Clinical: Vaccine Information

Which 3 vaccines are recommended in patients with asplenia (either the spleen has been removed (splenectomy) or is severely damaged (patients with sickle cell disease)?

- H. influenzae type B (HiB) vaccine - Pneumococcal vaccines (Prevnar and Pneumovax 23) - Meningococcal vaccines (Menactra or Menveo + Bexsero or Trumenba)

What vaccine is recommended for pregnant patients to provide protection from pertussis before the child is old enough to be fully vaccinated?

1 dose of Tdap is recommended with each pregnancy (optimal time is between weeks 27 and 36)

What vaccine comes first, PCV13 (Prevnar) or Pneumovax 23 (PPSV23)?

13 comes before 23

If a pregnant patient has not received a tetanus vaccine or if vaccination history is unclear, what is recommended?

A 3-dose series is needed; 1 Tdap then 2 Td doses, one at 1-2 months and another at 6 months

RotaTeq (RV5) should be administered as a: A) 2-dose series to infants at 2 and 4 months of age. B) 2-dose series to infants at 0 and 6 months of age. C) 3-dose series to infants at 2, 4, and 6 months of age. D) 3-dose series to infants at 1, 2, and 6 months of age.

A) 2-dose series to infants at 2 and 4 months of age.

Which of the following patients is a candidate for both MenACWY and MenB vaccines? A) A 10 year-old who just had his spleen removed. B) A 16 year-old with HIV. C) A 2-month old with a C2 deficiency (a complement component deficiency). D) A 22 year-old military recruit.

A) A 10 year-old who just had his spleen removed.

Which of the following patients should receive Pneumovax 23 x1 before age 65? (Select ALL that apply.) A) A patient with diabetes B) A patient with asthma C) A patient who smokes D) A patient with heart failure E) A patient with a history of meningitis

A) A patient with diabetes B) A patient with asthma C) A patient who smokes D) A patient with heart failure These patients should receive PPSV23 x 1 dose before age 65. Patients with these disease states are considered to be immunocompetent, but have higher risk of pneumococcal disease.

At what point during pregnancy is it recommended to administer the influenza vaccine? A) Anytime is safe B) During the 1st trimester C) 27 to 36 weeks D) Wait until after the baby is delivered

A) Anytime is safe

A community pharmacist who runs a vaccination clinic wants to review current vaccine administration recommendations. What source is best to obtain the current vaccine recommendations and other essential immunization information? A) Centers for Disease Control (CDC) website B) Koda Kimble: Applied Therapeutics C) His pharmacy school notes D) The vaccine manufacturer's product package inserts E) A website he found by searching with Google

A) Centers for Disease Control (CDC) website The vaccine recommendations are developed by the Advisory Committee on Immunization Practices (ACIP) and published in the Morbidity and Mortality Weekly Report (MMWR). All of this information, including the full vaccination schedules, is available from the CDC website. The Pink Book is on the CDC website, in both chapters for free download and some of the topics in slide-sets. When the Pink Book was only available in hard copy it bore a pink cover. It contains all aspects of immunization, including a background on immunology and principles of immunization.

Which of the following is incorrect regarding vaccine storage? A) Cholera vaccine must be stored in the refrigerator. B) MMR vaccine can be stored in the refrigerator. C) MMR vaccine can be stored in the freezer. D) Vivotif must be stored in the refrigerator. E) MMRV vaccine must be stored in the freezer.

A) Cholera vaccine must be stored in the refrigerator. Vaxchora is oral cholera vaccine that must be stored in the freezer prior to reconstitution with water.

According to ACIP, which of the following is a contraindication to receiving HZV? A) Current treatment for lymphoma. B) Age 59 years or younger. C) Past history of herpes zoster. D) Has never received the varicella zoster vaccine (VAR).

A) Current treatment for lymphoma.

A pharmacy that is administering vaccines must be prepared to administer the following medication in the event of an anaphylactic reaction: A) Epinephrine injection B) Dexamethasone injection C) Triamcinolone injection D) Hydroxyzine injection E) Epinephrine and dexamethasone

A) Epinephrine injection Epinephrine must be available to treat anaphylaxis. Diphenhydramine can be given for less severe reactions, if needed, but epinephrine is the most important first injection to get the airways open so that the patient can breathe. Steroids may be given in the emergency department.

