Unit 4 Pharm

What is the primary function of the body's immune system?

To distinguish 'self' from 'nonself' and eliminate harmful pathogens or atypical cells.

The _____ immune system acts as the body's first line of defense, providing nonspecific and rapid responses.

Innate

Which subsystem of the immune system identifies specific antigens and creates memory cells for long-term protection?

Adaptive immune system

Name the three key features of the adaptive immune response.

Specificity, cell heterogeneity, and memory.

How does natural active immunity differ from natural passive immunity?

Active results from infection survival; passive involves maternal antibody transfer via placenta or breast milk.

What term describes the intentional introduction of small quantities of disease antigen to develop immunity?

Artificial immunity (or Induced immunity)

_____ immunity occurs when a large proportion of a population is immune, protecting vulnerable individuals who cannot be vaccinated.

Herd (or Population)

What is the required vaccine coverage percentage to maintain herd immunity for measles?

At least $95\%$.

Explain the difference between humoral and cell-mediated immunity regarding their drivers.

Humoral is antibody-mediated by B-cells; cell-mediated is driven by mature T-cells.

"Vaccine: MMR (Measles, Mumps, Rubella) Classification: _____"

Live-attenuated combination vaccine

What is the standard administration route and schedule for the primary MMR series?

Subcutaneous injection at 12 to 15 months and 4 to 6 years of age.

"Vaccine: Varicella (Varivax) Classification: _____"

Live-attenuated vaccine

What specific patient education is required for a client of childbearing age receiving the Varicella vaccine?

Avoid becoming pregnant for at least 3 months following vaccination.

"Vaccine: Rotavirus (Rotarix, RotaTeq) Classification: _____"

Live-attenuated oral vaccine

Which gastrointestinal history is an absolute contraindication for the Rotavirus vaccine?

History of intussusception.

Why are live-attenuated vaccines generally contraindicated for immunocompromised patients?

The weakened pathogen can replicate in the host and cause vaccine-induced disease.

"Vaccine Class: Inactivated (Killed) Mechanism of Action: _____"

Uses killed pathogens that cannot replicate, primarily triggering antibody production.

How does the duration of immunity for inactivated vaccines typically compare to live-attenuated vaccines?

It is generally shorter and requires periodic supplemental 'booster' doses.

"Vaccine: Inactivated Poliovirus (IPOL) Contraindication/Interactions: _____"

It should not be mixed in the same syringe with any other vaccine.

"Vaccine: Hepatitis A (Havrix) Specific Contraindication: _____"

Previous anaphylactic reaction to neomycin.

What is the definition of a conjugate vaccine?

A vaccine where a polysaccharide antigen is chemically attached to a protein molecule to enhance immunity.

"Vaccine: Haemophilus Influenzae Type B (Hib) Nursing Assessment: _____"

Monitor for apneic episodes following administration to premature infants.

"Vaccine: Pneumococcal 13-Valent Conjugate (Prevnar 13) Therapeutic Use: _____"

Prevention of invasive and otitis media infections caused by multiple $S. pneumoniae$ strains.

At what ages are the Meningococcal Conjugate (MenACWY) doses typically administered?

Initial dose at 11 to 12 years and a booster at 16 years.

"Vaccine Class: Toxoid Definition: _____"

Vaccines made from bacterial toxins inactivated by heat or chemicals.

"Vaccine: DTaP (Infanrix) Indicated Age Group: _____"

Clients aged 6 weeks to less than 7 years.

Which neurologic history finding is a precaution for the DTaP vaccine?

History of encephalopathy within 7 days of a previous pertussis vaccine dose.

"Vaccine: Hepatitis B (Recombivax) Classification: _____"

Inactivated, recombinant vaccine

What nursing assessment is critical for a newborn receiving the Hepatitis B vaccine?

Assess birth weight; lower doses are recommended for low-birth-weight infants.

"Vaccine: Human Papillomavirus (HPV/Gardasil-9) Nursing Precaution: _____"

Monitor for syncope (fainting) following administration.

"Vaccine Class: mRNA Mechanism of Action: _____"

Synthetic mRNA instructs host cells to produce a viral spike protein, triggering an antibody response.

What is a major advantage of mRNA vaccine production during a pandemic?

They can be produced rapidly using only the pathogen's genetic code.

Identify a serious adverse effect of mRNA COVID-19 vaccines most prevalent in males aged 12 to 39 years.

