Module 6: Immune System, Anti-infectives, and Anti-inflammatory Agents Flashcards

Exactly 281 flashcards covering the module 6 exam blueprint objectives, including immunizations, immunosuppressants, antibiotics, antivirals, and disease-specific therapeutic guidelines.

Who sets recommended vaccine schedules?

CDC Advisory Committee on Immunization Practices (ACIP) sets childhood, adult, catch-up, and pregnancy vaccination guidance.

What are live vaccines made from?

Attenuated, weakened but viable pathogens.

Give examples of live vaccines.

LAIV/FluMist, MMR, and varicella.

Who should generally NOT receive live vaccines?

Pregnant patients and immunocompromised patients.

How should two live vaccines be timed if both are needed?

Give both on the same day OR separate them by at least $4\text{ weeks}$.

When should live vaccines usually be delayed?

During a febrile illness.

What is LAIV?

Live attenuated influenza vaccine given intranasally; replicates in nasal mucosa.

What age group may receive LAIV if healthy?

Healthy persons ages $2 \text{ to } 49\text{ years}$.

What are LAIV contraindications?

Chronic disease, immunocompromise, pregnancy, or prior anaphylaxis to influenza vaccine/component.

What patient education is needed after LAIV?

Avoid close contact with immunocompromised persons for $7\text{ days}$ after administration.

What serious reactions should be reported after LAIV?

Difficulty breathing, wheezing, hives, swelling, unusual weakness, or temperature $38.9\,^{\circ}\text{C}$ or higher.

Why is MMR contraindicated in pregnancy?

Risk related to congenital rubella syndrome.

How long should pregnancy be avoided after MMR?

Avoid pregnancy for $1\text{ month}$ after vaccination.

What are inactivated vaccines made from?

Killed pathogens.

Give examples of inactivated vaccines.

DTaP/Tdap, HAV, HPV, IPV, inactivated influenza, and pneumococcal vaccines.

Can inactivated vaccines be coadministered with other vaccines?

Yes, they may be coadministered.

If a patient gets off schedule with an inactivated vaccine series, should the series be restarted?

No. Continue the series; do not restart.

What is the difference between DTaP and Tdap?

DTaP is full-dose diphtheria, tetanus, and pertussis for children $< 7$. Tdap has full tetanus and lower diphtheria/pertussis doses for older children/adults.

What is the true contraindication to DTaP/Tdap?

Immediate anaphylaxis after a previous dose.

What is the routine age range for HPV vaccination?

Ages $9 \text{ to } 26\text{ years}$.

How many HPV doses are needed if started at age 9-14?

$2$ doses.

How many HPV doses are needed if started at age 15 or older?

$3$ doses.

When is HPV vaccination shared decision-making?

Adults ages $27-45\text{ years}$.

What is the most common serious reaction after HPV vaccine?

Syncope; observe for $15\text{ minutes}$ after administration.

What are examples of inactivated influenza vaccines?

Fluzone and Flublok.

How quickly does inactivated influenza vaccine provide protection?

Protection develops in about $10-14\text{ days}$.

How long does influenza vaccine immunity last?

About $6\text{ months}$ to $1\text{ year}$.

What is a contraindication to inactivated influenza vaccine?

Severe allergic reaction to a previous influenza vaccine.

What rare neurologic complication can occur after influenza vaccination?

Guillain-Barre syndrome is rare but possible.

When should inactivated influenza vaccine be delayed?

During acute febrile illness.

At what age can children start receiving inactivated influenza vaccine?

Starting at $6\text{ months}$ of age.

Which influenza vaccine formulation is used for older adults?

High-dose influenza vaccine for adults $65\text{ years}$ and older.

What are the two broad pneumococcal vaccine types?

Pneumococcal polysaccharide vaccine PPSV23 and pneumococcal conjugate vaccines PCV15, PCV20, PCV21.

Who is pneumococcal vaccine indicated for?

Children $< 5$, adults $> 50$, and patients at increased pneumonia risk such as immunocompromised patients.

What is the routine pediatric PCV series?

$4$ doses at $2, 4, 6, \text{ and } 12-15\text{ months}$.

What should an unvaccinated adult >=50 receive for pneumococcal protection?

One dose of PCV. If PCV15 is used, give PPSV23 one year later; if PCV20/PCV21 is used, the series is complete.

What is RhoGAM?

Rho(D) immune globulin containing IgG antibodies against Rho(D) antigen.

What does RhoGAM prevent?

Isoimmunization in Rho(D)-negative mothers exposed to Rho(D)-positive fetal blood.

When is RhoGAM given?

At $28\text{ weeks}$ gestation and within $72\text{ hours}$ after delivery of an Rho(D)-positive newborn.

What is the general vaccine rule in pregnancy?

Benefits usually outweigh theoretical risk when exposure risk is high, infection poses risk to mother/fetus, and vaccine is unlikely to harm.

What vaccine type is generally contraindicated during pregnancy?

Live virus vaccines.

What should happen if a live vaccine is accidentally given during pregnancy?

Counsel about potential fetal effects; it is not usually an indication to terminate pregnancy.

What vaccines are routinely recommended/allowed in pregnancy if indicated?

COVID-19, inactivated influenza, Tdap, hepatitis A/B if indicated, polio/rabies if needed.

Which vaccine is preferred in pregnancy for tetanus/pertussis protection?

Tdap; ACIP recommends Tdap with every pregnancy.

What is the pregnancy recommendation for HPV vaccine?

Not recommended during pregnancy.

What is the pregnancy recommendation for MenB?

Precaution: delay until after pregnancy unless risk is increased and benefits outweigh risks.

What is the pregnancy recommendation for varicella and zoster vaccines?

Contraindicated because they are live vaccines.

