Pharmacology Final Exam Study Guide, Exams of Nursing

Download Pharmacology Final Exam Study Guide and more Exams Nursing in PDF only on Docsity! NR565 Pharmacology Final Exam Study Guide Drugs that Reduce Theophylline Levels (CYP3A Inducers) (Ans - Phenobarbital, phenytoin, rifampin; May need to increase drug level if given in conjunction; Increase metabolism rate of target drug; Drugs that Increase Theophylline Levels (CYP3A Inhibitors) (Ans - Cimetidine, fluoroquinolone antibiotics; May need to reduce drug level if given in conjunction; These drugs will increase AE associated w/ target drug due to prolonged activity and decreased metabolism of target drug. Theophylline Lifespan Concerns (Ans - Elderly patients: Use with extreme caution in elderly patients as these patients are at an increased risk of serious toxicity. Pediatric patients: Dose selection requires caution, and regular monitoring of concentrations is necessary (especially if the child is younger than 1 year of age) as the rate of clearance varies significantly in these patients. Pregnancy: Use cautiously only if risk outweighs benefit Roflumilast (Daliresp) (Ans - phosphodiesterase-4 inhibitor (PDE) approved for the treatment of COPD (and not asthma) Roflumilast MOA (Ans - selective action that inactivates cyclic adenosine monophosphate (cAMP) which results in decreased cytokine release and subsequent lower levels of pulmonary infiltration by neutrophils and other white blood cells Roflumilast (Daliresp) Indication Ans - not a first-line drug treatment and is reserved for severe cases of COPD with a primary component of chronic bronchitis. Bronchodilators: Anticholinergic Drugs Prototype Drugs (Ans - Ipratropium (inhaled, short acting; SAMA) Tiotropium (inhaled, long acting; LAMA) ipratropium/Tiotropium are anticholinergics, it is also considered a muscarinic receptor antagonist as it relates specifically to the lungs. Blocks acetylcholine receptors and prevents bronchospasm/bronchoconstriction. Anticholinergic Drugs MOA (Ans - blocks acetylcholine, preventing bronchial constriction and narrowing of the airways, which indirectly facilitates bronchodilation. improve lung function by blocking muscarinic receptors in the bronchi, reducing bronchoconstriction. Varenicline (Chantix) Duration (Ans - Decrease use after 12 weeks Nicotine patch (NicoDerm CQ) Benefits (Ans - Nonprescription; provides a steady level of nicotine; easy to use; unobtrusive Nicotine patch (NicoDerm CQ) Duration (Ans - 8-10 weeks Nicotine patch (NicoDerm CQ) Patient Education (Ans - applied once a day to clean, dry, nonhairy skin of the upper body or upper arm. Site should be changed daily and not reused for at least 1 week. patches are left in place for 24 hours and then immediately replaced with a fresh one Nicotine gum (Nicorette, others) Benefits (Ans - Nonprescription; user controls dose; Nicotine gum (Nicorette, others) Patient Education (Ans - chew the gum slowly and intermittently for approximately 30 minutes; should not eat or drink while chewing or for 15 minutes before chewing Nicotine gum (Nicorette, others) Duration (Ans - Use beyond 6 months is not recommended Nicotine lozenge (Nicorette Lozenge, Thrive ) Benefits(Ans - Nonprescription; user controls dose; easier to use than nicotine gum Nicotine lozenge (Nicorette Lozenge, Thrive ) Duration(Ans - Dosing should decrease over a period of 12 weeks Dosing should stop after 12 weeks Nicotine lozenge (Nicorette Lozenge, Thrive ) Patient Education(Ans - not eat or drink for 15 minutes before dosing and while in the mouth; should not chew or swallow the lozenge Nicotine nasal spray (Nicotrol NS) Benefit(Ans - User controls dose; fastest nicotine delivery and highest nicotine levels of all nicotine-based products Nicotine nasal spray (Nicotrol NS) Duration(Ans - After 3 months, taper use to complete cessation over additional 2-3 months Nicotine inhaler (Nicotrol Inhaler, Nicorette Inhaler ) Benefit(Ans - User controls dose; mimics hand-to-mouth motion of smoking Nicotine inhaler (Nicotrol Inhaler, Nicorette Inhaler ) Duration(Ans - Decrease use after 4-6 weeks Isoniazid (INH)(Ans - drug that can be used to prevent TB in people that have been exposed. isoniazid, rifampin, pyrazinamide, ethambutol(Ans - first-line drugs for TB treatment; used in most treatment regimens; Antituberculosis regimens Guideline(Ans - must always contain two or more drugs to which the infecting organism is sensitive. TB Patient-Centered Care Across the Life Span: Children(Ans - First-line antitubercular drugs with the exception of rifapentine are approved; Rifapentine (TB Drugs)(Ans - approved for children 12 years of age and older. Ethambutol(Ans - reserved for children older than 8 years Rifabutin (TB Drug)(Ans - deemed the safest TB drug during pregnancy. Isoniazid and Rifampin(Ans - mothers taking these drugs for TB should be encouraged to breastfeed. Signs and symptoms of hypothyroidism (Ans – Face is pale, puffy, and expressionless. Skin is cold and dry. hair is brittle, and hair loss occurs. Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance to cold. High Risk Patients for Methimazole(Ans - Should be avoided in the first trimester of pregnancy. Methimazole Toxicity(Ans - Agranulocytosis is the most dangerous toxicity. PTU High Risk Warning(Ans - Carries a risk for liver toxicity. Although rare, the FDA recommends against using as a first-line treatment due to potential for hepatic toxicity. Effects of maternal hypothyroidism on offspring and appropriate patient teaching related to need for treatment.(Ans - Can cause delay in mental development and derangement of growth. In the absence of thyroid hormones, the child develops a large and protruding tongue, potbelly, and dwarfish stature. Development of the nervous system, bones, teeth, and muscles is impaired. Congenital Hypothyroidism Treatment(Ans - requires replacement therapy with thyroid hormones. If treatment is initiated within a few days of birth, physical and mental development will be normal. replacement therapy should continue for 3 years, after which it should be stopped for 4 weeks to determine whether thyroid deficiency is permanent or transient. Patient Teaching for Methimazole(Ans - Tell your healthcare providers that you are taking this drug. Check blood work as directed. Taking this drug may cause harm to the unborn baby if you are pregnant, especially in the first trimester. If you are pregnant or become pregnant while taking this drug, call your healthcare provider right away. Tell your healthcare provider if you are breast-feeding to discuss risks to the baby. Have your baby's thyroid checked if you are using this drug and breast-feeding. Agranulocytosis is the most dangerous toxicity risk for this medication but is very rare. Sore throat and fever should be reported immediately. Patient Teaching for Levothyroxine(Ans - works best if you take it on an empty stomach, 30 to 60 minutes before breakfast. take the medicine at the same time each day. Ideal HbA1C goal for diabetic, non-pregnant adults(Ans - less than 7%. HbA1C 8%(Ans - history of severe hypoglycemia, limited life expectancy, or advanced microvascular or macrovascular complications HBA1C Value considered diagnostic of diabetes.