Chapter 14, 15 & 16: Vaccines, anaesthesia, emergency treatment of poisoning Flashcards
What vaccines are indicated for a patient with Sickle cell anaemia for prophylaxis of infection?
Pneumonococcal vaccineInfluenza type B vaccine+ Anual Influenza vaccinePoss Hepatitis BProphylactic penicillins also consideredRemember HYDROXYCARBAMIDE (anti-cancer drug) can reduce the frequency of sickle cell crises!!
Which anti-malarial treatment is suitable for short trips as it only needs to be taken for 1-2 days before and 7 days after the trip?
Malarone- Proguanil + Atovaquone
Which antibiotic can be used for malarial prophylaxis?
Doxycycline
How long is malarial prophylaxis usually indicated for after leaving the area?
4 weeks(apart from malarone- 7 days)
Any illness within __ months of returning from travel to a malarial region should be referred to their GP
within 3 months especially
Which anti-malarials are unsuitable for a patient with a history of EPILEPSY?
ChloroquineMefloquineEMC (epilepsy)
Which anti-malarial is to be avoided in renal impairment?
Proguanil
Which two anti-malarials can be continued at their normal doses in pregnancy?
ChloroquineProguanilCPP (pregnancy)
Which drug, safe to be used in pregnant women at the usual dose, should folic acid be taken with?
ProguanilEspecially in 1st trimester
Where travels require two different regimens for two diff areas, what should be done?
Regimen for the higher risk area should be used for the whole journey
Which antibiotic, that can be used for falciparum malaria treatment, should be avoided in pregnancy?
Doxycycline- effects teeth and bone developmentQuinine and clindamycin used instead
What anti-malarial drug can possibly cause ocular toxicity when its used at higher doses for Rhumatoid Arthritis / Lupus etc?
ChloroquineHydroxychloroquine also causes this
Which anti malarial drug has been associated with neuropsychiatric reactions, and should be discontinued if patients experience nightmares, anxiety, depression, confusion?
MefoloquineIt is contraindicated in those with a history of psychiatric disorders or convulsions.
What drug do impregnated mosquito nets contain?
Permethrin
Incubation period for whooping cough
6 - 21 days
Incubation period for chicken pox
7 - 21 days (1-3 weeks)
Incubation period for mumps
14 - 21 days
Incubation period for rubella (german measles)
14 - 21 days
Incubation period for measles
7 - 14 days
Which vaccine leaves a blister immediately after/ a crusty spot (papule) at the injection site 2-6 weeks after it?
TB (BCG) VaccineIt usually leaves a small scar
When is the TB (BCG) vaccine given?
babies (neonate), children and adults under the age of 35 who are considered at risk of catching tuberculosis (TB). Not given to anyone over the age of 35, as there’s no evidence that it works for people in this age group
When is the 5 in 1 DTaP/IPV/Hib Jab first doses given?DiptheriaTetanusPertussis (whooping cough)PolioHeamophilus influenza type B
2 months 3 month4 months (8,12,16 weeks)remember: 5 in 1 = 2, 3, 4
When is the Pneumococcal vaccine (PCV) given? And booster?
2 months4 months Booster 12-13 months
When is Meningitis C first vaccine doses given?And booster ?
3 months4 months Booster :12-13 months
When is rotavirus (stomach bug) vaccine given?
2 months3 months
When is the Meningitis C/ heamophilus influenza B (Hib) booster given?
12 - 13 months
When is the pneumococcal vaccine (PCV) booster given?
12 -13 months
When is the first dose of the MMR jab given?
12- 13 months
The 5 in 1 DTap/IPV/Hib vaccine is firstly given at 2,3,4 months old. A Heamophillus influenza B (Hib) booster is then given at 12 months with Men C. When is the next dose, containing only diphtheria, polio, tetanus and pertussis, given?
Between 3 years 4 months and 5 years (before they start school)
How many doses of the 5 in 1 (DTaP/ IPV/ Hib) vaccine is there in total?
3 doses to start, then a another of Hib at 12 months and the rest at 3 years 4 months, then a fifth dose of just Tetanus, Diptheria and Polio needed in high school (13-18 years)Remember it is active against 5 in 1 and5 doses doses
What vaccine is given to girls aged 12- 13 years?
HPV (human papillomavirus- cervical cancer) 2 dose schedule: first 11- 13 years (must be given before 15), second 6-12 months later
When is the final dose of Tetanus, diphtheria and polio (only 3 of the 5 in 1 jab) given?
