Chapter 14, 15, 16: Vaccines, Anaesthesia, Poisoning Flashcards
Antibodies of human origin are termed as what?
Immunoglobulins
What are the two types of human immunoglobulin?
Human
Disease- 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
Measles
Rubella
All 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-specific
Has 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 foetus
It 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 water
All 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 cleansing
Antibacterial prophylaxis if appropriate (Ben Pen, co-amox, or metronidazole)
Tetanus vaccine
How do you treat established cases of tetanus?
Tetanus immunoglobulin
Metronidazole
Wound 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
