PHARM: VACCINATIONS/ANTIVIRAL DRUGS
PNEUMOCOCCAL VACCINES PCV 13 -Conjugated to nontoxic diptheria toxin to improve immunologic response in children < ___ years of age -___ dose series with a booster at ___ months -Certain high risk groups receive 1 dose followed by PPSV23 ___ weeks later -PCV 13= given in __, __, __ mo age PPSV23 -Poor i____ response in children -1 dose recommended at ___ years -High risk patients may receive ___ doses between age 19-64, ___ year interval between doses recommended. -PCV 23= 1 dose at 65 or high risk patients: immunocomp, COPD, asthma, c____, cardiac dz
-2 -3, 12 -8 -2, 4, 6 -immune -65 -2, Five -cancer
VACCINATION TIMING BIRTH-15 MO -pneumococcal conjugate (PCV-13) -first dose at ___ mo -second dose at ___ mo -third dose at ___ mo -inactivated polio -first dose at ___ mo -second dose at ___ mo -third dose at ___ mo-___ mo (like hep B) -influenza -if first flu shot for a child (birth-15 mo-6 years ) they get 2 doses ___ mo apart *** -after that, just ___ dose yearly
-2 -4 -6 -2 -4 -6-15 -1 -one
INACTIVATED VACCINES CONT. Polysaccharide Vaccines: Pure polysaccharide -Not consistently immunogenic in children younger than ___ years -No b____ response (repeat doses of polysaccharide vaccines usually do not cause a booster response.) -Antibody with less functional activity (response Ig___ and little Ig___) -Types: p____, m____, s____ Typhi (Vi) Conjugate polysaccharide -Improves upon immunogenicity (the ability of a molecule or substance to provoke an immune response). ___ cell dependent -Types: Haemophilis influenzae type ___ (Hib), p___, m___
-2 -booster -IgM, IgG -Pneumococcal, Meningococcal, salmonella -T -B, Pneumococcal, Meningococcal
UNCOMPLICATED INFLUENZA -Symptoms should gradually improve over __-__ days, lasting up to ___ days -Post flu symptoms of f____ can persist for up to several weeks -a lot of flu care is just s____ care: fluids, rest, Tylenol, ibu COMPLICATIONS OF INFLUENZA -p____- influenza and secondary bacterial -m____itis and r____lysis (muscle breakdown)- reported most frequently in children
-2-5, 10 -fatigue -supportive -Pneumonia -Myositis, rhabdomyolysis
HUMAN PAPILLOMAVIRUS- Two HPV vaccines licensed -Gardasil- Quadrivalent HPV (HPV4- ___ strains) -Contains types ___ and ___ (high risk-cervical cancer) and types ___ and ___ (low risk-genital warts) -Approved for use in females and males age __-__ years -If female reaches 26 years of age and vaccine series is not complete re____ doses may be administered -3 injections at __, __ and __ months apart (months apart, not of age) -HIGHER OR LOWER titrers of HPV-16 and HPV-18 -Cervarix- Bivalent HPV (HPV2- 2 strains) Contains type ___ and ___ -Approved for use in females only age __-__ (cuz just cervical cancer) -3 injections at __, __ and __ months apart -HIGHER OR LOWER titers of HPV-16 and HPV-18
-4 -16, 18, 6, 11 -9-26 -remaining -0,2, and 6 -lower -16, 18 -10-25 -0,1, and 6 -HIGHER
DRUGS THAT BLOCK DNA SYNTHESIS FROM VIRAL DNA -Active against H___ family of viruses: Guanosine analogs -acyc____ -vala____ -pen____ -fami____ -gan____ -valgan____ Cytosine analog -cid____- for resistant herpes strains
-herpes -Acyclovir -Valacyclovir -Penciclovir -Famiciclovir -Ganciclovir -Valganciclovir -Cidfovir
BENEFIT TO ANTIVIRAL THERAPY -When initiated early (within ____ hours to 3 days) neuraminidase inhibitors orbaloxavir can shorten duration of symptoms ½ to ___ days -Therapy may reduce s___ of symptoms and com____ development WHO SHOULD GET THERAPY -Patient h____ with influenza -Outpatients with s____ or progressive illness -Outpatients at ____ risk for complications -Should initiate within ___h of symptom onset (you can within 72 but its not as effective. def not after 72 hours)
-48, 3 -severity, complication -hospitalized -severe -high -48h
MULTIPLE TYPES OF INFLUENZA VACCINES Egg-based -Live attenuated (LAIV) -2-49 years of age (WE DONT USE THIS ONE ANYMORE) -Inactivated (IIV) -^^ Standard dose IM: >___ months of age -^^ High dose IM: ≥___ years of age -^^ Standard dose IM: 18-__ years of age Non egg-based -Cell culture (ccIIV) -≥___ years of age -^^ Still contains some e___ protein -Recombinant (RIV) -18-____ years of age -^^ Expiration date is ___ weeks -non egg based are Able to be produced more q___
-6 -65 -18-64 -18 -egg -49 -16 -quickly
TYPES OF INFLUENZA VACCINES -Standard dose quadrivalent IIV's (inactive)-approved for > ___ mo-___ years -Standard dose quadrivalent LAIV (live)- intranasal vaccine for ages 2-49 years of age. this is not used anymore. if see this on test, not the right answer******** -High dose trivalent IIV (inactive)- adults > or equal ____ years...ederly ANTIVIRALS -Three classes used in treatment of flu -Neuraminidase inhibitors- zana____, oselt___***, pera___ -Selective cap dependent endonuclease- balo___ (for resistant) -Adamantanes-amant____ and rimant____ (these are not used anymore)
