Vaccines, Antidotes

Question 1

Effectiveness of live attenuated vaccines?

Answer 1

durable immunity but not always as long lasting as that from natural infection

Question 2

Duration of immunity of inactivated vaccines?

Answer 2

months to years

Question 3

Examples of live attenuated

Answer 3

MMR, BCG, rotavirus, smallpox, chickenpox, yellow fever

Fluenz tetra influenza spray

Question 4

Examples of inactivated

Answer 4

influenza, polio, hep A, rabies

Question 5

Examples of detoxified endotoxins (or toxoid)

Answer 5

tetanus, diptheria

Question 6

Exampes of extracted micro-organism

or recombinant DNA

Answer 6

pneumococcal vaccine
hep B vaccine
meningococcal
shingles
HPV
HiB
Whooping cough

Question 7

Schedule for MMR

Answer 7

1 year - first dose (Priorix or MMR VaxPro)

3yrs 4 months - second

Question 8

Diptheria with tetanus

Answer 8

8 weeks - Infanrix hexa - this also covers pertussis hep B poliomyelitis, H. influenzae)
12 weeks - 2nd Infanrix
16 weeks - 3rd infanrix

3yrs 4 months - booster - Repevax

13-18 years - single booster - Revaxis

Question 9

varicella zoster age?

Answer 9

70 years - live vaccine - zostavax likely duration of protection - 7 years
when administered with MMR should be same day or separated by 4 weeks

Question 10

Drugs to stop before surgery

Answer 10

COC pill
MAOI interact pethidine
TCAs potentially (arrhythmias)
K sparing diuretics
ACE/ARB

Question 11

Features of alcohol poisoning and management

Answer 11

ataxia, dysarthia, nystagmus, drowsiness (hypotension and acidosis)

Maintain airway
Reduce aspiration
blood glucose managed

Question 12

Aspirin poisoning features and management

Answer 12

hyperventilation, tinnitus, deafness, vasodilation, sweating
acid-base disturbances are complex

plasma-salicylate concentrations taken
activated charcoal given if more than 125mg/kg of aspirin taken

replace fluid loss
sodium bicarbonate(ensures plasma potassium optimal) to encourage salicylate excretion in urine
haemodialysis for severe poisoning

Question 13

opioid poisoning

Answer 13

coma, respiratory depression, pinpoint pupils
arrhythmias may occur for up to 12 hours
naloxone is antidote (shorter duration of action so may need repeat injection)
buprenorphine effect only partially reversed

Question 14

paracetamol poisoning

Answer 14

hepatocellular necrosis
N+V which settle in 24 hours
right subcostal pain and tenderness (indicates hepatocellular necrosis)

Liver damage maximal 3-4 days after OD - may lead to encepholopathy, haemorrhage, hypoglycaemia, cerebral oedema and death

Acetylcysteine may protect liver if given 24 hours or after

activated charcoal in excess

Question 15

TCA plus related poisoning

Answer 15

dry mouth, coma, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, resp failure, arrhythmias, dilated pupils, urinary retention

Symptomatic treatment - lorazepam, diazepam
Activated charcoal within 1 hour
Correct hypoxia and acidosis
IV bicarbonate

Question 16

Antimalarial poisoning

Answer 16

Quinine, hydroxychloroquine hazardous - features include arrhythmias

Question 17

Antipsychotic poisoning

Answer 17

Phenoziathine related - hypotension, hypothermia, sinus tachycardia complicate poisoning
- prochlorperazine can cause dystonia (treat with injected procyclidine or diazepam)

2nd gen APs - drowsiness, convulsions, EPSEs, hypotension and ECG abnormalities
Activated charcoal in 1 hr plus supportive management

Question 18

BZD poisoning

Answer 18

drowsiness, ataxia, dysarthria, nystagmus, resp depression, coma,
activated charcoal in 1 hour - awake patient with maintained airway
Flumanezil

Question 19

Beta-blockers

Answer 19

therapeutic OD - light-headedness, syncope, dizziness, bradycardia, heart failure may be precipitated or exacerbated
propranolol OD in particular may cause coma and convulsions

Ensure airway is clear with adequate ventilation
IV atropine for bradycardia
glucagon for cardiogenic shock
a cardiac pacemaker can be used to increase the HR

Question 20

Lithium poisoning symptoms, management

Answer 20

Precipitated by factors such as dehydration, deterioration, reduced renal function, infection, diuretics, NSAIDS,
Onset may be 12 hours due to slow entry to tissues
Lithium target 0.4-1mmol/l >2 severe toxicity

apathy, restlessness, confusion,vomiting, diarrhoea, TREMOR, muscle twitching
convulsions, coma, renal failure, hypotension

Treat- increase fluid intake, electrolyte balance, renal function, manage convulsions, gastric lavage within 1 hour. whole bowel irrigation considered in significant OD

Question 21

Iron salt poisoning

Answer 21

N+V, rectal bleeding, abdominal pain, hypotension, hepatocellular necrosis

Mortality reduced with desferrioxamine mesilate which chelates iron. Usually a serum-iron is taken first but not always

Question 22

Stimulant drug poisoning

Answer 22

Diazepam to treat cocaine and ecstasy OD
then specialist help to treat other symptoms
cooling treatment for hyperthermia
MI, arrhythmia

Question 23

Heparin toxicity

Answer 23

Protamine

Question 24

Warfarin

Answer 24

Phytomenadione