13-18 years
When is the (newly introduced 2015) children annual LIVE nasal spray flu vaccine (FLUENZ) given?
2, 3, 4 years for sureThose in their 1st and 2nd year school (5+ 6 years) possiblyIf they are at particular risk they can get it up to 17 years
Adults aged __ and over are eligible for the NHS Flu Jab free?
65
Mr H has a BMI of 36. What jab does this make him eligible for free of charge?
NHS Flu JabFree for those very overweight
Mrs M has been on long term corticosteroid therapy for her stage 5 Asthma. What vaccine is she eligible for and why?
Flu vaccine Long term steroids: immune system suppressed. Asthma
What 6 ingredients do vaccines sometimes contains, excluding the virus itself?
Thiomersal (mercury, a preservative)Aluminium adjuvants: inactive vaccine adsorbed onto aluminium to enhance immune responseStabilizers: Gelatine, AlbuminFormaldehydeAntibioticsEggs
Neonates at risk should receive what two vaccines?
BCG (TB)Hepatitis B
Give examples of LIVE vaccines?
MMRBCG
What age can the meningitis C vaccine booster be given?
13 - 15 years
What vaccine is indicated for women of child bearing age if they have not previously received the 2 jabs for it?
MMR vaccineBut must exclude pregnancy before hand! do not give vaccines to pregnant women bar the flu vaccine
What vaccine is indicated for 70 year olds (hint: not the flu vaccine- over 65s)
Varicella zoster vaccine (shingles)
What vaccine is indicated for parenteral drug misusers?
Hep B
Patients with certain medical conditions such as asthma, COPD, neurological conditions, diabetes, HIV, are eligible for the flu vaccine from what age?
6 months!
Food hygiene is recommended in areas where there is poor sanitation to prevent what diseases?
Hepatitis ATyphoidCholera Travellers diarrhoea
Food hygeine is recommended in areas where there is poor sanitation. This involves sticking to hot, freshly prepared foods and avoiding what?
Green salads, uncooked vegetablesOnly eat fruit that can be peeledOnly bottled water or tap water that has been boiled or treated with sterilising tablets
When should LIVE vaccines be avoided?
In individuals who are immunocompromised
How should post-vaccine pyrexia be managed in infants (1-12 months)?
Paracetamol (dose for over 2 months: 60mg [2.5ml] followed by second dose 4-6 hours later if needed)Can use Ibuprofen if needed: for over 3 months
How long does the yellow fever vaccine provide immunity for before requiring re-vaccination?
10 years
How long can doxycycline be used for malaria prophylaxis?
2 years
Is DEET safe to use in pregnancy and breast feeding?
No
Is there a link between the MMR vaccine and bowel disease/ Autism?
NO- CSM have ruled this out
Can the MMR vaccine be given if a child is hypersensitive to Eggs?
Yes!
What are the common SE’s of the MMR jab?
Malaise, fever, rash - can occur a week after the vaccine
Can MMR and Yellow fever vaccines be given on the same day?
No- leave at least 4 week interval
Can antipyretics/ analgesics (paracetamol etc) be given BEFORE live vaccine administration?
No- may decrease immune response so avoid before but can give it after
If two live vaccines need to be given, when should they be given?
Give them on the same day- if not possible then give 4 weeks apart. this is so that you reduce the interference of immune response to the first vaccine by the second one. NB: a Live and an inactive vaccine may be given at any time in relation to each other… same with parenteral and intranasal.
Pregnant women can be vaccinated against ____ at 28-32 weeks pregnancy and pass it onto their newborn?
Pertussis (whooping cough)
Antibodies of human origin are termed as what?
Immunoglobulins
What are the two types of human immunoglobulin?
NormalDisease- specific
Normal immunoglobulin is available from regional Public health labs for the control and outbreak of what 3 conditions?For any other indications, where should the immunoglobulins be purchased from?
Hepatitis A MeaslesRubellaAll other indications- purchased from the manufacturer
What disease-specific immunoglobulin would you not be able to get from public health labs?
Tetanus - get this from manufacturer, hospital pharmacies
True or false:Hepatitis B immunoglobulin required by transplant centres should be obtained commercially
TRUE
How is normal immunoglobulin administered for protection of conditions?
Intramuscular injection
What is normal immunoglobulin?
Non-specificHas antibodies for conditions such as measles, mumps, rubella, Hepatitis A and other viruses that would affect the general population
After how long of an injection of normal immunoglobulin are you protected?
Immediately
Normal immunglobulin for protection is administered via IM. For what indication would you give it IV?
