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AGPCNP Board Prep > Ch2: Primary Prevention > Flashcards

Ch2: Primary Prevention Flashcards

1
Q

the most cost effective form of healthcare

A

primary prevention

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2
Q

detecting disease in early, asymptomatic, preclinical state including screening tests (BP, mammogram, colonoscopy)

A

secondary prevention

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3
Q

minimizing negative disease-induced outcomes (adjusting therapies to avoid further target organ damage)

A

tertiary prevention

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4
Q

benefits of polio vaccination

A

10,000 children are not paralyzed, and 3,000 do not die per year

fecal-oral route of transmission (contaminated food and water)

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5
Q

benefits of rubella vaccination [MMR] (german measles)

A

20,000 newborns are spared congenital rubella syndrome (developmental disability, blindness, hearing loss) per year

rubella is one of the most teratogenic viruses known to humankind

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6
Q

benefits of measles vaccine [MMR]

A

12,000 deaths avoided in the US per year (and 2.7 million worldwide)

encephalitis, pneumonia, death, blindness

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7
Q

benefits of influenza vaccine

A

prevents 7 million cases of illness per year and 110,000 influenza-related hospitalizations and 9,000 deaths prevented (with most deaths being in children, elderly, and pregnant women)

5x more likely to be hospitalized with influenza complications in pregnancy

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8
Q

benefits of pneumonia [pneumococcal] vaccine

A

pneumonia death rate = 1 in 20 (1 in 5 if they develop septicemia or meningitis complication)

40,000 deaths per year, 50% could be prevented if everyone got the vaccine

mortality risk is greatest in early childhood, elderly, and underlying medical conditions

two options: Prevnar, Pneumovax

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9
Q

is it ok to give another vaccine if they are unsure their receipt status in the past?

A

better to give an extra vaccine dose than to give none. risk of reaction with re-immunization is minimal

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10
Q

when should a vaccine dose be deferred or delayed?

A

moderate-severe illness with or without fever (her personal rule is that the only time she will skip a vaccine that is due is when she is sending that person to the hospital)

do NOT need to defer in the presence of minor illness

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11
Q

what is active immunity

A

given via vaccine

resistance is developed in response to a vaccine, usually characterized by the presence of an antibody produced by the host

given in anticipation of exposure to an infecting agent

onset of protection is usually within 1 month of the dose

protection usually lasts years or lifelong

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12
Q

which is preferred: active vs. passive immunity

A

active

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13
Q

what is passive immunity

A

given via immune globulin

immunity is conferred by an antibody produced in another host, via administration of an antibody-containing preparation (antiserum or immune globulin [IG])

given post-exposure to select infecting agents

onset of protection is usually within hours of dose

duration of protection is time limited, usually 6-9 months

available for only a limited number of infectious agents

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14
Q

example infectious agents we have immune globulin available for? (5)

A

varicella, hepatitis A, hepatitis B, tetanus, rabies

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15
Q

what happens to your immunity if you get acute hepatitis B and then your body clears it without becoming chronic

A

lifetime immunity

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16
Q

can you get active hepatitis B infection from sexual contact with someone who has chronic (asymptomatic) hepatitis B

A

yes

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17
Q

tetanus organism

A

c. tetany

anaerobe - does better where there is less oxygen (deeper wounds, not superficial ones)

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18
Q

dirty wound, think of giving this prophylactically….

A

tetanus immune globulin and/or tetanus vaccine

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19
Q

characteristics of the type of wound you need to consider tetanus for

A
  • > 6hrs old
  • contaminated [soil, feces, saliva, dirt]
  • puncture or crush wound
  • avulsions
  • wounds from missiles, burns, or frostbite
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20
Q

Pt presents with a clean, recent, minor, superficial wound. They don’t remember if they have ever completed their Tdap vaccine series. What do you recommend today?

A

Tdap today

they do not need TIG (immune globulin)

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21
Q

Pt presents with a clean, recent, minor, superficial wound. They completed their Tdap series on schedule, but their last dose was >10 years ago. What do you recommend today?

