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PHM 704: gremlins and wizards > Gremlin: Immunizations and Fluids > Flashcards

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)
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2
Q

toxiod vaccines

A
  • diptheria
  • tetanus
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3
Q

inactivated vaccines

A
  • HepA
  • inactivated flu (IIV)
  • pertussis
  • polio (IPV)
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4
Q

recombinant vaccines

A
  • HepB
  • HPV
  • RZV (shingles)
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5
Q

conjugate/polysacchraide vaccines

A
  • Hib
  • meningococcal
  • pneumococcal
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6
Q

Infanrix

A

DTaP

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7
Q

Daptacel

A

DTaP

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8
Q

Adacel

A

Tdap

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9
Q

Boostrix

A

Tdap

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10
Q

Tenivac

A

Td

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11
Q

Tdvax

A

Td

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12
Q

Kinrix

A

DTaP + IPV

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13
Q

Quadracel

A

DTaP + IPV

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14
Q

Pentacel

A

DTaP + IPV + Hib

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15
Q

Pediarix

A

DTaP + IPV + HepB

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16
Q

Vaxelis

A

DTP + IPV + Hib + HepB

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17
Q

ProQuad

A

MMR + Varicella

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18
Q

Twinrix

A

HepA + HepB

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19
Q

MenHibrix

A

Hib + MenCY

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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
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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
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22
Q

vaccines and chemo

A

radiation therapy, chemo: give live vaccines 2 weeks before or 3 months after treatment

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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
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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
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25
Q

vaccines and PPD

A

live virus vaccine can suppress TB skin test: give simultaneously or wait 4-6 wks to place PPD

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26
Q

vaccines and antivirals

A
  • avoid live vaccines 48 hrs after completeion of antiviral
  • avoid antiviral 14 days after live vaccine ( if posible)
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27
Q

fridge temp

A

2-8 C

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28
Q

most vaccines are IM EXCEPT for

A
  • 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)
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29
Q

where to admin a subQ vaccine

A
  • pts < 12 months: thigh
  • pts > 12 months: outer triceps of arm
  • 45 degree angle
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30
Q

where to admin IM vaccine

A
  • 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
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31
Q

recommendations for a baby with a neonatal weight > 2 kg born to a mother who is HepB (-)

A
  • give vaccine only within 24 hrs of birth
  • follow CDC guidelines for routine vaccination (2 additional doses)
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32
Q

recommendations for a baby with a neonatal weight < 2 kg born to a mother who is HepB (-)

A
  • give vaccine at hospital discharge or at 1 month PNA
  • follow CDC guidelines on routine vaccination (2 additional dose)
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33
Q

recommendations for a baby with a neonatal weight > 2 kg born to a mother who is HepB (unknown)

A
  • 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
Q

recommendations for a baby with a neonatal weight < 2 kg born to a mother who is HepB (unknown)

A
  • 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
Q

recommendations for a baby with a neonatal weight > 2 kg born to a mother who is HepB (+)

A
  • 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
Q

recommendations for a baby with a neonatal weight < 2 kg born to a mother who is HepB (+)

A
  • 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
Q

HPV 2 dose vs 3 dose

A
  • pts starting HPV series before age 15: 2 dose
  • starting afte age 15: 3 dose
38
Q

why do pts need to be monitored after HPV vaccine

A

syncope is a common side effect

39
Q

all flu vaccine are ____ valent

A

all flu vaccines are quadrivalent
- contain 4 strains

40
Q

which four flu vaccines are egg based?

A
  • afluria
  • fluarix
  • flulaval
  • fluzone
41
Q

efficacy of flu vaccine

42
Q

Tdap and DTap efficacy

A
  • DTaP: 80-90%
  • Tdap: 70%
43
Q

HepA vaccine effectiveness

44
Q

efficacy of HPV-9

45
Q

when give 2 doses of flu

A
  • in pts < 9: first lifetime dose give 2 doses separated by 4 weeks

if vaccine available, can consider giving first dose wayyyy early, like august becaue they will be getting a seocond dose later on

46
Q

how old do you ahve to be to receive flu vaccine

A
  • 6 months for inactivated
  • 2 yrs for live
  • 65+ for high dose fluzone
47
Q

MMR efficacy

A
  • after first dose: 93% for measles, 78% for mumps
    • after second dose: 97% for measles, 88% for mumps
48
Q

varicella efficacy

A
  • in pts < 13 yrs: > 95%
  • in pts > 13 yrs
    - after dose 1: 78-82%
    - after 2: 99%
49
Q

meningitidis vaccines

A
  • 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

serotype B vaccination, not for routine use, jus tin pts who are high risk -> trumenba, bexsero, and penbraya not for routine use

