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TOP 300 drugs - NAPLEX > Vaccines > Flashcards

Vaccines Flashcards

Immunizations + Travel vaccines

1
Q

FDA vs ACIP vs CDC

A

FDA - approves indication
ACIP - provides recommendations
CDC - approves ACIP recommendations and publishes them in the MMWR & pink book

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2
Q

Live-attenuated vaccines are contraindicated in..

A

Immunocompromised
Pregnancy

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3
Q

Common Live Vaccines

A

MMR
Intranasal influenza
Cholera
Rotavirus
Oral Typhoid
Varicella
Yellow fever
MICRO-VY

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4
Q

Polysaccharide vaccines

A

Do NOT produce a good response in children under 2 yrs

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5
Q

Conjugate vaccines & infants

A

Increases immune response in infants

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6
Q

Live vaccines & age

A

Most live vaccines withheld until 12 months of age
EXCEPTION: rotavirus

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7
Q

Inactivated vaccines & age

A

Started when babies are 2 months old
EXCEPTION: Hep B vaccine (given at birth)

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8
Q

Live vaccines and TB skin test: effect

A

Can cause a false negative

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9
Q

Ways to reduce risk of Live vaccines causing false negative on TB skin test

A
  1. Give live vaccine same day as the TST
  2. Wait 4 weeks after live vaccine
  3. Administer the TST first, wait 2-3 days to get the results, THEN get the live vaccine
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10
Q

Live vaccines & antibodies timing

A
  1. Vaccine –> 2 weeks –> antibody product
  2. Antibody product –> 3 months + –> vaccine
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11
Q

The only REAL contraindications to vaccines

A

Live vaccines: immunocompromised, pregnant
Inactivated vaccines: anaphylaxis (to the same vaccine)

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12
Q

Vaccines for adults

A

Influenza: ≥ 6 months
Tdap x1 then Td or Tdap every 10 years
Shingrx ≥ 50 or ≥ 19 (if immunocompromised)
HPV ≤ 26 yrs who did not complete the HPV series
Pneumonia ≥ 65 or ≥ 19 with medical conditions
Meningococcal
Hep B: All 19-54 yrs, 60+ yrs with risk factors
Hep A: traveling, risk factors (same as hep B)

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13
Q

Pneumonia vaccine options

A

PCV20 x1 or
PCV15 followed by PPSV23 ≥ 12 months later (or 8 weeks later if immunocompromised)

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13
Q

Risk factors for Hep B

A

Liver disease, HIV infection, exposure via sexual activity, IVDU, travel to endemic areas, blood exposure

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14
Q

Vaccinations for infants & children

A

3-dose hep B at birth
2 months: PCV13 or PCV15, DTaP, Hib, polio, rotavirus
≥ 12 months: MMR, varicella (live vaccines)
No polysaccharide vaccine before 2 yrs of age

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15
Q

Vaccinations for healthcare professionals

A

Flu shot
Hep B
Tdap
Varicella
MMR

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16
Q

Vaccines for adolescents & young adults

A

Meningococcal: 1 dose at 11-12 yrs and 1 dose at 16 years. First yr college students at residential housing if not previously vaccinated: 1 dose
HPV vaccine: 11-12 yrs (2-3 doses depending on when started)
TDaP: 1st dose at 11-12 yrs

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17
Q

Vaccinations for Sickle Cell Disease/Asplenia

A

H. influenzae (Hib)
Pneumococcal: either PCV20 x1 or PCV15 then PPSV23 ≥ 8 weeks later
Meningococcal vaccines

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18
Q

Vaccinations for pregnancy

A

NO LIVE VACCINATIONS
Influenza
TDaP x1 each pregnancy (weeks 27-36 optimally)

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19
Q

Vaccinations for Immunodeficiency

A

NO LIVE VACCINATIONS
Pneumococcal vaccine
Herpes zoster vacines
Additional for those with HIV: Meningococcal, Hep A, Hep B

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20
Q

Vaccinations for diabetes

A

Pneumococcal vaccine
Hep B: age ≥ 60 yrs (if not previously vaccinated)

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21
Q

Egg-free influenza vaccines

A

FluBlok (18+)
Flucelvax

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22
Q

What forms of the pneumonia vaccine should those < 2 yrs NOT get?

A

Pneumovax 23 (PPSV 23)

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23
Q

Typhoid oral vaccine: administration

A

Take with empty stomach with cold/lukewarm water

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24
Q

When to give the Typhoid vaccines?

A

Oral - 1 week prior to exposure then every 5 yrs
IM - 2 weeks prior to exposure then every 2 yrs`

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25
Q

Yellow fever: contraindications

A

Severe allergy to eggs or gelatin
Immunosuppression, breastfeeding, pregnant
Age < 6 months

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26
Q

cholera vaccine: when to give

A

≥ 10 days prior to exposure

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27
Q

Cholera vaccine: storage

A

Freezer. Remove no more than 15 mins prior to administration

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28
Q

Which vaccines need to be in the freezer? (-50 to -15 degrees celcius)

A

Varicella, MMRV, oral cholera
M-M-R II can be stored in either the refrigerator or freezer

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28
Q

How long to keep temp logs

A

3 years+

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29
Q

Which vaccine is given SC only?

A

Yellow fever

30
Q

Which vaccines are given either SC or IM?

A

MMR, MMRV, Varicella, PPSV23

31
Q

Which vaccines are given oral?

A

Typhoid (Vivotif)
Cholera
Rotavirus (RotaTeq, Rotarix)

32
Q

DTaP vs TDaP

A

DTaP (Peds formulation) have 3-5 times the diphteria component
DTaP given in < 7 yrs of age

33
Q

When to give HPV9 (Gardasil 9) vaccine?

