Gremlin: Immunizations and Fluids Flashcards
1
Q
live vaccines
A
- MMR
- varicella
- Rotavirus PO
- LAIV
- polio (OPV) - no longer used in USA
- ZVL (live shingles)
2
Q
toxiod vaccines
A
- diptheria
- tetanus
3
Q
inactivated vaccines
A
- HepA
- inactivated flu (IIV)
- pertussis
- polio (IPV)
4
Q
recombinant vaccines
A
- HepB
- HPV
- RZV (shingles)
5
Q
conjugate/polysacchraide vaccines
A
- Hib
- meningococcal
- pneumococcal
6
Q
Infanrix
A
DTaP
7
Q
Daptacel
A
DTaP
8
Q
Adacel
A
Tdap
9
Q
Boostrix
A
Tdap
10
Q
Tenivac
A
Td
11
Q
Tdvax
A
Td
12
Q
Kinrix
A
DTaP + IPV
13
Q
Quadracel
A
DTaP + IPV
14
Q
Pentacel
A
DTaP + IPV + Hib
15
Q
Pediarix
A
DTaP + IPV + HepB
16
Q
Vaxelis
A
DTP + IPV + Hib + HepB
17
Q
ProQuad
A
MMR + Varicella
18
Q
Twinrix
A
HepA + HepB
19
Q
MenHibrix
A
Hib + MenCY
20
Q
vaccine adminstration spacing
not in a series
A
- any vaccines can be given at same time
- any vaccine can be given without regard to other vaccine adminstration EXCEPT in the case of 2 live vaccines NOT given at the same time
- space by 28 days
21
Q
vaccine series admin
A
- stay on time
- admin too early: reduced protection
- if > 5 days too soon: consdier invalid and redose when appropraiate - admin too late: delayed protection but nusually no need to restart the series
22
Q
vaccines and chemo
A
radiation therapy, chemo: give live vaccines 2 weeks before or 3 months after treatment
23
Q
vaccines and IVIG
A
- give 14 days before therapy or 3 months after
- if high dose of IVIG, no live vaccine for 11 months
24
Q
vaccines and prednisone
A
- high dose: 2 mg/kg/day or 20mg/day for > 14 days
- live vaccies: don’t give during treatment
- if hgih dose cs were being given (qod or qd) for < 14 days, can vaccinate immediately following dc or wait ~ 2 weeks
- if high-dose cs being given (qd OR qod) for 14+ days of treatment, wait a month to vaccinate
- inactivated vaccines may result in aindequate resopnse but benefit > risk
- live vaccies: don’t give during treatment
25
vaccines and PPD
live virus vaccine can suppress TB skin test: give simultaneously or wait 4-6 wks to place PPD
26
vaccines and antivirals
- avoid live vaccines 48 hrs after completeion of antiviral
- avoid antiviral 14 days after live vaccine ( if posible)
27
fridge temp
2-8 C
28
most vaccines are IM EXCEPT for
- PO
- rotovirus
- live polio - OPV (not used in USA, USA uses IPV which is IM/SQ)
- nasal
- live flu
- subQ only
- herpes ZVL (RZV is IM)
- menincococcal MPSV-4 (MCV-4 is IM)
- IM AND SQ
- PPSV 23 (PCV 15/20 are IM only)
- polio IPV
- MMRV (MMRII and proquad only can also be IM)
29
where to admin a subQ vaccine
- pts < 12 months: thigh
- pts > 12 months: outer triceps of arm
- 45 degree angle
30
where to admin IM vaccine
- pts < 36 months: anteriolateral thigh
- pts > 36 months: deltoid
- do NOT admin in butt: inadequate response and risk of injury to sciatic nerve
- 90 degree angle
31
recommendations for a baby with a neonatal weight **> 2 kg** born to a mother who is **HepB (-)**
- give vaccine only within 24 hrs of birth
- follow CDC guidelines for routine vaccination (2 additional doses)
32
recommendations for a baby with a neonatal weight **< 2 kg** born to a mother who is **HepB (-)**
- give vaccine at hospital discharge or at 1 month PNA
- follow CDC guidelines on routine vaccination (2 additional dose)
33
recommendations for a baby with a neonatal weight **> 2 kg** born to a mother who is **HepB (unknown)**
- give vaccine only within 12 hours of birth
- determine mother's hepb status
- if unknown or positive, give HBIG within 7 days PNA then follow CD guidelies
- if negative, follow CDC guidelines on routie vaccination (2 additional doses)
34
recommendations for a baby with a neonatal weight **< 2 kg** born to a mother who is **HepB (unknown)**
- give both vaccine and HBIG within 12 hours of birth
- give 3 additional vaccine doses starting at PNA 1 month
| same as <2kg and mother (+), minus additional testing
35
recommendations for a baby with a neonatal weight **> 2 kg** born to a mother who is **HepB (+)**
- give both vaccine and HBIG within 12 horus of birht
- follow CDC guidelines on routine vaccination (2 additional doses)
- test for HBV (HepB) at age 9-12 months
36
recommendations for a baby with a neonatal weight **< 2 kg** born to a mother who is **HepB (+)**
- give both vaccine and HBIG within 12 hours of birth
- give 3 additional vaccine doses starting at PNA 1 month
- test for HBV (HepB) at age 9-12 months
| same as <2kg and mother (unkown) but with additional testing
37
HPV 2 dose vs 3 dose
- pts starting HPV series before age 15: 2 dose
- starting afte age 15: 3 dose
38
why do pts need to be monitored after HPV vaccine
syncope is a common side effect
39
all flu vaccine are ____ valent
all flu vaccines are quadrivalent
- contain 4 strains
40
which four flu vaccines are egg based?