(Ans - a value of 6.5% or greater HbA1C Measuring Interval(Ans - every 3 months until value is <7%; every 6 months thereafter HbA1C Goal for Older Adults(Ans - <7.5% [58 mmol/mol]), while those with multiple coexisting chronic illnesses, cognitive impairment, or functional dependence should have less stringent glycemic goals (such as A1C <8.0-8.5% [64- 69 mmol/mol]). Criteria for the Diagnosis of Diabetes Mellitus(Ans - -Fasting plasma glucose ≥126 mg/dL -Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes -Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLcor -Hemoglobin A1c 6.5% or higher T1DM Etiology and MOA(Ans - Autoimmune process; Loss of pancreatic β cells; T2DM Etiology and MOA(Ans - Unknown—but there is a strong familial association, suggesting that heredity is a risk factor; Insulin resistance and inappropriate insulin secretion the total daily dose (TDD) of insulin calculation(Ans - total weight of the patient in kilograms (kg), multiplied by 0.6 units Basal insulin replacement(Ans - 50% of the total daily insulin dose which replaces insulin from fasting (overnight) and between meals. Bolus insulin replacement(Ans - 50% of the total daily insulin dose and provides carbohydrate coverage and high blood sugar correction. Biguanides Drug Class(Ans - Metformin Metformin(Ans - Decreases glucose production by the liver (glucogenesis), increases tissue response to insulin; Bladder cancer Fractures (in women) Ovulation and thus possible unintended pregnancy Pioglitazone Black Box Warning(Ans - associated with heart failure (HF) secondary to renal retention of fluid. If HF is diagnosed, should be discontinued or used in reduced dosage. Thiazolidinediones (TZDs) Contraindicatgions(Ans - patients with heart failure, bladder cancer or history of bladder cancer. Dipeptidyl Peptidase-4 Inhibitors (Gliptins) Prototype/MOA(Ans - Sitagliptin/Januvia (Prototype Drug) -Enhances actions of incretin hormones to stimulate glucose dependent insulin and suppresses glucagon release Dipeptidyl Peptidase-4 Inhibitors (Gliptins) Main AE(Ans - -joint pain -hypersensitivity/ angioedema -acute pancreatitis. Dipeptidyl Peptidase-4 Inhibitors (Gliptins) Contraindications(Ans - Use cautiously with patients with hx of pancreatitis Sodium-Glucose Cotransporter 2 Inhibitors Prototype/MOA(Ans - -Canagliflozin (Prototype Drug) -Reduces the reabsorption of glucose, increasing urinary excretion of glucose Sodium-Glucose Cotransporter 2 Inhibitors Contraindications(Ans - Use with caution in patients prone to vulvovaginal and urinary tract infections. Sodium-Glucose Cotransporter 2 Inhibitors Main AE(Ans - Educate patients on signs and symptoms of hypoglycemia. These drugs also cause a diuretic effect; therefore patients should stay hydrated and monitor for signs and symptoms of urinary tract or vulvovaginal infections. α-Glucosidase Inhibitors MOA/Prototype(Ans - -Acarbose (Prototype Drug) -delays absorption of dietary carbohydrates and thereby reduces the rise in blood glucose after a meal α-Glucosidase Inhibitors main AE(Ans - flatulence, cramps, abdominal distention, borborygmus (rumbling bowel sounds), and diarrhea. Glucagon Like Peptide-1 Receptor Antagonists (GLP-1)(Ans - -Non Insulin Injectable -Exenatide (Byetta) (Prototype Drug); Liraglutide (Victoza) Dulaglutide (Trulicity) Lixisenatide (Adlyxin) -Activates receptors for GLP-1- slowing gastric emptying, inhibits glucagon, suppresses appetite, and stimulates glucose-dependent release of insulin Glucagon-like Peptide-1 Receptor Antagonists Contraindication(Ans - should be used with caution in pregnancy; benefits should clearly outweigh risks. Avoid use in patients with renal dysfunction or patients that have undergone renal transplant. Use with caution in patients with a history of pancreatitis. Glucagon-like Peptide-1 Receptor Antagonists Main AE(Ans - Educate patients on the signs and symptoms of hypoglycemia. These drugs also delay gastric emptying, so may delay the absorption of other drugs if taken simultaneously. Drugs More Likely To Cause Hypoglycemia(Ans - insulin sulfonylureas = (Glyburide) meglitinides = (Glinides==>Repaglinide) amylin analogues Drugs Less Likely To Cause Hypoglycemia(Ans - incretin mimetics = (GLP-1) Receptor Agonists metformin thiazolidnediones = (Glitazone) DDP-4 inhibitors = (Gliptins) The first-line treatment for all patients with diabetes(Ans - Metformin and lifestyle changes Know what type of insulin and how much is needed according to carbohydrate intake.