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NAPLEX - OUR cards > Immunizations > Flashcards

Immunizations Flashcards

1
Q

Difference between polysaccharide and conjugate vaccines

A

Polysaccharide not given to children under 2 yo because their immune system is not completely developed so they dont provide an effective immune response

Conjugated (combined w/ a protein molecule) improves the antibody response, so this vaccine is viable for children under 2 yo

(This is why children < 2 get the conjugated pneumococcal vaccine (prevnar) and then get the polysaccharide (pneumovax) when they’re older than 2 yo)

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2
Q

Which vaccines are live

A 
Injections:
MMR
MMRV
Varicella
Zoster (but now we have Shingrix)
Yellow fever
Other routes:
Flumist
Rotavirus
Cholera
Typhoid
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3
Q

Risk with increasing or decreasing the interval between multi dose vaccines?

A

Increasing: does not diminish the effectiveness after completeness of all doses, but does delay complete protection

Decreasing: can interfere with antibody response and production

Safer to increase interval rather than decrease

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4
Q

Necessary interval between an antibody containing blood product (IVIG, blood transfusions) and MMR or varicella containing vaccine…

A

If getting blood product first, wait minimum of 3 months and may be up to 11 months before vaccine

If getting vaccine first, wait 2 weeks before getting antibody containing blood product

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5
Q

At what age can babies receive live vaccines?

A

12 months

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6
Q

Can live vaccines be given on the same day?

A

Yes
Exception: in patients with asplenia, prevnar and menactra must be separated by 4 weeks

If not given on the same day, they must be spaced 4 weeks apart
Exception: no separation required for oral rotavirus vacicne

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7
Q

How to avoid false negative with Tb skin testing in relation to timing of the vaccine

A

Give the same day as the skin test or wait 4 weeks before giving the skin test

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8
Q

Where should you report adverse events related to administering a vaccine?

A

Vaccine Adverse Event Reporting System (VAERS)

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9
Q

How many epinephrine pens should be on hand for pharmacists to use?

A 
3 adult (0.3 mg) auto injectors
Most adults require 1-3 doses spaced every 5-15 minutes until paramedics arive
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10
Q

Contraindications to use of live vaccine

A

Pregnancy and immunosuppression

HIV with CD4 count < 200 (MMR and varicella)

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11
Q

Pregnancy vaccines

A

Influenza, inactivated (in season)
Tdap x 1 for each pregnancy (optimal time between 27 and 36 weeks)
NO LIVE VACCINES

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12
Q

Asplenia vaccines

A

H influenzae type B
Pneumococcal (both)
Meningococcal (both)

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13
Q

Indications for DTaP

A

DTaP = more diphteria than Tdap

Given to children younger than 7 years of age

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14
Q

HPV vaccine schedule

A

before age 15: give 2 doses at month 0 then 6-12 months later

after age 15: give 3 doses (month 0, 1-2, then 6 months)

Females up to age 26, males up to age 21 or up to 26 in immunocompromised/men who have sex w men

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15
Q

Hepatitis A and B schedule

A

3-dose series given at months 0, 1, and 6

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16
Q

What are the H and N in flu subtypes, ie H1N1

A

H=hemagglutinin
N=neuramidase
The two surface antigens that viruses are categorized by, aside from A and B

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17
Q

Why is there a new flu vaccine every year?

A

Frequent development of antigenic developments through antigenic drift, this is the basis for seasonal epidemics

Note: more dramatic antigenic changes or shifts occur approximately every 30 years, and can result in the emergence of a novel influenza virus with the potential to cause a pandemic

18
Q

How does the flu virus spread?

A

Primarily through respiratory droplet transmission (coughing, sneezing)

19
Q

Who does CDC recommend receives flu vaccine?

