Other Immunobiologics Flashcards
Antigenic substances
vaccines and toxoids
antibody-containing preparations
globulins and antitoxins
Immunobiologics
- Antitoxin
- Convalescent plasma
- Immune globulin
- Hyperimmune globulin
- Monoclonal antibodies
- Toxoids
- Vaccines
type of immunity for vaccines and toxoids
Active immunity
Type of immunity for passive immunity
antibody-containing preparation
A solution of antibodies against a toxin
Antitoxin
- This can be derived from either human (e.g., tetanus immune globulin) or animal (usually equine) sources (e.g., diphtheria and botulism antitoxin)
- It is used to confer passive immunity and for treatment
Antitoxin
It is the plasma that comes from people who have recovered from an infection
Convalescent plasma
● This plasma may contain antibodies against the microorganism that caused the infection of the donor.
● It provides passive immunity for someone who has an illness for the first time.
Convalescent plasma
the process of separating
plasma from the whole blood
plasmapheresis
Convalescent plasma is obtained through ________________
Plasmapheresis
stage na gumaling na ang
pasyente and during that present pa yung antibodies.
convalescent
Special preparations obtained from blood plasma from donor pools preselected for a high antibody content against a specific antigen
Hyperimmune globulin (specific)
● hepatitis B immune globulin, varicella zoster immune globulin, rabies immune globulin, tetanus immune globulin, vaccinia immune globulin, cytomegalovirus immune globulin, botulism immune globulin
● Used as either prophylaxis or for providing passive immunity.
Hyperimmune globulin (specific)
immediate protection before exposure
Prophylaxis
has a certain period or doses before it takes effect
Vaccine
A sterile solution containing antibodies, which are usually obtained from human blood.
Immune globulin/Immunoglobulin
● It is obtained by cold ___________ of large pools of blood plasma and contains 15%-18% protein.
(Immune globulin/Immunoglobulin)
ethanol fractionation
● Intended for ___________
(Immune globulin/Immunoglobulin)
intramuscular administration
● Primarily indicated for routine maintenance of
immunity among certain immunodeficient persons and for __________ protection against measles and hepatitis A.
(Immune globulin/Immunoglobulin)
passive
Found in mucous, saliva, tears, and breast milk. Protects against pathogens
IgA
Part of the B cell receptor. Activates basophils and mast cells
IgD
Protects against parasitic worms. Responsible for allergic reactions
IgE
Secreted by plasma cells in the blood. Able to cross the placenta into the fetus.
IgG
May be attached to the surface of a B cell or secreted into the blood. Responsible for early stages of immunity.
IgM
Both are used for oncological and immunological/infectious
diseases, but these are expanding into other disease areas
Monoclonal antibodies (mAbs) and polyclonal antibodies (pAbs)
antibody products prepared from a single lymphocyte clone, which contains only antibody against a single antigen
MAbs
mixture of antibodies that react against a specific antigen, each identifying a different epitope on
an antigen.
PAbs
A modified bacterial toxin that has been made nontoxic, but retains the ability to stimulate the formation of antibodies to the toxin
Toxoids
● These are active (artificially-acquired) immunization agents, but they don’t give long-term protection like vaccines
Toxoids
A suspension of live (usually attenuated) or inactivated microorganisms (e.g., bacteria or viruses) or fractions thereof administered to induce immunity and prevent infectious disease or its sequelae
Vaccines
Pharmacy Staff should complete training regarding procedures on:
■ Receipt of vaccines
■ Storage requirements
■ Emergency procedures (in terms of storage in case of power interruptions)
■ Monitoring inventory
■ Immunization workflow
A complete ___________ that is written and dated should be obtained from each patient at every visit.
