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11 Flashcards

1
Q

example of live attenuated vaccine

A

mmr

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2
Q

example of inactivated

A

hep A, polio

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3
Q

example of toxoid vaccine

A

diphtheria, tetanus

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4
Q

eg of subunit vaccine

A

hep B, influenza, pertussis

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5
Q

which vaccine type needs refrigerati

A

live attenuated vaccine

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6
Q

precautions for live attenuated - 5

A

-avoid in pregnancy
-usually not in infants <1
-not in severely immunocompromised
-spaced at least 3-10 months from antibody containing products ike immunoglobulins and blood transfusions
-avoid giving another vaccine in 28 days

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7
Q

precautions for live attenuated - 5

A

-avoid in pregnancy
-usually not in infants <1
-not in severely immunocompromised
-spaced at least 3-10 months from antibody containing products ike immunoglobulins and blood transfusions
-avoid giving another vaccine in 28 days

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8
Q

national childhood immunisation schedule

A

BCG, Tdap, MMR, varicella, Hep B, polio, hemophilus influenzae type b, pneumococcal, HPV, influenza (aged 6mo - 4 years)

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9
Q

national adult immune schedue

A

tdap (if other indications), varicella, MMR, HPV, influenza (if other indications), pneumococcal (if other indications), Hep B

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10
Q

contraindications

A

allergy to vaccine or components, bleeding risk, severe illness (eg fever more than 38), live attenuated not for pregnant and immunocmprimsed

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11
Q

exception to rule of simultaneous vaccine administration

A

pneumococcal conjugate and meningococcal conjugate vaccine in those with asplenia–> 4 wk interval

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12
Q

how long should live attenuated via IM or SQ be spaced

A

28 days

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13
Q

what is surgical AB prophylaxis

A

admin of antimicrobials just prior to clean and clean contaminated surgeries to prevent post op surgical site infections

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14
Q

SSI are defined as

A

infections that occur within 30 days after operation of 1 year if an implant was left in place

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15
Q

SSI are considered

A

health care associated infections

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16
Q

SSI can be

A

superficial or Deep incisional affecting body spaces and organs

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17
Q

deep incisional SSI affects

A

fascia and muscle layers

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18
Q

superficial incisional SSI affects

A

skin and SQ tissue

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19
Q

patient related risk factors for SSI

A

extreme age, smoking, coexisting infection at other sites, immunosuppressed, length of hospital stay, MRSA infection, recent surgical procedure, obese, malnourished, diabetes, underlying disease

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20
Q

operation related risk factors for SSI

A

pre op shaving, inadequate sterilisation, antimicrobial prophylaxis, foreign material in surgical site, skin antisepsis, duration of surgery and surgical scrub

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21
Q

SAP indicated for

A

clean surgery when implant is inserted

clean contaminated surgery always need SAP

contaminated surgery needs AB used as treatment not prophylaxis

always needed for immunocompromised pts or those w conditions that increase risk of SSI

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22
Q

clean contaminated surgery examples

A

respiratory, alimentary and genitourinary tract penetrated

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23
Q

examples of clean surgery and is SAP recommended for these?

A

healthy skin incised (not)

mucosa of respiratory, alimentary and genitourinary tract and oropharyngeal cavity not traversed (not)

insertion of prosthesis or artificial device (recommended)

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24
Q

broad or narrow spectrum preferred for SAP

A

narrow

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25
Q

should conc be high or low at site prior to infections

A

high

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26
Q

ABs with high risk of Cdiff infections

A

3rd gen cefalosporins, clindamycin, FQ

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27
Q

common pathogens and recommended abntimicrobials for coronary artery bypass, implants

A

staph aureus, staph epidermidis

use cefazolin or cefuroxime

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28
Q

for GI ops w entry into GI lumen common pathogens and AB for SAP

A

enteric G neg bacilli and G pos cocci

use cefazolin

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29
Q

cefazolin IV can begin as SAP for all ops except

A

Genitourinary
use ciprofloxacin (PO or IV) or cotrimoxazole (PO) unless open laparoscopic surgery (cefazolin)