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) It is true that receiving HPV will encourage her daughter to have sexual relations earlier than she might otherwise, but she should get the vaccine anyway. 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. B) The vaccine series should be completed before the patient is sexually active. HPV vaccine is recommended for all girls (ideally at age 11-12 years) and women through age 26 who did not get all three doses of the vaccine when they were younger. Upon investigation after initial reports of patients fainting after receiving HPV vaccine, incidence was found to be similar to other vaccines. All vaccines should be administered to a seated patient, who should be monitored for 15 minutes after vaccination.

Prior to the introduction of a vaccine, what was the leading cause of bacterial meningitis in children younger than 5 years of age? A) Haemophilus influenzae type b. B) Diphtheria. C) Varicella. D) Streptococcus pneumoniae.

A) Haemophilus influenzae type b.

Which of the following best describes how to administer MMR vaccine to an adult patient weighing 210 lb? A) Inject subcutaneously at a 45° angle in the outer aspect of the upper arm. B) Inject intramuscularly at a 45° angle in the deltoid muscle. C) Inject subcutaneously at a 90° angle in the outer aspect of the upper arm. D) Inject intramuscularly at a 90° angle in the deltoid muscle.

A) Inject subcutaneously at a 45° angle in the outer aspect of the upper arm.

Which of the following vaccines comes as a powder that is stored in the freezer and requires reconstitution with the supplied diluent? (Select ALL that apply.) A) MMR with Varicella (MMRV, ProQuad) B) Zostavax C) Pentacle D) Vivotif E) Varivax

A) MMR with Varicella (MMRV, ProQuad) B) Zostavax E) Varivax If you did not know that ProQuad was stored and reconstituted the same as the other vaccines, you may be able to make a good guess that it is by considering that the vaccine contains varicella. Also, they are all administered by subcutaneous injection. MMR without varicella can be stored in the refrigator or freezer.

Which of the following immunization strategies is preferred for adults under the age of 65 years with immunocompromising conditions who require both PCV13 and PPSV23? A) PCV13 first, followed by PPSV23 at least 8 weeks later. B) PCV13 first, followed by PPSV23 at least 1 year later. C) PPSV23 first, followed by PCV13 at least 8 weeks later. D) PPSV23 first, followed by PCV13 at least 6 months later.

A) PCV13 first, followed by PPSV23 at least 8 weeks later.

KP will receive multiple vaccines at a clinic visit. His height is 5 feet 11 inches, weight is 88 kg. 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. Patient weighs 88 kg (193.6 pounds), so a 1 inch needle can be used for IM injections, as he is < 260 pounds. In adults these IM injections are administered into the deltoid muscle at a 90 degree angle. Tdap (Boostrix and Adacel) and Fluzone are given IM. Pneumovax 23 can be given subcutaneously or IM. A 25 gauge needle can be used for IM or subcutaneous injections (for IM injections range is 22-25 gauge and for subcutaneous injections 23-25 gauge needles can be used).

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 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. Patients with sickle cell disease are considered functionally asplenic (their spleen does not function) and both the quadrivalent (ACWY) and serogroup B vaccines are recommended.

A patient at your pharmacy has had diabetes and heart disease for over ten years. She remembers that she got the pneumococcal shot when she turned 50 years old and was diagnosed with diabetes. She is now 67 years old. Select the correct statement: A) She needs both Prevnar 13 and Pneumovax 23. B) She requires one dose of Pneumovax 23 but not Prevnar 13. C) She requires one dose of Prevnar 13 and one dose of Pneumovax 23 at the same time. D) She does not need a pneumococcal vaccine, but she does need to get the MMR vaccine. E) She does not need the pneumococcal vaccine, but she should receive the FluMist vaccine annually.

A) She needs both Prevnar 13 and Pneumovax 23.

Kimberly is a 34 year-old woman who is 30 weeks pregnant. She received a Td booster dose 1 year ago when she cut her hand while working in the kitchen. She has no documentation of receiving a Tdap vaccine. The most appropriate recommendation would be to administer: A) Tdap as soon as possible. B) Tdap immediately postpartum. C) DTaP as soon as possible. D) Td in 9 years.

A) Tdap as soon as possible.

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.

LM, a 29 year-old female, is getting her first job as a hospital pharmacist since completing school. Her first day of work is September 15. She completed her hepatitis B vaccine series (three doses, with evidence of immunity) during pharmacy school. Her mother reports that she was the only child in the family who did not contract chickenpox. What other vaccines should LM receive now? (Select ALL that apply.) A) The influenza vaccine, seasonally B) Tdap vaccine, if no record of previous booster with a pertussis-containing tetanus vaccine, and Td every 10 years thereafter C) Varivax D) Cervarix E) Hib vaccine

A) The influenza vaccine, seasonally B) Tdap vaccine, if no record of previous booster with a pertussis-containing tetanus vaccine, and Td every 10 years thereafter C) Varivax It is unusual not to have contracted chickenpox, but if this appears to be the case, healthcare workers should receive the varicella vaccine. Children have been receiving the chickenpox vaccine in the United States since 1995. Hepatitis B vaccine is required for healthcare workers and MMR, if not fully vaccinated. Health care workers exposed to meningococcal isolates (typically in the microbiology lab) will also need the meningitis vaccine.