Replacement therapy
Is immunoglobulin recommended for Hep A protection in travellers?
No Hep A vaccine by itself is recommended for individuals visiting high risk areas
Public Health England recommends normal immunoglobulin in addition to Hep A vaccine in which individuals?
- If in close contact with Hep A positive people- > 60 years- Chronic liver disease/Hep B or C positive- HIV infection
In non-immune patients who have had exposure to measles can be given the MMR vaccine, although this is not suitable for prophylaxis as the effect is too slow. In what patient groups would this be inappropriate for, and what should be given instead?
IM normal immunoglobulin for the following patient groups:Non-immune pregnant women (if clinically appropriate- it will not prevent infection but may prevent clinical attack)Infants under 9 months
True or false: After a pregnant woman is exposed to rubella, it is recommended they have IM immunoglobulin to prevent infection
No It is not recommended and it does not prevent infection in non-immune patients. However, it may reduce the risk of a clinical attack so may reduce the risk to the foetusIt should only be used if termination of pregnancy is not possible, and should be given as soon after the exposure
Risk of rubella transmission in pregnant women to the foetus is greatest in the first how many weeks of gestation?
Great risk in the first 11 weeks
Females of childbearing age should avoid getting pregnant until how long after getting the MMR vaccine?
At least 4 weeks
True or false:Pregnant women should have the MMR vaccine
False Live vaccines should not be administered routinely to pregnant women because of the theoretical risk of fetal infection but where there is a significant risk of exposure to disease
If a patient requires rabies prophylaxis after a bite, where should the rabies immunglobulin be administered?
Bite should be washed with soapy waterAll of the dose should be injected around the site of the wound; if this is difficult or the wound has completely healed it can be given in the thigh (remote from the site used for vaccination).
If a patient is bitten in a high risk rabies area, what should happen?
Bite should be washed with soapy water Specific rabies immunoglobulin should be injected into site of wound when possible (if not, thigh) Rabies vaccine should also be given IM at a different site
How do you manage tetanus prone wounds?
Tetanus immunoglobulin should be used Wound cleansingAntibacterial prophylaxis if appropriate (Ben Pen, co-amox, or metronidazole)Tetanus vaccine
How do you treat established cases of tetanus?
Tetanus immunoglobulin MetronidazoleWound cleansing
Varicella-zoster immunoglobulin is recommended in what patient groups?
Increased risk of severe infection in those who have few/no antibodies to the virus:Neonates, pregnant women, immunosuppressed
In immunocompromised patients on long term antiviral prophylaxis, if they are exposed to the virus, what is the recommendation regarding their antiviral prophylaxis?
Increase the dose temporarily
Immunosuppressed patients receiving regular intravenous immunoglobulin replacement therapy only require varicella-zoster immunoglobulin if the most recent dose was administered more than how many weeks before exposure?
3 weeks
What is the anti-D (Rho) immunoglobulin used for?
In rhesus-negative pregnant women to prevent sensitisation if e.g. gives birth to a rhesus-positive baby
Is the MMR vaccine live or inactivated?
Live
Is the BCG vaccine live or inactivated?
Live
Is the influenza vaccine live or inactivated?
Inactivated
Are live or inactivated vaccines more likely to require booster injections?
Inactivated
Vaccination in HIV depends on their immunity status, however there are 3 vaccines that should always be avoided. What are these?
BCGTyphoidYellow fever
What vaccines are recommended in asplenic patients?
InfluenzaPneumococcalHaemophilus influenza type B with meningococcal type CMeniningococcal (B and ACWY)
From what age is the influenza vaccine recommended in adults?
65 years
From what age is the pneumococcal vaccine recommended in adults?
65 years
From what age is the varicella-zoster vaccine recommended in adults?
70 years(At 80 years, they are no longer eligible)
How is the cholera vaccine given?
Orally
How long does the diphtheria vaccine last?
10 years
A Hep A booster dose is given how long after the initial dose?
6-12 months after
Primary immunisation of Hep B requires how many doses?
3
HPV vaccination is how many doses if the first dose is given before 15 years of age?What time frame?
2 Second dose to be given 6-24 months after the initial one
HPV vaccination is how many doses if the first dose is given after 15 years of age?Within what time frame?
3 All in the space of a 12 month period
What are the ideal months for influenza vaccination?
Between September and early November
True or false:People with diabetes are recommended to get the flu vaccine
TRUE
True or false:Morbidly obese patients are recommended to get the flu vaccine
TRUE