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30
Q

MRSA choice of AB for SAP

A

screen for MRSA for pts who are going through high risk surgeries (cardiac, orthopedic, neurosurgery with implant)

use vancomycin for pts w known MRSA colonisation recent MRSA infection

can add cefazolin to Vanco to cover MSSA in MRSA colonised patients

31
Q

choice of AB for SAP in B lactam allergy

A

verify true allergy
If severe penicillin allergy (anaphylaxis, urticaria, angioedema, SJS, TEN), should not receive a B lactam

If uncomplicated non IgE mediated reaction to penicillin eg maculopapular rash –> consider cephalosporins or cefazolin which has unique R1 side chain

32
Q

when to start administration before surgical incision

A

30 - 60 min

but for Vanco and FQs, start 60-120 min before

33
Q

when is intra operative re dosage required

A

when duration of exposure exceeds 2 half lives of drug or extensive blood loss (more than 1.5l) or extensive burns

34
Q

duration of SAP should not exceed

A

24h

35
Q

what happens if SAP given more for than 24h

A

risk of Cdiff infection, acute kidney injury, increase section pressure and risk or MDR orgs

36
Q

non SAP strategies

A

don’t remove hair unless necessary and don’t shave (use depilators or clippers)

control post op blood glucose to be below 180mg/dL

maintain normothermia (more than 35.5) during peri op period

use alcohol contains pre op skin prep agents

maintain adequate oxygenation of tissue

use impervious plastic wound protectors for GI and biliary tract surgery

37
Q

useful resources for travel health

A

CDC Health information for travellers, CDC Yellow book, WHO Travel advice, Ministry of foreign affairs travel restriction and requirements

38
Q

medical considerations before international travel

A

pre travel consult 4-6 weeks before

look for individual risk factors

include post op advice if relevant

focussed education eg precautions etc

39
Q

information for risk assessment during ore travel lconsult

A

PMH, special conditions, immunisation history, prior travel experience (experience with malaria chemoprophylaxis and altitude), itinerary, timing, reason for travel, travel style, special activities

40
Q

major routes of infection

A

food/water borne infections via fecal oral,
insect vector borne
transcutaneous, respiratory, blood and body fluids via sex or sharing contaminated needles

41
Q

travel vaccines - 14
not all are compulsory for all countries

A

respiratory - influenza, meningococcus *, deptheria, MMR, pertussis

food and waterborne - hep A, typhoid, cholera, polio *

vector borne - yellow fever*, Japanese encephalitis

blood/fluid borne - hep B

Transact - tetanus, rabies

42
Q

hep A virus is
cholera is
hep B is
influenza is
jap encephalitis is
mmr is

A

inactivated
live atten
recombinant
inactivated or recombinant
inactivated
live atten

43
Q

muslims taking Hajj and pilgrimages in Saudi Arabia should be vaccinated against

A

meningococcal

44
Q

participating in injury prone activities should take

A

tap (tetanus dipth) - toxoid vaccine

45
Q

vaccines take __ to elicit protective effects

A

2 weeks

46
Q

can 2 live vaccines be administered on same day

A

can be done, of not second should be given 28 days after first

47
Q

coadministration of which 2 vac is recommended

A

yellow fever and MMR

48
Q

missed dose

A

don’t give additional dose
continue w the overdue dose

there is no max interval between doses of primary vaccine series

49
Q

which vac has oral ROA

A

cholera

50
Q

influenza ROA

A

instransal or IM

51
Q

SQ vacs

A

polio and MMR and yellow fever

52
Q

which parasite causes malaria

A

protozoan parasite called plasmodium

53
Q

5 species of plasmodium

A

P falciparum, malariae, ovale, vivax and Knowlesi

54
Q

most prevalent plasmodium:

A

vivax and falciparum (most dangerous is falc)

55
Q

clinical features of malaria

A

fever, chills, body ache, cough, vomitingm diarrhoea, sweats, headaches, abdominal pain, nausea

