week 5: Ch. 43 [Immunizing Agents] Flashcards
Immune response occurs when Antigen (a foreign substance) are recognized by:
B or T lymphocytes
During ___________ period following exposure, symptoms of infection and tissue injury develop.
incubation`
Vaccination is the Introduction of ________________ ____ ___________ to trigger immune response before patient is exposed to pathogen.
foreign cells or proteins
[Boosters, or follow-up doses, may be required to
provide prolonged protection]
Active VS passive immunity
*Active immunity
–Natural: Body produces its own antibodies
–Vaccination-induced
*Passive immunity
–Preformed antibodies transferred from one person to another
–Natural: Mother to child via placenta
Four traditional methods are used to produce vaccines:
Attenuated (live) virus B-cell response
[Risk for disease in individuals with reduced immune function]
Inactivated (killed) virus
[Does not confer lifelong immunity]
Toxoid
[Large quantities of antigen needed]
Recombinant technology vaccine
[Contains no viral genetic material]
3 most common effects after a vaccination
pain, redness, and swelling at injection site
Vaccine Adverse Event Reporting System (VAERS)
▪Conducted by CDC and FDA
▪Limited because it does not attempt to confirm
that reported event was: ?
actually caused by the vaccine
Vaccinations expose immune system to : ?
inactive ____________________.
–Immune system will remember protein-based toxin and respond rapidly by producing ____________ to ____________ it.
inactive bacterial toxins.
–Immune system will remember protein-based toxin and respond rapidly by producing antibodies to neutralize it.
Several childhood vaccines can be combined into single administration (ex: ? )
DTaP
Diphtheria is an upper ____________ ________ infection caused by Corynebacterium diphtheriae
what does it cause?
respiratory tract
▪Toxin causes thick coating across soft palate,
tonsillar areas, and uvula.
Diphtheria __________ triggers immune memory without producing the disease in upper airways
toxoid
Pertussis is AKA ( ? )
Whooping Cough
Pertussis/Whooping Cough
▪Gram-______1______ infection caused by Bordetella
pertussis
▪Cough characterized by inspiratory ____2____
▪Increased incidence in adolescent age group
Immunization: Acellular (aP) form within DTaP
1- negative
2- “whoop”
Tetanus
▪Clostridium tetani spores in soil
▪Toxin produced by C. tetani is one of most toxic substances known
▪Enters PNS and migrates to CNS
Immunization:
▪Alone, in DT, or DTaP
▪5 doses within the first 6 years of life
Pneumococcus
▪Streptococcus pneumoniae
▪Most common cause of bacterial otitis media,
_____________, and _____________
▪Immune health greatly affects progress.
–Immunization
▪PPSV23 is recommended for 65+, or
those with chronic illness ages 2+
meningitis, and pneumonia
Meningococcus
▪Caused by Neisseria meningitidis, a highly virulent
gram-negative, toxin-secreting organism
▪Symptoms often appear less than _____1______ before hospitalization.
▪______2______ if known exposure
–Immunization
▪Recommended for children 2 months - 10 y.o.
▪MenACWY, Hib-MenCY-TT, MPSV-4
1- 24 hours
2- Antibiotics
Viral immunization: Viral proteins recognized as foreign by immune system and trigger immune response.
–Recognition takes place through ___________
interferons
Hepatitis B
▪Can lead to life-threatening ____1____ failure
▪Patients with HBV may develop chronic carrier state > Cirrhosis and/or Hepatic cancer
–Immunization
▪Original HBV vaccine was derived from blood of chronic carriers. [1982]
▪Current vaccine form is hepatitis B______________ 2___________ (HBsAG).
1- liver
2- surface antigen
Prototype drug: Hepatitis B vaccine (Engerix-B,
Recombivax HB)
– Therapeutic classification ?
– Pharmacologic classification ?
Therapeutic classification
▪Vaccine
Pharmacologic classification
▪Vaccine
Hepatitis B vaccine (Engerix-B, Recombivax HB)
Therapeutic effects and uses:
▪All infants at birth
▪All children under 19 who have not been vaccinated
▪Healthcare/public safety workers at risk for exposure to blood on the job & residents & staff of facilities for people with developmental disabilities
▪People engaging in high-risk sexual practices
▪Those who inject drugs
▪Patients with end-stage renal disease
▪Travelers to regions with high rates of HBV infection
▪People with chronic liver disease or diabetes
Hepatitis B vaccine (Engerix-B, Recombivax HB)
Mechanism of action:
▪HBsAg produced through recombinant DNA
technology using _________ __________
▪Vaccine antibodies _________ over time
▪HBsAg produced through recombinant DNA
technology using yeast cells
▪Vaccine antibodies decline over time
Hepatitis B vaccine (Engerix-B, Recombivax
HB)
Adverse effects:
▪Pain at injection site
▪Mild to moderate fever
▪Adults
–Fatigue, dizziness, fever, diarrhea, headache
▪Children
–Irritability, fever, diarrhea, fatigue, weakness,
diminished appetite, rhinitis
– Serious adverse effects
▪Anaphylaxis
▪Guillain-Barré syndrome is rare
Hepatitis B vaccine (Engerix-B, Recombivax HB)
Contraindications/precautions
Drug interactions
Overdose?
Contraindications/precautions:
▪Hypersensitivity to yeast or any component of the
vaccine
▪Severe cardiopulmonary impairment
▪Pregnant or lactating women
Drug interactions:
▪Hepatitis B immunoglobulin can impair
development of immunity
▪Immunosuppressant drugs may require higher
dose of vaccine.
Overdose not reported
Hepatitis A
▪Acquired through contact with _____1______ of infected person
▪Good personal ___________2____________ can prevent HAV infection.