A

Tdap today

they do not need TIG (immune globulin)

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22
Q

Pt presents with a deep wound from 8 hrs ago that is visibly soiled with dirt. They do not know if they ever completed their Tdap vaccine series. What do you recommend today?

A

Tdap today

TIG (immune globulin) today 250 units IM (??)

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23
Q

Pt presents with a deep wound from 8 hrs ago that is visibly soiled with dirt. They completed their Tdap series on schedule, but their last dose was >5 years ago. What do you recommend today?

A

Tdap today

?? TIG (immune globulin) today 250 units IM ??

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24
Q

Pt has a history of anaphylactic reaction to neomycin. What vaccine(s) should they avoid?

A

inactivated polio vaccine (IPV), MMR, varicella

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25
Q

Pt has a history of anaphylactic reaction to baker’s yeast (in all commercially-prepared bread). What vaccine(s) should they avoid?

A

hepatitis B

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26
Q

Pt has a history of anaphylactic reaction to gelatin. What vaccine(s) should they avoid?

A

MMR

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27
Q

anaphylaxis is an acute, life-threatening systemic reaction that results from the ….

A

sudden systemic release of mediators from mast cells and basophils

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28
Q

most common presentation of anaphylaxis (3)

A
  • urticaria (hives, may become coalescent, pruritic)
  • angioedema (tissue edema most commonly involving the head and neck)
  • respiratory compromise
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29
Q

Primary care interventions for anaphylactic reactions (6)

A
  1. assess airway, breathing, circulation
  2. place in supine position
  3. activate EMS
  4. administer IM epinephrine (anterior-lateral thigh)
  5. give an H1 (diphenhydramine [benadryl]) or H2 blocker (ranitidine [Zantac]) PO
  6. IV access if available, oxygen, ongoing clinical monitoring (do not leave them alone in the exam room)
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30
Q

Contraindications to epinephrine in emergency situations

A

NONE! it is life-saving

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31
Q

folks with a history of anaphylactic reactions should have prescriptions provided for… (3)

A
  • epinephrine (EpiPen)

Also consider….

  • oral antihistamines
  • systemic corticosteroids

Refer to an allergist!!!!

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32
Q

Community disaster: Uninjured adults and children are evacuated to a crowded group setting. Which vaccine will you prioritize?

A

influenza (respiratory droplets)

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33
Q

Community disaster: Adults with deep lacerations from flying debris. Which vaccine will you prioritize?

A

tetanus (contaminated wounds)

34
Q

Community disaster: community is exposed to unsafe water supply after a hurricane. Which vaccine will you prioritize?

A

hepatitis A (fecal-oral route through contaminated food and water)

35
Q

what is immune globulin made of

A

a concentrated solution of antibodies derived from pooled donated blood

36
Q

previously unvaccinated adults with newly diagnosed T1DM or T2DM should be vaccinated against ______ as soon as possible d/t risk for contracting from their glucose testing

A

hepatitis B

higher risk of developing chronic hepatitis B

people with DM in a group setting (e.g., hospital, LTAC), there are outbreaks of Hepatitis B from caregivers who did not properly disinfect the testing equipment or not changing the lancet

37
Q

for routine tetanus immunization UPDATE (booster) in adults, which version should you use?

A

either Td or Tdap is ok

38
Q

discuss PCV13 vs. PPSV23

A

PCV13 = stronger protection, more narrow coverage

PPSV23 = broader coverage, less strong protection

both tend to be pretty well-tolerated

39
Q

anticipatory guidance for patients regarding pneumococcal vaccine adverse reactions

A

30-50% will experience local reactions including pain and redness

systemic reaction (fever, myalgia) is rare, highest in children (11-40% of children will have short-term mild systemic reaction)

severe reactions are rare

40
Q

what is a live attenuated vaccine

A

live, weakened virus

vaccine prepared from live microorganisms that are cultured under adverse conditions leading to loss of virulence but retention of their ability to induce protective immunity

41
Q

live vaccines most commonly used in the US (4)

A
  • MMR
  • varicella (chickenpox)
  • intranasal flu (FluMist)
  • zoster (only zostavax, shingrix is not)
42
Q

difference between zostavax and shingrix for zoster vaccination?

