RX prep immunization

The live oral vaccine are

1)typhoid- vivotif capsule 2)Both rotavirus vaccines (rotaTeq and Rotarix) 3) cholera (Vaxchora)

which patient should receive pneumovax 23 before age 65? 1) history of meningitis 2) DM 3)Smokes 4)HF 5)ASTHMA

2) DM 3)Smokes 4)HF 5)ASTHMA Give 1 dose before age 65: --Immunocompetent patients 2-64 ( dm, heart, lung, liver, alcohol abuse and smoker) Give 2 doses before age 65 --immunocompromised patient 2-64 (sickle cell disease, asplenia, HIV, chronic kidney failure, transplant, immunosuppressive drugs like steroid,malignancy

which one shouldnt get the MMRV 1) HIV with CD4 of 292 2) Preggo 31 weeks 3) fever of 100.1 the night before 4) 56 female who lives with grandma who takes MTX for RA

2) Preggo 31 weeks ==> live vaccines: MMR, MMRV, Varicella, Zoster, Yellow fever, Flumist, Rotavirus, Cholera, Typhoid (Vivotif) ARE CONTRAINDICATEd CORRECTION 1) HIV WITH CD4 OF 292 ==> A patient with HIV is contraindicated to live vaccines like MMR OR MMRV OR VARICELLA ONLY IF THEY HAVE CD4 LESS THAN 200. 292 didnt make the cut off

which is incorrect regarding vaccine storage? 1) MMR in fridge or freezer 2) Vivotif in fridge 3) CHolera in fridge 4)MMRV in freezer

3) (vaxchora) on cholera vaccine in fridge prior to reconstitute ==> live needs to be in freezer Vaccines that is mandated to be in freezer 1) MMRV 2) Cholera 3) Varicella 4) Zostavax Live vaccine that can be stored in either fridge or freezer 1) MMR Live vaccine that only to be stored in fridge 1) Vivotif- capsule

shingrix(recombinant zoster vaccine) is recommended in which patient group

50 years and older preferred over zostavax (live vaccine and requirements are different, zostavax is patient aged 60 years and older

Which of the following vaccines comes as a powder that is stored in the freezer and requires reconstitution with the supplied diluent? (select all) A. Zostavax B. Vivotif C. Pentacel D. Varivax E. MMRV, Proquad

ALL SUBCUT too A. Zostavax D. Varivax E. MMRV, Proquad Has V= will have powder. MMR without varicella can be stored in refrigerator or freezer B. Vivotif ( capsule) C. Pentacel( DTAP/IPV/Hib) - syringe/vial

It is very rare for a patient receiving an injection to experience anaphylaxis. However, if any serious reaction does occur to a vaccine, it must be reported to the following agency: A) www.immunize.org B) The local department of public health (for your city, or county) C) The Centers for Disease Control D) The Morbidity and Mortality Weekly Report E) VAERS

E) VAERS record and report the proceedings of an event to both the patient's physician and to vaccine and adverse event reporting system which is run by the FDA and CDC. The pharmacist may also wish to notify the manufacture

what vaccine is Menhibrix?

Meningococcal Groups C and Y and Haemophilus b Tetanus Toxoid Conjugate Vaccine only in children age 6 weeks to 18 months.

67 pt with heart disease and DM. She states she has not received any immunization in the past 10 years except for her annual flu shot. Which one should she get today?

PPSV 23- a dose is recommended for all patient over 65 regardless of PMH

Pt: 66 years old how should prevnar 13 and pneumovax 23 be adminstered

Prevnar 13 is no longer routinely recommended in those ≥ 65 years of age. It can be administered based on shared clinical decision making between the patient and healthcare provider. A single dose of Prevnar 13 is still recommended for immunocompromised patients ≥ 6 years old if not previously received A single dose of Prevnar 13 is still recommended for immunocompromised patients ≥ 6 years old if not previously received

12 month old with sickle cell disease. She will get her 4th pneumococcal vaccine. Which one is she getting today

Prevnar 13 which is a pneumococcal conjugate vaccine-13 valent because prevnar 13 is a routine childhood series starting at 2 month old and for children less than 5 . The polysaccharide from 23 does not elicit an adequate antibody response in children less than 2 y- it is not even started for her yet. Because she fits into immunocompromised category, she should receive 23 when she turns 2 ( 23 is for 2-64 for immunocompetent and immunocompromised)

50 y old got a cut from working in garden and never received anything in terms of vaccines. what vaccine is preferable tdap td

Tdap because it is used for anyone who has never had a dose previously Note: a person who gets a cut or burn might need a dose of Td or Tdap to prevent tetanus infection but if he never got anything before, go for Tdap and if he did, then go for Td. Td should also be used if Tdap is not available and for anyone who has had a dose of Tdap

Hep A vaccines all the names

Vaqta and Havrix

DtaP- what does a stands for

a- The "a" in DTaP and Tdap stands for "acellular", meaning that the pertussis component contains only a part of the pertussis organism. D- Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) T-tetanus (T) toxoids full strength P-pertussis (P) vaccine full strength d-Lower-case d denote reduced doses of diphtheria p- lower-case p denote lower dose of pertussis used in the adolescent/adult-formulations.

Which of the following vaccines can be given in the time interval as stated below? A. proquad(MMRV) and flumist separated 14 days b. mmr and zostavax separated 7 days c. mmr and zotavax separated 14 days d. varivax and flumist separated 28 days

d. varivax and flumist separated 28 days live vaccines can be given on the same day, if separated, have to sep at least or minimum of 4 weeks, 28 days between 2 lives if not given on the same day Don't need to separate for oral rotavirus there is no a minimum interval for separating an inactivated (influenza shot) and live vaccine ** patient with asplenia, prevnar and menactra should be separated by 4 weeks

Preggo which vaccines

influenza- not the live ones Tdap with every pregnancy, ideally between 27-36 weeks. If not given , adminster immediately post partum Flumist and MMR = CI

which vaccine to avoid in severe allergy to eggs or gelatin

yellow fever note: zostavax is also CI with severe analphy to gelatin

correct site for zostavax injection

fatty tissue over the triceps since it is SC deltoid- for IM

77 y old with DM, CHF, RA. WHich formulation is not appropriate for her flumist fluzone HD flubok Quad Fluarix Quad Fluad

flumist - ONLY INDICATED IN HEALTHY PATIENT 2-49. SHE IS 77 AND NOT HEALTHY. fluad trivalent inactivated influenza that has MF59 (an adjuvant) to increase antibody production and improve immunity even though it doesn't have the word QUAD in it.

