Vaccines, Antidotes Flashcards
(24 cards)
Effectiveness of live attenuated vaccines?
durable immunity but not always as long lasting as that from natural infection
Duration of immunity of inactivated vaccines?
months to years
Examples of live attenuated
MMR, BCG, rotavirus, smallpox, chickenpox, yellow fever
Fluenz tetra influenza spray
Examples of inactivated
influenza, polio, hep A, rabies
Examples of detoxified endotoxins (or toxoid)
tetanus, diptheria
Exampes of extracted micro-organism
or recombinant DNA
pneumococcal vaccine hep B vaccine meningococcal shingles HPV HiB Whooping cough
Schedule for MMR
1 year - first dose (Priorix or MMR VaxPro)
3yrs 4 months - second
Diptheria with tetanus
8 weeks - Infanrix hexa - this also covers pertussis hep B poliomyelitis, H. influenzae)
12 weeks - 2nd Infanrix
16 weeks - 3rd infanrix
3yrs 4 months - booster - Repevax
13-18 years - single booster - Revaxis
varicella zoster age?
70 years - live vaccine - zostavax likely duration of protection - 7 years
when administered with MMR should be same day or separated by 4 weeks
Drugs to stop before surgery
COC pill MAOI interact pethidine TCAs potentially (arrhythmias) K sparing diuretics ACE/ARB
Features of alcohol poisoning and management
ataxia, dysarthia, nystagmus, drowsiness (hypotension and acidosis)
Maintain airway
Reduce aspiration
blood glucose managed
Aspirin poisoning features and management
hyperventilation, tinnitus, deafness, vasodilation, sweating
acid-base disturbances are complex
plasma-salicylate concentrations taken
activated charcoal given if more than 125mg/kg of aspirin taken
replace fluid loss
sodium bicarbonate(ensures plasma potassium optimal) to encourage salicylate excretion in urine
haemodialysis for severe poisoning
opioid poisoning
coma, respiratory depression, pinpoint pupils
arrhythmias may occur for up to 12 hours
naloxone is antidote (shorter duration of action so may need repeat injection)
buprenorphine effect only partially reversed
paracetamol poisoning
hepatocellular necrosis
N+V which settle in 24 hours
right subcostal pain and tenderness (indicates hepatocellular necrosis)
Liver damage maximal 3-4 days after OD - may lead to encepholopathy, haemorrhage, hypoglycaemia, cerebral oedema and death
Acetylcysteine may protect liver if given 24 hours or after
activated charcoal in excess
TCA plus related poisoning
dry mouth, coma, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, resp failure, arrhythmias, dilated pupils, urinary retention
Symptomatic treatment - lorazepam, diazepam
Activated charcoal within 1 hour
Correct hypoxia and acidosis
IV bicarbonate
Antimalarial poisoning
Quinine, hydroxychloroquine hazardous - features include arrhythmias
Antipsychotic poisoning
Phenoziathine related - hypotension, hypothermia, sinus tachycardia complicate poisoning
- prochlorperazine can cause dystonia (treat with injected procyclidine or diazepam)
2nd gen APs - drowsiness, convulsions, EPSEs, hypotension and ECG abnormalities
Activated charcoal in 1 hr plus supportive management
BZD poisoning
drowsiness, ataxia, dysarthria, nystagmus, resp depression, coma,
activated charcoal in 1 hour - awake patient with maintained airway
Flumanezil
Beta-blockers
therapeutic OD - light-headedness, syncope, dizziness, bradycardia, heart failure may be precipitated or exacerbated
propranolol OD in particular may cause coma and convulsions
Ensure airway is clear with adequate ventilation
IV atropine for bradycardia
glucagon for cardiogenic shock
a cardiac pacemaker can be used to increase the HR
Lithium poisoning symptoms, management
Precipitated by factors such as dehydration, deterioration, reduced renal function, infection, diuretics, NSAIDS,
Onset may be 12 hours due to slow entry to tissues
Lithium target 0.4-1mmol/l >2 severe toxicity
apathy, restlessness, confusion,vomiting, diarrhoea, TREMOR, muscle twitching
convulsions, coma, renal failure, hypotension
Treat- increase fluid intake, electrolyte balance, renal function, manage convulsions, gastric lavage within 1 hour. whole bowel irrigation considered in significant OD
Iron salt poisoning
N+V, rectal bleeding, abdominal pain, hypotension, hepatocellular necrosis
Mortality reduced with desferrioxamine mesilate which chelates iron. Usually a serum-iron is taken first but not always
Stimulant drug poisoning
Diazepam to treat cocaine and ecstasy OD
then specialist help to treat other symptoms
cooling treatment for hyperthermia
MI, arrhythmia
Heparin toxicity
Protamine
Warfarin
Phytomenadione
