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Pharmacology Exam 1 > Immunizations > Flashcards

Immunizations Flashcards

1
Q

Process by which the body makes it’s own antibodies

A

active immunity

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2
Q

Process by which antibodies are given through exposure

A

passive immunity

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3
Q

Which type of immunity provides longer immunity in general?

A

active immunity

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4
Q

Which type of immunity provides temporary protection (few weeks)?

A

passive immunity

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5
Q

Which type of immunity takes several weeks before protection is provided?

A

active immunity

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6
Q

Which type of vaccine induces an immune response more consistent with naturally occurring infections?

A

live vaccine

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7
Q

Which type of vaccine confers life long immunity in a single dose?

A

live vaccine

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8
Q

What are the live vaccines?

A

OPV, MMR, varicella, flu mist

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9
Q

What type of vaccine does not induce permanent immunity and requires additional doses (boosters)?

A

killed vaccine

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10
Q

What are some inactivated vaccines?

A

pertussis, IPV, hib, hep a/b, flu shot

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11
Q

This stimulates formation of antitoxin antibodies that will neutralize the toxin upon exposure before it can do damage.

A

toxoid

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12
Q

Tetanus and Diptheria are types of what?

A

toxoids

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13
Q

This is a sterile solution containing antibodies derived from human or equine sources.

A

immune sera

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14
Q

Immune sera confers what type of immunity?

A

passive immunity

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15
Q

Preferred IM site in infants

A

anterolateral aspect of thigh

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16
Q

Preferred IM site in larger toddlers, adolescents and adults

A

deltoid

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17
Q

Preferred depth for killed vaccines

A

Deep IM (not subq due to risks for inflammation, granuloma and necrosis)

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18
Q

Vaccine administration - multiple inactivated vaccines?

A

Yes, at different sites

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19
Q

Vaccine administration - inactivated and live concurrently?

A

yes (except cholera and yellow fever - 4 weeks)

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20
Q

Vaccine administration - concurrent live vaccines?

A

No (except MMR and OPV)

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21
Q

Vaccine administration - live vaccine and PPD?

A

No

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22
Q

Vaccine administration - live vaccine and immune sera?

A

No

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23
Q

Vaccine administration - inactivated vaccine and immune sera?

A

Yes

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24
Q

Immunization during pregnancy - Considerations

A

No live vaccines, killed vaccines in second trimester

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25
Q

Immunization for preemies - Considerations

A

Same age, schedule and precautions as full term. Hep B may be delayed 2 months or >2000g.

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26
Q

Immunization for immunocompromised hosts - Considerations

A

Immune response is typically diminished. May need higher doses or more frequent boosters. Live vaccines can replicate easier.

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27
Q

Immunization if active malignant disease - Considerations

A

Killed vaccines and toxoids only. Live vaccine leukemic off chemo x 3 months.

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28
Q

Immunization if HIV - Considerations

A

Suboptimal response

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29
Q

Which vax are contraindicated if anaphylactic reaction to neomycin?

A

MMR, IPV, varicella

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30
Q

Which vax is contraindicated if anaphylactic reaction to streptomycin?

A

IPV

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31
Q

Which vax are contraindicated if anaphylactic reaction to eggs?

A

Flu, yellow fever

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32
Q

What are some factors that affect response to immunization?

A

viability of antigen (live vs killed), total dose, interval and number of doses, immunocompromise, route/site, length of needle (1 in)

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33
Q

What organisms does the TDAP/DTAP vax protect against?

A

corynebacterium diptheriae, clostridium tetani (the toxin not the bacteria) and bordetella pertussis

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34
Q

TDAP - live or killed?

A

killed

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35
Q

s/s diptheria

A

“bull neck” due to cervical lymphadenopathy

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36
Q

s/s pertussis

A

AKA whooping cough

inspiratory whoop after a series of paraoxysmal coughing

37
Q

s/s c. tetani

A

tetanus from production of exotoxin that blocks glycine release from Renshaw cells in spinal cord
typically hear about “lock jaw” but diaphragm/chest involovement is more significant

38
Q

Who gets the DTAP?

A

<7

39
Q

Who gets the TDAP?

A

> 7

40
Q

DTAP

A

4 doses + booster
IM
refrigerated

41
Q

Contraindications to Pertussis vax

A 
encephalopathy (within 7 days)
seizure (within 3 days)
persistent screaming 3+ hours or high pitched cry (within 48 hrs)
Temp 104.9 + (within 48 hrs)
shock like state (within 48 hrs)
42
Q

Tx for diptheria exposure

A 
immune sera (equine)
For exposed household members, give Benzathine PCN.
43
Q

Tx for tetanus exposure

A

tetanus immunoglobulin

44
Q

Pertussis DOC

A

Macrolides: E-mycin or azithromycin

45
Q

s/s measles

A

“Koplik spots” in the mouth (small white spots), conjunctivitis, coryza, cough x 7 days. Ultimately will get pneumo and encephalitis and die.

46
Q

s/s mumps

A

parotitis (inflammation of cheeks), orchitis (inflammation of testes) and aseptic meningitis

47
Q

MMR vaccine

A

SQ
2 doses, combo vax
Live vax (no preg or immuno.)
contains neomycin, made from chick eggs (allergy considerations)

48
Q

Inactive Polio Virus (IPV)

A

inactivated
preferred over OPV (live)
4 doses

49
Q

Haemophilus Influenzae Type B Vax

A

Inactivated
given in children <5 yrs old
IM
Various combinations (PedvaxHIB and Comvax - HIB + HepB), TriHIBit

50
Q

HIB bacteria responsible for…

A

meningitis, epiglottitis, pneumo, sepsis, septic arthritis

51
Q

Strep pneumoniae can cause…

A

OM, sinusitis, pneumonia

52
Q

Pneumococcal Conjugate Vaccine (Prevnar 13)

A 
inactivated
SQ or IM
children 6 wks-59 months
4 doses
*we don't see much bacterial OM/sinusitis b/c of this vax
53
Q

Pneumococcal Polysaccharide Vaccine (Pneumovax 23)

A

Inactivated
SQ or IM
and adults

54
Q

Who should get Pneumovax 23?