What is the time interval for which the development of Guillain-Barré syndrome following influenza vaccination would result in a precaution for future influenza vaccines? A) Within 6 weeks B) Within 6 months C) Within a year D) Within 5 years

A) Within 6 weeks

A pharmacist is preparing to begin offering vaccines at her pharmacy in the fall. She will be offering the Zostavax vaccine. Choose the correct statements concerning Zostavax administration: (Select ALL that apply.) A) Zostavax vaccine (not the diluent) is stored in the freezer. B) Zostavax should be administered within 30 minutes of reconstitution. C) MMR is an intramuscular vaccine, and Varivax and Zostavax are not. D) SC injections are administered at a 45 degree angle. E) SC injections are administered with a 23 to 25 gauge needle that is 5/8 inch long.

A) Zostavax vaccine (not the diluent) is stored in the freezer. B) Zostavax should be administered within 30 minutes of reconstitution. D) SC injections are administered at a 45 degree angle. E) SC injections are administered with a 23 to 25 gauge needle that is 5/8 inch long. The upper outer arm (the fatty tissue over the triceps) is the preferred site for a SC vaccine injection in an adult. A 5/8 inch needle and injection at a 45 degree angle is recommended for SC vaccine administration. The shorter needle and angle of injection prevents intramuscular injection.

What vaccine is recommended to all pregnant patients?

An inactivated influenza vaccine, due to the risk of poor outcomes from influenza infection in pregnancy.

Which of the following groups should receive the pneumococcal polysaccharide vaccine (Pneumovax 23)? (Select ALL that apply.) A) 8 month old baby with patent ductus arterioles B) 26 month old child with asthma receiving high-dose corticosteroids C) 50 year old male with COPD D) 68 year old female with hypertension, no other comorbidities. E) 6 year old child receiving chemotherapy for lymphoma

B) 26 month old child with asthma receiving high-dose corticosteroids C) 50 year old male with COPD D) 68 year old female with hypertension, no other comorbidities. E) 6 year old child receiving chemotherapy for lymphoma Polysaccharide vaccines are not given to children < 2 years of age, due to an inadequate antibody response.

Which of the following patients should receive Bexsero? A) A 6 year old with sickle cell disease B) A 19 year old on a college campus during a meningitis serogroup B outbreak C) A 25 year old with HIV D) A 10 year old with sickle cell disease E) A 38 year old person traveling to the meningitis belt of Sub-Saharan Africa

B) A 19 year old on a college campus during a meningitis serogroup B outbreak C) A 25 year old with HIV D) A 10 year old with sickle cell disease The serogroup B meningococcal vaccines are indicated for patients age 10+ years. They are recommended for patients with asplenia/sickle cell disease, HIV and during an outbreak situation. The MenACWY vaccine, but not the MenB vaccine, is recommended for travelers to the meningitis belt in Sub-Saharan Africa.

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 Infants receive hepatitis B vaccine wthin 24 hours of birth. All healthcare and public safety workers exposed to blood on the job are vaccinated. Patients with chronic liver disease should receive hepatitis A and B vaccines. Others who should receive hepatitis B vaccine include patients with diabetes, HIV, end-stage renal disease, anyone with multiple sex partners and IV drug users. Persons traveling to regions with high HBV infection rates should consider vaccination.

Which of the following represent patient groups that are candidates for the Zostavax vaccine, according to the ACIP recommendations? A) Adults 50 years and older B) Adults 60 years and older C) Adults 50 years and older and children at 2-3 months and 10-11 years D) Adults 60 years and older and children at 2-3 months and 10-11 years E) Adults 60 years and older and college students who live in dormitories

B) Adults 60 years and older Zostavax vaccine is live and cannot be given to patients with severe immunosuppression. This includes individuals with AIDS or clinical manifestations of HIV, such as a CD4+ count less than 200 per mm3 and patients on high doses of steroids (prednisone or its equivalent of 20 mg daily or more for more than 2 weeks). The FDA has approved Zostavax for adults over 50 years of age, but ACIP recommends that patients 60+ years old should receive it.