A

zostavax (old version) was a live vaccine (no longer being manufactured). was only 50% efficacious

shingrix is NOT LIVE!!! nearly 100% efficacy :)

43
Q

in which populations do we avoid live vaccine use? (2)

A
  • pregnancy d/t theoretical risk of passing along virus to fetus
  • severe immunocompromise d/t potential risk of becoming ill with the virus or a lack of clinical effect (e.g., HIV with AIDS, on immunemodulators)
44
Q

if CD4 count is above _____, it is generally safe to give a live vaccine to someone with HIV

A

> 200

45
Q

if someone had zostavax in the past, should they still receive shingrix?

A

yes, shingrix is more efficacious

46
Q

if someone had shingles in the past, should they still receive shingrix?

A

yes, can prevent severity and post-herpetic neuralgia

wait 6-8 weeks after last outbreak before giving

47
Q

ACIP recommendation for who should receive the Shingrix vaccine

A

adults 50yo+, including those who previously received the live zoster vaccine (Zostavax)

48
Q

patient counseling: Shingrix

  • vaccine type
  • dosing
  • FDA indication
  • contraindications
  • ACIP recommendation
  • adverse effects
A
  • vaccine type: recombinant adjuvanted (NOT live)
  • dosing: two doses, IM injection (0 and 2-6 months)
  • FDA indication: prevention of herpes zoster (shingles) in adults 50yo and older
  • contraindications: h/o severe allergic reaction to any component of vaccine. it is ok to give to folks who are immunosuppressed. has not been studied in pregnancy
  • ACIP recommendation: adults 50yo+ including those who previously received Zostavax
  • side effects: pain at injection site (78%), redness at injection site (38%), swelling (26%), myalgias (44%), fatigue (44%), headache (37%), shivering (26%), fever (20%), GI symptoms (17%)
49
Q

expected adverse reactions: Hepatitis A vaccine

A

COMMON (>25%)
- injection site soreness

LESS COMMON (<25%)

  • headache
  • poor appetite

RARE (<1%)
- allergic reaction

50
Q

expected adverse reactions: Hepatitis B vaccine

A

COMMON (>25%)
- injection site soreness

LESS COMMON (<25%)
- mild fever

RARE (<1%)
- allergic reaction

51
Q

expected adverse reactions: Influenza vaccine

A

COMMON (>25%)

  • injection site soreness
  • injection site redness

LESS COMMON (<25%)

  • muscle aches
  • mild fever

RARE (<1%)
- allergic reaction

52
Q

expected adverse reactions: MMR

A

COMMON (>25%)

  • fever
  • arthralgias

LESS COMMON (<25%)

  • mild rash
  • lymphadenopathy

RARE (<1%)

  • seizure
  • allergic reaction
  • potential teratogen
53
Q

expected adverse reactions: Meningococcal types A, C, Y, W-135 (Menactra)

A

COMMON (>25%)
- injection site redness

LESS COMMON (<25%)
- fever

RARE (<1%)
- none

54
Q

expected adverse reactions: Meningococcal serogroup B (MenB)

A

COMMON (>25%)

  • injection site soreness
  • injection site redness
  • injection site swelling
  • mild generalized malaise
LESS COMMON (<25%)
- fainting

RARE (<1%)
- allergy

55
Q

expected adverse reactions: Pneumococcal conjugate vaccine 13 (PCV13, Prevnar)

A

COMMON (>25%)

  • injection site redness
  • temp >100.4 (children)
LESS COMMON (<25%)
- none

RARE (<1%)
- none

56
Q

expected adverse reactions: pneumococcal polysaccharide vaccine 23 (Pneumovax 23)

A

COMMON (>25%)
- injection site redness

LESS COMMON (<25%)

  • fever
  • myalgia

RARE (<1%)
- allergy

57
Q

expected adverse reactions: HPV-9 vaccine (Gardasil-9)

A

COMMON (>25%)

  • injection site soreness
  • injection site redness
  • injection site swelling

LESS COMMON (<25%)

  • generalized body aches
  • mild fever
  • headache

RARE (<1%)
- syncope

58
Q

expected adverse reactions: Tdap

A

COMMON (>25%)
- injection site redness

LESS COMMON (<25%)