(Ans - The mealtime carbohydrate-to-insulin dose is calculated using the 450 rule for regular insulin and the 500 rule for rapid-acting insulin; thus insulin 5th Step Therapy For Asthma Treatment(Ans - Ages 0-4: SABA PRN + High-dose IGC + LABA or Montelukast Ages 5-11: SABA PRN + High-dose IGC + LABA Ages 12-Adult: SABA PRN + High-dose IGC + LABA AND consider omalizumab for patients with allergies 6th Step Therapy For Asthma Treatment(Ans - Ages 0-4: SABA PRN + High-dose IGC + LABA/montelukast + Oral glucocorticoids Ages 5-11: SABA PRN + High-dose IGC + LABA + Oral glucocorticoids Ages 12-Adult: High-dose IGC + LABA + Oral glucocorticoids and Consider omalizumab for patients with allergies Asthma Severity Classification Domains(Ans - Impairment and Risk. Impairment(Ans - effect of asthma on quality of life and functional capacity in the present Risk(Ans - possible adverse events in the future, such as exacerbations and progressive loss of lung function. Intermittent Asthma (Initial Treatment)(Ans - Symptoms 2d/week or less; SABA use 2d/week or less; No effect on activity-->Step 1 Treatment Mild Persistent Asthma (Initial Treatment)(Ans - Symptoms more than 2 d/wk but less than daily; SABA use more than 2 d/wk but less than daily; Minimal Activity Limitation-->Step 2 Treatment Moderate Persistent Asthma (Initial Treatment)(Ans - Symptoms daily. Some limited activity; Weekly nighttime awakenings. Severe Persistent Asthma (Initial Treatment)(Ans - Symptoms several times daily; Severe activity limitation Ages 0-4: Step 3 Treatment Ages 5-11: Step 4 Treatment Ages 12-Adult: Step 4 or 5 Treatment Well Controlled Asthma(Ans - Continue current therapy. Reevaluate in 1-6 months. May step down after control well maintained for 3 months. Not Well Controlled Asthma (0-4 y/o)(Ans - Step up therapy by 1 step. Reevaluate in 2-6 weeks. If no improvement in 4-6 weeks, consider adjusting therapy or consider alternative diagnoses. Not Well Controlled Asthma (5-Adult)(Ans - Step up therapy by at least 1 step. Reevaluate in 2-6 weeks. Very Poorly Controlled Asthma(Ans - Step up therapy by 1-2 steps. Consider short course of oral systemic glucocorticoids. Reevaluate in 2 weeks. Inhaled β2 agonists(Ans - most effective drugs available for relieving acute bronchospasm and preventing exercise induced asthma (EIB). β2 agonists MOA(Ans - sympathomimetic drugs that activate β2-adrenergic receptors; promote bronchodilation SABA(Ans - used as needed (PRN) for prophylaxis of exercise-induced bronchospasm and to relieve ongoing asthma attacks and chronic obstructive pulmonary disease exacerbation SABA Inhalations Preparations(Ans - MDIs, DPIs, and nebulizers SABA Adverse Effects(Ans - Systemic effects—tachycardia, angina, and tremor— can occur but are usually minimal. SABA Prototype Drug(Ans - Albuterol (inhaled, short acting) Glucocorticoids Prototype Drugs(Ans - Beclomethasone, Budesonide, Fluticasone (inhaled) Prednisone, Methylprednisolone (oral) Leukotriene Receptor Antagonists (LTRA) MOA(Ans - block the action of leukotrienes in the lungs and bronchial tubes, which reduces bronchoconstriction. used for the prevention and chronic treatment of asthma and the prevention of exercise-induced bronchospasm in both adults and children. Montelukast (Singulair):(Ans - most commonly used leukotriene modulator. The drug has three approved indications: (1) prophylaxis and maintenance therapy of asthma in patients at least 1 year old; (2) prevention of exercise-induced bronchospasm (EIB) in patients at least 15 years old; and (3) relief of allergic rhinitis Black Box Warning for Montelukast (Singulair)(Ans - Drug is known to cause serious neuropsychiatric effects such as agitation, aggression, insomnia, depression, anxiety, and suicidal ideation. Mast Cell Stabilizers Prototype Drug(Ans - Cromolyn (Inhalation) Mast Cell Stabilizers MOA(Ans - is used for prophylaxis—not