Week 11: Immunizations and Toxicology Flashcards
How do immunizations work?
By mimicking the antigen that is required for an adaptive immune response
Types of vaccines (3)
- Inactivated (killed) - viral
- Live (attenuated) - viral
- Toxoid (nontoxic) - bacterial
Common post-immunization symptoms
- Immune response occurs: Fatigue, joint pain/aches, fever, swollen lymph nodes
- Injection site reactions: Pain, redness, sore muscles
MMR: Vaccine type, administration schedule, RoA, AE (4), cautions/contraindications (3)
Vaccine type: Live
Administration schedule: 2 doses - 12-15m, 4-6yrs
RoA: SubQ upper arm
AE:
- Localized lymphadenopathy
- Joint stiffness
- Transient thrombocytopenia
- Anaphylaxis
Cautions/contraindications:
- Pregnancy
- Allergy to neomycin or gelatin
- Severe immunocompromise (avoid for 3-6m after IV IgG)
DTaP: Vaccine type, administration schedule, RoA, AE (3), cautions/contraindications (2)
Vaccine type: Inactivated
Administration schedule: Initial 5-vaccine series, then booster Q10years
- 2m, 4m, 6m, 15-18m, 4-6yrs
RoA: IM in deltoid or thigh
AE:
- Crying
- High fever (+febrile seizure)
- Encephalopathy
Cautions/contraindications:
- Anaphylaxis with prior dose
- Any AEs with prior dose
Poliovirus: Vaccine type, administration schedule, RoA, AE, cautions/contraindications (3)
Vaccine type: Oral (live) or IM (inactivated)
Administration schedule: 4 doses - 2m, 4m, 6m, 12-15m
RoA: Oral or IM
AE: Polio-like syndrome with oral RoA (rare)
Cautions/contraindications:
- Allergy to streptomycin, neomycin, and bacitracin
HiB: Vaccine type, administration schedule, RoA, AE, cautions/contraindications
Vaccine type: Inactivated
Administration schedule: 4 doses - 2m, 4m, 6m, 12-15m
RoA: IM to thigh/upper arm
Cautions/contraindications and AE: One of the safest and most well-tolerated vaccines
Varicella: Vaccine type, administration schedule, RoA, AE, cautions/contraindications (6)
Vaccine type: Live
Administration schedule: 2 doses - 12-15m, 4-6yrs
RoA: SubQ upper arm/anterolateral thigh
AE: Mild rash
Cautions/contraindications:
- Could transmit to others (theoretically)
- Avoid in pregnancy, blood CA, allergy to neomycin/gelatin, immunocompromised
Hepatitis B: Vaccine type, administration schedule, RoA, cautions/contraindications
Vaccine type: Recombinant DNA
Administration schedule: 3 doses - birth, 1-2m, 6m
RoA: IM anterolateral thigh
Cautions/contraindications:
- If mom is hepB+, give hep B immune globulin with the first dose
Hepatitis A: Vaccine type, administration schedule
Vaccine type: Inactivated
Administration schedule: 1 dose at 12-23m
- 2nd dose recommended for those that live in or travel to areas of increased risk
Pneumococcal conjugate: Vaccine type, administration schedule, RoA
Vaccine type: Purified polysaccharides of many different strains
Administration schedule: 4 doses - 2m, 4m, 6m, 12-15m
RoA: IM in anterolateral thigh or deltoid
Meningococcal conjugate: Administration schedule, RoA, other guidelines
Administration schedule: 2 doses - 11-12yrs, booster at 16yrs
RoA: IM deltoid
Other guidelines: Recommended for higher-risk populations (military, college freshmen, travel, post-splenectomy)
Influenza: Vaccine type, administration schedule, RoA, cautions/contraindications
Vaccine type: Inactivated or recumbent
Administration schedule: Given annually starting at 6m
RoA: IM or SubQ deltoid
Cautions/contraindications:
- Caution in severe egg allergy
Rotavirus: Vaccine type, administration schedule, RoA, AE (2), cautions/contraindications (3)
Vaccine type: Live
Administration schedule: 3 doses - 6-12wks, then 4-10wks later, then 4-10wks later
RoA: PO to allow replication in the gut
AE:
- Diarrhea
- Intussusception
Cautions/contraindications:
- Uncorrected GI tract malformation
- Severe immunocompromise
- Avoid with moderate/severe diarrhea or vomiting
HPV: Vaccine type, administration schedule, RoA, AE, cautions/contraindications
Vaccine type: Virus-like particles
Administration schedule: 3 doses over 6m intervals starting at 11-12yr
RoA: IM deltoid
Cautions/contraindications:
- Still need annual pap smears
RSV: Vaccine type, administration guidelines (3)
Vaccine type: Monoclonal Ab
Only for special populations:
- Preterm infants
- Congenital heart disease <24m
- Bronchopulmonary dysplasia <24m
Activated charcoal: MoA, cautions/contraindications, other notes (3)
MoA: Irreversibly absorbs drugs/chemicals in GI tract. Cannot be absorbed into blood
Cautions/contraindications: Bowel obstruction/perforation
Other notes:
- Avoid if antidote given PO
- Mix with water, give ASAP
- Most effective within 30 minutes of poison ingestion
Polyethylene glycol: MoA, cautions/contraindications (3), other notes (2)
MoA: Decreases GI transit time, decreases time available for GI absorption prior to fecal excretion
Cautions/contraindications:
- Ileus
- Peritonitis
- Bowel obstruction/perforation
Other notes:
- Effective for iron, lithium, and lead
- Can be given repeatedly PO or NGT
Gastric lavage: MoA, cautions/contraindications
MoA: Flush stomach with fluid (NG tube) then sucking back out
Cautions/contraindications: Decreases HCl in stomach
Methods to accelerate poison removal: Ion trapping
Administration of basic drugs traps acidic substances and vice versa
Methods to accelerate poison removal: Alternating urinary acidity
Lower urinary pH = Inc. basic substance excretion
Methods to accelerate poison removal: Nondrug treatments (2)
Hemodialysis and exchange transfusion
