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Peds and Geriatrics > Week 3 > Flashcards

Week 3 Flashcards

1
Q

dfine immunizarion

A

process of infucing/ providing immunity artificially by administering an immonobiologic agent

can be done passively or actively

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2
Q

passive immunity:

A

ex: IG
palivizumab

provides temporary immunity in an unimmunized person prior to or after exposure to an infectious disease

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3
Q

active immunity:

A

ex: vaccines

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4
Q

categories of vaccines

live attenuated

A

MMR
rubella
varicella
rotavirus
LAIV ingluenza
polio (OPV)
zoster (ZVL)

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5
Q

categories of vaccines

toxoids

A

diptheria

tetanus

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6
Q

categories of vaccines

inactivated

A

hepatitis A

influenza IIV

pertusis

polio (IPV)

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7
Q

categories of cvaccines

recombinnant

A

Hep B

HPV

RZV

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8
Q

categories of vaccines

conjugated/ polysaccharide

A

Hib

meningococcal

pneumococcal

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9
Q

ultimate goal of vaccines

A

eradification

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10
Q

guidelines for spacing of live and inactivated vaccines

A

> 2 inactivated: can be given at same time or at any interval between doses

inactiated + live: can be given at same time or anytime

> /2 live parenteral: 28 day min interval, if not administered simultaneously

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11
Q

not vaccinating on schedule consequences

A

too soon: reduce antibody response

too late: delayed protection

vaccine dose adminstered >5 days before the minimum dosing intervalor age should not be counted as valid doses and should be repeated as age appropriate

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12
Q

when should immunization be avoided

A

mod-severe illnedd

hx of typ1 anaphylaxis ANA

immunodeficiencies apples to live attenuated vaccines) leukemia, malignancy, hiv, chemo, redioation, prednisone

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13
Q

vaccination and pregnancy

A

live atewnnuated vaccine CI

recommended: influenze LIV, Tdap, covid 19

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14
Q

vaccine interactions

A

chemo/radiation (live virus vaccines)

vaccinate 2 weeks b4 or 3 mo after

systemic coticosteroids (live virus vaccines)
*high dose treatment for an extended duration >/2 mg/kg/d or >/20 mg/d prednison for >/14 days

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15
Q

when is it ok to vaccinate child during CTS trt

A

topical therapy or local injections

physiologic maintenance theraoy

low/mod systemic cts daily or on alternate days

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16
Q

when is it okay to vaccinate following cts treatment

A

high dose of systemic cts (2mg/kg) giben orally or on alternate days for fewer than 14 days. canvaccinate immediately following d/c or wait~2 eeks (14 days

high doses of systemic coticosteroids (2mg/kg) given daily or on alternate days for 14 days or more. must wait >1 month to vaccinate

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17
Q

ivig effects on vaccination

A

ivig should not be admin for 14 days after immunization.

if needed in <14 days, need to readminster vaccine

post ivig, vaccine shouls not be given <3 months post ivig. following high dose ivig fo rtrt of kawasaki disease, hold live vaccines for 11 months

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18
Q

ppd and live vaccines

A

live vaccines can supress tb skin tests

must be given simultaneously or wait 4-6 weeks to place ppd

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19
Q

antivirals and vaccination

A

may decrease effectiveneess of LAIV

avoid use 14 days after LAIV

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20
Q

inactivated and activated vaccine SS

A

inactivated
injectin site reactions w. or w.o fever

inflammtory reponse

welling redness pain

sq>im

activates: mild form of natural illness, tiredness

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21
Q

vaccine myths

diseases that vaccines prevent are not serious

A
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22
Q

Vaccine overview

Disease(s) covered:
diptheria, tetanus, pertussis

Etiology:

Vaccine(s) available):

Vaccine Schedule:

Adverse effects:

Vaccine precautions:

Contraindications

A

Vaccine overview

Disease(s) covered:
a. Diptheria
b.Tetanus
c) Pertussis

Etiology:
a: corynebacterium diptheriae
b. Clostridium tetani (ubiquitous): causes muscle regidity and spasms.
c)Bordetella pertusis: whooping cough- very contagious