A

All patients age 6 months or higher unless there is a contraindication

Patients age 6 months to 8 years: should receive 2 doses if never vaccinated, spaced 4 weeks apart

Patients with egg allergy: Flublok (egg free product) approved for age 18+ only

Pregnant patient: inactivated vaccine only

Age 65+: fluzone, fluad (high dose)

20
Q

High dose flu shots

A

Fluad
Fluzone HD
Approved for age 65 and older

21
Q

Trivalent inactivated influenza vaccines

A

Afluria
Fluvirin
Fluzone HD
Fluad

22
Q

Quadrivalent inactivated influenza vaccines

A

Fluarix quadrivalent
Fluzone quadrivalent

+ others (not bolded)

23
Q

Quadrivalent live attenuated vaccine

A

Flumist (intranasal)

Not recommended for use in 2017-2018 season

24
Q

Which flu vaccine can be given with a needle free jet injector

A

Afluria

25
Q

MMRV storage

A

MMRV=MMR plus varicella

Store vaccine in freezer, diluent at room temp or in refrigerator

26
Q

Meningococcal vaccine brands, schedule

A 
Menactra = age 9 months to 55 years
Menveo = age 2 months to 55 years

Give one dose of MCV4 at age 11-12, give booster dose at age 16

27
Q

Menveo clinical pearl

A

Menveo = meningococcal vaccine (MCV4)

Both vials (poweder and liquid) contain vaccine - use only supplied liquid for reconstitution

28
Q

Pneumococcal vaccine schedule

A

Children age < 2: Prevnar only (don’t have immune response to respond to polysaccharide vaccines, like pneumovax)

65 and older w no previous pneomococcal vaccines: receive PCV13 then PPSV12 months later

29
Q

When do we give Pneumovax before age 65?

A

1 dose: Immunocompetent patients with diabetes, heart, lung, liver disease, alcohol abuse, smokers

2 doses of PPV23: Immunocompromised patients age 2-64 with sickle cell disease, asplenia, HIV, chronic renal failure, malignancy, transplant, or immunosuppressive drug use (including steroids)

30
Q

When do we give Prevnar before age 65?

A

Always! Indicated in children < 5 years, but also indicated in age 6-64 if they’ve never received if they’re immunocompromised (HIV, sicke, asplenia, steroid use) and indicated in all patients > 65

31
Q

How to dose pneumococcal vaccines in immunocompromised patients

A

Age 6-64: 1 dose prevnar, 2 doses pneumovax
Separate prevnar and pneumovax by 8 weeks, then pneumovax series by 5 years

If pneumovax is given first, must wait 1 year to give prevnar (delays protection)

32
Q

How to dose pneumococcal vaccines in patients 65 or older

A

Give prevnar 13 x 1 dose, followed by pneumovax 1 year later

Need to separate pneumovax 5 years from any previous pneumovax dose

33
Q

Rotavirus vaccine schedule

A

Given to infants, do not give after age 15 weeks
Oral vaccine
RotaTeq is the brand

34
Q

Poliovirus vaccines schedule

A

Given to all children

35
Q

Tdap brands, vaccine schedule

A

Boostrix, Adacel

Give as booster age 11+ years with no previous Tdap record
Indicated for pregnant or postpartum women, and family members with close contact to infants

36
Q

Td brand, vaccine schedule

A

Tenivac
Routine booster every 10 years in patients 7+
For patients with deep or dirty wound who havent received a booster in the past 5 years

37
Q

Varicella brand, vaccine schedule, considerations

A

Varivax (chickenpox), zostavax/shingrix (herpes zoster/shingles)

Varivax: 2 doses at age 12-15 months and again at 4-6 years, and anyone without evidence of immunity to varicella should receive 2 doses

Zostavax: 14 times more potent than varivax, ACIP recommends use in 60+ years (FDA approved 50+)

Antivirals (ayclovir, valacyclovir, famciclovir) can interfere with this live vaccine. Stop 24 hours before vaccine and do not administer for 14 days following vaccine

Store in freezer and diluent in fridge or at room temp

Reconstitute immediately after removing from freezer, give subcutaneously

Do not give if hypersensitivity to gelatin or neomycin

38
Q

Needle size for IM injections

A

1 inch needle (or 1.5 for women over 200 lb or men over 260 lb), 22-25 gauge

39
Q

Needle size for SC injections

A

5’8’’ needle, 23-25 gauge at 45 degree angle

40
Q

Which vaccines are SC?

A 
MMR
MPSV (meningococcal polysaccharide)
PPSV (can be IM or SC)
Varicella
Zoster

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