immunization record
○ Vaccination Administration Record
Stay with pharmacy
○ Vaccine Immunization Card
For patient
Prior to vaccine administration, patients should be screened for _______________ and ____________ . Also, the benefits and risks of the vaccine should be discussed with the patient and safety concerns addressed. The patient should also be provided with after care instructions at this point
contraindications and precautions
To help ease and relieve anxiety of the patient prior to and during vaccination, the following simple strategies could be used:
○ Displaying a positive attitude;
○ Using a soft and calm voice;
○ Making eye contact
○ Explaining why the vaccine is needed; and
○ Being honest and explaining what to expect
○ Have patient sit or lie down during vaccination (t or f)
(Positioning and comforting restraint)
T
○ Observe for symptoms of ___________
(Positioning and comforting restraint)
syncope (fainting)
○ Observe patient while seated or lying down for at least _______ after vaccination
(Positioning and comforting restraint)
15 minutes
○ Avoiding ________ during vaccine administration
(Pain management)
aspiration
○ Administering most painful vaccine first (t or f)
(Pain management)
F; last
○ _____or _______ the skin near the injection site prior to and during injection may decrease pain
(Pain management)
Rubbing or stroking
○ Applying __________ before vaccine administration
(Pain management)
topical anesthetics
may occur with most vaccines but common with inactivated vaccines, particularly those that contain adjuvants
(Potential Adverse Reactions to Vaccines (side effects))
Local reactions
pain, redness, swelling at
injection site; occurs after the injection and are usually mild and
self-limited
(Potential Adverse Reactions to Vaccines (side effects))
Local reactions
enhance the effect of
the vaccine
Adjuvants
- more generalized reactions and are more common and non-specific. These could occur in vaccinated individuals who have received the vaccines or may be unrelated to the vaccine.
- This reaction is more common with live attenuated vaccines
(Potential Adverse Reactions to Vaccines (side effects))
Systemic reactions
Fever, malaise, myalgia,
loss of appetite, headache
(Potential Adverse Reactions to Vaccines (side effects))
Systemic reactions
Fever or rash seen after receiving vaccine are signs of viral replication;
usually patients may experience a milder form of the disease
(Potential Adverse Reactions to Vaccines (side effects))
Systemic reactions
may be due to the vaccine antigen or a vaccine component. Vaccine components that may cause an allergic reaction include: stabilizers, cell
culture material, adjuvants, preservative, antibiotic (used to inhibit bacterial growth in multi-dose vials)
(Potential Adverse Reactions to Vaccines (side effects))
Allergic reactions
If allergy, considered as
contraindications. But, there are exemptions. (t or f)
(Potential Adverse Reactions to Vaccines (side effects))
T
are rare but could be
life-threatening.
(Potential Adverse Reactions to Vaccines (side effects))
Severe allergic reactions (anaphylactic reactions)
Signs and symptoms of reactions from injection site
- soreness, redness, itching, or swelling
- slight bleeding
- continuous bleeding
apply a wet cloth to the injection site. Consider giving medication to reduce pain (ex. tylenol) or itching (ex. Benadryl) if needed
management for soreness, redness, itching and swelling
Apply pressure and an adhesive compress over the injection site
management for slight bleeding
Place thick layer of gauze pads over site and maintain direct and firm pressure. Raise the bleeding injection site (Ex. arm) above the level of the patient’s heart
management for continuous bleeding
sings and symptoms of psychological fright, presyncope and syncope (fainting)
- anxiety before injection
- patient feels “faint” (light headed, dizzy, weak, nauseated, or has visual disturbance)
- loss of consciousness
have patient sit or lie down for the vaccination
management for anxiety before injection
have patient lie flat. Loosen any tight clothing and maintain open airway. Apply cool, damp cloth to patient’s face and neck. Keep patient under close observation until full recovery
management for patient feels “faint” (light headed, dizzy, weak, nauseated, or has visual disturbance)
Check the patient for injury before trying to move patient. Place patient flat on back with feet elevated. Call 911 if patient does not recover promptly
management for loss of consciousness
signs and symptoms for anaphylaxis
skin and mucosal symptoms such as generalized hives, itching or flushing; swelling of lips, face, throat, or eyes. Respiratory symptoms such as nasal congestion, change in voice, sensation of throat closing, stridor, shortness of breath, wheeze, or cough. Gastrointestinal symptoms such as nausea, vomiting, diarrhea, cramping, abdominal pain. Cardiovascular symptoms such as collapse, dizziness, tachycardia, hypotension
Infection control
- hand hygiene
- gloves
- equipment disposal
performed before vaccine preparation, in-between patients, and anytime the hands become soiled. Waterless alcohol-based hand sanitizer or soap
and water should be used
hand hygiene
If gloves are worn:
■ These should be changed after each patient and hand hygiene should be performed.
