Primary and Secondary Prevention Flashcards
Primary Prevention
Preventing the health problem
* Immunizations
* safety counseling
* disease prevention
Secondary Prevention
Detecting disease early, asymptomatic, or in a preclinical state
* Screening tests
* BP check
* mammography
* colonoscopy
Tertiary prevention
minimizing negative disease induced outcomes
* disease is established
* adjusting therapy to avoid further target organ damage
Immunization Principles
- Remove geographic barriers - vaccinate where people are located
- When in doubt re-immunize
- IZ deffered = IZ denied - the presence of a minor illness does not necessate deferring or delay - defer only in presence of mod to severe illness with or without fever (need for hospital)
- Hive alone without annaphylaxis is not a contratindication to vaccinate
Active immunization
response to a vaccine resulting in the creation of antibodies
* protection in aticipation of possible exposure
* onset usually within 1 month
* durration years-lifelong
Passive immunization via adminstration of immune globulin
- anibody produced in another host and conferred to patient
- given post exposure - patient needs to present with risk or report of exposure
- onset within hours
- durration 6-9 months
- limited diseases - varicella, hep A/B, tetanus, rabies
Hx of Anaphylactic reaction to Neomycin
Avoid IPV, MMR, Varicella
Hx of Anaphylactic reaction to Streptomycin, polymixin B, Neomycin
Avoid IPV, Vaccinina (small pox)
Hx of Anaphylactic reaction to
Baker’s yeast
Avoid Hep B vaccine
Hx of Anaphylactic reaction to Gelatin
Avoid MMR
Anaphylaxis
Acute lifethreatenting systemic reaction that results from sudden systemic release of mediators from mast cells and basophils
* rapid onset within minutes-hours of exposure to allergen
Most common Anaphylaxis presentation
- Uticaria
- angioedema
- respiratory compromize (cough/wheeze)
- Sudden reduced BP
- GI symptoms
Anaphylaxis criteria
- Sudden onset with involvemtn of the skin, mucosal tissue or both and sudden resporitory symtoms or sudden reduced BP/symptoms of end organ dysfunction (hypotonia, incontinence) OR
- 2 or more of the following that occur suddenly - sudden skin or mucosal s/s, sudden respiratory s/s, sudden reduced BP, sudden GI symptoms OR
- Reduced BP after exposure to a known allergen (gerater than 30% decrease in systolic BP
Primary care interventions for anaphylaxis
- assess ABC
- Place pt in supine possition
- Activate EMS for ER transfer
- Admin Epi to antiror-lateral thigh - no contraindication for use in anaphylaxis
- Give H1/H2 blocker PO (diphenhydramine/famotadine)
- IV access, O2, onging monitoring
Anaphylaxis after care
- education on the use of EPI pen, potential for bi-phasic reaction, trigger avoidance
- consider Rx for PO antihistamines and systemic corticosteroids
- referral to allergist if unknown cause.
Live attenuated Virus vaccine
MMR
Varicella
intranasal influenza virus vaccine
Rotavirus (PO for infants)
Precautions to live virus
- theoretical risk in pregancy - may pass virus to fetus
- Severe immnicompromise - risk of becomminginfected
- Guidelines if HIV + ( usuallu ok if CD4 >200
- Rotaviris not for infants with severe combined immunodeficiency - recognized early ot Hx of intussusception. Shed in stool practice diaper hand hygeine
Hep B vaccine
- transmission via blood/body fluids
- 3 dose series starting at birth
- catch up 3 doese series at 0, 1-2, and 6 months
- revaccination in not generally reccomended
- post vaccination serology available
DTaP
teanus, diptheria, accellular pertussis
- 5 dose series with completion at 4-6 years of age (ages 2, 4, 6, 18months and 4 years)
- wound mamgement in children >7 with atleast 3 doses: wounds other than clean supperficial admin DTap if >5 years since last dose
- booster Q 10 years
- reactions: fatigue, poor appetite, Gi upset, rare: seizure, nonstop crying, T>105, anaphylaxis
Tetanus prophylaxis in wound mamgement
- obligate anaerobe- grows in deep wounds
- with unknow tetenus vaccine Hx or <3 doses - vaccinate
- Hx of 3+ doses: give if >10 yrs from last dose or >5years for deep wound/dirty wound
- DTap should be used for children <7
- Tdap is reccomended booster for adolecents and adults
- Tdap dose reccomednded during each pregnancy reguardless of Hx.
