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Pulm block Pharm > Influenza > Flashcards

Influenza Flashcards

1
Q

According to the CDC who should get the flu vaccine?

A

CDC currently recommends everyone 6 months and older get yearly immunization

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2
Q

What is a contraindication to the flu vaccine?

A

hypersensitivity reaction in the past

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3
Q

is an egg allergy considered a CI for all influenza vaccine products?

A

NO

IT is not considered a CI for all products

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4
Q

In general, health-care providers should begin offering vaccination soon after vaccine becomes available, and if possible, by what month?

A

October

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5
Q

All children aged 6 months to 8 years who are recommended for 2 doses should receive their first dose as soon as possible after vaccine becomes available; these children should receive the second dose how many weeks later?

A

≥4 weeks later.

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6
Q

What are the major types of influenza vaccines?

A

o Live-attenuated

o Inactivated

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7
Q

Influenza vaccines contain how many influenza antigens?

A

Formulation contains 3 (trivalent) or 4 (quadrivalent) antigens

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8
Q

what type of influenza vaccine would be a good option for vegans or those worried about it containing animal parts?

A

RIV - Recombinant Influenza Vaccine

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9
Q

what type of influenza vaccine would be a good option for vegans or those worried about it containing animal parts?

A

RIV - Recombinant Influenza Vaccine

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10
Q

If the patient has a needle phobia, that flu vaccines can they take?

A

IIV3 Afluria

IIV4 Afluria Quadrivalent

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11
Q

Which flu vaccines do not contain animal vectors or incubators in production process.

A

RIV3 Flublok

RIV4 Flublok Quadrivalent

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12
Q

which flu vaccines have intradermal delivery

A

IIV4-ID Fluzone Intradermal

IIV4-ID Quadrivalent

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13
Q

which flu vaccines are high dose and recommended for geriatric patients

A

IIV3-HD§§ Fluzone High-Dose

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14
Q

which flu vaccine is the only live attenuated influenza vaccine and is an intranasal spray?

A

LAIV4 FluMist Quadrivalent

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15
Q

FluMist nasal spray is the Only one_______ formulation

A

live-attenuated

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16
Q

“Special” preparations of flu vaccines

A 
o	Only one live-attenuated formulation
	FluMist nasal spray
o	Only one nasal spray product
o	Only one high-dose product
o	Only one intradermal product
o	Only one IM needle-free delivery
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17
Q

In the 2017-2018 flu season, who should get the LAIV?

A

NOONE!

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18
Q

in other years, what population has been able to receive the LAIV?

A

healthy, nonpregnant persons aged 2-49 years

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19
Q

who should NOT get LIVE formulation of the influenza vaccine?

A
  1. Immune compromised - disease or medications!!!
  2. Children 2-17 on Aspirin, if they have influenza on aspirin therapy they can develop Reye’s syndrome which can be fatal.
  3. Chronic disease: CV, lung, metabolic, liver, renal, hematologic, etc.
  4. Nasal congestion (due to delivery system)
  5. Pregnant
  6. Adults ≥50 years
  7. Individuals who have taken influenza antiviral mediations within previous 48 hours
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20
Q

Formulation Choice 2017-2018 for Individuals 18-64?

A

Standard dose IIV- Favor quadrivalent formulation when possible

For Needle phobics:
Fluzone intradermal
Afluria using a jet injector device

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21
Q

Formulation Choice 2017-2018 for Individuals 65+?

A

o IM high-dose trivalent IIV (Fluzone high-dose) where available
o Geriatrics tend not to respond as well to regular dose which is why we use high dose

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22
Q

Should Persons with a history of egg allergy who have experienced only hives after exposure to egg receive the flu vaccine?

A

yes

23
Q

should Persons who report having had reactions to egg involving symptoms other than hives, such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention receive the flu vaccine?

A

yes,they may similarly receive any licensed and recommended flu vaccine (i.e., any form of IIV or RIV) that is otherwise appropriate for the recipient’s age and health status.

o The selected vaccine should be administered in an inpatient or outpatient medical setting (including, but not necessarily limited to hospitals, clinics, health departments, and physician offices).
o Vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic conditions.
o basically, They can still get it, we just need to watch the patient for a little while.

24
Q

should a person with a previous severe allergic reaction to flu vaccine, regardless of the component suspected of being responsible for the reaction, receive the flu vaccine?

A

no
it is a contraindication

  • A previous severe allergic reaction to flu vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.
25
Q

what age group may be predisposed to more severe ADR symptoms after receiving the flu vaccine?

A

≥65 years of age may predispose to more severe symptoms

26
Q

local ADRs of the flu vaccine

A

injection site reactions (including bruising, erythema, induration, inflammation, itching at injection site, pain, soreness, swelling at injection site, tenderness at injection site)

27
Q

Neuromuscular & skeletal ADRs of the flu vaccine

A

arthralgia, back pain, myalgia (may start within 6 to 12 hours and last 1 to 2 days; incidence generally equal to placebo in adults; occurs more frequently than placebo in children)

28
Q

Ophthalmic ADRs of the flu vaccine

A

eye redness

29
Q

respiratory ADRs of the flu vaccine

A

bronchitis, cough, dyspnea, nasal congestion, nasopharyngitis, oropharyngeal pain, pharyngitis, pharyngolaryngeal pain, respiratory congestion (upper), rhinitis, rhinorrhea, upper respiratory tract infection, wheezing

30
Q

PO Antivirals for Influenza have 2 major uses, what are they?