Vaccine(s) available):
1. DTap (infanrix, Daptacel) : use in children
2.Tdap (Adacel, Boostrix)
3. Td Tenivac, Tdvax)
4. DTAP+IPV (kinrix)
5.DTap +IPV+Hib (Pentacel)
6.DTap+IPV +HebB (pediarix)
7. DTaP+IPV+Hib+Heb B (Vaxelis

Vaccine Schedule:
DTap: 5 doses
*2,4,6 months
*15-18 months
*4-6 years

Tdap: 1 dose@11-12 y.o
followed by Tdap or Td booster q10 years and during every pregnancy regardless of when the most recent dose was given

Adverse effects:
local reaCTIONS(redness, swelling, pain
fever

Vaccine precautions:
hx of arthus type hy[ersensitivity reactions
unstanle progressive neurologic problem/uncontrolled seizures

Contraindications:
severe allergic reaction
hx of encephalopathy

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23
Q

Vaccine overview

Disease(s) covered: Haemohpalus influenze type B

Etiology:

Vaccine(s) available):

Vaccine Schedule:

Also recommended for:

Adverse effects:

Vaccine precautions:

Contraindications

A

Vaccine overview

Disease(s) covered:
Haemophilus influenzae type B

Etiology: most common cause of childhood bacterial meningitis pre -vaccination

Vaccine(s) available):
Hib:( ActiHib, Hiberix, Pedvax Hib)
DTap +IPV+Hib (Pentacel)
DTaP+IPV+Hib+Heb B (Vaxelis

Vaccine Schedule:
2months, 4 months, and 12 -15 months (6 mo dose permissible if combo vaccine is used)

Also recommended for: high risk pts >12-15 mo old recieving chemo/radiation, immunodeficient, asplenia (including sicklecell)

Adverse effects:
local reactions, fever

Vaccine precautions: –

Contraindications: severe alergic reactions

24
Q

Vaccine overview

Disease(s) covered: Hep A

Etiology:

Vaccine(s) available):

Vaccine Schedule:

Also recommended for:

Adverse effects:

Vaccine precautions:

Contraindications

A

Vaccine overview

Disease(s) covered: HEp A

Etiology:

Vaccine(s) available):
HVA:Havrix, Vaqta
HVA+HVB: Twinrix

Vaccine Schedule:
HVA vaccine: all children 12-23 month
2 doses given months apart.
*can be given from 6-12 months if in high risk group

HVA+HVB: >/18 y.o high risk groups. 3-4 dose series (high risk groups such as chronic liver disease, clotting factor disease, MWHSWM injection or non injection drug use, homelessness, work w. ppl w. HVA, internatinal travel)

Also recommended for:

Adverse effects: injection stie sorenss and headache

Vaccine precautions:

Contraindications: severe allergy

25
Q

Vaccine overview

Disease(s) covered: HBV

Etiology:

Vaccine(s) available):

Vaccine Schedule:

Also recommended for:

Adverse effects:

Vaccine precautions:

Contraindications

A

Vaccine overview

Disease(s) covered: HBV

Etiology:

Vaccine(s) available):
Hep b: recombivax HB,Engerix-B
6.DTap+IPV +HebB (pediarix)
DTaP+IPV+Hib+Heb B (Vaxelis)
HVA+HVB: Twinrix

Vaccine Schedule:
3 doses
I.at birth (based on cdc recommendations)
II.1-2 months
III.6-18 months

Also recommended for:

Adverse effects: local pain, fatigue, low grade fever

Vaccine precautions:

Contraindications: severe allergic reactino

26
Q

when to give Hep B based on maternal hep b status

A

Maternal sttaus negative:
>/2 kg: vaccine only w.in 24 hours of birth
</2: admin at 1 month or at baby discharge

