week 5: Ch. 43 [Immunizing Agents]

Question 1

Immune response occurs when Antigen (a foreign substance) are recognized by:

Answer 1

B or T lymphocytes

Question 2

During ___________ period following exposure, symptoms of infection and tissue injury develop.

Answer 2

incubation`

Question 3

Vaccination is the Introduction of ________________ ____ ___________ to trigger immune response before patient is exposed to pathogen.

Answer 3

foreign cells or proteins

[Boosters, or follow-up doses, may be required to
provide prolonged protection]

Question 4

Active VS passive immunity

Answer 4

*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

Question 5

Four traditional methods are used to produce vaccines:

Answer 5

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]

Question 6

3 most common effects after a vaccination

Answer 6

pain, redness, and swelling at injection site

Question 7

Vaccine Adverse Event Reporting System (VAERS)
▪Conducted by CDC and FDA
▪Limited because it does not attempt to confirm
that reported event was: ?

Answer 7

actually caused by the vaccine

Question 8

Vaccinations expose immune system to : ?

inactive ____________________.

–Immune system will remember protein-based toxin and respond rapidly by producing ____________ to ____________ it.

Answer 8

inactive bacterial toxins.

–Immune system will remember protein-based toxin and respond rapidly by producing antibodies to neutralize it.

Question 9

Several childhood vaccines can be combined into single administration (ex: ? )

Answer 9

DTaP

Question 10

Diphtheria is an upper ____________ ________ infection caused by Corynebacterium diphtheriae

what does it cause?

Answer 10

respiratory tract

▪Toxin causes thick coating across soft palate,
tonsillar areas, and uvula.

Question 11

Diphtheria __________ triggers immune memory without producing the disease in upper airways

Answer 11

toxoid

Question 12

Pertussis is AKA ( ? )

Answer 12

Whooping Cough

Question 13

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

Answer 13

1- negative
2- “whoop”

Question 14

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:

Answer 14

▪Alone, in DT, or DTaP

▪5 doses within the first 6 years of life

Question 15

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+

Answer 15

meningitis, and pneumonia

Question 16

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

Answer 16

1- 24 hours

2- Antibiotics

Question 17

Viral immunization: Viral proteins recognized as foreign by immune system and trigger immune response.

–Recognition takes place through ___________

Answer 17

interferons

Question 18

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).

Answer 18

1- liver

2- surface antigen

Question 19

Prototype drug: Hepatitis B vaccine (Engerix-B,
Recombivax HB)

– Therapeutic classification ?
– Pharmacologic classification ?

Answer 19

Therapeutic classification
▪Vaccine

Pharmacologic classification
▪Vaccine

Question 20

Hepatitis B vaccine (Engerix-B, Recombivax HB)
Therapeutic effects and uses:

Answer 20

▪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

Question 21

Hepatitis B vaccine (Engerix-B, Recombivax HB)
Mechanism of action:

▪HBsAg produced through recombinant DNA
technology using _________ __________
▪Vaccine antibodies _________ over time

Answer 21

▪HBsAg produced through recombinant DNA
technology using yeast cells
▪Vaccine antibodies decline over time

Question 22

Hepatitis B vaccine (Engerix-B, Recombivax
HB)

Adverse effects:

Answer 22

▪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

Question 23

Hepatitis B vaccine (Engerix-B, Recombivax HB)

Contraindications/precautions
Drug interactions
Overdose?

Answer 23

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

Question 24

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]

Answer 24

1- stools

2- hygiene and sanitation

Question 25

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

Answer 25

1

Question 26

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.

Answer 26

winter months.

Question 27

Influenza: Two types of vaccine available –__________ _______ ________ form (TiIV) –____________ vaccine

Answer 27

–Trivalent inactivated subcutaneous form (TiIV) –Quadrivalent vaccine

Question 28

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

Answer 28

50

Question 29

Rabies: Caused by virus that invades______________ ___________; carried in saliva

Answer 29

nervous system

Question 30

Rabies: Mortality rate nearly ______ in unvaccinated people

Answer 30

100%

Question 31

Rabies Immunization ▪Preexposure immunization –?? inoculations ▪Postexposure immunization –?? inoculations over 28-day period

Answer 31

▪Preexposure immunization –Three inoculations ▪Postexposure immunization –Five inoculations over 28-day period

Question 32

_____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

Answer 32

1- Measles 2- Mumps 3- Rubella (German measles)

Question 33

Maternal infection of Measles/Mumps/Rubella during first 12 weeks of pregnancy can cause :

Answer 33

fetal defects

Question 34

Measles, mumps, and rubella Immunization ▪MMR vaccination ▪Live or attenuated virus ▪Immunity rate: 92% to 95% ▪Excluded: ???

Answer 34

–Pregnant women –Immunosuppressed patients –People with allergy to neomycin or gelatin

Question 35

Polio ▪Poliomyelitis replicates in : _____1______ ▪Spread by ________2________ route ▪Leading cause of permanent disability in era before vaccines

Answer 35

1- GI tract 2- oral–fecal

Question 36

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

Answer 36

99% to 100%

Question 37

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

Answer 37

1- chickenpox 2- shingles

Question 38

Varicella Zoster Immunization ▪Live or attenuated vaccine (Varivax) Effectiveness: ?

Answer 38

Wide variation in effectiveness [for some, 1 dose is sufficient, but others require booster shot(s)]

Question 39

Human Papillomavirus ▪Most common __________1____________ disease in United States ▪Associated with : ______2____________ ▪Can cause : _________3___________

Answer 39

1- sexually transmitted 2- cervical cancer 3- genital warts

Question 40

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

Answer 40

1- recombinant DNA technology 2- 100%

Question 41

Rotavirus ▪Mostly found where? ▪Oral-fecal transmission

Answer 41

in developing countries

Question 42

Rotavirus Immunization ▪CDC recommends vaccine administered before 15 weeks of age for prevention of : ???

Answer 42

gastroenteritis ▪Reduced gastroenteritis by 74% and hospitalization by 96%

Question 43

Passive Immunity is very different from active immunity: *Administration of : _________1_________ *Immune system is not activated and _______2________ are not produced.

Answer 43

1- preformed antibodies (immunoglobulins) 2- memory cells

Question 44

Prototype drug: Rho [DM] Immune Globulin (RhoGAM) Therapeutic& Pharmacologic classifications?

Answer 44

– Therapeutic classification ▪Immunizing agent (passive) – Pharmacologic classification ▪Antibody ▪Immunoglobulin

Question 45

Rho [DM] Immune Globulin (RhoGAM) – Therapeutic effects and use: ▪__________________ between mother and her fetus

Answer 45

▪Rh incompatibility between mother and her fetus

Question 46

Mechanism of action of Rho [DM] Immune Globulin (RhoGAM)

Answer 46

▪Suppression of immune response of Rh- mothers to Rh+ fetuses or newborns

Question 47

drug: Rho [DM] Immune Globulin (RhoGAM) – Adverse effects:

Answer 47

▪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

Question 48

Rh [DM] Immune Globulin (RhoGAM) – Contraindications/precautions ▪No drug interactions have been reported. ▪Overdose not reported

Answer 48

▪History of hypersensitivity reaction to human immunoglobulin injection ▪Immunoglobulin A (IgA) deficiencies ▪Severe anemia ▪Disseminated intravascular coagulation (DIC) ▪Hemolysis ▪Renal disease ▪Splenectomy