-6months-64 -65 -zanamivir, oseltamivir, peramivir -Baloxavir -amantadine, rimantadine
INFLUENZA Trivalent inactivated influenza vaccine contains three inactivated viruses: type ___ (H1N1, type A (H3N2) and type ___ -Pediatric, adult and Fluzone High dose (this one is for persons ___ years and older) -Grown in chicken e____ Live attenuated influenza vaccine -Grown in chicken e____ -Nasal spray approved for healthy, non-p___ persons 2-___ years of age (WE DONT USE THIS ONE ANYMORE) -Vaccinated children can shed vaccine viruses in nasopharyngeal secretions for up to ___ weeks
-A, B -65 -eggs -eggs -pregnant, 49 -3
INFLUENZA -Seasonal influenza is caused by influenza ___ or ___ viruses. -Transmitted in respiratory s____ by sneezing and coughing -Incubation period is one to four days (average ___ days). how long it takes before sx may start to appear -Viral shedding can occur 24 h before symptoms but at much lower viral load then while symptoms, average duration of the flu is ___ days SYMPTOMS -Abrupt onset of f___, __ __, m___algia and mala___ along with nonproductive c____, ___ throat, nasal dis____ -Some patients have af____ illness similar to a cold and with others, systemic symptoms predominate over r____ ones. this is why the flu vs. cold is diff to diagnose
-A, B -secretions -2 -5 -fever, headache, myalgia, malaise, cough, sore, discharge -afebrile, respiratory
-____ immunity: Protection that is produced by the person's own immune system. This type of immunity is usually permanent. -____ immunity: Protection by products produced by an animal or human and transferred to another human, usually by injection. -Passive immunity often provides effective protection, but this protection wanes (dis____) with time, usually within a few weeks or months. -example of passive: b___ feeding
-Active -Passive -disappears -breast
Nucleotide analogs -ade____- does not require phosphorylation to become active and work -^^^ FDA approved for treatment of chronic active infections in h___ __ -teno____- hydrolysis then phosphorylation -^^^ H__ __ treatment and h___ __ --------------------------------------------- -riba____- purine nucleoside analog. Phosphorylated intracellularly by host cell enzymes -Ribavirin aerosol- treatment of __ __ __ (childhood resp virus) -Ribavirin plus peginterferon - for h___ __ ***
-Adefovir -HepB -Tenofovir -HIV, Hep B -Ribavirin -RSV -Hepatitis C
MONOCLONAL ANTIBODIES -Produced from a single clone of ___ cells -Antibody to ___ antigen or closely related antigens -Used for diagnosis of certain types of C____, treatment of C___, prevention of t____ rejection, and treatment of auto____ disease -Palivizumab (sy____) available for the prevention of __ __ __. resp virus for peds -only used for pr____, only used in select few. not everyone. bc its expensive and hasn't been shown to prevent RSV in every child (only for very sick kids, congential l___ dz, congenital h___ dz)
-B -one -cancer, cancer, transplant, autoimmune -Synagis, RSV -prevention -lung, heart
Inhibitors of Viral Attachment, Uncoating or Release -doco____ -aman____ -riman____ -oselta_____ -zana____ -pera____ -these often work with the f____
-Docosanol -Amantadine -Rimantadine -Oseltamivir -Zanamivir -Peramivir -flu
-fos____- an inorganic phosphate analog -Directly inhibits DNA and RNA polymerases and reverse transcriptases- 100 x greater effect on viral vs human DNA polymerase (more t____ therapy) -Does not require phosphorylation to work- b____ spectrum activity -Active against all h____ viruses, in____, and H__ __ -Primary uses: __ __ __ infections, acyclovir resistant h___ s___ or v___ z___*** -Infusion in SMALL OR LARGE volume of fluid -N____tox- dose limiting in 10-25% of patients who already have underlying kidney disease -Increased risk with ampho____ B and amino____ (any nephrotoxic drugs)
-Foscarnet -targeted -broad -herpes, influenza, HIV -CMV, herpes simplex, varicella zoster -large -Nephrotoxicity -amphotericin, aminoglycosides
STORAGE OF VACCINES -stored ____: -58°F to +5°F (-50°C to -15°C) -^^^ ____ vaccines (i.e., v___, zoster, __ __ __) -stored ____: 35°F to 46°F (2°C to 8°C) -^^^ ____ vaccines -Storage and h___ errors (from manufacturer) -Reduced potency and efficacy, Increased c____ in wasted vaccine -t/f: It is better to not vaccinate than to administer a mishandled vaccine...if u admin mishandled one ur not giving something that is effective
-Frozen -Live, Varicella, Zoster, MMR -Refrigerated -Inactivated -handling -cost -true