50
Q

ppsv 23 vs. pcv15 and 20

A
  • 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
Q

rotavirus vaccine age restritions

A
  • MUST start before PNA 15 weeks
  • MUST finsih by PNA 8 months
52
Q

Rotateq vs Rotarix

A
  • Rotateq (RV 5): 3 dose series
    - reduced efficacy with second season
  • Rotarix (RV1) 2 dose series
    - efficacy maintained for 2 yrs
53
Q

COVID 19 2023-24 vaccination in an unvaccinated 6mo. - 4 yr

A
  • 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
Q

COVID 19 2023-24 vaccination in a pt 6 mo - 4 yrs with hx of 1 dose of original or bivalent moderna

A

give second dose of moderna 4-8 weeks after dose 1; use dark blue cap, green label

55
Q

COVID 19 2023-24 vaccination in a pt 6 mo - 4 yrs with hx of 2 or more doses of original or bivalent moderna

A

give 1 dose of moderna using dark blue cap, green label; give > 8 weeks after last dose

56
Q

COVID 19 2023-24 vaccination in a pt 6 mo - 4 yrs with hx of 1 dose of pfizer

A
  • give dose 2 3-8 weeks after dose 1 (use yellow cap)
  • give dose 3 >8 weeks after dose 2 (use yellow cap)
57
Q

COVID 19 2023-24 vaccination in a pt 6 mo - 4 yrs with hx of 2 or more doses of pfizer

A

give 1 dose pfizwe, using yellow cap; give >8 weeks after last dose

58
Q

COVID 19 2023-24 vaccination in a pts 5-11 yrs

A
  • regardless of whether vaccinated or not: 1 dose
    - moderna dark blue cap, green label
    - pfizer blue cap

if previously vaccinated, wait until > 8 weeks after last dose

59
Q

COVID 19 2023-24 vaccination in an unvaccinated pt age 12+ yrs

A

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
Q

COVID 19 2023-24 vaccination in a pt age 12+ yrs with hx of any COVID 19 vaccine

A

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
Q

storing the pfizer COVID 19 vaccine

A
  • ultra cold freezer (-90 to -60 C): until expiration
  • fridge: 10 weeks
  • room temp: 12 hrs
62
Q

storing the moderna COVID 19 vacine

A
  • freezer (-50 to -15C) until expiration
  • fridge: 30 days
  • room temp: 12 hrs
63
Q

storing novavax COVID19 vaccine

A
  • fridge: 9 months
  • room temp: 12 hrs
64
Q

though it is a rare side effect of the COVID-19 vaccine, occurence of myocarditis is highest in what group

A

12-17 yr males

65
Q

Which RSV vaccine is approved in pregnant peiopple, and when can it be given

A

Abrysvo
- give between 32 weeks 0 days and 36 weeks 6 days GWA
- only in sept through jan

66
Q

when might a ped receive the RSV mAb nirsevimab

A
  • 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
Q

Arexvy storage

A

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
Q

Abrysvo storage

A

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
Q

most common causes of dehdyration

A
  • viral gastroenteritis
  • fever
70
Q

how to calculate fluid deficite %

A

(pre illness weight -illness weight)/ pre illness weightx100

71
Q

dehydration ccurs more quickly in whcih age group

A
  • neonates and infants
72
Q

definition of mild dehydration (in term sof fluid deficit %)

A
  • infants: 1-5%
  • children 1-3%
73
Q

definition of moderate dehydration (in term sof fluid deficit %)

A
  • infnats: 6-9%
  • children 4-6%
74
Q

definition of severe dehydration (in term sof fluid deficit %)

A
  • infants > 10%
  • children > 6%
75
Q

s/s of dehydration

A
  • increased heart rate
  • decreased bp
  • decreased urine output
  • dry buccal mucosa
  • sunken eyes
  • sunken fontanelle
  • cyanosis
  • thirsty
  • no tears
  • ams
76
Q

mild dehydration treatment

A
  • oral rehydratio therpay (pedialyte)
  • 50ml/kg PO over 4 hrs; reassess Q2H + 10 ml/kg for each episode of loose stool/emesis
77
Q

moderate dehydration therpay

A
  • oral rehydratio therpay (pediatlyte)
  • 100ml/kg PO over 4 hrs; reassess QH + 10 ml/kg for each episode of loose stool/emesis
78
Q

severe dehdyration therapy

A
  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
Q

maintenance IV fluid rates

A
  • < 10kg: 4ml/kg/hr
  • 10-20kg: 40ml/hr + 2 (wt over 10kg)
  • > 20 kg: 60ml/hr + (wt over 20kg)
80
Q

maintenance fluidcomponents

A
  • NS 9needed to avoid Na shifts and brain edema)
  • D5W
  • 20mEq/L K (avoid in pts with renall impairment tho)

PHM 704: gremlins and wizards (16 decks)

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