PREGNANT WOMEN AND COVID 19
The special population chosen is pregnant women; the CDC noted that pregnant women are more highly susceptible to respiratory illnesses. There are changes in the immune system in pregnancy, and pregnancy affects the lungs and the heart. It also noted that pregnant women are likely to be hospitalized in need of ICU admission for non-pregnant women. Records show pregnancy loss and preterm deliveries in women having Covid 19 (Center for diseases control and prevention[CDC], 2020). In choosing a strategy for treating pregnant women with Covid 19, several factors come from changes in women’s body changes due to pregnancy and the severity of Covid 19 infection symptoms.
The changes that come with pregnancy include the physiological changes in that during pregnancy, the amount of body water increases and may alter the drug distribution. The cardiac output is higher; the liver metabolism and plasma volume increase, glomerular filtration, and the fat store increase. These changes lead to drug concentration reduction in pregnancy. Thus when choosing a treatment strategy, the drugs need close monitoring. Another factor to consider is the placental transfer; in most cases, the drugs can pass through the placenta though it has not been recorded to cause preterm births and pregnancy losses in Covid 19 treatment. The other factor is teratogenicity in that if treatment drugs are used should not cause fetal abnormalities (Louchet et al., 2020). In Covid 19, the considered drug has been repurposed to fit the treatment of the infection.
In choosing a strategy, the severity of the symptoms needs consideration. Hospitalization for patients having Covid 19 is appropriate for patients with mild symptoms and comorbid conditions noteworthy diabetes, chronic kidney diseases, patients with fever, and patients with respiratory disease failure (Center for diseases control and prevention[CDC], 2020). These are a few of the scenarios that may present in pregnant women
Medication Drugs
According to Louchet et al., 2020, pregnant women fall under a special group in that the choice of the drug need not cause toxicity. In this case, the rational drug picked is hydroxychloroquine combined with azithromycin. Hydroxychloroquine is an anti-malarial drug, whereas azithromycin is an antibiotic. Arshad et al., 2020 studied the effect of hydroxychloroquine combination with azithromycin in hospitalized persons. They found out that a combination of the two minimized mortality rates. Hydroxychloroquine has been reported to have antiviral capabilities by reducing virus replication. The drug is still in investigation stages in clinical use but has proved to reduce viral activity in vitro. Of note, the toxicities include restrictive myopathy. Increased release of hydroxychloroquine from the body comes in the second and third trimester in pregnant women. It has not been reported to cause miscarriages, teratogenic effect and the newborn have no impact from it uptake. It is safe at doses of 200mg administered once or twice a day. The drug fulfills most of the factors to consider in choosing the treatment drugs for pregnant women with Covid 19, as discussed earlier. Azithromycin was found to have a minor malfunction on the fetus in its use. Even though the combination has negative impacts, it also stands as good therapy for pregnant women.
The contraindicated drug to use in this special group is Renin-angiotensin system blockers. These are drugs used to treat hypertension, and the drugs have been associated with adverse effects from Covid 19. Moreover, the angiotensin aldosterone system is potential use in treating covid-19 patients. They limit the endocytosis in the viral complex. Still, in pregnancy, they may result in kidney damage leading to renal failure (Louchet et al., 2020). Thye also causes retardation of growth by affecting the placental functions. Thus they are not used for pregnant women
Education for the patient
The health education needed for the group in the discussion includes the health outcomes that come with the diseases in severe infections. The women need to know how to prevent transmission to the newborn. The pregnant woman also needs to be equipped with all the precautions they need to avoid getting the disease. They need to maintain their health, which runs from prenatal care appointment, using hand wash in cleaning hands, maintaining social distance, and limited contact with people at high risk of contracting the disease (Center for diseases control and prevention[CDC], 2020).
Reference
Arshada, S., Kilgore, P., Chaudhry, Z. S., Jacobsen, G., Wang, D. D., Huitsing, K., . . . “Henry Ford COVID-19 Task”. (2020). Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19. International Society for infectious Infections, 97, 396-403. doi:doi.org/10.1016/j.ijantimicag.2020.105949
Center for diseases control and prevention[CDC]. (2020, November 3). Pregnancy, Breastfeeding and Caring for Newborns. Retrieved from Corona disease 2019(Covid-19): https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html
Fiolet, T., Guihur, A., Edouard, M. R., Mulot, M., Peiffer-Smadja, N., & Mahamat-Saleh, Y. (2020). Effect of hydroxychloroquine with or without azithromycin on the mortality of coronavirus disease 2019 (COVID-19) patients: a systematic review and meta-analysis. Clinical Microbiology and Infection, 1-9. doi:doi.org/10.1016/j.cmi.2020.08.022
Louchet, M., Sibiude, J., Peytavin, G., Picone, O., Tréluyer, J.-M., & Mandelbrot, L. (2020). Placental transfer and safety in pregnancy of medications under investigation to treat. American Journal of Obstetrics & Gynecology MFM, 2(3), 1-17. doi:doi.org/10.1016/j.ajogmf.2020.100159