POLIO -Inactivated Polio vaccine (__ __ __) 1 vaccine IPOL contains trace amounts of neomycin, streptomycin, and polymixin B -DTaP-IPV/Hib (P____) also available. also p____ (d-tap, polio and hep B) -___(route) poliovirus vaccine: shed in stool for up to ___ weeks (transmission possible) -polio vaccine given at __, ___ and ___ mo MEASLES/MUMPS/RUBELLA -L___ A____ available in combination with rubella as __ __ __ or in combination with rubella and varicella __ __ __ __ -Both vaccines are pr____ free and contain a small amount of albumin, neomycin, sorbitol, and gelatin -____ dose needs to be MMR + varicella separate, then subsequent can be with varicella (__ __ __ __)
-IPV -Pentacel, pediatrix -Oral, 6 -2, 4, and 6 -Live attenuated, MMR, MMRV -preservative -first, MMRV
PASSIVE IMMUNITY MAJOR SOURCE OF ANTIBODY USED IN MEDICINE Homologous pooled human antibody (immune globulin)- __ __ __ __ -Pooling of Ig___ antibody fraction from thousand of adult donors. Antibodies to many different antigens -Post exposure prophylaxis for Hep ___ and m____ and treatment of certain congenital immunoglobulin de____ Homologous human hyperimmune globin -High titers of a s____ antibody. Also contain other antibodies since made from donated plasma -Post-exposure prophylaxis for hepatitis ___, r___*, t___, v____ Heterologous hyperimmune serum (anti____) -Produced in animals mostly equine (serum sickness) and contains antibodies against only ___ antigen -b____ and d____, snake bites
-IVIG -IgG -A, measles, deficiencies -specific -B, rabies, tetanus, and varicella -antitoxin -one -Botulism, diphtheria
PRINCIPLES OF VACCINATION -I____ is the ability of the human body to tolerate self and to eliminate foreign ("nonself") material. This discriminatory ability provides protection from infectious disease, since most microbes are identified as foreign by the immune system. -Immunity to a microbe is usually indicated by the presence of anti____ to that organism. Immunity is generally specific to a single organism or group of closely related organisms. -The immune system is a complex system of interacting cells whose primary purpose is to identify foreign ("nonself") substances referred to as a____. -Antigens can be either l___ (such as viruses and bacteria) or in____. -The immune system develops a defense against the antigen. This defense is known as the immune response and usually involves the production of protein molecules by ___ lymphocytes -There are two basic mechanisms for acquiring immunity, a____ and p___.
-Immunity -antibody -antigens -live, inactivated -B -active, passive
HEPATITIS A -____ (live or inactivated) whole virus vaccines (HAVRIX and VAQTA) both available in pediatric (12months-18 years) and adult formulations -Combination Hep A and Hep B also available (Twinrix) for ___ and older -I____ travelers, men who have sex with ____, illegal d____ users, c____ factor disorders, occupational risk (those who work with hep A infected p___ or with Hep A virus in a l___ setting), chronic l___ disease **** this is who hepA vaccine is given to HEPATITIS B -Infants born to HBsAg-positive women should be tested after completion of at least ____ doses of hepatitis B series -if HBsAg not present and anti-HBs anti____ is present child can be considered to be protected
-Inactivated -18 -International, men, drug, clotting, primates, lab, liver -3 -antibody
VACCINATION TIMING CONT. -____ vaccines can be administered before, after, or at the same time as antibodies. i.e. you had exposure to rabies, tx would be antibody to rabies (ie. antitoxin or homologous antiglobulin) but you also give an inactivated vaccine for this -i.e. Hep ___, r___, t____ -Live vaccines cannot- ie __ __ __, v____ -for live, if Vaccine given first wait ___ weeks (incubation period) before giving antibody -if Antibody given first, wait ___ months or longer before giving vaccine -Exceptions ____ vaccine is not known to be affected by circulating antibody so it can be administered at anytime, yellow fever (because so few North Americans are immune to yellow fever) -Anti-Rho(D) admin to post-partum women has NOT been demonstrated to reduce response to ____ vaccine -Because of importance of rubella and varicella immunity in this population, women should receive __ __ __ or v___ (but not MMRV) immediately after delivery -___ (route) ___ vaccines (live attenuated influenza and rotavirus) are NOT believed to be affected by circulating antibodies
-Inactivated -B, rabies, tetanus -MMR, varicella -2 -3 -zoster -rubella -MMR, varicella -Oral live
NON SPECIFIC INHIB OF RNA AND PROTEIN SYNTHESIS -inter____- immunomodulatory and antiviral -Dose limiting toxicities include: n____penia and a____ -"f____ like syndrome"- fever, fatigue, myalgia -Interferon ___ and ___ may be produced by nearly all cells in response to viral infection -Interferon ____ is produced by T-cells and NK cells in response to antigens and cytokines -Interferons mainly act to prevent trans____ of viral proteins (if u cant translate the proteins, viruses cant replicate)