- afluria
- fluarix
- flulaval
- fluzone
41
efficacy of flu vaccine
~45-50%
42
Tdap and DTap efficacy
- DTaP: 80-90%
- Tdap: 70%
43
HepA vaccine effectiveness
94-100%
44
efficacy of HPV-9
97%
45
when give 2 doses of flu
- in pts < 9: first lifetime dose give 2 doses separated by 4 weeks
## Footnote
if vaccine available, can consider giving first dose wayyyy early, like august becaue they will be getting a seocond dose later on
46
how old do you ahve to be to receive flu vaccine
- 6 months for inactivated
- 2 yrs for live
- 65+ for high dose fluzone
47
MMR efficacy
- after first dose: 93% for measles, 78% for mumps
- - after second dose: 97% for measles, 88% for mumps
48
varicella efficacy
- in pts < 13 yrs: > 95%
- in pts > 13 yrs
- after dose 1: 78-82%
- after 2: 99%
49
meningitidis vaccines
- menveo (A, C, Y, W-135): approved for pts > 2 months
- MenQuadfi (A, C, Y, W-135): approved for pts > 2 yrs
- Truemenba (B): pts 10-25 yrs
- Bexsero (B): pts 10-25 yrs
- Penbraya (A, **B**, C, Y, W-135): 10-25 yrs
## Footnote
serotype B vaccination, not for routine use, jus tin pts who are high risk -> trumenba, bexsero, and penbraya not for routine use
50
ppsv 23 vs. pcv15 and 20
- ppsv 23: polysaccharide
- broader coverage, but canNOT usein pts < 2 yrs -> only used in combo with PCV 15 in pts with high risk conditions (give PCV 15 and then 8 wks later give PPSV 23)
- pcv15 and 20: conjugate
51
rotavirus vaccine age restritions
- MUST start before PNA 15 weeks
- MUST **finsih** by PNA 8 months
52
Rotateq vs Rotarix
- Rotateq (RV 5): 3 dose series
- reduced efficacy with second season
- Rotarix (RV1) 2 dose series
- efficacy maintained for 2 yrs
53
COVID 19 2023-24 vaccination in an unvaccinated 6mo. - 4 yr
- option 1: moderna dark blue cap with green label - 2 dose series
- dose 2 4-8 weeks after dose 1
- option 2: pfizer yellow cap: 3 dose series
- dose 2 3-8 weeks after dose 1
- dose 3 > 8 weeks after dose 2
54
COVID 19 2023-24 vaccination in a pt 6 mo - 4 yrs **with hx of 1 dose of original or bivalent moderna**
give second dose of moderna 4-8 weeks after dose 1; use dark blue cap, green label
55
COVID 19 2023-24 vaccination in a pt 6 mo - 4 yrs **with hx of 2 or more doses of original or bivalent moderna**
give 1 dose of moderna using dark blue cap, green label; give > 8 weeks after last dose
56
COVID 19 2023-24 vaccination in a pt 6 mo - 4 yrs **with hx of 1 dose of pfizer**
- give dose 2 3-8 weeks after dose 1 (use yellow cap)
- give dose 3 >8 weeks after dose 2 (use yellow cap)
57
COVID 19 2023-24 vaccination in a pt 6 mo - 4 yrs **with hx of 2 or more doses of pfizer**
give 1 dose pfizwe, using yellow cap; give >8 weeks after last dose
58
COVID 19 2023-24 vaccination in a pts 5-11 yrs
- regardless of whether vaccinated or not: 1 dose
- moderna dark blue cap, green label
- pfizer blue cap
## Footnote
if previously vaccinated, wait until > 8 weeks after last dose
59
COVID 19 2023-24 vaccination in an **unvaccinated** pt age 12+ yrs
use one of the following
- 1 dose of moderna dark blue cap, blue label
- 1 dose pfizer gray cap
- 2 doses novavax dark blue cap, blue label
- second dose 3-8 weeks after dose 1
60