Pericarditis and myocarditis.

List three universal contraindications for vaccines.

Previous anaphylaxis to the vaccine, its components, or Guillain-Barré syndrome after a prior dose.

Where is the preferred IM injection site for infants less than 12 months old?

Vastus lateralis muscle.

What needle size is appropriate for an IM injection in the deltoid of an adult female weighing more than $90\,kg$ ($200\,lb$)?

$1.5$-inch needle.

When administering an IM injection, at what angle should the needle be inserted?

$90^{\circ}$ angle.

What is the purpose of the Z-track method during IM administration?

To prevent medication from leaking into subcutaneous tissue and reduce irritation/staining.

At what rate should IM medication be injected?

$1\,mL$ over 10 seconds.

Which federal law requires providers to give a Vaccine Information Statement (VIS) to patients before vaccination?

National Childhood Vaccine Injury Act.

What is the first-line treatment for a vaccine-induced anaphylactic reaction?

Epinephrine

"Mechanism of Action: Epinephrine Effect on Airways: _____"

Binds to beta-adrenergic receptors to open airways (bronchodilation).

Where is the preferred injection site for an Epinephrine auto-injector?

Outer portion of the mid-thigh (anterolateral thigh).

"Vaccine: Zoster Recombinant (Shingrix) Indication: _____"

Prevention of herpes zoster (shingles) in adults older than 50 years.

Which vaccine is recommended during each pregnancy, ideally between 27 and 36 weeks gestation?

TDaP (to protect the newborn from pertussis via passive immunity).

In the preconception phase, how long should a client wait to conceive after receiving the Rubella vaccine?

At least 28 days.

Which childhood vaccine is associated with a rare risk of intussusception?

Rotavirus vaccine

"Term: Vaccine Hesitancy Definition: _____"

Reluctance or refusal to immunize despite the availability of immunization services.

What nursing action is required if a multi-use vial medication appears cloudy or contains particles?

Discard the vial and obtain a new one.

How should a nurse mix a reconstituted medication vial?

Gently roll the vial in the hands; do not vigorously shake.

Under what condition is the oral typhoid vaccine (Ty21a) administered?

One hour before a meal with a cold/lukewarm drink on alternate days (total 4 doses).

Signs of Anaphylaxis: Vascular _____, bronchoconstriction, and shock.

Collapse

Nursing Process (Analyze Cues): A child with acute flaccid paralysis and high fever most likely has _____.

Poliomyelitis (Polio)

What is the required waiting period between the two doses of the Hepatitis A vaccine?

6 to 18 months.

For adolescents starting the HPV series at age 15 or older, how many doses are required?

Three doses.

Why is the Influenza vaccine recommended annually?

Circulating strains change each year, necessitating an updated vaccine formulation.

Which adult population should avoid live-attenuated vaccines?

Severely immunocompromised individuals (e.g., those on cytotoxic agents or high-dose steroids).

How does trained innate immunity relate to live-attenuated vaccines?

They can reprogram innate immune cells to enhance antimicrobial function.

What is the recommended route for the adult PPSV23 pneumonia vaccine?

Intramuscular or Subcutaneous.

What should the nurse do if an accidental needlestick occurs during administration?

Follow the facility-designated protocol for disposal and post-exposure reporting.

Generic name suffix: -mab

Monoclonal Antibodies (e.g., Trastuzumab, Rituximab).

Generic name suffix: -sone or -lone

Corticosteroids (e.g., Prednisone, Dexamethasone).

Generic name suffix: -nib

Janus kinase (JAK) inhibitors / Targeted synthetic DMARDs.

Class: Antihistamines (H1-receptor antagonists). Prototype: _____

Diphenhydramine (Benadryl)

What is the primary mechanism of action for H1-antihistamines?

They bind to H1 receptors to block histamine from attaching, reducing the inflammatory response.

Why do first-generation antihistamines (e.g., diphenhydramine) cause significant drowsiness compared to second-generation agents?

First-generation agents readily cross the blood-brain barrier.

Antihistamine Use: Which generational class includes loratadine and cetirizine?

Second-generation antihistamines.

What common 'anticholinergic' side effects should a nurse monitor for in a client taking diphenhydramine?

Dry mouth, constipation, blurred vision, and urinary retention.

Which serious cardiovascular adverse effect is associated with certain H1-antihistamines?

