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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
What vaccines can be given at the same time?
Generally all vaccines (except in patients with asplenia)
26
How far should live vaccines be spaced out? Can they be given on the same day?
Can be given on the same day or spaced by 4 weeks
27
How far do MMR and varicella-containing (not zoster) require separation from antibody-containing products (e.g. blood, IVIG)?
Vaccine --> 2 weeks --> antibody-containing product Antibody-containing product --> 3 months or longer --> vaccine
28
Can administration of a vaccine and antibody be given on the same day?
Can be given for post-exposure prophylaxis of hepatitis A and B, rabies, and tetanus
29
How can minor allergic reactions to vaccines be treated? Is this a contraindication for future vaccines?
Benadryl or hydroxyzine | NOT a CI for future vaccines
30
Contraindication for live vaccines
Pregnancy and immunosuppression
31
Contraindication for Hepatitis B vaccine
hypersensitivity to yeast
32
Contraindication for flu vaccine
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
Recombinant zoster vaccine (RZV) and Zoster vaccine live (ZVL) contraindications
RZV: lactation, pregnancy ZVL: hx of anaphylaxis to gelatin or neomycin, pregnancy
34
Contraindication for varicella vaccine
Hx of anaphylaxis to gelatin or neomycin
35
Contraindication for rotavirus vaccine
Hx of intussusception
36
Contraindication for yellow fever vaccine
Anaphylaxis to eggs
37
Contraindication for vaccines with latex stoppers and in prefilled syringes
Anaphylaxix to latex | ***Most latex sensitivity is a contact-type allergy and does not prohibit vaccine administration
38
Vaccines recommended for infants and children
Birth: Hep B 2 months: Prevnar 13, DTaP, Hib, polio, rotavirus >12 months: MMR, varicella NO polysaccharide vaccines before age 2
39
Vaccines recommended for healthcare workers
``` Flu Hep B (if no immunity) Tdap q10 years Varicella (if no hx or immunity) MMR (if no hx or immunity) ```
40
Vaccines recommended for adolescents and young adults
Meningococcal HPV Tdap (first dose >11 years)
41
Vaccines recommended for sickle cell disease and other causes of asplenia (damaged or missing spleen)
``` H. influenzae type b (Hib) Pneumococcal vaccines (1 prevnar then 2 pneumovax before 65) Meningococcal ```
42
Vaccines recommended for Pregnancy
NO live vaccines!!! Influenza (inactivated) Tdap (gestation week 27-36)
43
Vaccines recommended for diabetes
Pneumococcal (1 dose pneumovax before 65) | Hepatitis B
44
Vaccines recommended for immunodeficiency
NO live vaccines Pneumococcal vaccines (1 prevnar then 2 pneumovax before 65) If pt has HIV give meningococcal, Hep A and Hep B
45
Vaccines recommended for older adults
Shingrix or zostavax | Pneumococcal vaccine
46
Vaccinations for adults
``` Influenza Tdap q10 years Shingles HPV (<23 years) Pneumococcal Meningococcal Hepatitis B and A ```
47
DTaP or Tdap administration recommendations
``` DTap for children <7 Tdap or Td for Deep or dirty wound Each pregnancy Close contacts of infants <12 months ```
48
H influenzae type B (Hib) administration recommendation
adults with asplenia
49
Hepatitis A administration recommendation
Adults with chronic liver disease
50
Hepatitis B administration recommendation
vaccine series started within 24 hours after birth | Healthcare workers, ESRD, chronic liver disease, HIV, diabetes age 19-59
51
Which hepatitis B vaccine can only be given to age 18 and up?
Heplisav-B
52
HPV9 (Gardasil) administration recommendation
Age 11-12 (may be started at 9) If started before 15 - 2 doses If started older than 15 or immunocompromised - 3 doses
53
If a patient is age 6 months to 8 years and is not previously vaccinated with the flu vaccine, what should be given?
2 doses 4 weeks apart
54
What egg-free flu vaccine is approved and for what patients?
Flubok | Ages 18 and up
55
What flu vaccine should not be administered in pregnant patients and why?
FluMist | It is a live vaccine
56
Who is FluMist approved for and how is it administered
Healthy people age 2-49 | 0.2 mL mist divided between the two nostrils
57
How is the MMR vaccine administered and who should it not be used it?
SQ | Do not use in pregnancy or immunocompramised
58
Who gets PCV 13 (prevnar 13)
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
Who gets PPSV23 (pneumovax
All adults >65: 1 dose | Patients 2-64 years with select risk factors
60
What type of vaccines are Prevnar 13 and Pneumovax?
Prevnar 13 - conjugate | Pneumovax - polysaccharide
61
If Prevnar 13 and Pneumovax are both needed, which is given first?
PCV13 (prevnar 13)
62
How far should the 2 pneumonia vaccines be separated by if the patient is <65?
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
How is rotavirus vaccine administered?
Orally
64
Which varicella vaccines are live vaccines? What medications should be stopped 24 hours before administration of the vaccine?
Zostavax | Antivirals
65
Which vaccines need to be stored in the freezer
``` Varicella Zostavax MMRV Cholera Ebola Smallpox ```
66
Which vaccines are given SQ only
MMR, MMRV, Varicella, Zostavax, Yellow fever, Dengue, Smallpox
67
Which vaccines are given IM or SQ?
PPSV23
68
Which vaccines are given intranasally?
FluMist
69
Which vaccines are given PO
Typhoid capsules
70
What is the yellow book?
CDC's standard resource on travel information
71
What is dysentery?
travellers diarrhea with blood
72
What is the most common primary pathogen for travlers diarrhea?
E. Coli
73
Prophylaxis with what helps reduce the incidence of travelers' diarrhea by 50%?
bismuth subsalicylate (in Pepto-Bismol) four times daily (with meals and at bedtime)
74
How should mild travelers' diarrhea be treated?
loperamide or bismuth subsalicylate
75
How should moderate travelers' diarrhea be treated?
loperamide +/- antibiotics (quinolones, azithromycin, or rifaximin)
76
How should severe travelers' diarrhea be treated?
antibiotics preferred (azithromycin preferred, quinolones, or rivaximin) +/- loperamide
77
Which vaccines should travelers have?
Inactivated: Hepatitis A and B, Japanese encephalitis, meningococcus, polio, typhoid Live vaccines: cholera, typhoid, yellow fever

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