A

11-12 (May be started at 9 yrs if hx of sexual abuse)

34
Q

HPV 9 regimen

A

Started before 15: 2 doses (6-12 months apart)
Started at 15+ or immunocompromised: 3 doses (2-3 months apart)

35
Q

Travel vaccination should be documented in:

A

International certificate of vaccination or prophylaxis (ICVP) AKA “Yellow card”

36
Q

Dysentery definition

A

If blood is mixed with stool
Often accompanied by systemic symptoms such as fever
Classified as severe

37
Q

TD: prophylaxis

A

Bismuth Salicylate Reduces incidence of TD by 50%

38
Q

Who should you avoid bismuth salicylate in:

A

Aspirin allergy, pregnancy, renal insufficiency, gout, ulcer, anyone taking anticoagulants, probenecid, methotrexate

39
Q

Antibiotic prophylaxis for TD

A

NOT recommended for most (except immunocompromised, significant comorbidites)
Preferred: Rifaximin
ALT: Azithromycin, Rifamycin

40
Q

TD treatment

A

Hydration
Loperamide (Max dose 16mg/day or OTC 8mg/day) x2 days
Bismuth subsalicylate
Antibiotics (only for moderate/severe): Azithromycin or quinolone (low resistance) OR Rifaximin

41
Q

Which antibiotic is preferred for severe TD & dysentery?

A

Azithromycin

41
Q

Typhoid fever: transmission

A

Food or water contaminated by feces of someone with acute or chronic asymptomatic carrier

42
Q

Cholera: most common symptom

A

Rice-water stools

43
Q

Travel vaccines

A

Hep A, Hep B, Japanese encephalitis, meningococcus, Polio, Typhoid (IM = inactivated, PO = live), Cholera-PO, Yellow fever-SC

44
Q

Hep B Vaccine prior to travel

A

3 doses, takes 6 months to finish
Don’t forget that Hep B can also be transmitted by tattoos & piercings

45
Q

Highest risk of meningitis

A

Meningitis belt of africa during the dry season

46
Q

Meningitis & Saudi arabia

A

The government of Saudi arabia requires meningococcal vaccine for travel during the annual Hajj & Umrah pilgrimages

47
Q

Type of meningococcal vaccines recommended for travels

A

Quadrivalent vaccines (Menactra, Menveo, MenQuadfi)

48
Q

Mosquitoes can act as vectors and transmit the following diseases:

A

Japanese encephalitis, yellow fever, dengue, malaria, zika virus

49
Q

Severe Dengue (5%)

A

Shock, severe bleeding, organ failure

49
Q

Dengue: treatment

A

Supportive care
Dengvaxia - for those with past dengue infection

50
Q

Japanese encephalitis: complications

A

encephalitis with rigors, seizures, coma & death

51
Q

Who is the Ixiaro (JE) vaccine particularly recommended to?

A

Those traveling to asia with plans to spend extended exposure to the outdoors or spend 1+ month during JE transmission season

51
Q

Malaria: transmission

A

Anopheles mosquito

52
Q

Malaria: classic symptoms

A

Shaking, chills, high fever, flu-like illness

52
Q

Which is the most common malaria species?

A

P. vivax contributes to half of cases in India

53
Q

Which malaria species is the most deadly?

A

P. falciparum

54
Q

Malaria ppx- quick starts (1-2 days prior)

A

Doxycycline daily: Stop 4 wks after travel
Atovaquone/Proquanil: Stop 1 week after travel
Primaquine: stop 1 week after travel. Avoid in G6PD deficiency
Avoid all these in pregnancy

55
Q

Malaria ppx- advance starts (1-2 weeks prior)

A

Chloroquine weekly - stop 4 wks after
Mefloquine: start ≥ 2 weeks prior and stop 4 weeks after
BOTH SAFE IN CHILDREN, PREGNANCY

56
Q

Chloroquine: side effects

A

Retinal toxicity/visual changes

57
Q

Do not use Mefloquine in

A

Underlying psych conditions
Seizures
Arrhythmias

58
Q

Yellow fever: treatment

A

symptomatic relief with fluids, analgesics & antipyretics
ASA and other NSAIDs can’t be used d/t inc risk of bleeding

59
Q

Zika virus: complications

A

Fever, maculopapular rash, arthralgia, conjunctivitis

INFANTS BORN WITH MICROCEPHALY (small head)

60
Q

Acetazolamide: contraindication

A

sulfa allergy

61
Q

Engerix-B

A

Hepatitis B vaccine

62
Q

When should loperamide NOT be used for TD?

A

When bloody diarrhea is present

63
Q

What could interfere with the effectiveness of a dose of Varivax?

A

Systemic antivirals with effectiveness against herpes (Valtrex, Acyclovir) - 24 hrs before or 14 days after
Live vaccines - separate 4 weeks (if not given on same day)

64
Q

The presence of a ESRD would qualify a patient for which of the hepatitis vaccines?

A

Hep B

65
Q

age indications for FluMist?

A

Healthy patients 2-49 yrs old

66
Q

What is an contraindication to receiving the Varicella vaccine?

A

Gelatin or neomycin allergy

67
Q

Vaxchlora

A

Cholera vaccine
Live
Administered orally
Supplied as a powder & reconstituted with water
Stored in freezer

68
Q

Children 6 months to 8 years: Flu vaccine recommendation if they have never received one

A

2 doses, separated by 4 weeks

69
Q

Serogroup meningococcal vaccine is indicated for

A

ages 10-25 years old
exposure to N. meningitidis
asplenia/sickle cell disease
during outbreak season

70
Q

VAQTA, Havrix

A

Hep A vaccines

71
Q

ProQuad

A

measles, mumps, rubella, and varicella

TOP 300 drugs - NAPLEX (12 decks)

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