IC12 PR3151 Flashcards
contraindications for live attenuated vaccines
x preg
x infant <1
x immunocompromised (cd4<200, chemo, drugs)
x >1 vax (28 days)
x antibody products (3-10 month)
how long to split live vax
28 days
how long to split antibody products
3-10months
what to do w missed dose
take next possible date; respect interval
what to do w intervals
respect the interval
what are the vaccines in NCIS
BHDTIHPPMVHI
BCG
HepB
Dtap
Tdap
IPV
HiB
PCV
PPSV
MMR
VAR
HPV
INF
What are the doses
1 3 3 x 3 3 2 x 222 x
hep b how many booster
1
dtap how many booster
1 (2nd booster after birth)
tdap how many booster
2
IPV how many booster
1
Hib how many booster
1
what special conditions for influenza vax
take annually from 5 - 17 for special medical
what special conditions for PPSV
1-2 doses from 2-17 years
vaccines for NAIS
IPPTHHMV
which vax is for female ONLY
HPV
what are the general vax considerations
effectiveness
ADR
precautions: e.g., fever, live vaccines, allergy, preggos, live vax, bleeding risk
what are the airborne respi virus
IDMMP PHCB
influ
dipth
mmr
menningococ
pertussis
pneumococcal
haem inf
chicken pox (varicella)
bcg
what airbone resp virus have vaccines
IDMMP
what are the food and water transmission viruses includes faecal contact
HTCP
hepA
typhoid
cholera
polio
what are the blood/bodily fluids
hep B
hpv
what are the cutaneous viruses
rabies tetanus
what are the vector virus
JE yellow fever malaria
what are the live vaccines
mmr varicella rotavirus cholera yellow fever
what are the inactivated vax
hep A je tickborne E(tbe) rabies polio
what are the subunit vax
HIPPTM
HEPB
inf
pertussis
pneumococcal
typhoid
meningococco
what are the toxoid vax
TDAP
what are the recombinant vax
HPV hepB
Medical considerations before international travel
pre travel consult 4-6 weeks prior including risk assessment, standard in office interventions, focused education before the trip
what are the bugs that spread malaria
plasmodium
falcifaram
vivax
knowlesi
malariae
ovlae
what is the mosquito that spreads malaria
anopheles
what is the malaria life cycle
exo erythro step
- multiple in the liver
- lay dormant (vivax and ovales)
erythro step
- multiply in rbc
- form gametocytes
sporigenic step
- breed, multiply
malaria strategies for prevention
ABCDE
awareness of risk
bite prevention
chemoprophylaxis
diagnosis
environments
what are the times where mosquito are less frequent
day time, high altitudes, desert regions, colder regions, dryer seasons (without rainfall)
what are the drugs for malaria
atorvaquone proguanil
chloroquine
doxycycline
mefloquine
atorvaquone method of admin
daily
2 days before and 7 days after
take with food or milky products
atorvaquone ADR
gi side effects
atorvaquone contraindx
x pregnancy
x lactation
x infants <5kg
x renal impairment w crcl <30ml/min
x hypersx
chloroquine method of admin
weekly
1-2 weeks prior
4 weeks after
take with food or after food
chloroquine ADR
gi side effects
atorvaquone DDI
rifampicin, metoclopramide, efavirenz
cholroquine contraindx
CYP3a4 qt prolonging drugs like azoles and macrolides
chloroquine pregnancy lactation and child risk
none
choloroquine precautions
precaution in patients with myasthenia gravis, psoriasis, seizure disorders, auditory disorders, liver impairment
doxycycline method of admin
take daily with a full glass of water standing up and avoid going to sleep after
1-2 days before
4 weeks after
doxycycline contraindx
divalent ions
doxycline adr
photosx, gi discomfort, ototoxicity, calcification of tissues, hepatotoxicity, CDAD, and renal, photosx
doxycycline pregnancy risk
contraindicated in children <8 and pregnancy + breast feeding
mefloquine method
take weekly
1-2 weeks
4 weeks
mefloquine ADR
gi, headache, insomnia, vivid dreams, fatigue, neuropsych disorder
mefloquine contra
patients with hypersx, psychiatric disorders, convulsion disorders, cardiac conduction problems
mefloquine prgnancy risk
okay in preg, lactation, and infants >5kg
mefloquine sales
exemption drug
types of repellents
DEETS, picaridin, IR3535, 2undecanone
risk level for malaria and the treatment
risk 1: no risk –> preventive measures
risk 2: non-falciparam –> preventive measures + A /D/M
risk 3: falciparum –> preventive measure + D/M (m has increasing resistance in Thailand, Cambodia, Myanmar)
what is the criteria superficial SSI
within 30 days (only in the superficial or subq layer of the skin)
culture evidence
signs and symptoms of pain or inflammation
purulent drainage
DOES NOT COUNT:
x burn infections
x stitch abscess
x episiotomy
x newborn circumcision site
what is the criteria for deep tissue SSI
within 30 days or a year after implant (muscle layer)
abscess or other evidence of infection
fever or pain
purulent drainage
what is the criteria for organ or space SSI
within 30 days or a year after implant
culture evidence
abscess or other evidence of infection
purulent drainage from a stab wound in the organ
SAP indications: what is a clean surgery and is SAP recommended
superficial layers and surgical prophylaxis not recommended unless there is an implant
SAP indications: what is a clean-contaminated surgery and is SAP recommended
deeper layers but with minimal contamination. SAP is recommended
SAP indications: what is a contaminated surgery and is SAP recommended
there is macroscopic soiling of operative field. SAP is recommended but it is considered a treatment method and not an SAP
What is the choice of therapy for a cardiac SAP? include alternative agents
Cefazoline or cefuroxime and or vancomycin.
second line treatment is vancomycin and or clindamycin
what is vancomycin commonly added with in SAP
addition of cefazolin to cover MSSA since vancomycin has poor coverage against MSSA.
what is the choice of therapy for GI SAP? include alternative agents
cefazolin w/w/o metronidazole.
second line: gentamicin + metronidazole OR clindamycin
What is the choice of therapy for a genitourinary SAP? include alternative agents
ciprofloxacin w/w/o cotrimoxazole
unless laproscopy –>cefazolin
SAP options for patient with beta lactam allergy? consider the two types of allergy.
if severe: dont use
if non igE mediated: consider cephalosporins.
SAP duration of therapy
should not be longer than 24 hours
SAP initiation
should be 30min to 1h prior to the surgery.
for vancomycin and fluoroquinolones –> at least an hour
When to redose for SAP
1) when the patient has extensive burns
2) when the patient blood lose >1500ml
3) when the procedure more than 2 half lives of the drug
non sap procedures to prevent SSI
1) ensure normothermic >35.5degC
2) ensure blood glucose <10mmol/L
3) avoid shaving hair or using razer unless needed. if needed, remove with clippers or depilatory agent
4) use of plastic wound protectors for gi AND biliary
5) alcohol disinfection where possible
6) adequate tissue oxygenation