A

o Treatment

o Prophylaxis

31
Q

who should receive Pre-exposure prophylaxis for influenza?

A

o Only be used for persons at very high risk of influenza complications who cannot be otherwise protected at times of high risk for exposure. (Patients that can’t take the vaccine)

o Also be administered to all eligible residents of institutions that house patients at high risk when needed to control outbreaks.

32
Q

who should receive Post-exposure prophylaxis for influenza?

A

o May be considered for family or close contacts of suspected or confirmed cases, who are at higher risk of influenza complications, and who have not been vaccinated against the circulating strain at the time of the exposure.
o May be considered for unvaccinated healthcare workers who had occupational exposure without protective equipment

33
Q

is prophylaxis PO meds an alternative for yearly flu vaccines?

A

NO

34
Q

who should be treated for influenza?

A
  • Persons with severe, complicated or progressive illness
  • Hospitalized persons
  • Persons at risk for complications (following 2 slides)
  • Consider others based on clinical judgement
35
Q

what populations are high risk for flu complications?

A
  • Children <2 years of age (highest risk in children <6 months of age)
  • Adults ≥65 years of age
  • Persons with chronic disorders of the pulmonary (including asthma) or cardiovascular systems (except hypertension)
  • Persons with chronic metabolic diseases (including diabetes mellitus), hepatic disease, renal dysfunction, hematologic disorders (including sickle cell disease), or immunosuppression (including immunosuppression caused by medications or HIV)
  • Persons with neurologic/neuromuscular conditions (including conditions such as spinal cord injuries, seizure disorders, cerebral palsy, stroke, mental retardation, moderate to severe developmental delay, or muscular dystrophy) which may compromise respiratory function, the handling of respiratory secretions, or that can increase the risk of aspiration
  • Pregnant or postpartum women (≤2 weeks after delivery)
  • Persons <19 years of age on long-term aspirin therapy
  • American Indians and Alaskan Natives
  • Persons who are morbidly obese (BMI ≥40)
  • Residents of nursing homes or other chronic care facilities
36
Q

What are the 2 Classes of PO medications used to treat influenza?

A

Neuraminidase inhibitors (covers A and B)

Adamantanes (covers A only)

37
Q

names of three drugs that are Neuraminidase inhibitors

A

Oseltamivir (Tamiflu): PO capsule and oral suspension

Zanamivir (Relenza): PO inhalation

Peramivir (Rapivab): IV, single-dose

38
Q

most people use which Neuraminidase inhibitor drug?

A

Oseltamivir (Tamiflu)

39
Q

which Neuraminidase inhibitor drug Can’t be used in really young children or in patients with lung disease or smokers?

A

Zanamivir (Relenza)

40
Q

which Neuraminidase inhibitor drug is IV only?

A

Peramivir (Rapivab): IV, single-dose

41
Q

Do we use Adamantanes to treat flu in the US?

A

no
adamantanes are no longer recommended for use in the US due to resistance except in special circumstances, so only use Neuraminidase inhibitors

42
Q

Neuraminidase Inhibitors MOA

A

o Neuraminidase is an enzyme known to cleave the budding viral progeny from its cellular envelope attachment point
o Neuraminidase inhibitors interfere with the release of progeny influenza virus from infected cells, thereby preventing new rounds of infection

43
Q

who should you use caution in when prescribing Oseltamivir for the flu?

A

chronic CV, hepatic, renal, respiratory disease, immune compromised

44
Q

hoe would you prescribe Oseltamivir for prophylaxis treatment?

A

initiate within 48 hours of contact and treat for 7-10 days (depending on which recommendation you follow)

45
Q

how should Oseltamivir and Zanamivir be prescribed for treatment?

A

initiate within 48 hours of onset and treat for 5 days

46
Q

Oseltamivir product formulations? (2)

A

o Capsule

o Oral suspension

47
Q

hoe would you prescribe Zanamivir for prophylaxis treatment?

A

initiate within 36 hours of exposure/sx onset of index case for 10-28 days (depends on setting of exposure)

48
Q

contraindications for Zanamivir

A

contains milk proteins so not for true lactose allergies (ok for lactose intolerant, not for a true lactose allergy)

49
Q

who should you use caution in when prescribing Zanamivirfor the flu?

A

o Lung disease (this is an inhaled product)
o Hepatic/renal impairment
o Elderly (delivery system)

50
Q

Zanamivirfor is Not indicated for children less than ages _ to __

A

Not indicated for children <5-7

51
Q

Neuraminidase Inhibitor ADRs

A
  • Slight dependance on specific product
  • GI: pharyngitis/throat discomfort, n/v
  • Resp: cough, nasal congestion, rhinorrhea
  • CNS: HA
52
Q

what is the name of the New Drug Approved to treat influenza?

A
  • IV peramivir
53
Q

FDA labelled indications of peramivir to treat influenza?

A

Treatment of acute, uncomplicated influenza in patients ≥2 years of age who have been symptomatic ≤2 days.

Pulm block Pharm (4 decks)

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