COVID 19 2023-24 vaccination in a pt age 12+ yrs **with hx of any COVID 19 vaccine**
use one of the following* at least 8 weeks after last COVID 19 dose*
- 1 dose of moderna dark blue cap, blue label
- 1 dose pfizer gray cap
- 1 dose novavax dark blue cap, blue label
61
storing the pfizer COVID 19 vaccine
- ultra cold freezer (-90 to -60 C): until expiration
- fridge: 10 weeks
- room temp: 12 hrs
62
storing the moderna COVID 19 vacine
- freezer (-50 to -15C) until expiration
- fridge: 30 days
- room temp: 12 hrs
63
storing novavax COVID19 vaccine
- fridge: 9 months
- room temp: 12 hrs
64
though it is a rare side effect of the COVID-19 vaccine, occurence of myocarditis is highest in what group
12-17 yr males
65
Which RSV vaccine is approved in pregnant peiopple, and when can it be given
Abrysvo
- give between 32 weeks 0 days and 36 weeks 6 days GWA
- only in sept through jan
66
when might a ped receive the RSV mAb nirsevimab
- out of season (NOT oct through march), age 8-19 months and high risk
- during season (Oct - march) **and** less than 8 months old **and** [born to an unvaccinated mother **OR** born within 14 days of mother vaccination]
- if current weight <5: use 50mg/0.5m;
- if current weight > 5: 100m/ml
67
Arexvy storage
RSV vaccine: needs to be reconstitued
- store in fridge and **protect from light**
- admin vaccine within four hours after preparing
- if not immediately administering vacvcine, can store **in fridge or room temp** (still protect form light) for those 4 hours
68
Abrysvo storage
RSV vaccine: needs to be reconstitued
- store in fridge
- admin vaccine within four hours after preparing
- if not immediately administering vacvcine,** store at room temp** for those 4 hours
69
most common causes of dehdyration
- **viral gastroenteritis**
- fever
70
how to calculate fluid deficite %
(pre illness weight -illness weight)/ pre illness weightx100
71
dehydration ccurs more quickly in whcih age group
- neonates and infants
72
definition of mild dehydration (in term sof fluid deficit %)
- infants: 1-5%
- children 1-3%
73
definition of moderate dehydration (in term sof fluid deficit %)
- infnats: 6-9%
- children 4-6%
74
definition of severe dehydration (in term sof fluid deficit %)
- infants > 10%
- children > 6%
75
s/s of dehydration
- increased heart rate
- decreased bp
- decreased urine output
- dry buccal mucosa
- sunken eyes
- sunken fontanelle
- cyanosis
- thirsty
- no tears
- ams
76
mild dehydration treatment
- oral rehydratio therpay (pedialyte)
- 50ml/kg PO over 4 hrs; reassess Q2H + 10 ml/kg for each episode of loose stool/emesis
77
moderate dehydration therpay
- oral rehydratio therpay (pediatlyte)
- 100ml/kg PO over 4 hrs; reassess QH + 10 ml/kg for each episode of loose stool/emesis
78
severe dehdyration therapy
1. bolus: 10-20ml/kg/dose of NS or LR infused voer 30-60 min; repeat up to 3x PRN
2. maintenance
- first 8H: replace deficit
- next 16H: maintenace *isotonic* fluids
79
maintenance IV fluid rates
- < 10kg: 4ml/kg/hr
- 10-20kg: 40ml/hr + 2 (wt over 10kg)
- > 20 kg: 60ml/hr + (wt over 20kg)
80
maintenance fluidcomponents
- NS 9needed to avoid Na shifts and brain edema)
- D5W
- 20mEq/L K (avoid in pts with renall impairment tho)
81