-Interferons -Neutropenia, anemia -Flu -alpha, beta -gamma -translation
PREGNANCY -____ vaccines should NOT be administered to pregnant patients -____ vaccines may be administered when indicated -__ __ __ (NOT MMR) vaccine should be deferred during pregnancy -should Household contacts of pregnant (or immunosuppressed persons) be vaccinated??? BREASTFEEDING -Does not decrease response to routine childhood vaccines and is not a contraindication for any except ___ pox (____ fever should be avoided) -Breast feeding does not extend or improve passive immunity to vaccine preventable disease that is provided by maternal antibody except possibly for ___ ____ type B. (breast feeding does not imoprve passive immunity to diseases that can be prevented from vaccines...still need pneumococcal vaccine, for example)
-Live -Inactivated -HPV -yes -small, yellow -Haemophilus influenzae
CONTRAINDICATIONS TO LIVE VACCINES Complete (meaning u cant give) -m____, radiation, c____therapy -i___s___ therapy ->20mg/d of p____ (high doses) -TNF and non-TNF b____ (e.g. infliximab, rituximab)1 -__ __ __ adult patients with CD4<200 cells/mm3 -Children with CD4 cell count percentage of <___% -pr____ -Not recommended for patients who have recently received a t____ or other blood products Not Valid (meaning u CAN get the vaccine in these cases) -Mild disease -____-grade fever, U __ __, ____ media, mild d____ -anti____ therapy -b____feeding -pre___ birth -pr___ or immunosuppression in household (but isnt you yourself) -w____ (med)
-Malignancy, chemotherapy -Immunosuppressive -prednisone -biologics -HIV -15 -Pregnancy -transfusion -low, URI, otitis, diarrhea -Antibiotic -Breastfeeding -Premature -Pregnancy -Warfarin
LIVE ATTENUATED VACCINES -Viral: M___, m___, r___, ___ pox, v____ zoster, y____ fever, r____virus, intranasal i____, oral p____ -Bacterial: Oral ty____ vaccine INACTIVATED VACCINES -Cannot R____ -Less interference from circulating anti____ than live vaccines (but bc of this, need more than 1 dose) -Generally require __-__ doses -First dose primes immune system, immune response develops after __nd or __rd dose -Immune response mostly h___ (secretes antibodies to fight against antigens). Little or no cellular immunity occurs (occurs inside infected cells and is mediated by T lymphocytes) -Antibody titer diminishes with time (this is where b____ come in to bring back up antibody)
-Measles, mumps, rubella, small pox, varicella zoster, yellow fever, rotavirus, intranasal influenza, oral polio -typhoid -replicate -antibody -3-5 -2nd, 3rd -humoral -boosters
GIVE PCV-13 + PPSV23 -m____ risk: Cochlear implant, CSF leak -Adults > ___ year old who have not previously received PCV13 GIVE PCV-13 + 2 DOSES OF PPSV23 -i____: CRF, HIV, Malignancy -Functional or anatomic as_____ (including sickle cell disease) -PPSV23 should be administered ___ weeks after PCV 13 -PCV 13 at least ___ year after PPSV23 GIVE PPSV23 -Adults > ___ years old who have previously received PCV 13 (if haven't had 13 give 13 and then 23 8 weeks later) -Chronic conditions (high risk): d___ ,COPD and/or asthma, Cardiovascular disease, Chronic l____ disease, n____ home resident, sm___
-Meningitis -65 -Immunocompromised -asplenia -8 -1 -65 -Diabetes, liver, Nursing, Smoker
CHOICE OF ANTIVIRAL 1. Oselt____ (most common- oral) 2. balo____ (oral) or inhaled zana____ 3. preffered over IV pera____ in most patients -with inhaled zanamivir, be careful with as____ and __ __ __ __, can also cause bronchospasm -____(route) preffered in severe patients
-Oseltamavir -baloxivir, zanamivir -peramivir -asthma, COPD -Oral
NEURAMINIDASE INHIBITORS -oselt___, zana___, pera____ -Selective inhibitors of viral neuraminidases which are essential for r____ of virus from the infected cell -Treatment of influenza ___ and ___, duration ___ days*** -About 70-90% effective for pro____ before or after exposure to influenza A or B -More effective if started within ____ hours after the onset of illness (the earlier the better) -if given beyond ___ hours, they are not worth giving -Oseltamivir- ____(route) -__/__- helped by food -Zanamivir- intra___ or in____ of dry powder -May produce bronchospasms, careful in patients with as____ or __ __ __ __ -Peramivir- __ __ -s/e: d____
-Oseltamivir, Zanamivir, Peramivir -release -A, B, 5 -prophylaxis -48 -72 -oral -N/V -intranasal, inhalation -asthma, COPD -IV -Diarrhea
INACTIVATED VACCINES Whole-cell Vaccines -Viral: P___, hepatitis ___, ra____ -Bacterial: ty___, ch___, pl___ - Not available in US Fractional Vaccines -Subunit: Hepatitis ___, i____, acellular per____, human pap___, an____ -Toxoid: d___, t___
-Polio, A, rabies -Typhoid, cholera, plague -B, influenza, pertussis, papillomavirus, anthrax -Diptheria, tetanus
