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Pharmacology > Immune > Flashcards

Immune Flashcards

1
Q

Attenuated Live Vaccines

A 
Live attenuated influenza vaccine (LAIV)
Measles, mumps & rubella vaccine (MMR)
Oral poliovirus vaccine
Rotavirus vaccine 
Varicella virus vaccine 
Herpes zoster vaccine 
Typhoid vaccine
Yellow fever vaccine
Bacillus Calmette-Guerin (BCG) vaccine
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2
Q

Live Vaccines: General Principles

A

Not administered to immunocompromised patients
Usually not given if patient has febrile illness
If patient needs two live vaccines:
- Give both the same day OR
- Administer at least 4 weeks apart
Not administered in pregnancy
- Pregnancy should be avoided for 1 month after vaccination
Drug interactions
- Antiviral drugs
Separate IG administration from live vaccine administration

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3
Q

Live Attenuated Influenza Vaccine

A
  • LAVI (Flumist)
  • Contains two strains of Flu A and one strain of Flu B
  • Administered intranasally
  • Live vaccine replicates in nasal mucosa
  • Contraindicated: egg allergy, asthma, immunocompromised state, pregnancy
  • Administered annually to healthy patients at 2 years to 49 years
  • – Children ages 2-8 years need two doses the first year
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4
Q

MMR Vaccine

A
  • 2 doses 99% effective in providing immunity for measles (88% for mumps)
  • Contraindications: neomycin allergy, pregnancy, immunosuppression, febrile illness
  • – Ok to give to those with egg allergy
  • – May be given to breastfeeding women
  • ADRs: fever 7-12 days after vaccination
  • Drug interactions: IG, high-dose corticosteroids, chemotherapy
  • First dose given at age 12-15 months
  • Second dose given at ages 4-6 years or at least 4 weeks after first dose
  • One dose given to any infants 6-12 months who will be traveling internationally
  • – Does not “count” as first dose; give a dose at 12-15 months
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5
Q

Measles, Mumps, Rubella, and Varicella (MMRV) Vaccine

A

ProQuad
Similar to MMR
Contraindications are the same as MMR
- Use caution in patients with hx of cerebral injury, seizures, or where physiological stress caused by fever should be avoided
ADRs: fever greater than 102 (21.5% vs 14.9% with MMR); increased risk of febrile seizures
May administer on same schedule as MMR
- Use MMR+ varicella for first dose and MMRV for second dose if there is a fever
- Informed consent includes risk of fever and febrile seizures

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6
Q

Oral Polio Vaccine (OPV)

A

Not used in U.S. since 2000

Effective, easy to administer

Virus lives in GI tract for 4-6 weeks after administration

Rare risk of vaccine-associated paralytic poliomyelitis
- patient and household contacts

Still used throughout the world

  • Bivalent vaccine sued worldwide- not valid in the US
  • Only trivalent OPV counts
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7
Q

Rotavirus Vaccine

A
  • RotaTeq and Rotarix
  • Orally administered and replicated in small intestines
  • Contraindicated: immunocompromised state, febrile illness
  • ADRs: mild GI upset, no or slight risk of intussusception in new vaccination
  • First dose administered to infants by age 14 weeks and 6 days and last dose by 8 months
  • – Rotarix (RV1): given at age 2 months, 4 months
  • – RotaTeq (RV5): given at age 2 months, 4 months, 6 months
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8
Q

Varicella

A
  • Varivax Vaccine
  • 2 doses 98.3% effective against any disease
  • May be administered after exposure (within 3 days)
  • Contraindications: neomycin allergy, febrile illness, immunocompromised state, high dose steroids, pregnancy
  • ADRs: fever, rash, injection site reaction
  • First dose at age 12-15 months
  • Second dose at age 4-6 years
  • Adolescents and adults with no hx of varicella given 2 weeks 4-8 weeks apart
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9
Q