Fluvirin was found in freezer. What to do with it

this vaccine and other Flu vaccines requires only refrigeration and can't be stored in the freezer. If it has been frozen in error, vaccine can't be used

which vaccine has both hep A and B for a 6 month old infant.? Birth- hep B is started at birth and it is 3 dose series. 6 month- 8 years old- getting Influenza for the first time need 2 doses (4 weeks apart) 12 months-live vaccine like MMR and MMRV 2 years old- Other vaccine like prevnar 13, DTaP, Hib, Polio and rotavirus NO POLYSACCHARINE before 2

twinrix- 2 vaccines included Recombivax-B and Engerix-B : hep B only, has "B" in both" Pediarix(3): DTaP-HepB-IPV Havrix :HepA , has only " A" in the name

which diluents come with the vaccines and can be stored in RT or Fridge

vacricella zostavax MMR MMRV

Name for chickenpox vaccine

varivax is from chickenpox zostavax is from herpes zoster virus/shingles

what source is the best to obtain current vaccine recommendation and other essential immunization information?

what source is the best to obtain current vaccine recommendation and other essential immunization information?

pt 67. Wants to get shingrix but heard it is painful and it requires 2 doses. She request a single dose zostavax instead, she also wants to get pneumococcal and influenza. Can she get all 3?

yes *** simultaneous administration is recommended whenever possible to increase immunization rate EXCEPTION: patient without a spleen, Menactra and Prevnar need to be separated by 4 weeks HOWEVER, live vaccines such as MMR, MMRV, Varicella, Zostavax, and Yellow Fever and live intranasal influenza vaccine are not administered at the same visit, they should be separated by at least 4 weeks. ------THIS IS NOT TRUE FOR ORAL ROTAVIRUS VACCINE If more than one injection is given in the same limb, separate the injection site by at least inches.

which patient should get bexsero ( men B or serogroup B meningococcal vaccine)? 1) 25 year old lab worker exposed to N meningitis 2)10 y with sickle cell disease 3) 19 y on campus during meningitis serogroup B outbreak 4) 6 y old with sickle cell disease 5) 38 y traveling to menignitis belt of sub-saharan africa

1) 25 year old lab worker exposed to N meningitis==> also true for this is for for MenACWY vaccines aka MCV4 aka Menactra/Menveo 2)10 y with sickle cell disease ==> both serogroup B vaccines ( Bexsero and Trumenba are for 10 years or older all way to 25 years old ). Recommended for patient with asplenia/sickle cell disease 3) 19 y on campus during meningitis serogroup B outbreak Recommendation for Bexsero and Trumenba (SeroB vaccines) Age: 10-25 1) asplenia 2)sickle cell d 3) lab workers exposed to N meningitis 4) outbreak of serogroup B mening CORRECTION 4) 6 y old with sickle cell disease ==> too young, needs to be at least 10 to get bexsero or trumenba, use menactra(9 months or older) or menveo ( 2 months and older) instead with HIV/sickle cell disease/asplenia) 5) 38 y traveling to menignitis belt of sub-saharan africa ==> this is for for MenACWY vaccines aka MCV4 aka Menactra/Menveo not for the MenB or seroB caccines.

12 month child received immune globulin for kawasaki disease 2 months ago. Which vaccine would be adversely affected by this txtment 1) Varicella 2)MMR 3)Influenza 4) Pneumoccocal 5) inactivated polio

1) Varicella 2)MMR PATIENT NEEDS TO WAIT 3 months or longer to get the vaccine, BECAUSE SHE GOT THE IMMUNO G FIRST. IF SHE GOT VACCINE FIRST, THEN SHE WAIT 2 WEEKS TO GET THE IMMUNO MMR and Varicella containning vaccines not ZOSTERs require separation from antibody containg products like immuno globulin Schedule 1) vaccine==> 2 week==> immunog 2) immuno==> need to wait 3 months or longer to get the vaccines ---- Simultaneous administration of vaccine and antibody informs of immunoglobulins is recommended for post exposure prophylaxis of certain diseases (hep A, hep B, rabies and tetanus)

SC administration of vaccine is correct? 1) Zostavax, Varivax, MMR are SC 2) Flumist, fluzone, Vivotif are SC 3) SC - 45 d 4) SC- fatty tissue over triceps 5) needle that is 5/8 long

1) Zostavax, Varivax, MMRV, Yellow fever MMR are SC 3) SC - 45 d==> the shorter needle and angle of injection prevents IM injection) 4) SC- fatty tissue over triceps-- > upper outer arm the fatty tissue over tricep is preferred for SC 5) needle that is 5/8 long ( shorter than IM needle, the shorter needle and angle of injection prevents IM injection) CORRECTION 2) Flumist, fluzone, Vivotif are SC ==> Flumist is intranasal, Vivotif (typhoid) is PO, fluzone- is IM

57 y patient has ESRD what vaccines to give him? 1) influenza annually 2) hep A 3) Tdap if never gotten pertussis booster 4)13 for 1 dose, then 23 after 1 year, then repeat 23 in 5 years and 23 again after 65. 5)13 for 1 dose, then 23 after 1 year, then 23 again after 65.

1) influenza annually ( age 6 months or older) FluLaval Quadrivalent (GSK) and Fluarix Quadrivalent (GSK) vaccines is 0.5 mL for children age 6 months and older. 3) Tdap if never gotten pertussis booster for anyone age >11 who has not gotten a pertussis booster should get a dose of Tdap. 4)13 for 1 dose, then 23 after 1 year, then repeat 23 in 5 years and 23 again after 65. Patient with ESRD is considered immunocompromised(other are, transplant patient, HIV with CD4 less than 200, chemotherapy/bone marrow transplant that causes myelosuppression - decrease in WBC, systemic steroid for more than 14 days at 20mg or 2mg/kg of pred daily equivalent , asplenia, the vaccines that they need to get are: 1) influenza(annually) 2) pneumoccocal 3) hep B 4) meningococal (menactra or menveo) CORRECTION: 2) hep A==> hep B is the one for immunocompromised==> hep A for adults traveling to countries outside of US except developed countries, liver disease, hemophilia, men who have sex with men, IVDA, homeless, household member and other close contacts of adopted children newly arriving from countries with moderate high infection risk. 5)13 for 1 dose, then 23 after 1 year, then 23 again after 65. ==> he is 57 sooooo 57( gets 23 today) ==> 1 year later 58( gets 23)==> 5 years later, 63 years old, he can get another dose of 23, then ===> 65 ( another dose) TOTAL = 3 doses of 23 and 1 dose of 13

shingrix (recombinant aka non live) vaccine that is correct 1) injected into deltoid muscle 2) SC into fatty tissue 3) prevent infxn caused by herpes simple virus 4) antiviral like acyclovir can interfere with vaccine response 5)administer even if patient had history of shingles

1) injected into deltoid muscle 5)administer even if patient had history of shingles CORRECTION 2) SC into fatty tissue==> not shingrix is IM 3) prevent infxn caused by herpex simple virus==> shingrix prevent herpex ZOSTER virus that causes shingles outbreak 4) antiviral like acyclovir can interfere with vaccine response ==> no antiviral interactions with shingrix, this is for varicella/zoster live vaccine- acyclovir, fami, vaala in the 24 hours prior to vaccination, avoid these antiviral 14 days after vaccination

which of the following groups age 6 to 64 should get Prevnar 13 followed by PPSV23 at least 8 weeks later and then PPSV23 again 5 years after first dose? 1) patient with mutiple myeloma about to begin txtment 2) HIV pt 3)Transplant Pt 4)Chronic renal failure underdoing hemodialysis 3 times weekly 5) HF patient