Hib vaccine
Heamophilus influenzae type B
- 4 dose series
- 2, 4, 6, months with booster at 12-15 months
- Unvaccinated at 15-59 months- 1 dose needed
- Previously unvaccinated 60 months or older, not at high risk do not require catch up vaccine
IPV
polio
- 4 dose series @ 2,4,6-18 months, and 4-6 years
- Catch up in 1st 6 months of life only for travel to polio-enemic region or during outbreak
- Not routinely reccomended for US resident 18 years or older
MMR
- minimum age 12 months
- 2 dose series, 1 year and 5 years
- Catch up children/adolescents 2 doses at least 4 weeks apart
- reaction: mld rash. lymphadeopathy, Rare: seizure, teratogen
Varicella
minimum age 12 months
* 2 dose series 12-15months, 4-6 yrs
* catch up 2 dose series at least 4 weeks apart for people >7 yrs
Hep A
- minumum age 12 months for routine
- 2 dose series 6 months apart
- Catch up - up to age 18 should get 2 dose series
- 18 or older can get combined HepA/B series
MenACWY
meningococcal
- 2 dose series at age 11-12 years and 16 years
- reccomended for 1st y ear college students or military recruits if not previously vaccinated by 16
RZV
Zoster
- shingles
- age 50 or older
- 2 dose series at least 4 weeks apart
Pneumococcal Vaccination
PCV 15, 20, 23
- Series for adults 65 or older
- one dose of PCV 15 or PCV 20, one year later PPSV 23 (if Pcv 15 used)
calculation og pack year Hx
number of packs per day x number of years smoked
5 A’s of smoking intervention
- Ask - id and document tabacco use with every pt visit
- Advise - in a personalized manner urge quitting
- Assess - willingness to quit
- Assist - couseling and pharmacotherapy to help quit
- Arrange- follow up in 1 week after the quit date.
top causes of death
- ages 10-44 - #1: unintentional injury (includes firearms)
- 45 - 64 #1 maliganant neoplasms, #2, heart disease
- All ages
1. Heart disease
2. malignant neoplasms
3. Covid
4. unintentioanl injury
5. cerebrovascular disease
6. Chronic lower respirtaroy disease
New Cancer Cases
- Male
1. Prostate
2. lung
3. colon
4. bladder
5. melanoma - Female
1. Breast
2. Lung
3. colon
4. uterine
5. melanoma
Cancer deaths
Male
1. lung
2. prostate
3. colon
4. pancreas
5. liver/bile duct
Female
1. Lung
2. breast
3. colon
4. pancreas
5. ovary
Prostate cancer screen
- men 55-69 years PSA based screening
- based on family Hx, race, comorbids, benifits/risks of treatments
- USPSTF reccomends against PSA-based screening in men >70
Genitic risk assessment and BRCA mutation for breast and ovarian Ca
- assess women with personl or family Hx of breast, ovarian, tubal, or peritoneal cancer, or people with acestery associated with BCRA mutation,
colorectal screening
- initiated at 45 years, contine to 75 possibly up to 85 yrs
- FIT annually,
- Stool DNA Q3 years
- Colonoscopy Q10 yrs
- Flexible sigmoidoscopy Q5 yrs
Endometrial cancer screening
wmn shoul dbe informed to report post menopausal bleeding, screening is performed by endometrial Bx
* Heriditary non-polposis colon cancer - anual screening with endometrial bipsy begining at 35
Lung cancer screen
- annual low dose CT for ages 55-74 in good health with a 30 year pack Hx who currently smoke or who quit in the last 15 years
- may be discontinued if more than 15 years since smoking.
Cervical Cancer Screen
- no screening before 21 - then q3 yrs Pap only
- women over 30-65 HPV and Pap every 3-5 years
- > 65 no screening after adequate negative screening
Candities for TB testing
- suspected exposure
- From a country wher TB is endemic (latin america, carribian, africa, aisia, eastern europe, Russia)
- People who live or work in ares where active TB is more common
- Healthcare workers
- People with HIV or weakened immune system
- People with s/s of TB
- People who inject illegal drugs
Reactive mantoux tuberculin skin test
- > 5mm: HIV, recent exposure, immunisuppresed, previous infection
- > 10mm: Immigrants from high-prevalance countires, IV drug user, work/live in high risk setting, <4 yrs, exposure to high risk adults
- > 15: considered positive for everyone
Latent TB
- No symptoms
- +skin test or serologic test
- Normal CXR
- Normal sputum
- Treatment : Isoniazid and Rifapentine (3 months), rifampin (4 months), Isoniazid (6-9 months)
TB disease
- Sig cough >3 wks, chest pain, hemoptysis or sputum production, weakness/fatigue, weight loss, lack of appetite, chills, fever, night sweats
- Positive skin or serologic test
- CXR consistent with TB
- Abnormal sutum
- Treatment: several drugs for 6-9 months, INH, rifampin, Ethambutol, pyrazinamide
- pregnant women should be treated immediately but medications may be adjusted (babies are rarley born with TB)