Herpes Zoster Vaccine

A
  • Shingles caused by reactivation of varicella
  • Zoster vaccine live (Zostavax)
  • Reduces risk of herpes zoster by 51.3 %
  • Reduces risk of post-herpetic neuralgia by 66.5% (reduced severity in 57%)
  • Contraindications: neomycin or gelatin allergy, immunocompromised state, pregnancy, acute illness, age less than 60 years
  • Drug interactions: high-dose steroids, antivirals
  • One dose given to all patients age 60 years or older
  • Decreased effectiveness beginning 1 year after administration, with less than 35% effectiveness 6 years after dose
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10
Q

Miscellaneous Live Vaccines - Oral Typhoid Vaccine

A

Travelers to South or Southeast Asia, Africa, Caribbean countries, Central and South America

Oral Capsule for age 6 years and up

Revaccination every 5 years

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11
Q

Miscellaneous Live Vaccines - Yellow Fever

A

Endemic in Sub-Saharan Africa and tropical South America

Certification required to enter some countries

Vaccination for all persons over 9 months of age traveling to endemic areas
- Use cautiously in patients over age 60 years

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12
Q

Miscellaneous Live Vaccines - Cholera Live Vaccine (Vaxchora)

A

Antibodies are measurable 10 days after vaccination

Drug interaction: do not administer systemic antibiotics within 14 days; chloroquine may decrease immune response

Clinical use: administer 10 days before possible exposure to adults age 18-64 years

  • Store in freezer, mixed in bottled water
  • Avoid eating or drinking for 60 minutes
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13
Q

Miscellaneous Live Vaccines - Bacillus Calmette-Guerin (BCG) Vaccine

A

Immune Stimulant
Most effective in children
ADRs: disseminated disease in patients with TB
- Skin lesions at injection site is normal reaction
May cause false-positive purified protein derivative (PPD) skin test result

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14
Q

Inactivated Vaccines

A 
Diphtheria, tetanus, pertussis vaccine 
Haemophilus B conjugate vaccine 
Inactivated poliovirus vaccine 
Hepatitis B virus (HBV) vaccine 
Hepatitis A virus (HAV) vaccine 
Human papillomavirus (HPV) vaccine 
Influenza vaccine 
- Pneumococcal vaccine 
- Meningococcal polysaccharide vaccine 
Lyme disease vaccine 
Typhoid vaccine 
Cholera vaccine 
Japanese encephalitis virus vaccine 
Plague vaccine 
Rabies Vaccine
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15
Q

Inactivated Vaccines: General Principles

A

Inactivated vaccines: “killed” virus

May be co-administered with other vaccines

No need to restart series if patient gets off schedule (catch-up schedule used)

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16
Q

Diphtheria, Tetanus, and Acellular Pertussis Vaccine

A
  • Diphtheria, tetanus, acellular pertussis vaccine (DTaP, or Tdap, or Td)
  • Contrainidcations: anaphylactic reaction, progressive neurological disease, high temperature or seizure after previous DTaP dose (not Tdap)
  • Diphtheria vaccine given before age 7 years and Tdap after
  • ADRs: pain at injection site, low-grade fever, aches, HA
  • Antipyretics given to children with hx of febrile seizures
  • Dosing:
  • – DTaP: 2 months, 4 months, 6 months, 15-18 months, & 4-6 years
  • – Tdap: 11 to 12 years
  • – Adults should receive Tdap or Td every 10 years
17
Q

Haemophilus B Conjugate Vaccine

A
  • Protects against invasive H. influenzae
  • Contraindications: allergy to components of vaccine, moderate to severe illness, only given to children younger than age 6 years
  • ADRs: injection site pain and redness
  • Dosing: depends on vaccine used
  • – ActHib or Pentacel: 2 mos., 4 mos., 6 mos., 12-15 months (booster dose)
  • – PedvaxHIB or Comvax: 2 months, 4 months, 12-15 months (booster dose)
  • – If first dose given after age 15 months, then child only needs one dose
18
Q

Inactivated Poliovirus Vaccine

A
  • Inactivated poliovirus vaccine (IPV), IPV/DTaP (Pediarix), DTaP/HIB/IPV (Pentacel)
  • Contraindications: allergy to neomycin, streptomycin, polymyxin B
  • Drug interaction: immunosuppressants
  • Dosing: 2 mos., 4 mos., 6-18 mos., 4-6 years
19
Q