1) patient with mutiple myeloma about to begin txtment 2) HIV pt 3)Transplant Pt 4)Chronic renal failure underdoing hemodialysis 3 times weekly THESE ARE IMMUNOCOMPROMISED --> others are asplenic, and steroid use CORRECT: 5) HF patient==> immunocompetent dont need 2 doses PPSV23, just 1 dose before 65 note patient may receive 1,2,3 doses in their lifetime

which group should get the PPSV23? 1) 8 month old with patent ductus arteriosus 2) 6 y child getting chemo for lymphoma 3)68 y with HTN and no other comor 4)26 month old with asthma getting high dose corticosteroid 5)50 y with COPD

2) 6 y child getting chemo for lymphoma 3)68 y with HTN and no other comor 4)26 month old with asthma getting high dose corticosteroid 5)50 y with COPD ALL OF THESE GROUPS ARE OVER 2 YEARS OLD AND THEY ARE EITHER IMMUNOCOMPETENT( asthma, copd) or IMMUNOCOMPROMISED (chemo, steroid) immunocompetent- diabetes, heart, lung, liver, alcohol , smoker == 1 dose from 2 years to 65 y immunocompromised- sickle cell, asplenia, hiv, chronic renal failure, malignancy, transplant, immunosup drugs, steroid=== 2 doses from 2 y to 65 y rest- 1 dose when they turn 65 CORRECTION 1) 8 month old with patent ductus arteriosus--> polysaccharide vaccines are not given to children <2 due to an inadequate antibody response

67 healthy patient got PPSV23 6 months ago. What can she get today 1) flubok and 13 2) Fluzone HD and Shingrix 3) Fluzone HD and 13 4)Flumist and Shingrix 5)Fluzone Intradermal and 13

2) Fluzone HD and Shingrix - HD influenza produces stronger immune response and may provide better protection vs influenza in adults 65 or older. She may be a candidate for 13 but she can't get it today since it must be space 1 year from PPSV23 , and receive if previously not received after 65 CORRECTION 4)Flumist and Shingrix==> flumist is for 2-49, shes 67 5)Fluzone Intradermal and 13 ==> fluzone intradermal is only 18-64, she's 67

Correct statement on Flubok 1) given SC 2) for 18 and older 3) preferred for children <8 4) recombinant DNA and is completely egg free 5) can't receive it in pharmacy

2) for 18 and older 4) recombinant DNA and is completely egg free CORRECTION 1) given SC==> IM 3) preferred for children <8 ==> it is for children 18 or older 5) can't receive it in pharmacy ==> can get it in the pharmacy even if they had a severe rxn to egg like anaphylaxis

pt is 7 years old and has bad egg allergy and thinks that getting getting the flu vaccination will cause her to get the flu. Which of the following is correct? 1) only children with chronic disease need to be routinely vaccinated against influenza 2) if this is the first time, need 2 doses spaced 4 weeks apart 3) can get flumist in the recommended season 4) fluad is preferred due to egg allergy

2) if this is the first time, need 2 doses spaced 4 weeks apart influenza is for 6 months and older ----if getting it the first time, needs to give 2 doses, 4 weeks apart CORRECTION 1) only children with chronic disease need to be routinely vaccinated against influenza ==> everyone needs to be routinely vaccinated with influenza 3) can get flumist in the recommended season==> she cant get this if she has egg allergy, this is a live vaccine. PREGGO CANT GET THIS EITHER 4) fluad is preferred due to egg allergy==> even patient with severe rxn can get the INACTIVATED influenza, flubok is recommended for egg allergy for age 18 or older though FLUAD and FLUZONE HIGH DOSE is for patient only older than 65

A 14 month old was hospitalized for dog bite injury. Was not given her tetanus vaccine series so tetanus immune globulin was given. Which vaccine would be affected by this txtment? 1)hep B 2)MMRV 3)Influenza 4)Polio 5)Pneumococcal conjugate

2)MMRV - MMR and varicella vaccine are live vaccine that require replication. If antibody containing products have been administered, the vaccine should not be given for at last 3 months (requires time of separation varies depending on the product received). If vaccine has been given, antibody product should be avoided for at least 2 weeks after MMR and varicella containing vaccine to avoid interference with vaccine efficacy Live Vaccines and Antibody(immune globulin) reaction - MMR and varicella containing vaccines (not zoster) require separation from antibody containing products (blood transfusion , IVIG) the recommended spacing: 1) vaccine==> 2 weeks==> antibody containing products 2) antibody containing products ==> 3 months or longer ==> vaccine ---- Simultaneous administration of vaccine and antibody informs of immunoglobulins is recommended for post exposure prophylaxis of certain diseases (hep A, hep B, rabies and tetanus)

21 y had a puncture wound in his foot. Remembers getting a tetanus shot at age 14, what vaccine would be appropriate for him rn? 1) DTaP 2) DT 3) Td 4) Boostrix

3) Td 4) Boostrix he can get Td for wound prophylaxis if it has been more than 5 years. He can also get Tdap (adacel or boostrix) as a substitute if he has not received a shot containing pertussis booster at 14 since Td doesn't have pertussis so giving him Tdap covers all CORRECTION 1) DTaP and DT are for children under adults version has less diphtheria and pertussis antigen because immune system is already primed.

Which of the following, if taken, would qualify as a steroid-induced immune suppressive state? (Select ALL that apply.) 1)The use of a beclomethasone inhaler twice daily for at least 4 weeks. 2)A patient who was recently infected with HIV. 3)An adult who received 4 mg of dexamethasone daily for the past three weeks. 4)An 11.8 kg child receiving 30 mg of prednisolone for the past 22 days. 5) An elderly female who received a triamcinolone intra-articular injection for gout x 1 two days ago.

3)An adult who received 4 mg of dexamethasone daily for the past three weeks==> convert it 5 pred= 0.75 dex, so after conversion it is 26mg , meets criteria of being at 20mg or more 4)An 11.8 kg child receiving 30 mg of prednisolone for the past 22 days==> Meets the criteria of being 14 days or more! Criteria for steroid induced immune suppressive state - systemic steroid for >14 days ( which does not include inhaled, topical or intra-articular) at 20mg or 2mg/kg prednisone daily, or an equivalent steroid dose CORRECTION 1)The use of a beclomethasone inhaler twice daily for at least 4 weeks==> WRONG, because INHALED steroid DOES NOT MEET THE CRITERIA 2)A patient who was recently infected with HIV==> WRONG bc THIS IS DISEASE INDUCED, NOT STEROID INDUCED 5) An elderly female who received a triamcinolone intra-articular injection for gout x 1 two days ago==> WRONG, because INTRA-ARTICULAR steroid DOES NOT MEET THE CRITER

Typhoid: choose correct statement 1) typhoid vaccine is mostly a concern for travelers to US 2) Typhoid is transmitted via mosquitos 3)vivotif is a capsule, needs to be refrigerated 4) vaccination must be completed 24 hour of travel to be effective 5) come in both capsule and IM injection

