The Centers for Disease Control and Prevention (CDC) recommends a first dose of rotavirus (RV), diphtheria, tetanus, & acellular pertussis (DTa

Number 1 post: JW

Q1.      The Centers for Disease Control and Prevention (CDC) recommends a first dose of rotavirus (RV), diphtheria, tetanus, & acellular pertussis (DTaP), Haemophilus influenzae type b (Hib), Pneumococcal conjugate (PCV13), inactivated poliovirus (IPV) and second dose of Hepatitis B (HepB) at the two-month-old appointment (CDC, 2022). This clinic has Vaxelis, the DTaP, IPV, Hib, and HepB combination vaccine (CDC, 2022).

Q2.      According to the CDC guidelines, the child does not require IPV or HepB due to receiving Vaxelis at two, four, and six months (CDC, 2022). The CDC recommends a fourth dose booster of PCV13 and Hib at this appointment. The CDC recommends the child start Hepatitis A (HepA), Measles, mumps, rubella (MMR), and varicella (VAR) vaccination series at this twelve-month-old appointment (CDC, 2022). The CDC does not recommend giving MMR and VAR at the same appointment unless the parents ask (CDC, 2022). The vaccines should be given in a combination vaccine. This clinic has ProQuad, the Measles, mumps, rubella, and varicella (MMRV) vaccine (CDC, 2022).

Q3.      The CDC recommends pneumococcal polysaccharide vaccine (PPSV23) for children over the age of two with immunocompromise, cerebrospinal fluid (CSF) leak due to cochlear implant, hematologic disorders, and chronic conditions such as congenital heart disease, COPD, diabetes mellitus (CDC, 2022). PPSV23 should be given eight weeks after the final dose of PCV13 has been administered (CDC, 2022).

Q4.      St. John's wort may reduce the efficacy of progestins and estrogen derivates in oral contraceptives (Drugs.com, 2022). If she continues to take St. John's wort, she may have increased irregular bleeding or unintended pregnancy (Drugs.com, 2021). St. John’s wort negatively interacts with tons of medications. As a serotonin modulator, St. John’s wort inhibits the neuronal uptake of serotonin (Drugs.com, 2021). Antipsychotic agents can optimize the serotonergic effect of St. John’s wort leading to a toxic amount of serotonin (Drugs.com, 2021). Excessive amounts of serotonin can cause serotonin syndrome.

Q5.      Echinacea is an herb derived from three species of plants that have been used as an anti-infective for centuries (Drugs.com, 2022). Echinacea is one of the most used herbal therapies in the country (Sholto & Cunningham, 2019). Echinacea can be administered as a tincture, dry root tea, juice expressed from E. purpurea, dry powder, or liquid extract (Drugs.com, 2022). If an individual chooses the tincture preparation, the dose would be one to two ml orally three times a day (Drugs.com, 2022). The individual should continue with the same preparation throughout the therapy  (Drugs.com, 2022).

Q6.      Echinacea is safe for short-term treatment of symptoms but may not actually be effective (Sholto & Cunningham, 2019). A meta-analysis of 24 random control trials (RCTs) provided doubt on the efficacy of treating upper respiratory infections with echinacea (Sholto & Cunningham, 2019). A Cochrane review of the literature in 2014 provided evidence that echinacea was as effective as the placebo used in the studies (DeGeorge et al., 2019). I would recommend the mother use nasal saline irrigation and NSAIDs to treat the symptoms her child experiences (DeGeorge et al., 2019).

Number 2 post: BP

Q1. As outlined by the Center for Disease Control, at 2 months the baby should have the following vaccinations, Hep B 2nd dose, Rotavirus, DTaP, HiB, pneumococcal conjugate, and inactivated poliovirus. DTaP is a combination available that is made up of tetanus-diphtheria and pertussis vaccination (Center for Disease Control, 2021). Measles, Mumps, & Rubella, also known as MMR is another combination vaccine that is available and can be administered at 12 months (Center for Disease Control, 2021).

Q2. At 12 months vaccines to be administered are HepB 3rd dose, inactivated poliovirus 3rd dose, pneumococcal conjugate, annual influenza vaccine, MMR 1st dose, Varicella 1st dose, Hep A first dose (Center for Disease Control, 2021).

Q3. Patients who are at increased risk for pneumonia include any who are immune suppressed. As we all as those that have sickle cell anemia, chronic heart conditions, chronic lung conditions, splenic injury, or cochlear implants (Rosenthal & Burcham, 2021). These patients may receive the PPSV23 starting at the age of 2 (Rosenthal & Burcham, 2021).

Q4. St. Johns Wort originates from a flower and has the active ingredients hyperforin and hypericin. These decrease the uptake of dopamine, serotonin, and nor-epinephrine much like antidepressants (Asher et al., 2017). When taken with antidepressants that have the same mechanism of action there is an increased risk of serotonin syndrome (Asher et al., 2017). St Johns Wort also stimulates the induction of certain enzymes such as P450 and 34A (Asher et al., 2017). These enzymes increase the rate at which some drugs are metabolized thus making them less effective. This can include drugs such as warfarin, protease inhibitors, and oral contraceptives. For the patient this will decrease the effect of oral contraception putting her at a higher risk for pregnancy (Asher et al., 2017). The patient and provider should discuss backup methods of contraception or perhaps a different form of contraception such as an IUD.

Q5. There is some clinical evidence that shows echinacea decreases inflammation and stimulates the immune system (Catanzaro et al., 2018). Many people use it in an effort to prevent contracting illnesses such as a cold or upper respiratory infection, as well as shortening the duration of illness (Catanzaro et al., 2018). Echinacea is available in many formulations over the counter such as teas or oral capsules (Catanzaro et al., 2018). It can be taken daily prophylactically or while actively ill and there is no strong evidence that there are drug interactions (Catanzaro et al., 2018).

Q6. Echinacea is safe to use in children. One study showed that echinacea decreased the incidence of colds in children ages 4-12 up to 32% (Ogal et al., 2021). While echinacea alone cannot treat an infection it is a complementary tool that can be used alongside traditional medical interventions (Ogal et al., 2021).

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