A
  1. immunocompetent adults >65, chronic disease, asplenia, environmental risk
  2. immunocompromised >2 yrs
  3. revaccination after 3-5 yrs for kids with nephrotic syndrome, asplenia, SC anemia
55
Q

Flu shot

A

Inactivated

IM

56
Q

Who should get a flu shot?

A

CV and lung disease, nursing home resident, HC worker, >65 yrs, metabolic disease, pregnant 2/3 trimester during flu season, HIV, household members of high risk groups

57
Q

FluMist

A

live vaccine

58
Q

Who should not get the FluMist?

A

egg allergy, Guillain-Barre syndrome, immunodeficiency, HIV, malignancy, leukemia, lymphoma, children taking ASA (Reye’s syndrome), pregnant women
Safety in asthmatics is unknow.

59
Q

Cold vs Influenza

A

Cold: rare fever, productive cough, rare HA, feel ok, congested, sneezing, sore throat
Flu - feel very sick, sudden onset, temp >101 x 3-4 days, nonproductive cough, seere HA, fatigue

60
Q

Influenza - treatment

A

Tamiflu or Relenza

61
Q

Meningococcal Vaccine

A

with the HIB vaccine

IM

62
Q

Who should get the meningococcal vaccine?

A
  1. Age 2-10 w/complement deficiencies, asplenia, high risk groups
  2. 11-18 yrs, previously not vaccinated
  3. unvaccinated college students in the dorm and anyone living in close quarters
  4. Revaccinataion at 11-55 yrs old
63
Q

Varicella Vaccine

A

live virus

SQ

64
Q

Who should not get the varicella vaccine?

A

pregnant, immunocompromised, 3wks before or 5 months after an immune globulin

65
Q

Hepatitis A vaccination

A

Killed virus

2 doses

66
Q

Who should get a Hepatitis A vaccination?

A

travelers to endemic areas, primate works, male homosexual, food handlers, HC workers

67
Q

Hepatitis B vaccination

A

killed virus
3 doses
Induces Anti-HBs

68
Q

For infants of HBsAg + mothers…

A

Heb B and HBIG at birth

repeat vax at 1 and 6 months

69
Q

Hepatitis Immune Globulin

A

post exposure
within 24 hours or before 14 days after exposure
Start vax series too

70
Q

HPV vaccine (Gardasil)

A

HPV proteins 6, 11, 16, 18

Help protect against cervical cancer, cervical adenocarcinoma, vag and vulvar neoplasia and genital warts

71
Q

HPV vaccine (Cervarix)

A

provides less coverage
HPV 16 and 18 only (warts)
doesn’t make sense to give

72
Q

Rotarix or RotaTeq vaccine

A

live
Rotarix (2 doses by 4th month)
Rota Teq (3 doses by 32 wks)
Only given to infants b/c they are at higher risk from dehydration/lyte imbalance from diarrhea

73
Q

Vaccine related anaphylactic reaction - s/s

A

flusing, facial edema, urticaria, itching, swelling of mouth/throat, wheezing, difficulty breathing

74
Q

Vaccine related anaphylactic reaction - treatment

A
  1. maintain airway and provide O2 if needed
  2. Epi 0.01 mg/kg up to 0.5 mg IM, repeat q 10-20 up to 3 doses
  3. Benadryl and/or Prednisone
75
Q

Can the flu vaccine cause the flu?

A

Flu shot - No (killed)

Remember: takes weeks for immunity

76
Q

Can vaccines be mixed in same syringe?

A

No, only if manufactured that way

77
Q

After a blood transfusion, which vax are CI and for how long?

A

MMR - 6 months (live)
Varicella - 5 months (live)
Inactivated - OK

78
Q

Can you give two IM injections in same arm?

A

Yes, 1 inch apart and document location well in case of ADE.

79
Q

Which vax cannot be given if the pt is taking steroids?

A

If 2mg/kg or >20mg of prednisone, considered “high dose” and immunocompromised so no live vax

80
Q

How long do you have to wait until getting the MMR or Varicella after IG?

A

3-11 months (remember, T1/2 is long)

81
Q

Can chemo patients can the flu shot?

A

Yes (killed)

82
Q

Why do kids get the pneumococcal conjugate vaccine (prevnar) instead of pneumococcal polysaccharide vaccine (pneumovax)?

A

Because the polysaccharide vaccine is not effective in children.

83
Q

What is the leading cause if vaccine preventable death?

A

Pneumonia

84
Q

What are the normal and expected side effects if FluMust?

A

Cough, runny nose, sore throat

85
Q

What is a main cause of pneumonia, OM, bacteremia and sinusitis?

A

Strep pneumonia

86
Q

What does it mean if a vaccine is conjugated?

A

It contains the antibodies against which immunity is desired.

87
Q

How does the immune system respond to encapsulated organisms?

A

Not very well. The immune system does not recognize them so an effective immune response is not triggered and thus infection can occur.

88
Q

Which immune cell does the prevnar vaccine activate?

A

CD4+ helper T-lymphocyte

Pharmacology Exam 1 (19 decks)

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