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NAPLEX Review > Immunizations > Flashcards

Immunizations Flashcards

1
Q

What is the pink book?

A

Epidemiology and prevention of vaccine-preventable diseases

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2
Q

Who…
approves vaccines
provides recommendations for vaccine administration
approves those recommendations?

A

FDA approves
Advisory Committee on Immunization Practices (ACIP) recommends
CDC approves recommendations

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3
Q

Federal law requires the Vaccine Inforamtion Statements (VIS) is given to the patient when?

A

Before vaccine is given

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4
Q

What is thimerosal

A

Mercury-containing preservative used in some vaccines - some people believe this contributes to autism (no evidence)

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5
Q

Gelatin in vaccines - what groups do you have to take this into consideration?

A

Gelatin is a stabilizer that comes from pigs
Muslims, Jews, and Seventh-Day Adventists do not ingest pork, but some religious leaders approve the vaccines because it is not ingested

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6
Q

Antigen definition

A

foreign substances that induces an immune response

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7
Q

Antibodies (immunoglobulins)

A

Produced naturally to provide immunity against certain antigens

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8
Q

Active vs passive immunity

A

Active - from a person’s own immune system (from vaccine or fighting off an illness); lasts a long time

Passive - from someone else (mom to baby) or IV immunoglobulin that provides already made antibodies and can be used for quick immunity (like rabies)

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9
Q

Which vaccine types are contrindicated in immunocompramised and pregnancy?

A

Live attenuated

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10
Q

Which vaccine type usually requires supplemental doses?

A

Inactivated

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11
Q

What is the downside of inactivated vaccines?

A

immunity is not as strong and boosters may be required for ongoing immunity

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12
Q

How do polysaccharide, conjugate, and recombinant vaccines work?

A

Target a section of the organism, such as a protein, sugar, or capsid

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13
Q

Who should you not use a polysaccharide vaccine in and why?

A

Children <2

Does not produce a good immune response

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14
Q

Conjugation (i.e. conjugated vaccines) increase the immune response in what patients

A

Infants

***these vaccines are used in all age groups tho

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15
Q

How are recombinant vaccines made

A

Gene segment of a protein from an organism is inserted into the gene of another cell (e.g. yeast cell)

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16
Q

How are conjugate vaccines made

A

use polysaccharide molecules from outside layer of encapsulated bacteria and join the molecules to carrier proteins

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17
Q

How do toxoid vaccines work

A

target a toxin produced by the disease

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18
Q

What vaccines are most similar to the actual disease?

A

Live vaccines

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19
Q

Common live vaccines

A

CHEMISTRY DOV

Cholera
Herpes Zoster (Zostavax)
Ebola
MMR
Intranasal influenza
Smallpox
Tuberculosis
Rotavirua
Yellow fever

Dengue
Oral Typhoid
Varicella

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20
Q

Should children get more than one vaccine at a time?

A

Yes! Always encourage getting all vaccines in one visit to increase compliance and probability of being fully vaccinated

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21
Q

Which is worse, increasing or decreasing intervals between vaccines?

A

Decreasing is worse - can interfere with antibody response and protection

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22
Q

Why are live vaccines not given to infants <12 months old (except rotavirus vaccine)

A

Maternal antibodies are passed to baby and reduce baby’s response to live vaccines

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23
Q

When are inactivated vaccines started in infants?

A

2 months old (except hep B which is given at birth)

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24
Q

How long should you wait between a live vaccine and a tuberculin skin test? Why?

A

4 weeks

Can cause false positive

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25
Q

What vaccines can be given at the same time?

A

Generally all vaccines (except in patients with asplenia)

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26
Q

How far should live vaccines be spaced out? Can they be given on the same day?

A

Can be given on the same day or spaced by 4 weeks

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27
Q

How far do MMR and varicella-containing (not zoster) require separation from antibody-containing products (e.g. blood, IVIG)?

A

Vaccine –> 2 weeks –> antibody-containing product

Antibody-containing product –> 3 months or longer –> vaccine

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28
Q

Can administration of a vaccine and antibody be given on the same day?

A

Can be given for post-exposure prophylaxis of hepatitis A and B, rabies, and tetanus

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29
Q

How can minor allergic reactions to vaccines be treated? Is this a contraindication for future vaccines?

A

Benadryl or hydroxyzine

NOT a CI for future vaccines

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30
Q

Contraindication for live vaccines

A

Pregnancy and immunosuppression

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31
Q

Contraindication for Hepatitis B vaccine

A

hypersensitivity to yeast

32
Q

Contraindication for flu vaccine

A

live, attenuated flu vaccine: severe egg allergy (anaphylaxis)
Use of aspirin containing products in adolescents
Use of influenza antiviral medications in the past 48 hours
Children 2-4 years with asthma or wheezing episode in last 12 months
Close contact with an immunosuppressed person

33
Q

Recombinant zoster vaccine (RZV) and Zoster vaccine live (ZVL) contraindications

A

RZV: lactation, pregnancy
ZVL: hx of anaphylaxis to gelatin or neomycin, pregnancy

34
Q

Contraindication for varicella vaccine

A

Hx of anaphylaxis to gelatin or neomycin

35
Q

Contraindication for rotavirus vaccine

A

Hx of intussusception

36
Q

Contraindication for yellow fever vaccine

A

Anaphylaxis to eggs

37
Q

Contraindication for vaccines with latex stoppers and in prefilled syringes

A

Anaphylaxix to latex

***Most latex sensitivity is a contact-type allergy and does not prohibit vaccine administration

38
Q

Vaccines recommended for infants and children

A

Birth: Hep B
2 months: Prevnar 13, DTaP, Hib, polio, rotavirus
>12 months: MMR, varicella
NO polysaccharide vaccines before age 2