ZOSTER -____grix is more effective than Zostavax and recommended for patients to receive even if they have already received z____ -FDA approved for ≥___ years of age -Shingrix contains an ad____, boosting the effectiveness of the vaccine -Not a ____ vaccine, does NOT need to be stored f____ -A 2 dose __ __ (route) series given 2-___ months apart ***
-Shingrix, Zostavax -50 -adjuvant -live, frozen -IM, 2-6
TD/TDAP -Single dose of T____ vaccine for previously unvaccinated individuals ≥ ___years of age (Regardless of timing of last Td) -Td b____ every 10 years (for everyone) -Pregnant women should receive Tdap during ___ pregnancy (___-___ weeks gestation) Independent of interval since last Td or Tdap HAEMOPHILUS INFLUENZAE TYPE B -Haemophilus influenzae type B leading cause of bacterial m____ prior to introduction of vaccine -Gram negative coccobacillus, generally aerobic but can grow as a facilitative anaerobe (if u cut off oxygen suppy it will still g____) -Management: Third generation c____ X 10 days, but main thing is __ __ __ vaccines -Two combination vaccines also available (DTaP-IPV/Hib (p____) and h____ B-Hib (Comvax)
-Tdap, 11years -booster -each, 27-36 -meningitis -grow -cephalosporin, hib -pentacel, Hepatitis
PASSIVE IMMUNITY -t____ protection Mother to Infant -Antibodies transported across the placenta during the last __-__ months of pregnancy -Full term infant has the same antibodies as mom for protection from some diseases up to a ____. infant also developing their own immunity in this age as well with routine vaccinations -Protection is better for some diseases (m___, r___ t___) than others (po___, per___) Blood Products -Many blood products contain antibody. could be Washed/ re____ RBC. small amount -__ __ __ __ / p___ products a large amount
-Temporary -1-2 -year -measles, rubella, tetanus, polio, pertussis -reconstituted -IVIG, plasma
DIPTHERIA -t____-mediated disease caused by bacterium Corynebacterium diphtheriae -Aerobic gram ____ bacillus Medical management -Diphtheria anti____ neutralizes circulating (unbound toxin) -available from CDC -Antibiotics- er___ or procaine __ __ __ G Prevention -Close contacts of ill (stay away): diphtheria b____ and anti___
-Toxin -positive -antitoxin -ERY, PEN -booster, antibiotics
VARICELLA CONT. -Varicella (VARI___) ___-dose series recommended for all patients without documented immunity Not Recommended if: -Documentation of two doses of varicella vaccine at least ___ weeks apart -US-born before 19___ (except healthcare personnel and pregnant women) -History of c___ or s____ based on diagnosis or verification by a healthcare provider -Laboratory evidence of i____ or confirmation of disease
-Varivax, two -4 -1980 -chickenpox, shingles -immunity
PERTUSSIS -aka ____ cough -Management- Primarily s____ -er____ drug of choice -is there a Vaccination against this??? -Three pediatric acellular vaccine all combined with d___ and t____ toxoids as D__ __ __ (Infanrix, Daptacel, and Tripedia) -DTAP includes p____. also adult versions -Two adult acellular pertussis vaccines (both with reduced amounts of d____ toxoid when compared to pediatric forms) Boostrix and adacel
-Whooping -supportive -Erythromycin -yes -diphtheria, tetanus, DTaP -pertussis -diphtheria
-viruses are intracellular parasites. viral replication depends on the use of h____ enzymes VIRUSES ARE HARD TO TX BC... -Effective treatment requires that the drug must enter the host cell. Many viruses incorporate into host __ __ __ -l____ viruses- illness recurs without re-exposure -Most antivirals agents inhibit si____ steps in viral replication and are virus____ (not cidal) -Competent host i____ system required -some viruses affect dna (incorp themselves into dna), some affect rna (affects more p____ devel)
-host -DNA -Latent -single, virustatic -immune -protein
Penciclovir and Famciclovir (oral prodrug of Penciclovir) -Both used to treat Herpes z____, Herpes simplex type ___, topical treatment of o___/l___ herpes simplex virus -Pregnancy Category B- acyc___ and pen____ Ganciclovir and Valganciclovir (Oral prodrug of ganciclovir) -Phosphorylated by viral protein kinase in ____ (CMV) and by viral thymidine kinase in h___ s____ virus then further phosphorylated by host enzymes (by phosphorylating will have better activity against the virus) -Active against all h____ viruses -Treatment of __ __ __ in immunocompromised patients*** -A/Es: n____penia, t____penia, t____ -Cat C -Vitasert- an intraocular sustained release implant for CMV r____itis (of the eye) ------------------------------------ -these have more side effects, so would rather start with a___ and v___ for herpes
-Zoster, II, oral/labial -Acyclovir, Penciclovir -cytomegalovirus, herpes simplex -herpes -CMV -Neutropenia, thrombocytopenia, teratogenic -retinitis -acyc, valcyc