Hepatitis A Vaccine

A
  • HAV vaccine provides 100% protection with 2 doses
  • – HAVrix (0.5 mL for children/adolescents; 1.0 mL for adults)
  • – VAQTA (0.5 mL for children/adolescents; 1.0 mL for adults
  • – Twinrix (HAV & HBV) adults only
  • Contraindications: severe reaction to HAV, moderate illness, younger than 12 months
  • ADRs: soreness at injection site
  • Dosing: 2 doses 6 months apart
  • – All children 12 months, dose 2 at 18-24 months
  • – Persons age 6 months and older traveling internationally
  • ——- HAV dose given between age 6-11 months does not “count”
  • – High risk adults
  • – Post-exposure prophylaxis for immunocompetent persons age 12 months or older within 14 days of exposure
20
Q

Hepatitis B Vaccine

A
  • HBV stimulates antihepatitis B surface antigen antibodies
  • Alone or in combination (Pediarix, Twinrix, Combax)
  • Contraindications: yeast allergy, moderate or severe illness, immunosuppression (give larger doses)
  • ADRs: local reaction, 15% experience systemic complaints of fever, malaise
  • Dosing: all ages, three doses over 6 months
  • – 4 weeks between dose 1 & 2, 2 months between dose 2 & 3, and 4 months between dose 1 & 3
  • – Newborns weighing less than 2000 g receive first dose within 24 hours of birth
21
Q

Human Papillomavirus Vaccine (HPV)

A
  • 9-valent HPV (Gardisil9) vaccine for females, males (types 6, 11, 16, 18, 31, 33, 45, 52, 58) is 97.9% effective against covered strains
  • Contraindications: allergic reaction
  • ADRs: syncope, injection site pain, and redness
  • Dosing: three doses at 0, 2, and 6 months
  • – Two doses if started age 14 years or younger
  • – Three doses if started age 15 years or older
22
Q

Inactivated Influenza Vaccine

A
  • Three or four strains of influenza: two type A and one or two type B
  • Strains change annually based on predicted circulating strains
  • Contraindications: anaphylaxis to eggs or influenza vaccine, Guillain-Barre Syndrome within 6 weeks of influenza vaccine, febrile illness
  • ADRs: local reaction, mild systemic effects
  • Drug interactions: immunosuppressants, theophylline, phenytoin, warfarin
  • Dosing: annual vaccine to all persons 6 months of age or older
  • – Patients younger than 9 years of age get 2 doses the first year
  • – High-dose flu vaccine for age greater than 65 years
  • – FluBlok or Flucelvax may be used in patients with egg allergies
23
Q

Pneumococcal Polysaccharide Vaccine (PPV)

A
  • Polyvalent pneumococcal polysaccharide vaccine (PSV23) contains 23 highly purified capsular polysaccharides from Streptococcus pneumoniae
  • Contraindications: moderate to severe febrile illness, give 10-14 days before splenectomy, organ transplant, or chemotherapy. No PPV in children age less than 2 years
  • ADRs: local reaction, mild systemic effects
  • Drug interactions: immunosuppressants (give 10-14 days before)
24
Q

Pneumococcal Polysaccharide Vaccine (PPV): Dosing

A
  • All adults over age 65 years
  • Persons 2 years to 65 years of age with chronic cardiac or pulmonary disease, chronic liver disease, or alcoholism, diabetes mellitus, cerebrospinal fluid leaks
  • Persons 2 years to 65 years of age with asplenia
  • Immunocompromised persons
  • Smokers age 19 years to 65 years of age
  • 12-24 months after bone marrow transplant
  • PSV23 given to children 2 months after last pneumococcal conjugate vaccine (PCV) dose
25
Q

Pneumococcal Conjugate Vaccine (PCV)