3)vivotif(live) is a capsule, needs to be refrigerated==> supplied as 4 capsules and it is a live vaccine. Take 1 vivotif 1 hour before a meal on alternative days, 0, 2, 4, 6 with cold or lukewarm water. Vaccination should be completed 1-2 weeks before travel. CDC says 1 week. 5) come in both capsule and IM injection( IM is typhim Vi and it is not live) CORRECTION 1) typhoid vaccine is mostly a concern for travelers to US==> CONCERN EXCEPT INDUSTRIALIZED REGION SUCH AS US, CANADA, AUSTRALIA, JAPAN AND WESTERN EUROPE 2) Typhoid is transmitted via mosquitos==> WRONG, bc it is transmitted via contaminated food and water ingestion/typhoid fever is caused by salmonella typhi 4) vaccination must be completed 24 hour of travel to be effective==> CDC SAID 1 WEEK, if doing IM injection, at least 2 weeks prior

Live Vaccine affect result of TB skin test==> can cause false negative of the TB skin test Patient got varicella vaccine last week. How long does she need to wait to get the TB skin test so it doesnt have a risk of being false neative

4 weeks to get the skin test for TB live vaccines such as varicella, zostavax MMR , proquad( MMRV) or flumist can be given on the same day as TB test if didnt give before TST skin test, a false negative skin test can result leading to untreated tuberculosis==l Recommend to wait 4 weeks after the live vaccine to administer then TST

which vaccine can cause a false positive reaction to tuberculin skin test 1) HPV 2) Varivax( varicella) 3) FluBok 4) Bacille Calmette Guerin( BCG) 5) Bexsero

4) Bacille Calmette Guerin( BCG) - previous BCG vaccine can cause positive reaction to TB test. This is not a routine vaccine given in the US, but BCG is given to infants and small children in countries with higher TB incidence Correction: 2) Varivax( varicella)==> live vaccine that can cause false negative to TB test ==> different ways to give the TB test 1) give live vaccine on same day as the TB skin test 2) wait 4 weeks after the live vaccine 4) skin test first, then wait 48-72 hours to get result, then go for the varicella live vaccine

WD is 13 years old. The mother is upset that the physician suggested that her daughter should receive the HPV vaccine. The pharmacist wishes to relay to the mother why this vaccine might be beneficial. Which of the following statements concerning the HPV vaccine are correct? (Select ALL that apply.) A) Gardasil 9 protects against the HPV strains that are associated with cervical, vaginal and oropharyngeal cancers as well as genital warts. B) The vaccine series should be completed before the patient is sexually active. C) if patient gets HPV today, only 2 doses are required D) HPV vaccine has been associated with fainting after vaccination more often other vaccines and should only be administered to patients who are lying down. E) HPV vaccine should only be administered to girls; boys are not candidates for the vaccine.

A) Gardasil 9 protects against the HPV strains that are associated with cervical, vaginal and oropharyngeal cancers as well as genital warts==> about 90% cervical cancer C) if patient gets HPV today, only 2 doses are required ===> before 15, 2 doses are required, after 15, 3 doses **NOTE Gardasil is given for Female 9-26 (recommended age is 11-12 but start at age 9 years in anyone with a history of sexual abuse ) Male 9-21 (recommended age is 11-12, and up to 26 for immunocompromised male like HIV) Before 15- 2 doses After 15- 3 doses B) The vaccine series should be completed before the patient is sexually active. D) HPV vaccine has been associated with fainting after vaccination more often other vaccines and should only be administered to patients who are lying down==> administer to SEATED patient==> monitor for 15 minutes afterward E) HPV vaccine should only be administered to girls; boys are not candidates for the vaccine.==> WRONG , both f and m are recommended for gardasil 9

A 20 year old female enters the pharmacy and requests a vaccination against shingles (herpes zoster). Prior to administering Zostavax the following screening question must be asked: A) Has she ever had a bad reaction to gelatin B) Does she have a history of smoking? C) Has she ever had Guillan Barre syndrome after flu vaccine D) Is she receiving more than 5 mg prednisone per day for at least the past two months? E) Has she ever had a bad reaction to eggs?

A) Has she ever had a bad reaction to gelatin because zostavax and varivax can't be administered to someone with true allergy to NEOMYCIN or GELATIN B) Does she have a history of smoking? ===> for immunocompetent C) Has she ever had Guillan Barre syndrome after flu vaccine==> this is for diphtheria/tetanus/pertusis vaccine within 6 weeks of previous DTP vaccine D) Is she receiving more than 5 mg prednisone per day for at least the past two months?==Varivax- live, no to severely immunocompromised but steroid dose here is not enough to cause immunosuppression, has to be 20mg for the past 14 days E) Has she ever had a bad reaction to eggs?==> for flu

KP will receive multiple vaccines at a clinic visit. His height is 5 feet 11 inches, weight is 88 kg (193lb). Which of the following is incorrect? A) Pneumovax 23 can be given intramuscularly at a 45 degree angle into the deltoid using a 25 gauge, 1 inch needle. B) Pneumovax 23 can be given subcutaneously at a 45 degree angle into the fatty tissue over the triceps area using a 25 gauge, 5/8 inch needle. C) Fluzone should be given intramuscularly into the deltoid at a 90 degree angle using a 25 gauge, 1 inch needle. D) Zostavax should be given subcutaneously at a 45 degree angle into the fatty tissue over the triceps area using a 25 gauge, 5/8 inch needle. E) Boostrix should be given intramuscularly at a 90 degree angle into the deltoid using a 25 gauge, 1 inch needle

A) Pneumovax 23 can be given intramuscularly at a 45 degree angle into the deltoid using a 25 gauge, 1 inch needle.==> IM is 90 degrees!!!!!!! **Pt is 193 lb so 1 inch needle canbe used for IM injection since he is less than 260lb.PPSV23 can be injected via sc or im. If IM, need to inject into deltoid at a 90 degree angle. If IM- the needle gauge is 22-25 and if SC- needle gauge 23-25 ADMISNTRATION IM ONLY vaccines: MOST SC ONLY: MMR, MMRV, Varicella, Zostavax, Yellow Fever (ALL THE LIVE ONES FOR SC ONLY) SC or IM : PPSV23 , IPV PO: Typhoid Intradermal: Fluzone Intradermal Quad IF DOING SC -use a 23-25 gauge , 5/8 needle at 45 degree into fatty tissue over the triceps IF DOING IM -use a 22-25 gauge needle, have to inject it at a 90 degree dangle into the deltoid muscle " m". Needle length depends on weight ---------1 inch for adults ---------5/8 to 1 inch for <130 lb ----------1.5 inch for >260 lb male and >200lb female Notes D) Zostavax( only SC allows for live) should be given subcutaneously at a 45 degree angle into the fatty tissue over the triceps area using a 25 gauge, 5/8 inch needle. E(boostrix or tdap) and C (Fluzone) are both given IM.

Choose the correct statement concerning immunizations: A) The CDC does not recommend using acetaminophen before or at vaccination as it may decrease immune response; it can be used afterwards if needed for mild pain and/or fever. B) You cannot vaccinate through a tattoo; use a different area. C) According to OSHA, gloves are always required when administering vaccines. D) If blood is drawn up through the syringe, pull the needle out approximately 1/4 of an inch, and continue injecting. E) If parents do not wish to vaccinate their children the children will be well protected in the United States by herd immunity.