■ Change gloves when damaged.
Used syringes and needles should be placed in a puncture-resistant biohazard container
(___________) to avoid _________ and reuse of said equipment
(Equipment Disposal)
sharps container; needlestick injuries
Empty or expired vaccine vials should be disposed as _______________
(Equipment Disposal)
medical waste
Gloves, alcohol wipes, cotton should be
disposed as medical waste; these can be
be disposed in sharps container (t or f)
(Equipment Disposal)
F; should not be disposed in sharps
Preparation of the Vaccine
- Inspection of the Vaccine
- Reconstitution of the Vaccine
- Beyond Use Date (BUD)
- Filling syringes
Equipment selection (two types)
- Syringe selection
- Needle selection
Check the following on the vials of the vaccine and diluent, as well as on prefilled syringes prior to vaccine administration:
- damage
- possible contamination
- expiry date
For the expiration date: (use until when)
Use through last day of the month indicated on the expiration date
if the indicated expiration is 6/2024 - vaccine is good through:
6/30/2024
(do not use after 7/1/2024)
if indicated expiration is 6/15/2024 (specific date) - vaccine is good until:
good until 6/15/2024; do not use on or after 6/16/2024
Some vaccines are packaged in the ________, and the manufacturer provides a specific diluent for the vaccine
(Reconstitution of the Vaccine)
lyophilized form
Reconstitute the vaccine following the manufacturer’s specific guidelines using ONLY the
diluent provided (t or f)
(Reconstitution of the Vaccine)
T
NEVER use a stock vial of _________ or ________ to reconstitute vaccines
(Reconstitution of the Vaccine)
sterile water or normal
saline
Check for __________ , __________or if it cannot be ___________. If any of these are present, DO NOT USE THE VACCINE.
(Reconstitution of the Vaccine)
precipitation, discoloration, resuspended
is the time or date when the vaccine should NO LONGER BE USED. This is different for each vaccine, and consult the product insert for beyond use
date.
Beyond use date (BUD)
The BUD is based on the time when it is _________,
or for multi-dose vials, when a needle is first ___________ into the vial.
reconstituted; inserted
The BUD occurs after expiration date (t or f)
F; prior
Vaccines should be prepared just prior to
administration (t or f)
T
- One-time use (do not contain preservative)
● NEVER use for more than one patient
Single-dose vials
Unused single-dose vials without a protective cap
should be discarded at the end of the workday (t or f)
T
Can be punctured more than once; contain a
bacteriostatic (preservative) agent
Multi-dose vials
- Prepared and sealed by manufacturer
● Once activated (syringe cap removed or needle
attached) sterile seal is broken
● Vaccine must be used or discarded by end of workday
Manufacturer-filled Syringes
● Most combination vaccines come in prefilled syringes and are combined by the manufacturer.
Combination Vaccines
ROUTES OF VACCINE ADMINISTRATION
- Oral Route (PO)
- Intranasal Route (NAS)
- Intramuscular Route (IM)
- Subcutaneous Route (SC, SQ)
- Intradermal Route (ID)
- Usually live vaccines, rotavirus and oral polio virus
Oral route
○ If given same day with injection, oral route should be given (before or after) injection
before
only approved vaccine by the US FDA that is administered via the intranasal route.
Flumist® live attenuated influenza vaccine
(LAIV)
The vaccine is packaged in a special sprayer device that contains _______ of the vaccine. The device is designed to deliver ______ of the vaccine into each nostril.