A
  • Pneumococcal 13-valent conjugate vaccine (Prevnar) targets the 13 most common strains of invasive pneumococcus in infants
  • Contraindications: moderate to severe febrile illness, give 10-14 days before splenectomy, organ transplantation, or chemotherapy; no PPV in children age less than 2 years or PCV in adults
  • ADRs: local reaction, mild systemic effects
  • Drug interactions: immunosuppressants (given 10-14 days before)
  • Dosing:
  • – Four doses given at ages 2, 4, 6, and 12-15 months
  • – Immunocompromised adults 19 years of age or older get one dose
  • – Adults older than 65 years of age get one dose
  • – PCV13 1 given year after PPV
26
Q

Meningococcal Vaccine

A
  • Meningococcal polysaccharide vaccine (MPSV) groups A, C, Y, and W-135 (Menomune A/C/Y/W-135) used to prevent meningococcemia and meningitis caused by Neisseria meningitidis serogroups A, C, Y, and W-135
  • MCV4 (menactra, menveo) is a tetravalent meningococcal conjugate vaccine that also provides protection against serogroups A, C, Y, and W-135
  • Contraindications: febrile illness, age guidelines
  • ADRs: local reactions
  • Drug interactions: none
27
Q

Meningococcal Vaccine: Dosing

A
  • Hib-MenCY for infants age 2-18 months with persistent complement deficiencies for functional or anatomic asplenia (2, 4, 6, and 12-15 months)
  • MCV4 at age 11-12 years with booster at age 16 years
  • MCV4 functional asplenia, travelers to high-risk areas, lab workers
  • MCV4 unvaccinated college freshmen or military recruits
  • MPSV adults older than age 55 years
28
Q

Typhoid Vaccine (Inactivated)

A
  • Parenteral typhoid vaccine
  • – Purified Vi polysaccharide (Typhim Vi)
  • Contraindications: acute febrile illness, children age less than 2 years
  • ADRs: mild local and systemic reactions
  • Drug interactions: immunosuppressants
  • Dosing: one dose to travelers, lab workers, household contacts; booster dose every 2 years
29
Q

Japanese Encephalitis Virus Vaccine

A
  • Inactivated Vero cell culture-derived vaccine (IXIARO)
  • Contraindications: pregnancy, thimerosol allergy
  • ADRs: local systemic reactions; urticaria and angioedema of face, lips and oropharynx
  • No drug interactions
  • Dosing: persons in endemic or epidemic areas, travelers spending more than 1 month in rural endemic areas
30
Q

Rabies Vaccine

A
  • Rabies vaccine (Imovax, RabAvert)- Inactivated rabies virus
  • Contraindications: moderate-to-severe illness
  • ADRs: mild local and systemic reactions, serum sickness may occur (6%)
  • Drug Interactions: chloroquine (Aralen), immunosuppressants, rabies IG (RIG)
  • Dosing:
  • – Pre-exposure vaccine given on day 0, day 7, and either day 21 or day 28; booster every 2 years
  • – Post-exposure prophylaxis given on days 0, 3, 7, and 14, with RIG given on day 0
31
Q

IG Serums

A
  • Provide passive immunity to infectious diseases
  • Derived from the pooled plasma of adults, processed by cold ethanol fractionation
  • Contraindications: not to be given within 3 months of live vaccine
  • ADRs: mild local and systemic reactions
  • Drug Interactions: live virus vaccines
  • Dosing: depends on IG serum used
32
Q

Tuberculin PPD

A
  • Used to screen asymptomatic individuals for infection with Mycobacterium tuberculosis
  • Contraindications: tuberculin-positive reactors, immunodeficiency
  • ADRs: In highly sensitive people, vesiculation, ulceration, necrosis can occur at the administration site
  • Drug interaction: live virus vaccines, BCG, and immunosuppressants
  • Dosing:
  • – Test consists of injecting 5 TU of PPD intradermally
  • – Reactions read in 48-72 hours
  • – Positive reading based on risk category
33
Q

Immunomodulators

A
  • Cyclosporine (Sandimmune) and azathioprine (Imuran) prescribed to organ transplant recipients and patients with severe rheumatoid arthritis
  • Drug interactions: many caused by liver metabolism, live virus vaccines
  • Dosing: specialty drug

Pharmacology (25 decks)

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