What vaccine approach is recommended for severely immunocompromised patients?

Avoid live vaccines; consider passive immunization with immunoglobulin when appropriate.

Can close contacts of severely immunocompromised patients receive MMR?

MMR is not contraindicated for close contacts.

What vaccine approach is generally used for HIV-infected patients?

Avoid most live vaccines; MMR may be recommended when otherwise indicated. Use inactivated polio vaccine; give pneumococcal vaccine for HIV patients age $\ge 2$.

How are patients with limited immune deficits handled for vaccines?

Usually follow routine schedules with live and inactivated vaccines, but may need special vaccines or higher doses.

When should travel vaccine planning begin?

At least $8\text{ weeks}$ before departure.

What should travelers carry with travel documents?

A copy of current immunization records.

What is cyclosporine used for?

Organ transplant rejection prevention, severe rheumatoid arthritis, and psoriasis.

What vaccine precaution applies to cyclosporine?

No live vaccines.

What are major boxed-warning-type risks of cyclosporine?

Severe infection, possible neoplasm, hypertension, and nephrotoxicity.

What monitoring is needed with cyclosporine?

Blood pressure, renal function, and hepatic function.

What patient education is important for cyclosporine?

Avoid crowds and sick people, report signs/symptoms of infection, and do not switch brands/formulations because they are not bioequivalent.

What is azathioprine used for?

Organ transplant, Crohn disease, lupus nephritis, and severe rheumatoid arthritis.

What precautions apply to azathioprine?

Renal or hepatic dysfunction and pregnancy.

What serious adverse effects are associated with azathioprine?

Hepatic failure, malignancy risk, blood dyscrasias, and bone marrow suppression.

What monitoring is needed with azathioprine?

CBC and liver function tests.

What patient education is important for azathioprine?

Report unusual bleeding/bruising and signs/symptoms of infection.

What is an antibiogram?

A report showing susceptibility of pathogens to different antibiotics.

How does an antibiogram guide prescribing?

It supports empiric therapy by showing local pathogen susceptibility patterns.

What is empiric therapy?

Treatment started without knowing the precise cause; a best educated guess based on likely pathogen and local resistance.

What is antibiotic stewardship?

Use antibiotics appropriately to minimize antimicrobial resistance.

What is broad-spectrum antibiotic coverage?

Acts against a wide variety of bacteria including gram-positive, gram-negative, and atypical organisms.

Give examples of broad-spectrum antibiotics from Module 6.

Amoxicillin/clavulanate, TMP-SMX, azithromycin, doxycycline/tetracyclines, and fluoroquinolones.

What is narrow-spectrum antibiotic coverage?

Targets a specific group of bacteria such as gram-positive organisms or certain gram-negative organisms.

Give examples of narrow-spectrum antibiotics from Module 6.

Penicillin G, vancomycin, clindamycin, and metronidazole.

What is the stewardship approach after cultures result?

Start broad if needed, then de-escalate to a narrow-spectrum agent once the pathogen is identified.

What drug classes are beta-lactams?

Penicillins, cephalosporins, carbapenems, and monobactams.

How do beta-lactamases cause resistance?

They hydrolyze the beta-lactam ring and inactivate the antibiotic.

What do beta-lactamase inhibitors do?

Inhibit beta-lactamases and allow the beta-lactam antibiotic to work.

Name beta-lactamase inhibitors.

Clavulanate, sulbactam, and tazobactam.

Give examples of beta-lactam + beta-lactamase inhibitor combinations.

Amoxicillin/clavulanate (Augmentin) and piperacillin/tazobactam (Zosyn).

What are penicillin examples from Module 6?

Penicillin G and amoxicillin.

What is a major penicillin contraindication?

Severe allergic reaction/anaphylaxis.

Is rash with amoxicillin or ampicillin always a true allergy?

No. Rash can occur and is not always a true allergy.

What are common penicillin adverse effects?

Nausea, vomiting, diarrhea, rash, and superinfection.

What are common clinical uses of penicillins?

URIs, pneumonia, STIs, UTIs, and skin infections.

What are cephalosporin examples from Module 6?

Cephalexin and ceftriaxone.

What is the PCN-cephalosporin allergy pearl?

Cross-sensitivity risk is low ($< 1\%$), but avoid cephalosporins if history of severe PCN allergic reaction.

What are common clinical uses of cephalosporins?

URIs, UTIs, and skin infections.

What are fluoroquinolone examples?

Ciprofloxacin, levofloxacin, and moxifloxacin.

What boxed warning is associated with fluoroquinolones?

Increased risk of tendinitis and tendon rupture.

What are fluoroquinolone precautions?

Renal impairment and use in children $< 18\text{ years}$.

What are important fluoroquinolone adverse effects?

Tendon rupture and prolonged QT interval.

When are fluoroquinolones generally used?

Not typically first-line; may be used for CAP or traveler diarrhea depending on patient factors.

What is the prototype lincosamide in Module 6?

Clindamycin.

What serious infection is associated with clindamycin?

Clostridioides difficile infection.

What are clindamycin clinical uses?

MRSA and dental infections.

What are macrolide examples?

Erythromycin, azithromycin, and clarithromycin.

What macrolide precaution is high-yield?

Arrhythmia risk.

What adverse effect is associated with macrolides?

Prolonged QT interval and GI upset.

What are macrolide clinical uses?

Community-acquired pneumonia and STIs.

What sulfonamide example is in Module 6?

Sulfamethoxazole/trimethoprim (Bactrim).

What are sulfonamide precautions/contraindications?

Blood dyscrasias, G6PD deficiency, renal impairment, and pregnancy.

What are sulfonamide adverse effects?

Rashes including Stevens-Johnson syndrome and photosensitivity.