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PR3151 CA2: Disinfection & Sterilization (NUS Pharmacy) > IC11 Immunization, Malaria, Surgical Prophylaxis > Flashcards

IC11 Immunization, Malaria, Surgical Prophylaxis Flashcards

1
Q

List the 14 Vaccines required in NCIS

A
  1. MMR (Measles Mumps Rubella)
  2. VAR (Varicella)
  3. IPV (Inactivated Poliovirus)
  4. Hepatitis B (HepB)
  5. Diphtheria, Tetanus, Acellular Pertussis (DTaP)
  6. Tetanus, reduced Diphtheria, Acellular Pertussis (TdaP)
  7. Bacillus Calmette-Guerin (BCG)
  8. Pneumococcal Conjugate (PCV10 or PCV13)
  9. Pneumococcal Polysaccharide (PPSV23)
  10. Haemophilus Influenzae Type B (Hib)
  11. Influenza (INF)
  12. Human Papillomavirus (HPV2 or HPV4)
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2
Q

Characteristics and Distinctions among live attenuated vaccines and inactivated vaccines (including polysaccharide vaccines, toxoid vaccines and recombinant vaccines)

A

Live Attenuated Vaccines
- Weakened viruses that replicate in the body
- Efficacy – Stronger immune response + Lifelong immunity
- Safety – Immunocompromised patients should not receive
- Storage – Refrigeration

Inactivated Vaccines
- Present foreign antigens of pathogen but cannot replicate
- Efficacy – Weaker immune response + Require several doses
- Safety – Low risk of adverse reactions / cause disease
- Storage – Easier to store

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3
Q

4 Precautions for use of live attenuated vaccines

A

Pregnancy & Infancy (< 1 year old) ⇒ Possible fetal infections

Severe immunocompromised patients (e.g. HIV CD4 < 200)

28 day period from 1st live vaccine

3-10 month period from administration of Antibody products (Ig, blood transfusion)

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4
Q

What is Herd immunity? What is it for? Percentage depends on?

A

Sufficiently immunized population (%) ⇒ Contain transmission

Protection of both vaccinated and unvaccinated individuals

The extent to which the disease is contagious ⇒ Percentage immunization needed for herd immunity

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5
Q

Purpose of Booster doses?

A

Antibody concentration wanes over time

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6
Q

NAIS has everything in NCIS except which 5?

A

DTaP, BCG, IPV, PCV10, Hib

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7
Q

Efficacy of vaccine depends on? (4 points)

A

Patient response (Varies)

Site of injection (Deltoid vs Gluteal – Depth and amount of muscle)

Age and immune status (80 y.o. Vs 60 y.o.)

Cold Chain problems (Temperature affects quality)

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8
Q

List of ADRs of vaccines

A

Pain, red, swell at injection site; headache, myalgia (Mild, common)

Fever, hematoma (Uncommon)

Anaphylaxis, hypersensitivity (Severe, rare)

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9
Q

Contraindications for vaccine use?

A
  1. Allergy
  2. Fever > 38
  3. Bleeding risk precaution & IM administration
  4. Pregnancy (Live vaccine)
  5. Immunocompromised (Live vaccine)
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10
Q

Are simultaneous vaccine administrations safe? Which vaccines should not be administered together?

A

All efficacious/safe when simultaneously administered

Exceptions: PCV and Meningococcal conjugate vaccine in Functional or anatomic asplenia ⇒ Should have 4-week interval apart

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11
Q

Can live vaccines be administered on the same day?

A

Live vaccines (IM, SC) CAN BE ADMINISTERED ON SAME DAY, Else ⇒ 28 days apart after the first

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12
Q

What happens if you miss a dose of vaccine?

A

Just take ASAP, additional dose not needed

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13
Q

4 Recommended resources to provide advice on preventing infections in travelers

A

CDC Health Information for International Traveler
CDC Yellow Book
WHO Travel Advice
MFA Travel Restrictions and Requirements

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14
Q

Pre-travel consultations should be done _____ weeks before departure

A

4-6

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15
Q

Outline the structured and sequenced approach to address the necessary preventive and educational interventions for medical advice before international travel.

