E3 pharm - immunizations

Passive or active immunity?

• Protection transferred from another person or animal as antibody

• Immediate protection

Passive

Passive - immune sera

Human sources (transplacental, breast-feeding)

Passive - immunoglobulin

Sterile homologous solutions containing pooled antibody

Passive - antitoxin

Heterologous hyperimmune serum

Produced from equine sources (horse)

Passive or active immunity?

• Protection produced by a person's own immune system

• Delayed protection

• e.g. natural disease, vaccines

Active

What type of vaccine?

Cultivated to disable their virulence, response similar to illness

Live attenuated

What type of vaccine?

• Whole micro-organisms killed by chemical or heat

• Need repeated dosing

Killed/inactivated

What type of vaccine?

• Toxoids - Inactive toxic compounds from micro-organisms

• Subunit - A fragment of an inactive or attenuated micro-organism

Protein based

What type of vaccine?

• Conjugate - Polysaccharide outer coating attached to proteins

Polysaccharide based

What type of vaccine?

• From pooled donor blood plasma (IgG)

• Passive immunity

Immune sera

Pure or conjugate polysaccharide vaccine?

• T-cell independent antigens

• Offer little/no protection to children < 2 years

• Repeat doses do not cause booster response in titer

Pure polysaccharide

Pure or conjugate polysaccharide vaccine?

• T-cell dependent – increases immunogenicity

• Effective in children as young as 2 months of age

Copnjugate polysaccharide

What timing/spacing can be done when giving 2 or more inactive vaccines together?

Simultaneously or at any interval

What timing/spacing can be done when giving a inactive and a live vaccine together?

Simultaneously or at any interval

What timing/spacing can be done when giving 2 ore more live vaccines together?

4 weeks, if not simultaneously

What may reduce live vaccine efficacy, as well as pose a risk for disseminated infection?

Immunosuppression

What conditions are contraindicated for both live & inactivated vaccines?

• Anaphylactic allergy to a component of the vaccine

• Encephalopathy

What conditions are contraindicated for live vaccines?

• Anaphylactic allergy to a component of the vaccine

• Encephalopathy

• Pregnancy

• Immunosuppression

Can you give a inactivated vaccine to a pregnant patient?

Yes

Can you give a inactivated vaccine to a immunosuppressed patient?

Yes

Can you give a inactivated vaccine to someone who recently received a blood product?

Yes

What conditions should you be precautious when administering a live or inactived vaccine?

Patient w/ a severe illness

Should you be precautious when administering a live vaccine to a patient who recently received a blood product?

Yes

Which HPV vaccines is a quadrivalent vaccine for HPV types 6, 11, 16, 18?

Gardasil®

Which HPV vaccines is indicated for prevention of HPV related cervical cancer, cervical cancer precursors, vaginal and vulvar cancer precursors, and anogenital warts?

Gardasil®

Which HPV vaccines is used for HPV type 16 & 18?

Cervarix

True or false?

Routine HPV vaccination is recommended for adolescents 11-12 years of age

True

What vaccination is recommended for all persons 9 - 26 years of age not previously vaccinated?

HPV vaccine

True or false?

HPV vaccine should be administered after the onset of sexual activity

False, before

True or false?

HPV vaccine will have no effect on the existing disease or infection

True

When given an HPV vaccine, is there a change in recommended cervical cancer screenings?

No

What vaccination is recommended for all persons 6 months and older who do not have a contraindication to the vaccine?

Influenza

Which influenza vaccine(s)?

• Inactivated vaccine (IIV)

• Approved for persons aged > 6 months

• Children less than 9 years getting a vaccination for the first time should get 2 doses (4 week intervals between doses)

Fluzone, Fluvirin, Fluarix, FluLaval

What influenza vaccine is made without egg proteins?

Recombinant influenza vaccine (RIV, FluBlok®)

Which influenza vaccine?

• Live attenuated influenza vaccine (LAIV)

• Intranasal administration

• Approved for healthy persons aged 2-49 years

FluMist®

What are the contraindications for FluMist®?

• Severe allergic reaction (including egg protein)

• Concomitant aspirin use in children/adolescents

What populations is FluMist® not recommended for?

• Pregnant women

• Immunosuppressed

• Egg allergy

• Children 2-4 years with asthma/wheezing episode

• Antivirals within 48 hours

What are the rabies immune globins?

Human derived (HRIG) 20 IU/kg - preferred in the US

Equine derived (ERIG) 40 IU/kg

Which rabies vaccines are human diploid cell vaccines?

HDCV, Imovax

Which rabies vaccines are purified chick embryo cell vaccines?

PCECV, RabAvert

True or false?

You should never administer a rabies vaccine in the deltoid

False, gluteal area (deltoid is preferred)

What is the only vaccine-preventable disease that is not contagious?

Tetanus

How does Tetanus work?

Blocks release of inhibitory neurotransmitters (glycine and GABA)

What form of tetanus vaccine provides protection for 10 years and is given for wound care management with diptheria (Td)?

Tetanus toxoid

What form of tetanus vaccine is indicated for more serious wounds in unvaccinated individuals?

Tetanus Ig

Where is immunoglobulin IgG derived from?

Pooled donor plasma (purified)

What is the ADEs of IVIG?

• Sensitization

• Rate related chills, N/V (start low and go slow)

What are the different type of RhO(D) immunoglobulin vaccines?

WinRho, HyperRHO, RhoGAM

What patient population is the RhO(D) immunoglobulin administerd to?

Patients who are RhO(D) negative and may be exposed to RhO(D) positive erythrocytes

What can result if a RhO(D) negative mother mounts a response to a newborn?

Hemolytic disease of the newborn

True or false?

You should not give RhO(D) immunoglobulin to patients who are RhO(D) positive or have anti-RhO antibodies

True

What is the MOA of the spike protein SARS-CoV-2 vaccines?

• Binds to ACE2 receptors to induce membrane fusion

• Antibodies bind to spike protein and prevents fusion

What SARS-CoV-2 vaccines are mRNA vaccines?

Pfizer

Moderna

What SARS-CoV-2 vaccines are adenoviral vector vaccines?

Johnson & Johnson

What SARS-CoV-2 vaccines are protein adjuvant?

Novavax

What type of SARS-CoV-2 vaccine platform?

• Injected mRNA stay in the cytoplasm (no DNA interaction)

• RNA translated to produce spike protein

RNA vaccines

What type of SARS-CoV-2 vaccine platform?

• Uses modified virus (adenovirus)

• Engineered to express spike protein

• Virus may or may not replicate

Vector vaccines

What type of SARS-CoV-2 vaccine platform?

• Contains spike protein to stimulate a response

Protein adjuvant

MOA of Nirmatrelvir

Inhibits SARS-CoV-2 protease (Mpro) = virus can't produce mature proteins

MOA of Ritonavir

PK booster = inhibits CYP3A to boost drug levels

Nirmatrelvir-ritonavir (Paxlovid) is not recommended when a patient has what kind of impairment?

Renal/hepatic impairment

What SARS-CoV-2 treatment has a risk for rebound COVID?

Nirmatrelvir-ritonavir (Paxlovid)

MOA of Remdesivir (Veklury)

Inhibits RNA-dependent RNA polymerase (RdRP)

What SARS-CoV-2 treatment is administered parenterally and is used in hospitalized patients who cannot receive Nirmatrelvir-ritonavir (Paxlovid)?

Remdesivir (Veklury)

What are the ADEs of Remdesivir (Veklury)?

Hyperglycemia, reduced GFR/increased SCr