A) The CDC does not recommend using acetaminophen before or at vaccination as it may decrease immune response; it can be used afterwards if needed for mild pain and/or fever. Although you can vaccinate through a tattoo, avoid it if possible, as a local vaccine reaction could alter the appearance of the tattoo. Gloves are required if the person administering the vaccine is likely to come into contact with body fluids. Wearing gloves is safe practice and is mandatory in most workplace settings. If gloves are used they must be changed with each new patient. Aspiration prior to vaccine administration is not recommended.

Choose the correct statements concerning HPV vaccine (Select all) A. 3 IM inj is required for 16 yo female receiving first dose B. 2 IM inj required for 12 yo female receiving first dose C. 3 IM inj required for 24 yo male with HIV receiving 1st dose D. Should only be given in children who are sexually active E. optional and not recommended for pts age 9-26 yo

A. 3 IM inj is required for 16 yo female receiving first dose ==> after 15 y, 3 series dose B. 2 IM inj required for 12 yo female receiving first dose==> before 15, 2 series dose C. 3 IM inj required for 24 yo male with HIV receiving 1st dose ==> " if started at age 15 or older or immunocompromised , 3 doses, for male, give up to age 21 in most male and up to age 26 in immunocompromised patient like HIV and men who have sex with men, vacc from 22-26 is optional CORRECTION D. Should only be given in children who are sexually active HPV vaccine is recommended for all females age 9-26 years and males age 9-21 years, or up to age 26 for men who have sex with men or are immunocompromised (including HIV). The 2-dose series can be used for immunocompetent patients when vaccination begins before age 15 years. It is preferred to give at age 11-12, along with the first dose of meningococcal vaccine( 1st dose of mening starts at 11 as a routine vacc) and the Tdap booster(Td booster begins at 11)

A child with sickle cell disease has not been vaccinated for meningococcal disease. Which of the following is true regarding meningococcal disease/vaccine? (Select ALL that apply.) A: Quadrivalent meningococcal vaccines include Menactra and Menveo B: The damage to the spleen caused by sickle cell disease puts this patient at risk for meningococcal disease. C: This patient should receive Trumenba or Bexsero once he turns 10 years old. D: Under current recommendations this patient will require repeated vaccination (boosters) every 5 years. E: Meningococcal vaccine is a routine childhood series given to all infants.

A: Quadrivalent meningococcal vaccines include Menactra and Menveo==> patient without a spleen needs both the quadrivalent (ACWY or Menactra or Menveo) when she she is 2 months or older B: The damage to the spleen caused by sickle cell disease puts this patient at risk for meningococcal disease. C: This patient should receive Trumenba or Bexsero once he turns 10 years old==> patient without a spleen needs both the quadrivalent and SerogropB vaccine( Trumenba or Bexsero) when she turns 10. Because Trumenba and Bexsero is for 10 and up all they way to 25 years old. D: Under current recommendations this patient will require repeated vaccination (boosters) every 5 years.==> pt with ongoing risk of mening disease should be revaccinated Q 5 Years

HPV for patient older than 26?

ACIP does not recommend HPV vaccination for adults older than age 26 years. ACIP recommends HPV vaccination based on shared clinical decision making for individuals ages 27 through 45 years who are not adequately vaccinated. [1] HPV vaccines are not licensed for use in adults older than age 45 years.

which statement concerning intramuscular injection in adult is incorrect? 1) separate 2 injections into the deltoid by a minimum of 1 inch 2)a 5/8 inch needle is preferred for most patient 3) inject below acromiun and level at armpit 4)inject at 90 degree angle into the central and thickest portion of the deltoid muscle 5)Td, Tdap, Hep A, Hep B, HPV, Inactivated influenza, and PCV13 are given by IM injection

Answer: 2)a 5/8 inch needle is preferred for most patient ==> incorrect because for IM, we use a 1 inch needle, if patient weighs less than 130 lb, then we can consider 5/8- 1 , and if they weigh more than 260 lb for male or >200lb for female, we use a 1.5 needle Correct statement regarding IM 1) separate 2 injections into the deltoid by a minimum of 1 inch 3) inject below acromion and level at armpit 4)inject at 90 degree angle into the central and thickest portion of the deltoid muscle 5)Td, Tdap, Hep A, Hep B, HPV, Inactivated influenza, and PCV13 are given by IM injection ==> PPSV23 and IPV are given either IM or SC

Which of the following could interfere with the effectiveness of a dose of Zostavax? A: Acyclovir B: Denavir C: Valtrex D: MMR given 2 weeks prior to the Zostavax E: Oseltamivir

Antivirals that interfere with Zostavax and also Varicella the same way A: Acyclovir C: Valtrex separation bc the antiviral might inactivate the vaccine strain and should not be used within 24 hours before or 14 days after giving the vaccine. Live Vaccines can be given at the same time, if they didnt, have to SEPERATE THEM by 4 weeks to avoid antibody interference D: MMR given 2 weeks prior to the Zostavax--> 2 WEEKS IS NOT ENOUGH OF A SEPARATION if MMR and Zostavax wasn't given at the same time ( both are live) CORRECTION B: Denavir--->Penciclovir is not part of the interaction

Which of the following is true regarding herpes zoster vaccine? (Select ALL that apply.) A) Store the unused vaccine vials (powder) in the refrigerator. B) Store the unused vaccine vials (powder) in the freezer. C) Once reconstituted the vaccine must be used within 30 minutes or discarded, according to ACIP .D) The diluent must be stored in the refrigerator only. E) The vaccine can be administered IM or SC

B) Store the unused vaccine vials (powder) in the freezer.==> needs to store this vaccine in freezer C) Once reconstituted the vaccine must be used within 30 minutes or discarded, according to ACIP==< zostavax has short stability CORRECTION .D) The diluent must be stored in the refrigerator only ==> diluent can be stored in RT or fridge E) The vaccine can be administered IM or SC==> that's only for PPSV23 and IPOL SC only: varicella MMR MMRV Zostavax Yellow Fever

A small community pharmacy just received a delivery of fall flu vaccine. The pharmacy had a small refrigerator that had a freezer compartment within the refrigerator. He tells the staff to make sure that the FluMist is kept in the refrigerator door to keep it separate from the influenza shot vials. Which of the following vaccine storage information is correct? A) The refrigerator he purchased is acceptable if the door is not open and closed repeatedly. B) This type of refrigerator is not acceptable. C) The vaccine shot vials should be kept in the door. D) The influenza vaccine should be frozen, not refrigerated. E) Food can be kept in the same refrigerator but not on the same shelf as the vaccine (or any medication).