Maternal sttaus unkown:
>/2 kg: vaccine only w.in 12 hours of birth
</2: vaccine AND HBIG within 12 hours at birth, then 3 additional doses starting at 1 mo

Maternal sttaus positive:
>/2 kg: vaccine and HBIG w.in 12 hours
</2: vaccine and HBIG w. in 12 hrs of birth, then 3 additional doses starting at 1 month

also note: when mom is hbv positive, baby should be tested at 9-12 months

27
Q

Vaccine overview

Disease(s) covered: HPVV

Etiology:

Vaccine(s) available):

Vaccine Schedule:

Also recommended for:

Adverse effects:

Vaccine precautions:

Contraindications

A

Vaccine overview

Disease(s) covered: HBV

Etiology: most common std in us causing genital warts. can cause cancer

Vaccine(s) available):
HPV: Gardisil 9

Vaccine Schedule:
if started 9-14: 2 dose series 6-12 months between eachother
>15: 3 dose series, first dose 1-2 months after 1st, then 6 months after second

Also recommended for:

Adverse effects: well tollerated

Vaccine precautions: pregnancy

Contraindications: hypersensitivity

28
Q

Vaccine overview
Influenza type A and B

Etiology:

Vaccine(s) available):

Vaccine Schedule:

Also recommended for:

Adverse effects:

Vaccine precautions:

Contraindications

A

Vaccine overview

Disease(s) covered: HBV

Etiology:

Vaccine(s) available):
trivalent (protect against 2 strains of type a and 1 strain of type b
quadrivalent: cover for 2-A strains a 2 b strains

inactivated vaccines that can be used in >6 mo: afluria, fluarix, flulaval, fluzone

Flumist: LAIV: age 2-49

Vaccine Schedule:
IIV: 6 months and older annually

LAIV: 2-49 y.o annually

NOTE: pts. <9 y.o who are receiving their first lifetime dosecan recieve flu vaccine in 1-2 doses seperated by 4 weekss

dose: 6-35 mo. .25-0.5 mL IM in one or 2 dose
3-8 years: 0.5 mL IM
>/9: 0.5 ML one dose

Also recommended for:

Adverse effects:
IIV: local reactions
LAIV: rhinorrhea

Vaccine precautions:
IIV/LAIV: history of GBS w.in 6 weeks of previous vaccination
LAIV: asthma >5 y.o; underlying medical conditions that increase influenza related complications; mod-severe illness.. other

Contraindications
vaccine allergy
LAIV: <2 y.o, adults >/50, pregnancy, healthcare workers that provide care to immunocompromised pts, asplenia, children 2-4 w. asthma or h/o wheezing in past 12 months

note: EGG ALLERGY NOT CI TO INFLUENZA VACCINATION

29
Q

Vaccine overview

Diseases covered: MMR

Etiology:

Vaccine(s) available):

Vaccine Schedule:

Also recommended for:

Adverse effects:

Vaccine precautions:

Contraindications

A

Vaccine overview
Diseases covered:
a) measles
b)mumps
c)rubella

Etiology:
a) rash, flat red spots.
b)rash
c)”german measles” congential rubella syndrome

Vaccine(s) available):
MMR
Proquad (MMR+V)

Vaccine Schedule:
2 doses:
1 @12 months
2@ 4-6 years

Pearl: admin pearl: for proquad. dose 1 of MMR+V can be adminstered as seperate vaccinations
if traveling to an area with measles
age 6-12 months: give b4 travel
>/12 months: give 2 doses of mmr >/4 weeks to travel
THESE DO NOT COUNT AS ONE OF THE SCHEDULED REG DOSES OF MMR

mups outbreaks: 3rd dose of mmr recommended

Adverse effects:
fever, rash, febrile seizures in pts who took MMRV vaccine

Vaccine precautions:

Contraindications
hypersensitivity
pregnancy
immunosupression
postpone vacination 1 mo following d/c og high dose CTS >/14 days

postpone vaccination several months after IVIG

30
Q

Vaccine overview
varicella

Etiology:

Vaccine(s) available):

Vaccine Schedule:

Also recommended for:

Adverse effects:

Vaccine precautions:

Contraindications

A

Vaccine overview

Etiology: chicken pox

Vaccine(s) available):
Varivax
Proquad MMR+V

Vaccine Schedule:

2 doses:
1@12 mo
2@4-6 years

Also recommended for:

Adverse effects:
maculopapular rash
injection site reactions
fever
transmission of varicella

Vaccine precautions:
avoid use of antivirals 14 days after vaccination if possible

Contraindications
pregnancy
immunosupression
postpone vaccination 1 month after high dose cts >/14 days
posptpone vaccination several months after ivig

31
Q

Meningococcus

available

schedule

A

menvea>/2 mo

Menactra >/9 months

schedule:2 doses
i1@11-12 doses: booster at 16
if dose 1 given at 13-15, booster at 16-18
if dose 1 given at >16: no booster needed

vaccination also recommended in immunocompromised, sicklecell,

meningococcal b vaccines not for routine use. can use in high risk pts

vaacine vaccine interactions:

menactra and PCV13: admin after 4 weeks of completion of pcv13

menactra and dtap: admin menactra before or concaminantly w.dtap

no interactions with manveo

32
Q

Vaccine overview

Etiology: INVASIVE PNEU OCOCCUS

Vaccine(s) available):

Vaccine Schedule:

Also recommended for:

Adverse effects:

Vaccine precautions:

Contraindications

A

Vaccine overview

invasive pneumococcus

Etiology:

Vaccine(s) available):
Prevnar (PCV13): conjugate vaccine
pneumovax: polysaccharide vaccine

Vaccine Schedule:
2,4,6, months, then 12-16 months

also pts w. high risk conditions

also giver to immunocompromised,

Also recommended for:

Adverse effects:

Vaccine precautions:

Contraindications

33
Q

pneumococcal vaccinairion in high risk pts age 2-5

A

determine if pcv13 series finished.

yes: and recieved 1 dose of ppsv23: no further interventin

not complete:
a) h/o 3 doses: give 1 dose of ppcv13 8 weeks apart, then 1 dose of ppsv23
b)h/o<3 doses: 2 doses pcv13 >8 weeks apart
—– then determine if they recieved ppsv23
if yes: no further intervention
if not: look at risk factors:

chd, cld, dm, csf leak, cochlear implant, high dose corticosteroids… give 1 dose of ppsv23

if immunocompromised: give 1 dose of ppsv23 >8 weeks after pcv13and then 2nd dose 5 years later

34
Q

pneumoccoal vaccine in high risk pts ages 6-18 months

A

chd, cld dm: recieve ppsv23 after pcv13

csf, cochlear implant: need 1 dose of pcv13 , 1 dose of ppsv23 8 weeks later

immunocompromised, and crf: need 1 dose pcv13 and 2 doses ppsv23 ( 1 8 weeks after , then 5 years later)

35
Q

poliomyolitis vaccine schedule

A

available vaccines:

IPV : IPV( IPOL)
4. DTAP+IPV (kinrix)
5.DTap +IPV+Hib (Pentacel)
6.DTap+IPV +HebB (pediarix)
7. DTaP+IPV+Hib+Heb B (Vaxelis

schedule:
2 months
4 months
6-18 months
4-6 years

CI: polymyxin, neomycin

36
Q

rota virus:

A

LAIV:
rotateq:
rotarix:

schedule:
rotarix: 2.4 months
rotateq: 2,4,6 mo

MUST BEGIN B4 15 WEEKS: do not start if >/15 weeks

MUST COMPLETE BY 8 MONTHS, 0 days

pt should recieve same brand. if not available and any dose of the series was rotateq, default should be 3 doses

CI: LATEX ALLERGY w. roatrix
SCID
HX OF INTUSSICEPTION (folding of bowel)