39
Q

Vaccines recommended for healthcare workers

A 
Flu 
Hep B (if no immunity)
Tdap q10 years
Varicella (if no hx or immunity)
MMR (if no hx or immunity)
40
Q

Vaccines recommended for adolescents and young adults

A

Meningococcal
HPV
Tdap (first dose >11 years)

41
Q

Vaccines recommended for sickle cell disease and other causes of asplenia (damaged or missing spleen)

A 
H. influenzae type b (Hib)
Pneumococcal vaccines (1 prevnar then 2 pneumovax before 65)
Meningococcal
42
Q

Vaccines recommended for Pregnancy

A

NO live vaccines!!!
Influenza (inactivated)
Tdap (gestation week 27-36)

43
Q

Vaccines recommended for diabetes

A

Pneumococcal (1 dose pneumovax before 65)

Hepatitis B

44
Q

Vaccines recommended for immunodeficiency

A

NO live vaccines
Pneumococcal vaccines (1 prevnar then 2 pneumovax before 65)
If pt has HIV give meningococcal, Hep A and Hep B

45
Q

Vaccines recommended for older adults

A

Shingrix or zostavax

Pneumococcal vaccine

46
Q

Vaccinations for adults

A 
Influenza
Tdap q10 years
Shingles
HPV (<23 years)
Pneumococcal
Meningococcal
Hepatitis B and A
47
Q

DTaP or Tdap administration recommendations

A 
DTap for children <7
Tdap or Td for
Deep or dirty wound
Each pregnancy
Close contacts of infants <12 months
48
Q

H influenzae type B (Hib) administration recommendation

A

adults with asplenia

49
Q

Hepatitis A administration recommendation

A

Adults with chronic liver disease

50
Q

Hepatitis B administration recommendation

A

vaccine series started within 24 hours after birth

Healthcare workers, ESRD, chronic liver disease, HIV, diabetes age 19-59

51
Q

Which hepatitis B vaccine can only be given to age 18 and up?

A

Heplisav-B

52
Q

HPV9 (Gardasil) administration recommendation

A

Age 11-12 (may be started at 9)
If started before 15 - 2 doses
If started older than 15 or immunocompromised - 3 doses

53
Q

If a patient is age 6 months to 8 years and is not previously vaccinated with the flu vaccine, what should be given?

A

2 doses 4 weeks apart

54
Q

What egg-free flu vaccine is approved and for what patients?

A

Flubok

Ages 18 and up

55
Q

What flu vaccine should not be administered in pregnant patients and why?

A

FluMist

It is a live vaccine

56
Q

Who is FluMist approved for and how is it administered

A

Healthy people age 2-49

0.2 mL mist divided between the two nostrils

57
Q

How is the MMR vaccine administered and who should it not be used it?

A

SQ

Do not use in pregnancy or immunocompramised

58
Q

Who gets PCV 13 (prevnar 13)

A

Children <5 years old: 4 dose series
Immunocompromised patients 6-64: 1 dose if never received
Adults >65: give 1 dose if never received before (optional)

59
Q

Who gets PPSV23 (pneumovax

A

All adults >65: 1 dose

Patients 2-64 years with select risk factors

60
Q

What type of vaccines are Prevnar 13 and Pneumovax?

A

Prevnar 13 - conjugate

Pneumovax - polysaccharide

61
Q

If Prevnar 13 and Pneumovax are both needed, which is given first?

A

PCV13 (prevnar 13)

62
Q

How far should the 2 pneumonia vaccines be separated by if the patient is <65?

A

PCV13 –> 1 year –> PPSV23

PPSV23 –> at least 1 year –> PCV13 –> at least 1 year –> PPSV23
***PPSV23 vaccines should be at least 5 years apart

63
Q

How is rotavirus vaccine administered?

A

Orally

64
Q

Which varicella vaccines are live vaccines? What medications should be stopped 24 hours before administration of the vaccine?

A

Zostavax

Antivirals

65
Q

Which vaccines need to be stored in the freezer

A 
Varicella
Zostavax
MMRV
Cholera
Ebola
Smallpox
66
Q

Which vaccines are given SQ only

A

MMR, MMRV, Varicella, Zostavax, Yellow fever, Dengue, Smallpox

67
Q

Which vaccines are given IM or SQ?

A

PPSV23

68
Q

Which vaccines are given intranasally?

A

FluMist

69
Q

Which vaccines are given PO

A

Typhoid capsules

70
Q

What is the yellow book?

A

CDC’s standard resource on travel information

71
Q

What is dysentery?

A

travellers diarrhea with blood

72
Q

What is the most common primary pathogen for travlers diarrhea?

A

E. Coli

73
Q

Prophylaxis with what helps reduce the incidence of travelers’ diarrhea by 50%?

A

bismuth subsalicylate (in Pepto-Bismol) four times daily (with meals and at bedtime)

74
Q

How should mild travelers’ diarrhea be treated?

A

loperamide or bismuth subsalicylate

75
Q

How should moderate travelers’ diarrhea be treated?

A

loperamide +/- antibiotics (quinolones, azithromycin, or rifaximin)

76
Q

How should severe travelers’ diarrhea be treated?

A

antibiotics preferred (azithromycin preferred, quinolones, or rivaximin) +/- loperamide

77
Q

Which vaccines should travelers have?

A

Inactivated: Hepatitis A and B, Japanese encephalitis, meningococcus, polio, typhoid
Live vaccines: cholera, typhoid, yellow fever

NAPLEX Review (79 decks)

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