quick relief—in patients with mild to moderate asthma; prescribed for exercise-induced asthma. They STABILIZE MAST CELLS TO REDUCE HISTAMINE RELEASE; , an inflammatory mediator. Cromolyn patient teaching(Ans - should be administered 10 to 15 minutes before anticipated exertion but no longer than 1 hour before exercise. Advantages of Inhaled Route of Anti-Asthma Drugs(Ans - (1) therapeutic effects are enhanced by delivering drugs directly to their site of action, (2) systemic effects are minimized, and (3) relief of acute attacks is rapid. Methylxanthines MOA(Ans - Bronchodilation to decrease the intensity and frequency of moderate to severe asthma attacks and to control chronic obstructive pulmonary disease exacerbations Methylxanthines Prototype Drug (Ans - Theophylline Theophylline Toxicity Risk (Ans - can cause severe cardiac dysrhythmias and convulsions Methylxanthines Contraindication (Ans - These drugs are contraindicated for patients with untreated seizure disorders or peptic ulcer disease Theophylline contraindication w/ Caffeine (Ans - can intensify the adverse effects of the drug on the heart and CNS; Can decrease drug metabolism. Theophylline contraindication w/ Smoking Tobacco or Marijuana (Ans - can increase clearance to 50% in adults and 80% in older adults; Can cause an ineffective dosing. TB Treatment considerations for older patients(Ans - No contraindications are identified. Dosing may need to be adjusted for patients with decreased renal function. Cimetidine (Tagamet) CYP450 Enzyme Interaction(Ans - Weak Inhibitor of CYP450 enzyme; concern for use w/ warfarin, phenytoin, theophylline, and lidocaine; Omeprazole/PPI CYP450 Enzyme Interaction(Ans - Inhibits Plavix Effectiveness due to inhibition of CYP2C19, the isoenzyme of cytochrome P450 Aprepitant (Emend) CYP450 Enzyme Interaction(Ans - Antiemetic drug; a substrate for, inhibitor of, and inducer of CYP3A4; Warfarin Rifampin Nutritional deficiencies associated with long term PPI use(Ans - Decreased absorption of calcium, magnesium, and vitamin B12 have also been associated with long-term use; PPI Contraindication(Ans - Individuals with hypocalcemia due to complications of bone fractures; Increased risk limited to the first few days of PPI use for community-acquired and hospital-acquired pneumonia.(Ans - Omeprazole and other PPIs Infant Care for PUD(Ans - PPIs and H2 receptor antagonists are used safely in infants as young as 1 month to treat GERD and duodenal ulcers. Surfactant Laxatives MOA(Ans - softens stool by lowering surface tension thereby facilitating penetration of water and also cause secretion of water and electrolytes into intestine; Group 3 Laxative Surfactant Laxative Example(Ans - Docusate Stimulant Laxatives MOA(Ans - (1) Stimulate peristalsis; (2) soften feces by increasing secretion of water and electrolytes into the intestine and decreasing water and electrolyte absorption Stimulant Laxative Applications(Ans - (1) treatment of opioid-induced constipation and (2) treatment of constipation resulting from slow intestinal transit. Group 2 Laxative Stimulant Laxatives(Ans - Most widely abused laxative Stimulant Laxative Examples(Ans - Bisacodyl (Correctol, Dulcolax) Senna (Senokot, Ex-Lax) Osmotic Laxative MOA(Ans - Causes retention of water within the intestine and softens the feces; fecal swelling promotes peristalsis; Group 1 (High Dose) or Group 2 Lower Dose) Osmotic Laxative Indication(Ans - High-dose therapy is employed to empty the bowel in preparation for diagnostic and surgical procedures as well as purge the bowel of ingested poisons and evacuate dead parasites after anthelmintic therapy. Low Dose produce a soft or semifluid stool in 6 to 12 hours. Osmotic Laxative Salts(Ans - Magnesium and Sodium Osmotic Laxative AE(Ans - Substantial Water Loss; Dehydration; Fluid Retention; Renal Failure Osmotic Laxative Contraindications(Ans - Laxative Group is