LIVE ATTENTUATED VACCINES -Usually disease does not occur but if cause "disease" it is usually much milder than natural disease and is referred to as an A___ r___*** -Could theoretically revert to original pathogenic form; known to happen only once with live (oral) p____ vaccine (very rare that this happens) -Severe reactions possible: Result of uncontrolled replication. Only occurs in patients with i____ and its very very rare Interference of vaccine from circulating antibody -m____ most sensitive to circulating antibody and polio and rotavirus vaccines least affected -if u already have circ antibodies to measles, upon getting vaccine it will in___ vaccine bc immune system will attack vaccine (for example) -Usually require ___ dose (unless admin orally- i.e. rotavirus) -Fragile- must be s___ and h___ carefully -Destroyed by h___ and l___ (just like regular circulating bacteria and viruses)
-adverse reaction -polio -immunodeficiency -Measles -inactive -one -stored, handled -heat, light
PRETERM BIRTH -Vaccines should be started on schedule on the basis of child's chronological A___ -All preterm infants born to hepatitis B surface antigen positive mothers and mothers with unknown HBsAg status must receive immunoprophylaxis with hepatitis B vaccine within ___ hours after birth. Hepatitis B immunoglobulin (HB__ __) also must be given to these infants -If infant weighs less than __,___ grams at birth (and mom is pos or unknown) the hepatitis B vaccine should not count towards the three vaccine series***. so they would get a total of ___ doses -Infants less than 2,000 grams born to HBsAg negative women should receive first dose of hepatitis B vaccine series at ___ month of chronologic age or at the time of hospital discharge. and they would get the normal ___ doses
-age -12, HBIG -2,000, 4 -1, 3
VIRAL ATTACHMENT, UNCOATING OR RELEASE -aman____ and riman____ block uncoating specifically -riba____in blocks RNA processesing -zana____ and oselta____ block viral release INHIBITORS OF VIRAL ATTACHMENT -aman____ and riman___: Bind viral protein M2 and inhibit viral uncoating (cant expose its own rna) -Used for treatment and prophylaxis of influenza type ___, no effect on type ___-lack M2*** -Large volume of distribution BUT ____ therapeutic index (therapeutic 0.5-0.8mcg/mL, CNS toxic >1-5 mcg/mL). if u are slightly above therapeutic range, can have the following s/es -s___, c___, del____ -Amantadine- 90% excreted unchanged in urine: Used in p____'s Disease -Rimantadine- Metabolized by the l___
-amantadine, rimantadine -ribavirin -zanamivir, oseltamivir -Amantadine, Rimantadine -A, B -Narrow -Seizure, coma, delirium -Parkinson's -liver
CONTRAINDICATIONS CONT. Permanent (cant get any of the vaccines again, live or inactive) -Severe allergic reaction to a vaccine component or following a prior dose (all vaccines)- i.e. ana____ -Allergic reaction to e___= no influenza vaccine (not really anymore) -e____pathy not due to another identifiable cause occurring within 7 days of p____ vaccine -Severe combined immunodeficiency (no live r____virus ) PRECAUTIONS WITH VACCINATION -Moderate or severe acute illness (all vaccines). d___ vaccine until illness has improved -mod/severe= h____, __ __ __ stay -Recent receipt of an antibody containing blood product ( __ __ __ and v___ vaccines)...want to delay it a little -t/f: these are just precautions not just full contraindications
-anaphylaxis -eggs -Encephalopathy, pertussis -rotavirus -Delay -hospitalization, ICU -MMR, varicella -true
***print slide 18 VACCINATION TIMING BIRTH-15 MO -hep B: -first dose is at ____ -second dose is btwn ___ and ___ mos -third dose is btwn ___ and ___ mos -DTaP (diphtheria, tetanus and pertussis) -first dose is at ___ mo -second dose is at ___ mo -third dose is at ____ mo -HIB (h. influ type B) -first dose is at ___ mo -second dose is at ___ mo -third dose is at ___ mo- ___ mo
-birth -1-2 mo -6-15mo -2 mo -4mo -6 mo -2 mo -4 mo -12-15 mo
***print slide 5, 7 MAJOR SITES OF ANTIVIRAL DRUG ACTION -viral attachment and entry: blocked by enfuv____ (hiv), doco____ (hsv), palivi____ (rsv) -penetration is blocked by: inter___-a___ (Hep b, Hep c) -uncoating is blocked by: amanta___, rimanta___ (influenza) -nucleic acid synthesis blocked by: __ __ __ __s (HIV), __ __ __ __ __s (HIV), acyc____ (HSV), fos___ (CMV), ente___ (hep b) -late protein synthesis and processing blocked by: pr____ inhibitors (HIV) -viral release is blocked by: n____dase inhibitors (influenza)
-enfuvirtude, docosanol, palivizumab -interferon alpha -amantadine, rimantadine -NRTIs, NNRTIs, acyclovir, foscarnet, entecavir -protease -neuramidase