B) This type of refrigerator is not acceptable because all vaccines are stored in the center , not at the door ALSO, a small refrigerator with an inside freezer shelf does not have reliable temp control. 5 vaccines out of 9 live ones needs to be in freezer 1) Varicella 2) MMR 3) Zoster 4)MMRV ( MMR with varicella added) 5) Cholera CORRECTION C) The vaccine shot vials should be kept in the door == at the center of frige!! D) The influenza vaccine should be frozen, not refrigerated==> flumist is a live vaccine that is kept in the fridge not frozen E) Food can be kept in the same refrigerator but not on the same shelf as the vaccine (or any medication)==> FOOD is not ALLOWED in the same FRIDGE because unit that store food are opened and shut more often, leading to temp instability

Select the correct statement concerning active and passive immunity: A)Active immunity is weaker than passive immunity. B)The MMR vaccine provides active immunity. C)One way to get passive immunity is to survive an infection. D)Breast milk, during the early days of a baby's life, provides active immunity .E)Immune globulin provides active immunity.

B)The MMR vaccine provides active immunity ==> active because immunity or antibody production occurs when a person becomes infected with an organism and recovers or after a vaccination. CORRECTION A)Active immunity is weaker than passive immunity==> active immunity is produced by person's own immune system and is usually permanent. Active immunity or antibody production occurs when a person becomes infected with an organism and recovers or after a vaccination. C)One way to get passive immunity is to survive an infection. D)Breast milk, during the early days of a baby's life, provides active immunity==> protection by products from mom and transfer to the recipient .E)Immune globulin provides active immunity.==> has antibody already in it, body doesnt need to produce it, hence, passive

Select the correct group of patients for whom hepatitis B vaccine is recommended: A: A 66 year old patient with heart failure and a 35 year old patient with history of IV drug abuse B: A 58 year old patient with diabetes, a 39 year old dialysis patient, and an infant born 12 hours ago C: A 44 year old patient with HIV, a 31 year old surgery resident, and a 27 year old patient with G6PD deficiency D: A 39 year old patient with cirrhosis and an 18 year old patient leaving for college next month E: A 52 patient who is status post splenectomy and a 28 year old patient with multiple sexual partners

B: A 58 year old patient with diabetes, a 39 year old dialysis patient, and an infant born 12 hours ago==> meets the 24 hour ,ESRD-dialysis, diabetes This is correct because it meets the requirements of hep B: 1) infants born within 24 hours of birth 2) healthcare and public safety workers 3) Patient with chronic liver disease- get both A and B 4) Diabetes patient 5)ESRD 6) anyone with multiple sex partners 7) IV drug users 8) person traveling to regions with high HBV infection CORRECTION A: A 66 year old patient with heart failure and a 35 year old patient with history of IV drug abuse==> failure dont count, only diabets C: A 44 year old patient with HIV, a 31 year old surgery resident, and a 27 year old patient with G6PD deficiency==> G6PD defiency dont count D: A 39 year old patient with cirrhosis and an 18 year old patient leaving for college next month==> cirrhosis yes but college next month dont count E: A 52 patient who is status post splenectomy and a 28 year old patient with multiple sexual partner===> post splenectomy gets another vaccine, not hepb , they get, Hib B, meningcocoal-both conjugate and serogroup B, prevnar 13,ppsv 23, then ppsv 23 again after 5 years

A 62 year old male underwent a splenectomy secondary to refractory thrombocytopenia. Which vaccine should he receive at least 2 weeks before this procedure? A: Menhibrix B: Menactra C: Twinrix D: Hepatitis B E: Boostrix

B: Menactra( 9 months- 55 years old) *Splenectomy patients should receive the meningococcal, pneumococcal, Hib vaccines, however, Menhibrix is used only in children age 6 weeks to 18 months. Menactra and Menveo(2 months to 55 y ) are quadrivalent conjugate vaccines containing the ACW and Y serogroups.

A community pharmacist who runs a vaccination clinic has run out of the vaccine information sheets (VIS) for one of the vaccines. What are recommended websites to get a current VIS to use to make more copies? (Select ALL that apply.) A) From the Pharmacist's Letter B) From the Medical Letter C) From the Immunization Action Coalition's website D) From the Centers for Disease Control (CDC) website E) From the World Health Organization (WHO) website

C) From the Immunization Action Coalition's website D) From the Centers for Disease Control (CDC) website The CDC website is www.cdc.gov and the Immunization Action Coalition's is www.immunize.org. The VIS handouts change (the updated date is listed on each version)-make sure you are giving a current VIS for each dose of each vaccine received. These cover who should get the vaccine and who should not, the complications of the illness and what to expect-including what to do if a serious reaction is experienced. The patient, or their parent, should read it.

A small community pharmacy just received a delivery of fall flu vaccine. The pharmacy owner needs to instruct the staff on storage requirements. He should include the following information: A) The refrigerator temperature is recorded in a log record once daily. B) The temperature log record is kept for at least one year. C) The stock should be rotated so that the oldest vaccines (earliest expiration dates) are in the front. D) The temperature log record can only be maintained by a registered pharmacist or intern. E) If administering vaccines, the temperature log must be checked every day (including days in which the pharmacy is closed).

C) The stock should be rotated so that the oldest vaccines (earliest expiration dates) are in the front. Correction A) The refrigerator temperature is recorded in a log record once daily==> twice daily B) The temperature log record is kept for at least one year==> at least 3 years D) The temperature log record can only be maintained by a registered pharmacist or intern==> tech can also record E) If administering vaccines, the temperature log must be checked every day (including days in which the pharmacy is closed).

In which of the following patients can Fluad be used for influenza prevention? A: A person who wishes to receive an egg-free vaccine B: A patient who had Guillain-Barre 2 weeks after recieving a flu vaccine 6 years prior C: A 67 year old female with a history of hypothyroidism D: A patient who has had a severe reaction 30 minutes after a dose of Flublok E: A patient who wishes to receive a quadrivalent vaccine

C: A 67 year old female with a history of hypothyroidism ==> anyone over 65, should get the fluzone HD or Fluad-a trivalent flu vaccine that contains an adjuvant to improve the antibody response. It is indicated for patients age 65+ years. CORRECTION: A: A person who wishes to receive an egg-free vaccine==> It is not an egg-free formulation. fLUBOK IS B: A patient who had Guillain-Barre 2 weeks after recieving a flu vaccine 6 years prior==> A patient who experiences Guillain-Barre within 6 weeks of a prior influenza vaccine should be referred to their healthcare provider. 6 YEARS AGO IS WAY TOO LONG D: A patient who has had a severe reaction 30 minutes after a dose of Flublok-->Patients who have experienced a severe reaction to a vaccine should not receive that vaccine again. E: A patient who wishes to receive a quadrivalent vaccine==> FLUAD IS a trivalent flu vaccine

A 64 year old female is in the pharmacy to pick up her meloxicam prescription and some throat lozenges on August 24. The pharmacist notices that she is congested, with sneezing and she mentions a sore throat. Upon questioning, she states that she has not received her influenza vaccine yet this season. Which of the following is correct? A: She should not receive the influenza vaccine today as she is too ill. B: She should not receive the influenza vaccine today because of an interaction with her medication C: She should receive the influenza vaccine today. D: She should not receive the influenza vaccine until after October 1, to avoid the immunity waning before the end of the influenza season. E:She will need to receive 2 doses of influenza vaccine this year, 1 dose today and 1 dose 4 weeks later.