56
Q

what transmits malaria

A

female anopheles mosquito or transfusions organ transplant and meter to foetus (vertical transmission)

57
Q

risk of transmission is higher during

A

higher between dusk and dawn
cold season
at end of rainy season
decreases at high altitudes

58
Q

does SEA have malaria risk

A

no

59
Q

those who developed malaria as children have immunity as adults/

A

yes

60
Q

plasmodium life cycle

A

exo erythrocytic cycle (grow an d multiply in human liver)
- P vivax and oval have possible dormancy

erythrocytic cycle in human blood
- differentiate into gametocytes
-clincal symptoms

mosquito (sporagenic cycle)

61
Q

strategies for malaria prevention

A

awareness
bite prevention
chemoprophylaxis
diagnosis through blood smear and seeing parasite in blood
environments

62
Q

drugs used for malaria chemoprophylaxis

A

atovaquone + proguanil (malarone)
chloroquine
doxycycline
mefloquine

63
Q

3 types of malaria risk prevention

A

A- bite prevention
B (non falciparum risk) - bite prevention + chloroquine or doxy or malrone or mefloquine
C (falciparum malaria risk = high resistance to chloroquine) - use bite prevention + malarone or doxy or mefloquine

64
Q

malaria advice after returning

A

no blood transfusion fr 4 month
monitor for fever and flu like symptoms for a year

65
Q

insect repellant precautions

A
  • only on exposed skin
  • not on broken skin
  • don’t spray on face directly
    -wash hands after
  • wash skin an clothes when home
66
Q

active ingredients in insect repellants

A

DEET, picaridine, oil of lemon eucalyptus, IR 3535, 2 undecanone

67
Q

which repellant ingredient is most effective

A

DEET provides 6-12h protection

68
Q

protection against malaria

A

wear light coloured clothing
stay indoors between dusk and dawn
expose less skin
sleep under a permethrin impregnanted bed net
sealed aircon room with or screened windows with fan

69
Q

atovaquone proguanil
- regimen
- CI
- ADR
- DDI
- avoid in
- classification in SG

A
  • start 1-2 days before travel and continue for 7 days after return (WITH FOOD OR MILKY DRINKS)
  • renall impairment (CrCl below 30) and hypersensitivity
  • nausea, vomiting, diarrhoea, headache, dizziness
  • rifampicin, metoclo[ramide
  • preg and lac
  • POM w exemption
70
Q

chloroquine
- regimen
- CI
-precautions
- ADR
- DDI
- classification in SG

A
  • weekly in one dose, with or after meals. start 1-2 weeks before departure, continue toll 4 weeks after return
  • hypersensitivity, chloroquine resistance
    -exacerbates psoriasis, myasthenia graves, seizure, liver impairment
  • NV, stomach pain, rash
  • QT prolonging CYP3A4 inhibitors eg clarithromycin and voricinazole
  • P only
71
Q

doxyxline
- regimen
- CI
-precautions
- ADR
- DDI
- classification in SG

A
  • daily with or after meals w FULL glass of water. start 1-2 days prior to top and continue till4 weeks after return
  • hypersens, children below 8, preg and lact
  • GI discomfort, photosens
  • reduce F w multivalent ions
  • prescription only

if a;rdy taking for acne, don’t need additional regimen

72
Q

least expensive malaria agent

A

doxy

73
Q

women prone to vaginal yeast infections when taking ABs should avoid

A

doxy

74
Q

mefloquine
- regimen
- CI
-precautions
- ADR
- DDI
- classification in SG

A

one dose weekly after meals. start 1 week prior at least and continue till 4 weeks after return
- hypersens, regions w meflo resistance, psychiatric conditions, convulsive disorders, cardiac conduction abnormalities (can cause QT prolongation)
- GI, dizziness, headache, insomnia, vivid dreams, NEUROPSYCHIATRIC DISORDER
- ketoconazole
- pharmacy only
- can be used in preg and lact and children above 5

dsv (6 decks)

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