A
  1. Risk Assessment
    - Health background
    - Trip details
  2. Standard In-Office Interventions (Pharmacological)
    - Travel Immunizations
    - Malaria Chemoprophylaxis
    - Traveler’s Diarrhea
  3. Focused Education before trip (Non-pharmacological)
    - Major routes of transmission
    - Travel-related illness
    - Medical Kit / Insurance
  4. Post-travel Advice
    - Malaria Chemoprophylaxis
    - Self-assessment of abnormal symptoms
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16
Q

5 Major routes of Transmissions and Vector Borne Diseases?

A
  1. Food and Water Borne Pathogens (Fecal-oral route)
  2. Insect Vector Borne Infections
  3. Transcutaneous Spread (Contact / Droplet)
  4. Respiratory Spread (Airborne / Droplet)
  5. Blood and Body Fluids (Sexually transmitted / Needles Sharing)
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17
Q

Match the travel vaccines to each route of transmission

A
  1. Food/Water (Fecal oral) - HepA, Typhoid, Cholera, Poliomyelitis
  2. Vector borne - Yellow fever, Japanese Encephalitis
  3. Transcutaneous spread - Tetanus, Rabies
  4. Respiratory - Influenza, Meningococcus, MMR
  5. Blood & Body fluids - HepB
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18
Q

Which travel vaccines are mandatory in some countries?

A

Meningococcus and Poliomyelitis vaccines

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19
Q

6 inactivated / recombinant viral travel vaccines

A

Influenza, HepA, Poliomyelitis, Japanese Encephalitis, HepB, Rabies

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20
Q

3 live attenuated viral travel vaccines

A

MMR, Cholera, Yellow fever

21
Q

For last minute travel, at least how long do you need to elicit protective vaccine response before travel?

A

2 weeks

For urgent travel, accelerated immunization schedules, risk avoidance counseling or drug prophylaxis

22
Q

5 Plasmodium species

A

Prevalent – P falciparum (Most dangerous), P vivax

P malariae, P ovale, P knowlesi (New)

23
Q

Transmission Mode of malaria

A

Female Anopheles Mosquito infected by plasmodium

24
Q

Malaria symptoms

A

Fever, chills, sweats, headache, body aches, weakness, N/V/D

Severe = Sepsis, organ failure, death

25
Q

Occurrence of Malaria is highest in _______ climate and _____ regions?

A

Tropical and Subtropical Climate

Highest in Africa South of Sahara & Oceania (Papua New Guinea)

26
Q

3 Phases of plasmodium life cycle

A

Liver Phase (Exo-erythrocytic cycle)
- Multiply in Liver cells → No symptoms
- Dormancy for P vivax, P ovale

Blood Phase (Erythrocytic cycle)
- Multiply in RBCs and Differentiation (Gametocytes) → Clinical Symptoms

Mosquito (Sporogonic cycle)

27
Q

Risk Factors for Malaria

A

Night biters – Dusk to dawn

Less risks in colder season/region

Less risks in deserts

Risk in urban areas of Africa and India

Less risks at high altitudes

More risks after rainy season

28
Q

ABCDEs of Malaria Prevention Strategies

A

• Awareness – of risk, the possibility of delayed onset, and the main symptoms.
• Bite prevention – stay away from mosquitoes, especially between dusk and dawn. Use chemical or physical repellents.
• Chemoprophylaxis – adhere closely to antimalarial preventive medications when prescribed
• Diagnosis – early recognition and seek treatment
• Environments – keep off mosquito breeding places, such as swamps or marshy areas, especially in late evenings and at night.

29
Q

Drugs used for malaria chemoprophylaxis?

A

• Atovaquone + Proguanil (Malarone®)
• Chloroquine
• Doxycycline
• Mefloquine

30
Q

Considerations for choosing an antimalarial chemoprophylaxis

A
  1. Travel itinerary of utmost importance - chloroquine and/or mefloquine resistance in some areas of the world
  2. Traveler’s medical history:
    - Medical conditions like pregnancy, G6PD deficiency, allergies, comorbidities
    - Medications - check for drug-drug interactions
  3. Traveler’s preferences that may affect adherence
    - Regimen may be taken daily or weekly
    - Cost consideration
  4. Travel departure date and duration
    - Regimen may need to be started as much as 2 weeks, some the day before
31
Q

Risk and Prevention Types

A

Non-Falciparum (Type B) – Any 4 drugs
Falciparum (Type C) – All EXCEPT Chloroquine

32
Q

Atovaquone 250mg / Proguanil 100mg (Malarone)

Dose, Regimen, CI, ADR, DDI

A

Dosing – 1 tab daily with food or milk
Regimen – Start 1-2 days before trip, End 7 days after return
Contraindications – Hypersensitivity, Renal (CrCl < 30 ml/min)
ADR – Less side effects, N/V/D, stomach pain, headache, dizzy
DDI – Rifampicin, Metoclopramide, efavirenz

33
Q

Atovaquone 250mg / Proguanil 100mg (Malarone) should be avoided in ____________________________

A

pregnancy, lactation, baby < 5kg

34
Q

What category of sales are each malaria agents under?