VACCINES Live attenuated -Produced by modifying a disease-producing (wild type) virus or bacterium. Resulting organism retains ability to grow and produce immunity but usually does not cause i____ Inactivated -Composed of whole v___ or b____ or fractions of either (protein based or polysaccharide based) -Protein -based: t____ (inactivated bacterial toxin), sub___ or subviron (virus) products -polysaccharide based: Most composed of pure cell w____ polysaccharide from bacteria -Conjugate polysaccharide vaccines contain polysaccharide chemically linked to a p____
-illness -viruses, bacteria -Toxoids, Subunit -wall -protein
ACTIVE IMMUNITY -Lasts many years or L____ -Surviving infection: m____ B cells circulate and reside in bone marrow for many years. Upon re-exposure to antigen memory B cells replicate and re-e_____ protection -v____ are a good example of active immunity -Produce an immune response similar to that produced by natural infection but without the d____ and c____ Many factors influence immune response to vaccination -Presence of maternal anti____ -Nature and d____ of antigen -r____ of administration -Presence of ad____ (aluminum-containing material in the vaccine could cause issues) -Host factors
-lifetime -Memory, reestablish -Vaccination -disease, complications -antibody -dose -Route -adjuvant
ROTAVIRUS -RotaTeq a l___ ___(route) vaccine (RV5) contains rotaviruses from human and bovine parent strains -Trace amounts of fetal b____ serum may be present -Rotarix (RV1) one strain of l___ a___ human rotavirus -can cause d____ even for those just handling it MENINGOCOCCAL -Neisseria meningitidis leading cause of bacterial m___ and se___ in US -Aerobic gram ____ bacteria -Management: e____ broad spec abx after cultures obtained, then more narrow __ __ __ (specific abx) -Two vaccines Menactra and Menveo for persons ___ thru __ __ years of age (ages where u are at increased risk for n. men)
-live, oral -bovine -live attenuated -diarrhea -meningitis, sepsis -negative -Empiric, PCN -2 through 55
VACCINATION TIMING -Do not administer before the ____ age (may lose efficacy) -Do not administer before the ____ interval between doses -Do not re___ series -a_____ time between immunizations does NOT significantly reduce Immunogenicity -Co-administration of vaccines does NOT "____" the immune system -If live vaccines are NOT administered together, separate by ___ weeks
-minimum -minimum -restart -Additional -overload -4
REMDESIVIR DATA -Does not appear to reduce overall m____ -Mortality benefit for select patients with s____ disease who only require ___-flow supplemental oxygen -____ time to recovery -only for h____ patients -t/f: we dont know all the data yet
-mortality -severe, low -Reduces -hospitalized -true
MULTI-DOSE INTERVALS -does Increasing the interval between doses of a multi-dose vaccine diminish the effectiveness?? -however, ____ the interval between doses may interfere with antibody response and protection ADRS -Providers should r___ clinically significant ADR even if unsure whether a vaccine caused the event http://vaers.hhs.gov (i.e. would want to report guillian barre) Local - up to 80% of vaccine doses -p___, sw____, r___ness at site of injection -Common with ____ vaccines -Usually mild and self limiting (they go away) Systemic -f____, mala___, __ __- nonspecific -May be unrelated to vaccine -Following ____ vaccines usually mild and occur 7-21 days after vaccine was given Allergic -May be caused by vaccine an____ itself or another component of the vaccine -Very rare
-no -Decreasing -report -Pain, swelling, redness -inactivated -Fever, malaise, headache -live -antigen
BALOXAVIR MARBOXIL -An ___(route) prodrug converted to baloxazir which inhibits endonuclease activity of a selective PA protein, which is required for viral gene transcription , resulting in inhibition of influenza virus re____ -virus cant make p____ bc viral gene transcription is blocked -Activity against influenza __ and __ including those resistant to s____ therapy (those on the prev slide) DOCOSANOL -Prevents A____ of the virus to the human cell -OTC c____ : used for recurrent o___/g_____ herpes -Begin treatment within ___ hours of prodromal symptoms (i.e. feel a cold sore coming on) or lesion onset
-oral, replication -proteins -A and B, standard -attachment -cream, oral/genital -12
DIPHTHERIA TOXOID VACCINE -Available combined with tetanus as ____(who gets it) diphtheria-tetanus toxoid (DT) or ____ tetanus-diphtheria (Td) and with both tetanus toxoid and acellular p____ vaccine as Dtap and Tdap (2 forms Boostrix 10-64 years and Adacel 11-64 years) -Also available in combination ___-___-___ (Pediarix) and ___-___-____ (pentacel)**** -DT (peds) versus Td - similar amounts of tetanus toxoid but DT contains 3-4 times as much ____ toxoid -< 7 years should receive __ __ > 7 years should receive adult __ __*** -DO DTaP and Tdap contain thimerosal as a preservative???