Which of the following is most likely to result in an influenza pandemic? A) Antigenic drift in an influenza A virus. B) Antigenic shift in an influenza A virus. C) Antigenic drift in an influenza B virus. D) Antigenic shift in an influenza C virus.

B) Antigenic shift in an influenza A virus.

Which vaccine does ACIP recommend for all college freshmen, aged 21 years or younger, living in dormitories, who have not been previously vaccinated? A) PPSV23. B) MCV4. C) 9vHPV. D) Varicella.

B) MCV4.

Name the vaccine-preventable disease that may be contracted by unimmunized children from adults serving as reservoirs for the disease, which causes a paroxysmal cough and potentially can result in pneumonia, seizures, encephalopathy, hypoxia, and death. A) Pneumococcal disease. B) Pertussis. C) Varicella. D) Influenza.

B) Pertussis.

Aiden is a 6-month-old healthy boy with no known allergies. He has received vaccinations in the past with no reported adverse reactions. Aiden's father asks about having his son vaccinated against influenza. The most appropriate response would be to inform the father that Aiden: A) Is too young to be vaccinated against influenza B) Should receive 1 dose of IIV4 today followed by a second dose of IIV4 administered 4 weeks later C) Should receive 1 dose of LAIV today followed by a second dose of LAIV administered 4 weeks later D) Should receive 1 dose of IIV3 or IIV4 today followed by a second dose 1 year later

B) Should receive 1 dose of IIV4 today followed by a second dose of IIV4 administered 4 weeks later

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. C) Once reconstituted the vaccine must be used within 30 minutes or discarded, according to ACIP. In practice, always verify the required freezer temperature, as some vaccines have stricter temperature requirements.

JB is a 72 year-old male who is due for his tetanus vaccine. He lives in an apartment with his daughter, a 3 month old granddaughter and a 2 year-old grandson. He does not know if he ever received the pertussis vaccine. Which vaccine should JB receive? A) Td B) Tdap C) TdP D) Tetanus only E) DTaP

B) Tdap Children get DTaP (5 doses) and older children, adolescents and adults get TdaP. Tdap is recommended for adults because they can pass it along to children and infants who are at highest risk of severe illness and death. Tdap is also recommended in patient who will have close contacts of infants younger than age 12 months

Arthus reactions, which are exaggerated local reactions that can occur if a patient is vaccinated too frequently, are most commonly reported after which vaccine? A) Inactivated influenza vaccine (IIV). B) Tetanus and diphtheria toxoid-containing vaccines. C) Pneumococcal polysaccharide vaccine (PPSV). D) Hepatitis B vaccine.

B) Tetanus and diphtheria toxoid-containing vaccines.

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 immunity is produced by the person's own immune system and is usually permanent. Active immunity (antibody production) occurs when a person becomes infected with the organism and recovers, or after receiving vaccination. Passive immunity is protection by products produced by another human (or animal) and transferred to the recipient. The most common form of passive immunity is immunity that an infant receives from its mother at birth or from breast milk. Antibody contained in intravenous immune globulin is a form of passive immunity.

Which of the following statements is true regarding how vaccines evoke an immune response? A) T cells bind directly to the antigen contained in the vaccine and activate the humoral immune response. B) The antigen in the vaccine activates B cells, which produce antigen-specific antibodies and memory cells. C) When exposed to the vaccine, T cells mature into plasma cells and produce antigen-specific antibodies. D) B cells bind directly to the antigen contained in the vaccine and activate the cell-mediated immune response.

B) The antigen in the vaccine activates B cells, which produce antigen-specific antibodies and memory cells.

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. All vaccines are stored in the center of the refrigerator except for five vaccines that are kept in the freezer (varicella, zoster, MMR, MMRV-this is MMR with varicella, and cholera vaccine). A small refrigerator with an inside freezer shelf does not have reliable temperature control. Food should be kept in a separate refrigerator. Units that store food are opened and shut more often, leading to temperature instability.

Select the correct name for the chickenpox vaccine: A) Zovirax B) Varivax C) Valtrex D) Zostavax E) Engerix-B

B) Varivax

Which of these vaccines is a live attenuated vaccine? A) IIV4. B) Zoster. C) PPSV23. D) Td.

B) Zoster.