contraindicated in patients with renal dysfunction. Osmotic Laxative Example(Ans - Polyethylene glycol (MiraLax) Lactulose Magnesium Hydroxide (milk of magnesia) Laxatives Contraindication(Ans - patients with symptoms of appendicitis, enteritis, diverticulitis, ulcerative colitis, acute surgical abdomen, fecal impaction, or bowel obstruction. Defining Criteria for Constipation(Ans - Rome IV Criteria Group 1 Laxatives(Ans - Laxatives in this group are especially useful when the bowel is being prepared for diagnostic procedures or surgery. Group 2 Laxatives(Ans - Laxatives in this group have an intermediate latency (6-12 hours) and produce a stool that is semifluid. Laxatives in this group are most frequently abused by the general public Group 3 Laxatives(Ans - Laxatives in this group act slowly (in 1-3 days) to produce a soft but formed stool. Uses for this group include treating chronic constipation and preventing straining during bowel movements. Children and adolescents Antiemetic Use(Ans - Promethazine is a commonly used antiemetic contraindicated in children below 2 years of age. Other antiemetics, including dronabinol, are approved for nausea and vomiting Pregnancy Antiemetic Use(Ans - First-line therapy in nausea and vomiting of pregnancy includes doxylamine and vitamin B6 in addition to diet changes. Other alternatives include prochlorperazine, metoclopramide, and ondansetron. The use of chenodiol is contraindicated during pregnancy. Breastfeeding Antiemetic Use(Ans - Prochlorperazine and promethazine appear safe for short-term use; their infants should be observed for sedation. Metoclopramide, dronabinol, and droperidol should be avoided Older Adults Antiemetic Use(Ans - Benzodiazepines, scopolamine, and metoclopramide should be avoided in older adults gastroesophageal reflux disease (GERD)(Ans - common disorder characterized by heartburn and acid regurgitation. Bismuth subsalicylate (Pepto-Bismol) AE(Ans - gray/black stools and black tongue from the bismuth. Traveler's diarrhea(Ans - Escherichia coli Traveler's Diarrhea Treatment(Ans - -Ciprofloxacin for adults. -Azithromycin (Zithromax) is preferred for children and for pregnant women). -Rifaximin (Xifaxan) may also be used provided the patient is not pregnant or febrile and that stools are not bloody. Metoclopramide MOA(Ans - A prokinetic agent: (1) suppresses emesis (by blocking receptors for dopamine and serotonin in the CTZ) (2) it increases upper GI motility (by enhancing the actions of acetylcholine). Prokinetic Agent(Ans - Metoclopramide; Drugs that increase the tone and motility of the GI tract. Indications include gastroesophageal reflux disease (GERD), CINV, and diabetic gastroparesis. Metoclopramide (Reglan) PO Dose Use(Ans - 1) diabetic gastroparesis 2) suppression of gastroesophageal reflux. Metoclopramide (Reglan) IV Dose Use(Ans - 1) suppression of postoperative nausea and vomiting, 2) suppression of CINV, 3) facilitation of small bowel intubation 4) facilitation of radiologic examination of the GI tract. Metoclopramide (Reglan) AE(Ans - High-dose therapy: sedation and diarrhea are common Long-term high-dose therapy: irreversible tardive dyskinesia, characterized by repetitive, involuntary movements of the arms, legs, and facial muscles. Metoclopramide contraindication(Ans - Contraindication in patients with GI obstruction, perforation, or hemorrhage. Misoprostol (Cytotec)(Ans - an analog of prostaglandin E1. In the United States, the drug's only approved GI indication is prevention of gastric ulcers caused by long-term therapy with NSAIDs. Misoprostol (Cytotec) Contraindication(Ans - contraindicated during pregnancy due to risk for partial or complete expulsion of the developing fetus. Peptic Ulcer Disease Step 2 Therapy(Ans - H. pylori testing & Treatment with PPIs H. pylori(Ans - gram-negative bacillus that can colonize the stomach and duodenum; most common cause of gastric and