C: She should receive the influenza vaccine today ==> she is not sick enough( this is mild only) to be deferred. If patient can walk into the pharmacy, they are likely a candidate for vaccination Invalid contraindications to vaccination: 1) milk acute illness like slight fever, mild diarrhea 2) current antimicrobial txtment ( some exception such as varicella, zoster, and oral typhoid vaccines 3)allergies: bird feathers, penicillin, allergies to products not in vaccine 4) pregnancy (except live vaccines) , breastfeeding, preterm birth 5) recent tuberculin test 6)immunosuppressed person in the household, recent exposure to the disease or convalescene 7) family history of adverse events to the vaccine CORRECTION A: She should not receive the influenza vaccine today as she is too ill==> she is only have mild sx B: She should not receive the influenza vaccine today because of an interaction with her medication==> no intxn with meloxicam D: She should not receive the influenza vaccine until after October 1, to avoid the immunity waning before the end of the influenza season==> CDC recommend getting influenza vaccine as soon as it is available rather than deferring until later in the season E:She will need to receive 2 doses of influenza vaccine this year, 1 dose today and 1 dose 4 weeks later==> adult gets 1 dose, if she is a child age 6 to 8 years, who never received the flu will require a 2 dose series where she gets 1 dose today and another dose 4 weeks later.

Freezer live vaccine and fridge live vaccine

Freezer live vaccine -Varicella, -zostavax -MMRV Fridge or Freezer -MMR

A pharmacist is preparing an injection for a male patient, 63 years old, who weighs 280 pounds. The pharmacist is going to administer the Zostavax vaccine. Which of the following statements concerning Zostavax injection is correct? (Select ALL that apply.) A: Use a needle at least 1.5" long. B: The vaccine must be reconstituted prior to use with sterile or bacteriostatic water. C: Zostavax will help protect the patient against developing a herpes zoster outbreak. D: Zostavax is recommended in patients who have had shingles before. E: This vaccine is administered subcutaneously in the fatty tissue over the triceps.

C: Zostavax will help protect the patient against developing a herpes zoster outbreak==>Zostavax will help protect the patient against a herpes zoster outbreak D: Zostavax is recommended in patients who have had shingles before==>Zostavax will help protect the patient against a herpes zoster outbreak, also known as shingles, even in patients who have previously had an outbreak. E: This vaccine is administered subcutaneously in the fatty tissue over the triceps ==> Yes, Zostavax is a Live vaccine, so SC CORRECTION A: Use a needle at least 1.5" long==> if patient was getting IM vaccine, then the 1.5 inch applies to them since he is more than 260 lb for male. FOR SC, NO NEED TO CHANGE LENGTH OF THE NEEDLE REGARDLESS OF WEIGHT==> NEEDLE SIZE FOR SC IS 5/8 AND GAUGE IS 23-25, 45 D IM GAUGE IS 22-25, 90 D B: The vaccine must be reconstituted prior to use with sterile or bacteriostatic water==>only reconstitute with supplied diluent

Correct info on Zostavax(for herpes zoster/shingles) and Varivax(for chickenpox) A) Only Zostavax (not Varivax) can be given during pregnancy. B) The diluent must be stored in the freezer and the vaccine is refrigerated. C) Both the diluent and the vaccine are kept frozen until needed. D) Once drawn up in a syringe, the vaccine must be used quickly; do not store reconstituted vaccine. E) The vaccines are ready to use; no reconstitution is required.

D) Once drawn up in a syringe, the vaccine must be used quickly; do not store reconstituted vaccine==> because it has short stability of 30 min CORRECTION: A) Only Zostavax (not Varivax) can be given during pregnancy.==> both are ALIVE so NO PREGGO ALLOWED B) The diluent must be stored in the freezer and the vaccine is refrigerated.==> DILUENT in FRIDGE or RT, will be ice and can't reconstitute C) Both the diluent and the vaccine are kept frozen until needed==> diluent in Fridge or room temp, store both vaccine in Freezer D) Once drawn up in a syringe, the vaccine must be used quickly; do not store reconstituted vaccine.==> it needs to recon immediately when removed from freezer, administer via SC right away E) The vaccines are ready to use; no reconstitution is required==> need to reconstitute both zostervax and varivax with diluent

How is influenza spread most commonly? A) Consuming contaminated food and/or water B) By blood borne products C) By sexual relations D) Through respiratory droplets, from sneezing or coughing E) Influenza is not spread person-to-person; it is contracted from mosquito bites

D) Through respiratory droplets, from sneezing or coughing Influenza spreads mainly from person to person through coughing or sneezing of people with influenza. The infection can spread if a person touches something with the virus on it and then touches their mouth, eyes, or nose. People can infect others beginning on the day before symptoms develop and up to 5 days after becoming sick. Proper hand washing is important to contain the disease spread. Instruct patients to sneeze into their elbow, if a tissue is not handy, rather than into their hands. A) Consuming contaminated food and/or water==> Norovirus B) By blood borne products==> HIV/Hep B ( note Hep A is from fecal and oral) C) By sexual relations==> HIV/Hep B E) Influenza is not spread person-to-person; it is contracted from mosquito bites==> ebola

A mother asks if her eleven month old son will receive thimerosal from vaccines. She is concerned that this mercury-containing preservative might increase the risk of autism in her son. Select the correct statements. (Select ALL that apply.) A)Children whose parents do not wish to vaccinate can choose to do so if they live in an urban (not rural) center where the child will likely be protected by "herd" immunity. B)While it is true that thimerosal is contained in many childhood vaccines, it is not linked to autism. C)There has been a lack of vaccine-preventable disease occurrence in recent years; instruct the mother to avoid vaccines in her children. D)Thimerosal may be present in multi-dose influenza vaccines, and can be avoided upon request. E)The link between vaccines and autism has not been shown to be valid; pharmacists should promote vaccination to reduce disease spread.

D)Thimerosal may be present in multi-dose influenza vaccines, and can be avoided upon request.==>FluMist does not contain thimerosal.Some of the multi-dose (but not single dose) influenza shot vials may contain thimerosal-the patient can request an injection without thimerosal and the pharmacy should have this option available E)The link between vaccines and autism has not been shown to be valid; pharmacists should promote vaccination to reduce disease spread. CORRECTION B)While it is true that thimerosal is contained in many childhood vaccines, it is not linked to autism==> has been removed from most chilhood vaccinations A)Children whose parents do not wish to vaccinate can choose to do so if they live in an urban (not rural) center where the child will likely be protected by "herd" immunity==>The recent pertussis outbreak indicates that the lack of vaccination among some groups has reduced the protection from herd immunity. The link between vaccines and autism is not proven and has been well studied.