▪Symptoms age-dependent [children more at risk due to hygiene]
1- stools
2- hygiene and sanitation
Hepatitis A Immunization
▪HAV vaccine recommended for:
–Children at age _____
–Travelers to regions where HAV is endemic.
–Illicit drug users
–Individuals with clotting factor disorders
–People with chronic liver disease
–Family and caregivers of recent adoptees from
countries where HAV common
–Men who have sex with men
1
Influenza: Respiratory disease spread by the 3 forms of influenza virus
–Type A causes seasonal outbreaks during _________ ___________
–Types B and C less common
▪Once outbreak occurs, immunization no longer
effective and pharmacotherapy of active infection
may be initiated.
winter months.
Influenza: Two types of vaccine available
–__________ _______ ________ form (TiIV)
–____________ vaccine
–Trivalent inactivated subcutaneous form (TiIV)
–Quadrivalent vaccine
Influenza Immunization
▪Annual vaccines recommended for:
–All children ages 6 through 59 months
–Everyone over ______
–Residents of nursing homes/long-term care
–Obese people
–chronic conditions such as asthma, diabetes, or heart disease
–Anyone whose immune system is compromised
–pregnant during flu season
–Healthcare providers
–Household contacts (including children) and caregivers of individuals at high risk of acquiring influenza
50
Rabies: Caused by virus that invades______________ ___________; carried in saliva
nervous system
Rabies: Mortality rate nearly ______ in unvaccinated people
100%
Rabies Immunization
▪Preexposure immunization
–?? inoculations
▪Postexposure immunization
–?? inoculations over 28-day period
▪Preexposure immunization
–Three inoculations
▪Postexposure immunization
–Five inoculations over 28-day period
_____1_______ one of most contagious viruses, readily transmitted by airborne particles and respiratory secretions
_____2______ transmitted through contaminated saliva; Infection self-limiting and mortality rare
_______3______ spreads through infected aerosol droplets
1- Measles
2- Mumps
3- Rubella (German measles)
Maternal infection of Measles/Mumps/Rubella during first 12 weeks of pregnancy can cause :
fetal defects
Measles, mumps, and rubella Immunization
▪MMR vaccination
▪Live or attenuated virus
▪Immunity rate: 92% to 95%
▪Excluded: ???
–Pregnant women
–Immunosuppressed patients
–People with allergy to neomycin or gelatin
Polio
▪Poliomyelitis replicates in : _____1______
▪Spread by ________2________ route
▪Leading cause of permanent disability in era
before vaccines
1- GI tract
2- oral–fecal
Polio vaccine
▪Vaccine developed by Dr. Jonas Salk in 1950s
▪Provides ___________ immunity
▪IM route, but oral vaccine still used in parts of
world where polio is endemic
99% to 100%
Varicella Zoster
▪Transmitted via inhaled droplets or by direct contact with infectious skin lesions
▪Infection by varicella zoster leads to : ____1_______
▪After initial infection, virus hides in spinal nerves
where it remains dormant.
–Can reactivate as ____2______, usually after age 50
1- chickenpox
2- shingles
Varicella Zoster Immunization
▪Live or attenuated vaccine (Varivax)
Effectiveness: ?
Wide variation in effectiveness
[for some, 1 dose is sufficient, but others require booster shot(s)]
Human Papillomavirus
▪Most common __________1____________ disease in
United States
▪Associated with : ______2____________
▪Can cause : _________3___________
1- sexually transmitted
2- cervical cancer
3- genital warts
Human Papillomavirus Immunization
▪Vaccine created using: _____________1__________
–Close to ___2____ effective in preventing infection
–CDC recommends routine vaccination of boys
and girls at 11 - 12 years of age
1- recombinant DNA technology
2- 100%
Rotavirus
▪Mostly found where?
▪Oral-fecal transmission
in developing countries
Rotavirus Immunization
▪CDC recommends vaccine administered before 15 weeks of age for prevention of : ???
gastroenteritis
▪Reduced gastroenteritis by 74% and
hospitalization by 96%
Passive Immunity is very different from active immunity:
*Administration of : _________1_________
*Immune system is not activated and _______2________ are not produced.
1- preformed antibodies (immunoglobulins)
2- memory cells
Prototype drug: Rho [DM] Immune Globulin (RhoGAM)
Therapeutic& Pharmacologic classifications?
– Therapeutic classification
▪Immunizing agent (passive)
– Pharmacologic classification
▪Antibody
▪Immunoglobulin
Rho [DM] Immune Globulin (RhoGAM)
– Therapeutic effects and use:
▪__________________ between mother and her fetus
▪Rh incompatibility between mother and her fetus
Mechanism of action of Rho [DM] Immune Globulin (RhoGAM)
▪Suppression of immune response of Rh-
mothers to Rh+ fetuses or newborns
drug: Rho [DM] Immune Globulin (RhoGAM)
– Adverse effects:
▪Low-grade fever
▪Hypersensitivity reaction
▪Bruising, lower back pain
▪Nausea
▪Local swelling, redness, mild pain at injection site
▪Polydipsia
▪Vomiting
▪Malaise
▪Increased risk of bleeding
▪Weight gain
▪Anemia
▪Anorexia
▪Disseminated intravascular Coagulation (DIC)
▪Dyspnea
▪Dysuria
▪Edema
▪Hematuria
▪Hemolysis
▪Hypertension
Rh [DM] Immune Globulin (RhoGAM)
– Contraindications/precautions
▪No drug interactions have been reported.
▪Overdose not reported
▪History of hypersensitivity reaction to human
immunoglobulin injection
▪Immunoglobulin A (IgA) deficiencies
▪Severe anemia
▪Disseminated intravascular coagulation (DIC)
▪Hemolysis
▪Renal disease
▪Splenectomy