-pediatric, adult, pertussis -DTaP-HepB-IPV, DTaP-IPV/Hib -diphtheria -DT, Td -no
INFLUENZA TREATMENT -Best treatment is PR____ -Recommend y____ influenza vaccine -s____ care -anti-retroviral therapy within ___ hours INFLUENZA VACCINE -Indicated for everyone > ___ MO of age -for the first flu shot ever for pediatric patient: give ___ shots, ___ mo apart -then y____ 1x -Vaccines are changed y___ to accommodate for viral changes to antigenic characteristic
-prevention -yearly -supportive -48 -6months -2, 1 -yearly -yearly
-NEW DRUG ALERT!!! Rem____ivir: Nucleotide analogue with activity against SARS-CoV-2 (AKA COVID-19) -ONLY given in h____ patients -never in outpatient. reserving it for most s____ patients -Potentially toxic with eGFR <___mL/min (low renal function), Unless benefit outweighs risk -Monitor L__ __s -Should not be used with hydro____ or chloroquine (have now fallen out of favor with covid)
-remdesivir -Hospitalized -serious -30mL -LFTs -hydroxychloroquine
Acyclovir, Valacyclovir, Penciclovir, Ganciclovir, Valganciclovir -Phosphorylated by viral thymidine kinase. Mechanism of viral resistance. Antiviral activity limited to re____ viruses Acyclovir and Valacyclovir (oral prodrug of acyclovir) -Treatment and Prophylaxis of: h___ s___ (type I and II) and z____ -Drug of choice for treatment of __ __ __ infections -Acyclovir used pro____ to prevent mucocutaneous HSV infection in seropositive patients undergoing i___s____ therapy -for g____ herpes: Decrease viral shedding, dec systemic symptoms, and dec time to resolution -v____ zoster- treatment -Used within 24hours of rash onset decreases symptoms by ~ ___ day- use in ____ risk patients
-replicating -Herpes simplex, zoster -HSV -prophylactically, immunosuppressive -Genital -Varicella -1, high
Cidofovir -Phosphorylated by host enzymes- so useful when viral thymidine kinase re____ has developed -b___ spectrum antiviral activity; herpes and pox viruses, adenoviruses, papilloma viruses, and hepadenavirus -Primary use for treatment of __ __ __ in __ __ __s patients who are intolerant, relapsed, or nonresponsive to gan___ or fos____**** -also be used for a____ resistant mucocutaneous H __ __ infection -s/es: n____penia and n___toxicity
-resistance -Broad, cytomegalovirus, AIDS, ganciclovir, foscarnet -Acyclovir, HSV -Neutropenia, nephrotoxicity
INFLUENZA CONT. -Patients age >6 months should receive s____ flu vaccine -Patients age ≥65 years may receive ___ dose IIV -Children who have never received influenza vaccination need ___ doses *** PNEUMOCOCCAL -Streptococcus ____ -Gram ___ bacteria -Vaccines -Pneumovax 23- polysaccharide vaccine (PPSV23) -^^ given in older than ___ -^^ or 2-64: if i____, __ __ __ __, as____, ca____ dz, etc -PCV___- pneumococcal conjugate vaccine
-seasonal -high -two -pneumoniae -positive -65 -immunocomp, CODP, asthma, cardiac -PCV13
TETANUS -Clostridium tetani produces t____ that can lead to neurologic damage and nerve type sx Wound management -Uncertain history or 0-2 prior doses of tetanus toxoid should receive __ __ __ as well as T__ or T__ __ __ -TIG provides t____ immunity Vaccine -DT (___-tap) pediatric (under 7) -__ __ for children 7 years and up
-toxins -TIG, Td, Tdap -temporary -d -Td
ADMINISTRATION -t/f: Simultaneous administration of most widely used live attenuated and inactivated vaccines does not result in decreased antibody responses or increased rates of adverse reactions. i.e. give rotavirus (live), diptheria, h.flu, pneumococcal, etc together -if dont give them all together, need to separate by ___ weeks -Separate MMR and varicella vaccines should be admin for children ___ through ___ months (basically around 4 years old. makes sense bc first dose starts at this age range and 2nd dose begins age 4) of age for the first dose (not MMRV) -so first dose give sep MMR and varicella, after this age range can give combo (__ __ __ __) -Individual vaccines should not be mixed in the same syringe (unless they come like this). i.e. p____cel (___-___/___ is licensed for mixing in the same syringe)
-true -4 -12-47 -MMRV -Pentacel: DTaP-IPV/Hib
VARICELLA -Caused by v____ zoster virus -Primary infection c____ (varicella) -Recurrent infection h___ zoster (s____) -Varicella vaccine: Varivax is a l___ a___ vaccine, Also __ __ __ __ Herpes Zoster vaccine -Zostavax- l___ a____ vaccine -^^ Contains same varicella zoster virus used in varicella and MMRV vaccines but at a much ____ titer -Shingrix- recombinant vaccine- currently recommended even if got Zostavax. still need this even if gotten Zostavax . this one is for s____ -^^ ___ dose series -herpes zoster vaccines are For patients > ___ years of age
-varicella -chickenpox -herpes, shingles -live attenuated, MMRV -Live attenuated -higher -shingles -2 -50