A
  1. Malarone - POM with exemption
  2. Chloroquine & Mefloquine - Pharmacy only
  3. Doxycycline - POM
35
Q

Chloroquine Phosphate 250mg (150mg base)

Dose, Regimen, CI, ADR, DDI

A

Dosing – 2 tab weekly with or after meals
Regimen – Start 1-2 weeks before trip, End 4 weeks after return
Contraindications – Hypersensitivity, Region resistance
ADR – N/V, stomach pain, skin rash/itch
DDI – QTc prolonging CYP3A4 inhibitors (clarithromycin, voriconazole)

36
Q

Chloroquine should be taken with precaution in

A

Exacerbate psoriasis, myasthenia gravis, auditory damage, liver impairment, seizure disorders

37
Q

Doxycycline 100mg

Dose, Regimen, CI, ADR, DDI

A

Dosing – 1 capsule daily with full glass of water, 30min upright
Regimen – Start 1-2 days before trip, End 4 weeks after return
Contraindications – Hypersensitivity, special populations
ADR – GI discomfort, sunburn, vaginal candidiasis
DDI – Multivalent ions

38
Q

Doxycycline should be avoided in ________

A

< 8 y.o., pregnancy, lactation

39
Q

Mefloquine 250mg

Dose, Regimen, CI, ADR, DDI

A

Dosing – 1 tablet weekly after meals
Regimen – Start 1 week before trip (preferred - 2-3 week), End 4 weeks after return
Contraindications – Hypersensitivity,
ADR – GI discomfort, dizzy, fatigue, headache, insomnia, vivid dreams, neuropsychiatric disorder
DDI – Ketoconazole

40
Q

Non-pharmacological protection examples

A

Barrier protection – Clothing / Light color clothing / Avoid dusk to dawn / Permethrin Impregnated Bed Net

Insect Repellent
DEET (Alpine) – 20-50% for 6-12h protection
Picaridin (Kiwi) – 20%
Oil of Lemon Eucalyptus (OLE) or PMD
IR3535
2-undecanone

41
Q

Define surgical site infections (SSIs)

A

Healthcare-associated Infection

Within 30 days after surgical operation or within 1 year for implants left affecting the incision or deep tissue at operation site

42
Q

Indications for SAP

A

Clean surgery = Healthy skin incised (Sites not usually traversed) only when:
1. Prosthesis or implant will be inserted
2. SSI poses catastrophic risk / Immunocompromised

Clean-contaminated surgery = Penetrated under controlled conditions without unusual contamination (Respiratory, alimentary, genitourinary)

Contaminated ⇒ Antibiotic treatment not prophylaxis

43
Q

Antibiotic of choice should be ______ spectrum, based on ________________

A

Narrow spectrum

Local resistance pattern, Site with expected pathogen, MDR bacteria and CDAD risks, MRSA Risks, Beta Lactam Allergy

44
Q

For those with MRSA risk, SAP with _______ +/- _______ is suitable

A

Vancomycin, Cefazolin

45
Q

When to administer antibiotic for surgeries?

A

30-60 min before surgical incision – Complete infusion
1h before incision for fluoroquinolones and vancomycin – Longer infusion time needed

46
Q

Factors requiring intraoperative redosing

A

Procedure Duration > 2 half-lives of drug

Intraoperative Blood loss > 1500mL

Extensive burns

47
Q

Antibiotic duration should be how long?

A

< 24h (CDAD and AKI risk for > 24h)

48
Q

List non-antimicrobial strategies recommended to reduce the risk of SSI

A

Hair removal only if it interferes with operation – NO RAZOR, use clipper, depilatory agent
Blood glucose control postoperative < 180 mg/dL (10 mmol/L)
Postoperative temperature > 35.5oC
Postoperative supplemental oxygen
Preoperative alcohol-containing skin preparatory agents
Plastic wound protectors (GI, biliary surgery)
WHO checklist
Surveillance
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PR3151 CA2: Disinfection & Sterilization (NUS Pharmacy) (5 decks)

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