duodenal ulcers H. Pylori Treatment(Ans - PPI plus antibiotics H. pylori triple therapy(Ans - Amoxicillin, Clarithromycin or Metronidazole, PPI (omeprazole) H. pylori quadruple therapy(Ans - PPI, bismuth, metronidazole, tetracycline Usually used as second-line therapy in patients who fail first-line therapy. H. Pylori Levofloxacin Triple Therapy(Ans - PPI, Levofloxacin, Amoxicillin Second-line or rescue therapy Antacids MOA(Ans - react with gastric acid to produce neutral salts or salts of low acidity; by neutralizing acid, these drugs decrease destruction of the gut wall. Antacid Uses(Ans - Primary indication is treatment of PUD; Not first line of treatment as alternate therapies may be more convenient with less AE Antacid Patient Teaching Consitpation/Diarrhea(Ans - -Some agents can cause diarrhea or constipation -Patients should be taught to adjust the dosage of one agent or the other to normalize bowel function. Antacid and Sodium Loading(Ans - -Some agents contain substantial amounts of sodium -Sodium excess can exacerbate hypertension and heart failure, patients with these disorders should avoid preparations that have high sodium content. -all children should receive HBV vaccine before entering school; -only contraindication to HepB is a prior anaphylactic reaction either to HepB itself or to baker's yeast. Know which vaccines tuberculin purified protein derivative can be given with(Ans - Rabies vaccination schedule.(Ans - Advisory Committee on Immunization Practice (ACIP) recommends four doses. 1 mL given IM on days 0, 3, 7, and 14, with RIG given on day 0. For those who have previously been vaccinated, two doses of rabies vaccine are given on days 0 and 3, with no RIG needed Who should receive a Tdap vaccine?(Ans - Used as a booster in adolescents and adults to protect against all three diseases What are the expected side effects from vaccines?(Ans - mild reactions are common, serious events are rare; local reactions (discomfort, swelling, and erythema at the injection site); Fever is also common. Very rare but severe effects include anaphylaxis (e.g., in response to measles, mumps, and rubella virus vaccine); acute encephalopathy (caused by diphtheria and tetanus toxoids and pertussis vaccine); vaccine-associated paralytic poliomyelitis (caused by oral poliovirus vaccine). 4-month-old child Vaccine(Ans - Rotavirus DTaP Hib PCV13 IPV 12-month-old child(Ans - Hep B Hib PCV13 Flu Vaccine MMR VAR Hep A 11-year-old child(Ans - Flu Vaccine Tdap HPV Meningococcal SX of Measles(Ans - Initial symptoms include fever, cough, headache, sore throat, and conjunctivitis. Three days later, rash develops. Rash begins at the hairline, spreads to the rest of the body in 36 hours, and then fades in a few days SX of Mumps(Ans - first symptom is swelling in one of the parotid glands, often accompanied by local pain and tenderness. The patient may also experience fever (100°F to 104°F). Swelling increases for 2 to 3 days and then fades entirely by day 6 or 7. Painful orchitis (inflammation of the testes) develops in approximately one-third of adult and adolescent males. Acute aseptic meningitis develops in approximately 10% of all patients; Sx of Varicella(Ans - Patients typically develop 250 to 500 maculopapular or vesicular lesions, usually on the face, scalp, or trunk. Other symptoms include fever, malaise, and loss of appetite. Sx of Rubella(Ans - AKA German measles; Initial symptoms include sore throat, mild fever, and swelling in lymph nodes located behind the ears and in the back of the neck. Shortly after, a rash develops on the face and scalp, spreads rapidly to the torso and arms, and then fades in 2 or 3 days. - Generally mild infections; During pregnancy, the consequences can be severe. Sx of Pertussis(Ans - AKA Whooping Cough; Initial symptoms include rhinorrhea, mild fever, and persistent cough. As infection worsens, coughing becomes more intense.