DTap how many doses for children DT is for what situation Td is for what situation Tdap is for what situation

DTaP - 5 doses for kids at age 2, 4, 6, 15 to 18 months, and 4-6 years. DT is for children who can't tolerate pertussis hence no P in the name Td- only tetanus and diphtheria for adolescents and adults booster every 10 years or after exposure to tetatanus Tdap is similar to Td but contains pertussis and is commonly used in adults with exposure to newborns to protect the infant from pertussis cough and in women during ech pregnancy for same reason

Which of the following vaccine names is not correctly matched? A: Adacel = tetanaus diphtheria pertussis vaccine B: Fluad = Influenza vaccine C: Trumenba = Meningococcal serogroup B vaccine D: Vaxchora = Cholera vaccine E: Hiberix = Hepatitis B vaccine

E: Hiberix = Hepatitis B vaccine *Hiberix is a H. influenzae type B vaccine. Hep B: energix B, Heplisav-B, Recombivax B ALL NEEDS TO HAVE A B at the end Adacel is Tdap = tetanaus diphtheria pertussis vaccine Boostrix is also Tdap pediarix has 3 - DTaP, HepB and IPV

PR is 45 years old and presents to the pharmacy on November 3rd to pick up a prescription. He has a history of asthma, hypertension, anxiety and intermittent depressive episodes. He was involved in a motor vehicle accident the previous summer. His injuries included a punctured lung, two fractured ribs and a lacerated spleen with subsequent splenectomy, but has otherwise recovered. He reports that he has not received any vaccines since he was 5 or 6 years old. The pharmacist can recommend the following vaccines: A: Pneumovax 23, Hiberix and Fluvirin B: Prevnar 13, Menveo and Fluvirin C: Pneumovax 23, Bexsero and Fluad D: Prevnar 13 and Fluzone High Dose E: Prevnar 13, Pneumovax 23, Menveo, Trumenba, Hiberix and Fluzone

E: Prevnar 13(because patient is asplenic, administer this first before 23), Pneumovax 23(patient has asthma) Menveo, Trumenba, (splenectomy is an indication for both quadrivalent and serogroup B meningococcal vacines), Hiberix(H influenza) and Fluzone( age 6 and older get this every year, fluzone and fluvirin are both inactive ) Special population( sickle cell disease and asplenia ( damaged or missing spleens) Vaccinations Requirements: 1) H influenza type B (Hib) 2) PNA ( before 65y, give 1 dose of prevnar 13 then give 23 8 weeks later, then give 23 again 5 years later) 3) Meningococcal ----- either menactra or menveo ( meningococcal conjugate vaccine) -----serogroup B meningococcal vaccine (bexsero or Trumenba) 4) everyone age 6 or older should receive influenza vaccine( inactive ones are fluvirin and fluzone)

how to administer MMR.MMRV, Varicella, Zostavax, Yellow Fever

LIVE- SC 45 d into fatty tissue overlying the triceps muscle. Pink up the subcutaneous tissue to prevent injection into muscle

Patient is 72 year old male who is due for tetanus vaccine. Lives with a 3 month old granddaughter . Does not know if he ever recieved the pertusis. Which vaccine Tdap Td TdP DTap Tetanus only

Tdap(adacel, boostrix)-- for older children, adolescents, and adults who never received previously and get it to prevent for passing to children Td- booster for every 10 years DT: infants and children <7 who have a CI to acellular pertussis antigen in DTap DTap(pediarix)- for children ( 5 doses) - capitalized because it has 3-5 times more of the diphtheria components than the adults formulation. Adult has a lower case d

which is not live flumist yellow fever vaxchora rotaTeq Typhim

Typhim - inactivated and is given IV for typhoid vivotif- live capsule for typhoid Yellow fever- YF-vac is given SC and is CI with severe egg or gelatin allergy Both rotavirus vaccines (rotaTeq and Rotarix) and cholera (Vaxchora) ARE LIVE ORAL

healthcare worker got Hepa B vaccine ( 3 series doses). She never got the chickenpox. What other vaccines should she get HiB RotaTeq Varivax Influenza seasonally Tdap if no record of previous booster with pertussis containing tetanus vaccine

Varivax Influenza seasonally Tdap if no record of previous booster with pertussis containing tetanus vaccine Healthcare professionals should receive the following: think of appe health clearance Annual influenza hep B if no evidence of vaccine series completion Tdap if not up to date, then Td every 10 years Varicella: if no history of vaccination or chickenpox infxn MMR: if no history of vaccination or blood test immunity NOTE: if healthcare worker work in lab who are exposed to meningococcal isolate , then also need the meningitis vaccine ( menB/seroB , menACWY

how to administer Tdap

below acromion and level of armpit, because it is IM vaccine, at the central and thickest portion of the deltoid muscle. Not too high in the deltoid==> injury

13 month old wants to get flu vaccine. How should it be administer? Can they receive fluad

children 6 months to 8 for the first time getting flu vaccine, requires 2 doses- 4 weeks apart Fluad is adjuvanted vaccine that is indicated for 65 y and older

administer this patient gets anaphylatic rxn

epinephrine pen diphendram given for less severe reaction.

a pharmacist working in a hospital did not return for 2nd dose of hep B vaccine which was due 1 month after 1 st dose. It is now 4 months after 1 dose. What is the recommendation

get the 2nd dose now and return for 3rd dose at a proper time Hepatitis B inf is an infectious hazard for healthcare personnel. Persons with chronic infection are at risk for chronic active hepatitis, cirrhosis and primary liver cancer. Usual schedule is 3 doses given by IM. 1st dose => 2nd dose 1 month later==>3rd dose 6 months later after 1 ist dose immune response is not diminished if a dose is delayed(It is best not to increase interval, delay increases risk of infection by delay immunity) however dosing interval should not be shortened unless an accelerated series is approved by ACIP.

exposure to which of the following commonly requires administration of immune globulin(passive immunity) at the time of vaccination?

rabies other: tetanus, hep B and hep A immune globulin(passive immunity) gives quick protection since it takes 2 weeks for protective antibody to be made. Rabies vaccine is not a routine vaccine so nearly all patient will require rabies IgB to be given with the first dose of rabies vaccine (Rabavert) to protect patient until antibody production is underway. OTHER that fit: Tetanus and Hep B

which vaccine contains hepatitis B only

recombivax and Energix B Harivax is only hep A Twinrix is both A and B Pediarix has inactivated polio vaccines hep B and DTaP

Risk for meningcoccal disease

serogroup B (Trumenba and Bexsero) starting 10 yearse - asplenia -microbiologist exposed to N.mening -serogrop B outbreak -complement component deficient -taking eculizumab Conjugated vaccine- quadrivalent ( Menactra and Menveo) starting age 2 months doe menveo and 9 months for menactra all way to 55 years old for both groups-- NOTE if asplenia, need to seperate menactra and prevnar 13 by 4 weeks -same group as above plus -HIV -traveled to countries like sub-haran -military recruits -first year college living on campus -if not up to date - revactinate every 5 years if ongoing risk for mening disease

pt ask if any of the vaccine contains animal products. RPH respond

some vaccine contains gelatin-porcine derived, however end product is rendered pure and it is injected not ingested. A few other vaccine contain eggs can be avoided (yellow fever) For observant Muslims, Jews, and Seventh Day Adventists who follow dietary rules that prohibit pork products, most religious leaders permit the use of gelatin-containing vaccines because the gelatin is injected, not ingested, and the end-product has been rendered pure