37
Q

covid vaccination

A

recommended in all children and adolescencts >6 mo
pfizer and moderna

novavaz: >12 years old

3 dose series with 3rd dose being bivalent

storage of pfizer: stored in ultracold freezer
moderna: cold freezer

AE: pain, fever, fatigue and sleepiness, irritability and crying

38
Q

covid vaccine color caps

A

bivalent for children 12-17.
pfizer: grey cap
moderna: blue cap/ grey label

bivalent for 6-11 years
pfizer: orange cap
moderna: blue cap grey label

bivalent for 6mo-4 years:
pfizer: maroon cap
moderna: dark pink cap yellow label

39
Q

dehydration in peds

A

intake of fluid less than loss of fluids

40
Q

causes of dehydration

A

fever

GI losses: viral Gastroenteritis
bacterial/parasitic infections
DKA
etc.
sweating/heat/burns
polyurica DKA

41
Q

does dehydratin occur more quicikly in neonayes/infants or adults

A

neonates

42
Q

degree of dehydration:

mild

percent
pulse:BP
UO
mucose
skin tueger

A

mild:
infants: 1-5%
older children: 1-3%

generally normal SS with decreased UO and slightly dry mucosa

moderate:
infants: 6-9%
4-6%

tachycardia, normal to low bp, little to no output (<1 ml/kg), dry and sukin appearance, thirsty. cool skin

severe: infants: >10 (>15% shock)
older children>6 %: >9% shock

rapid and weak pulse

oligouria «1mL/kg/hr

43
Q

how to calculate severeity of dehydration

A

preilness weight-illness weight / preillness weight

44
Q

treatment strategies for fluids

mild-mod

A

mild-mod

oral rehydratino therapy
*50ml/kg over 4 hr
mod: 100 ml/kg

add 10ml/kg fpr each loose stool/ vomiting

45
Q

trt strategy for severe =

A

IVF

phase 1: intial replacement
*IVF bolud
10-20 ml/kg/dose of NS or LR over 30-60 min repeated up to x3

phase 1: miaintenance
*first 8 hours: calculate deficit
next 16 hours: calculate and provide maintenance rae

46
Q

building an ivf bag

A
  1. sodium: must be included to avoid hyponatremia, sodium shifts: ns
  2. dextrose: d5w
  3. potassium: standard conc 20meq/L (dont use if concernfor renal impairment)

additonal electrolytes: mag, phosphate, calcium

negative ions: standard Chloride

47
Q

maintenance rate for IVF

A

wieght: < 10 kg: 4mL/kg/hr
10-20: 4 ml/kg/hr +2ml/kg/hr
>20 kg: 60 ml/hr+1ml/kg/hrx (weight-20kg)

48
Q

outpt trt of gastroenteritis in children

A

ondansentron:
use in pts >6 months of age

probiotics: help reestablish normal intestinal flora

zinc:replace nutrient defriciency if that were cause: dose expressed in elemental zinc

49
Q

Methods to assess adequate nutrition

A

Weight

Length (or height)

50
Q

failure to thrive

A

wiehgt for age <5th percentile on multiple occasions

51
Q

breastmilk nutritional content

A

20kcal/oz

breastfeeding recommended w.in first6 mo of life

52
Q

itamin-mineral supplementation

A

vit. D

fluoride: >6 months 0.5mg/day

iron: start at 4 months

53
Q

diet of peds:

A

solids starts 4-6 months of age

toddlers: regular diet

54
Q

GER

A

tratment: nonpharm: supine position, small voluume of food mroe frequently
us ehigher caloric density formula

55
Q

GERDS in peds

A

trial of acid supressin not recommended in dx of GERD

TRT: lifestyle modifications

pharm:
H2RAs: maintnenance for mild gerd
ae: tolerance

PPIs: maintenance for mild-severe
mor pptent: cyp polymorphisms: change sin cyp2c19 and 3a4. more metabolism , so children need more frequent dosing

prokinetic agents (metaclopromide etc.

antacids prn

Peds and Geriatrics (5 decks)

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