QTc interval prolongation.

Nursing Assessment: Prior to administering diphenhydramine IV, at what maximum rate should the medication be pushed?

$25\text{ mg/min}$

Client Education: What substance should be strictly avoided while taking first-generation antihistamines due to additive CNS depression?

Alcohol.

Class: Corticosteroids (Glucocorticoids). Prototype: _____

Prednisone (Deltasone)

How do corticosteroids achieve their broad anti-inflammatory effect?

They suppress cytokine production and inhibit the migration/activity of immune cells like neutrophils and lymphocytes.

Corticosteroids: Why is it critical to taper these medications rather than stopping them abruptly?

To prevent acute adrenal insufficiency (adrenal suppression).

Side Effects: What effect do corticosteroids have on a client's blood glucose levels?

They cause hyperglycemia (increased blood glucose).

Adverse Effects: Which condition involving bone density loss is a risk of long-term corticosteroid use?

Osteoporosis.

Corticosteroids: Identify the triad of 'Cushingoid' features associated with excessive cortisol levels.

Moon face, truncal obesity, and a buffalo hump.

Nursing Monitoring: Which specific electrolyte imbalances are common with corticosteroid therapy?

Hypernatremia (high sodium) and hypokalemia (low potassium).

Why should NSAIDs be avoided in clients receiving systemic corticosteroid therapy?

The combination significantly increases the risk of peptic ulcer disease and GI bleeding.

Corticosteroids: What is the recommended time of day for administration to mimic the body's natural cortisol rhythm?

Early morning.

Client Education: Clients on long-term corticosteroids should be advised to have periodic exams for which two ocular conditions?

Glaucoma and cataracts.

Class: Calcineurin Inhibitors. Prototype: _____

Cyclosporine (Sandimmune)

What is the primary mechanism of calcineurin inhibitors like tacrolimus?

They block the protein calcineurin to inhibit T-cell activation and inflammation.

Calcineurin Inhibitors: What is the most common indication for their use in solid organ recipients?

Prophylaxis (prevention) of organ transplant rejection.

Adverse Effect: Which serious toxicity is the primary concern when monitoring BUN and creatinine in a client on cyclosporine?

Nephrotoxicity (kidney damage).

Cyclosporine Side Effect: How does this medication typically affect a client's gums?

It causes gingival (gum) hyperplasia.

How does the effect on hair growth differ between Cyclosporine and Tacrolimus?

Cyclosporine causes hypertrichosis (increased hair growth), while tacrolimus can cause alopecia (hair loss).

Interactions: Why should clients on calcineurin inhibitors avoid consuming grapefruit juice?

It inhibits metabolism, leading to toxic drug levels.

Class: Antimetabolites (Purine Analogs). Prototype: _____

Azathioprine (Imuran)

Mechanism of Action: How does azathioprine inhibit the immune response?

It inhibits purine synthesis, which halts DNA replication in rapidly dividing immune cells.

High-Yield Monitoring: Which laboratory test is the priority for detecting hematological toxicity in a client on azathioprine?

Complete Blood Count (CBC) to monitor for leukopenia, anemia, and thrombocytopenia.

Class: mTOR Inhibitors. Prototype: _____

Sirolimus (Rapamune)

Action: Sirolimus reduces T-cell activation by inhibiting the mechanistic target of _____, a protein that controls cell division.

Rapamycin (mTOR)

Class: Monoclonal Antibodies (Biologics). Prototype (Oncology): _____

Trastuzumab (Herceptin)

Mechanism of Action: Trastuzumab specifically targets and binds to which protein found on certain cancer cells?

HER2 (Human Epidermal Growth Factor Receptor 2).

High-Yield Side Effect: Monoclonal antibody infusions frequently cause which immediate type of reaction?

Infusion reactions (chills, fever, dyspnea, hypotension).

Black Box Warning: What is the most serious cardiovascular adverse effect of Trastuzumab?

Cardiotoxicity leading to heart failure or myocardial dysfunction.

Nursing Assessment: Prior to starting trastuzumab, what diagnostic test must be verified in clients of child-bearing ability?

A negative pregnancy test.

Class: Conventional Synthetic DMARDs. Prototype: _____

Methotrexate (Trexall)

High-Alert Status: What is the standard dosing frequency for Methotrexate when used for Rheumatoid Arthritis?

Once weekly.