dyspnea: pulm rehab, repeat imaging, PFT
  • Cardiac: cardiac MRI, echo, holter
  • Active research; many proposed therapies; clinical trials enrollment

208.3.0.8 8⃣ 健保 / Taiwan

  • 健保 Paxlovid for high-risk indication
  • 健保 remdesivir, dexamethasone, tocilizumab indications
  • 公費 vaccines (annual)
  • 通報 mandatory
  • COVID hospitalizations + ICU resources

208.3.0.9 9⃣ Variant Surveillance + Future

  • WHO GISAID database
  • US CDC surveillance + NowCast variant prediction
  • Sub-variant evolution continuous (KP, LB, XEC, etc.)
  • Pan-coronavirus vaccines in development
  • Combination flu + COVID + RSV vaccines (2024-2025 launching)

208.3.0.10 10. Pediatric Considerations

  • MIS-C peak 8-18 yr
  • Long COVID in children less studied but real
  • Vaccine ≥ 6 mo
  • Lower acute severity than adults
  • Higher MIS-C / post-acute risk vs flu in some studies