  • myalgia
  • fever

RARE (<1%)
- allergy

59
Q

expected adverse reactions: Td

A

COMMON (>25%)
- injection site redness

LESS COMMON (<25%)
- none

RARE (<1%)
- allergy

60
Q

expected adverse reactions: varicella (chickenpox)

A

COMMON (>25%)
- injection site soreness

LESS COMMON (<25%)

  • fever
  • mild rash up to 1 month post-administration

RARE (<1%)

  • seizure
  • pneumonia
61
Q

expected adverse reactions: zoster (Shingrix)

A

COMMON (>25%)

  • injection site soreness
  • injection site redness
  • injection site swelling
  • myalgias
  • fatigue
  • headache
  • shivering

LESS COMMON (<25%)

  • fever
  • GI upset

RARE (<1%)
- none

62
Q

when should everyone have received their hepatitis B vaccine series

A

childhood (birth, 1-2 mo, 6-18mos)

63
Q

when should everyone have received their tetanus/diphtheria/acellular pertussis vaccine series

A

DTaP in childhood (2 mo, 4 mo, 6 mos, 18mos, and 4-6 yrs)

DTaP is for <7yo
Tdap is for > or = 7 yo

64
Q

when should everyone have received their first pneumonia vaccine

A

PCV13 in childhood (2mos, 4mos, 6mos, 12-18mos)

65
Q

when should everyone have received their inactivated polio vaccine

A

childhood (2mos, 4mos, 6-18mos, 4-6 yrs)

66
Q

when should everyone have received their MMR vaccine

A

childhood (1 yr, 4-6yrs)

67
Q

when should everyone have received their varicella vaccine

A

childhood (1yr, 4-6 yrs)

68
Q

when should everyone have received their hepatitis A vaccine series

A

childhood (~1 yr)

69
Q

when should everyone have received their HPV vaccine series

A

childhood (9-11yo ideally; <15yo is a two-dose series; 15-26yo is a three-dose series)

70
Q

when should everyone have received their meningococcal vaccine series

A

adolescence (7-10yrs, and 16yo)

71
Q

when should everyone have received their haemophilius influenza type B (HiB) vaccine

A

childhood

72
Q

which vaccines should all folks have been offered before 18yo (11)

A
  • hepatitis B
  • hepatitis A
  • rotavirus
  • DTaP (<7yo) or Tdap (>7yo)
  • Hib (haemophilius influenza type B)
  • pneumonia (PCV13)
  • inactivated polio
  • MMR
  • varicella (chickenpox)
  • meningococcal
  • HPV
73
Q

can you still give the IM flu vaccine to someone with an egg allergy?

A

yes!
if they had only hives, ok to give
if they had more severe allergic reaction, must give in a setting where possible to manage severe allergic reactions

74
Q

adult influenza vaccine, general recommendation

A

1 dose annually, no age limit for IM flu

75
Q

adult Tdap or Td vaccine, general recommendation

A

1 dose Tdap, then Td OR Tdap booster Q10 years, no age limit

76
Q

adult MMR vaccine, general recommendation

A

if they do not have demonstrated immunity, can give 1 or 2 doses depending on the indication. not ok to give when severely immunocompromised or pregnant. no recommendations on use beyond 64yo

77
Q

adult varicella vaccine, general recommendation

A

if they do not have demonstrated immunity, can give 2 doses. not ok to give when severely immunocompromised or pregnant. no age limit

78
Q

adult zoster recombinant (Shingrix) vaccine, general recommendation

A

everyone after 50yo, 2 dose series, no age limit

Shingrix preferred over Zostavax (live attenuated)

79
Q

adult HPV vaccine, general recommendation

A

should have received in adolescence. if >15yo, 3 dose series. if not received, recommend catch-up vaccination through age 26. after 26yo, shared decision making through 45yo. No guidance on recommendations after 45yo

80
Q

adult pneumonia vaccine, general recommendation

A

PPSV23 is recommended for everyone 65yo and older 1 dose. PCV13 is recommended for shared decision making for everyone 65yo and older.

May receive either dose earlier based on comorbidities/risk factors

AGPCNP Board Prep (21 decks)

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