(intranasal route)
0.2mL; 0.1mL
Have patient sit in an
__________, with
the head tilted back
and the provider’s hand
supporting the back
of the head
(intranasal route)
upright position
Place the tip of the
device just inside the
________ to ensure
delivery of the vaccine
into the nose
(intranasal route)
nostril
After delivering the first
dose, remove the
_____________ and
deliver the other dose
into the other nostril
(intranasal route)
separator clip
f the patient coughs,
sneezes, or expel the dose in any other way, there is no need to repeat the dose. (t or f)
T
- the vaccine is injected deep into the muscle, past the dermis and subcutaneous layer.
- Due to the presence of adjuvants in many inactivated vaccines, these vaccines are recommended to be administered ________ to avoid severe local reactions
Intramuscular route
Inactivated vaccines usual route of administration
IM
Recommended sites for IM injection:
- Deltoid muscle in the upper arm
- anterolateral thigh muscle (vastus lateralis)
(upper arm) - located about 2 to 3 fingerbreadths below the acromion and opposite the axilla.
Deltoid muscle
Deltoid muscles may not be well developed in
young adults and children, so it would be better to administer at the
anterolateral thigh muscle
located in the middle third of the upper, outer
thigh
Vastus lateralis (anterolateral thigh)
preferred site for infants
and young children. It is at the anterior surface of the mid-lateral thigh, this is easily located if the leg
is extended
Vastus lateralis (anterolateral thigh)
Vastus lateralis (anterolateral thigh) is also suited for ____________ or ___________
large adult or obese patients
Note that the selection of IM site depends on the ______ of the patient and muscle development
age
Size would depend on the amount of vaccine to be administered; 1 to 2 ml
syringe is commonly used while a ________ may be used for pediatric patients
(Intramuscular site)
tuberculin syringe
Needle size:
Intramuscular Route (IM)
- Gauge 22 to 25
- Needle length: 1 to 2 inches
Commonly used in the deltoid muscle; also used for younger patients
1-inch needle
may be considered in infants and young patients, and even adults
without enough muscle development in injection site
5/8-inch needle
o Diphtheria-tetanus-pertusis (DTaP, Tdap)
o Diphtheria-tetanus (DT, Td)
o Haemophilus influenza type b (Hib)
o Hepatitis A (HepA)
o Hepatitis B (HepB)
o Human papilloma virus (HPV)
o Inactivated influenza (TIV)
o Quadrivalent meningococcal conjugate (MCV4
o Pneumococcal conjugate (PCV)
Intramuscular Route (IM)
may be administered via IM or SC
- Inactivated polio (IPV)
- neumococcal polysaccharide (PPSV23)
the vaccine is injected into the fatty tissue (________ layer), below the dermis and above the muscle
subcutaneous route (SC, SQ)
Infants younger than 12
months of age
(Recommended site for SC injection)
Anterolateral thigh muscle
Recommended site for SC injection:
- Anterolateral thigh muscle or the fatty tissue over the triceps of the arm
- Anterolateral thigh muscle
persons 12 months of age or older
(Recommended site for SC injection)
Anterolateral thigh muscle or the fatty tissue over the
triceps of the arm
Needle size: Subcutaneous Route (SC, SQ)
o Gauge: 23 to 25
o Needle length: 5/8 of an inch
Insert the needle at a
angle
(Subcutaneous Route (SC, SQ))
45°
o Measles, Mumps, Rubella (MMR)
o Varicella (VAR)
o Meningococcal polysaccharide (MPSV4)
o Zoster (shingles)
Vaccines administered via the SC/SQ route
Only vaccine licensed by the US FDA that is administered via the intradermal route
Fluzone ID®
Fluzone ID® is approved only for patients __________ years old
18 to 64 years old
Fluzone ID® is (different or same?) from the inactivated influenza vaccine (TIV/IIV) that is
administered intramuscularly
different
All other influenza vaccine
formulations should not be administered intradermally (t or f)
T
Fluzone ID ® comes in a special syringe, called a
_____________ that is equipped with a very small needle that goes into the dermis where
specialized immune cells are present.
microinjection system
Site of administration: Intradermal Route (ID)
Deltoid muscle