Which of the following patients should not receive a measles-mumps-rubella vaccine, if is indicated? A) A 23 year old male who reports a having a "head cold" with a fever of 100.1 the previous evening B)A 31 year old female who is 31 weeks pregnant C) A 51 year old patient with HIV and a CD4 count of 292 D) A 27 year old patient who is currently on day 5 of a 7 day amoxicillin prescription for a tooth abscess E) A 56 year old female that lives with her elderly mother who takes methotrexate for rheumatoid arthritis

B)A 31 year old female who is 31 weeks pregnant Live vaccines, such as MMR, should not be given to pregnant patients. A patient with HIV and a CD4+ count < 200 should not receive MMR or varicella vaccines. The other answers do not represent contraindications to vaccination.

According to ACIP recommendations, what is the maximum number of doses of PPSV23 a patient should receive in his or her lifetime? A) 1 dose. B) 2 doses. C) 3 doses. D) Unlimited.

C) 3 doses.

When Mary turned 64, she was diagnosed with type 2 diabetes. At that time, she received PPSV23. Which of the following represents appropriate pneumococcal coverage for Mary. A) Administer PPSV23 at age 65, then PCV13 at age 66. B) Administer PPSV23 at age 69, then PCV13 at age 70 C) Administer PCV13 at age 65, then PPSV23 at age 69. D) Administer PCV13 at age 65, then PPSV23 at age 66.

C) Administer PCV13 at age 65, then PPSV23 at age 69. PPSV23 doses should be separated by at least 5 years

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

C) An adult who received 4 mg of dexamethasone daily for the past three weeks. D) An 11.8 kg child receiving 30 mg of prednisolone for the past 22 days. Steroid-induced immunosuppression is given in terms of prednisone equivalent doses on page 316 of the Immunization chapter in the 2018 RxPrep course book.

Select the correct administration site for the herpes zoster vaccine in an adult: A) Anterolateral thigh B) Biceps C) Fatty tissue over the triceps D) Deltoid muscle E) Gluteus maximus

C) Fatty tissue over the triceps This is the most likely subcutaneous vaccine (SC) administered in a community pharmacy setting.

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.

KH approaches the pharmacist in January and asks if her children should receive the seasonal influenza vaccination. She states that every time she has received the flu shot, she has gotten the flu, but is worried about her kids getting a bad strain of the virus this year. She notes that her seven-year old daughter has an allergy to eggs; every time she eats scrambled eggs she gets an upset stomach. Otherwise, she has no known medical conditions except for a possible sensitivity to gluten. KH home-schools her children. Which statements concerning the flu vaccine are correct? A) She can get the flu from the flu shot, but the disease should be mild. B) Unless children have a chronic disease, if they are home schooled they are not routinely vaccinated against influenza. C) If this is the first time she is receiving the vaccine, she should receive two doses spaced by 4 weeks. D) Her daughter cannot receive the nasal FluMist vaccine if it is recommended in the current season. E) Her daughter cannot receive MMR due to the allergy, but she can receive the influenza vaccine.

C) If this is the first time she is receiving the vaccine, she should receive two doses spaced by 4 weeks. One cannot get influenza from a flu shot. Because it is typically given during respiratory virus season, coincidental viral infections can cause some to think that the vaccine caused them to get a cold. This seven year old can receive any formulation of influenza vaccine that is indicated for her age, as her reaction to eggs is not a true allergy.

An 8 month old child was hospitalized two months ago for a dog bite injury. She was not on schedule with her tetanus vaccine series, so tetanus immune globulin was given. Which vaccine would be affected by this treatment? A) Pneumococcal conjugate B) Polio vaccine C) Measles-mumps-rubella-varicella (MMRV) D) Influenza vaccine, inactivated E) Hepatitis B vaccine

C) Measles-mumps-rubella-varicella (MMRV) MMR and varicella vaccines are live virus vaccines that require replication. If antibody-containing products have been administered, the vaccine should not be given for least 3 months (required time of separation varies depending on the product received). If vaccine has been given, antibody products should be avoided for at least 2 weeks after MMR and varicella-containing vaccines to avoid interference with vaccine efficacy.

The presence of fever, diffuse maculopapular rash, and Koplik spots are characteristic of which of the following diseases? A) Rubella. B) Varicella. C) Measles. D) Mumps.

C) Measles.

John is a 46-year-old man with diabetes. He requests a refill of his diabetes testing supplies on October 21st. His immunization record indicates that he has completed the primary series of MMR, DTaP, HepA, and HepB vaccines. John has a documented history of chickenpox, and his last Td booster dose was 19 years ago. Which of the following vaccines should he receive? A) Td and influenza. B) PCV13, Td, and IIV. C) PPSV23, Tdap, and IIV. D) PCV13 and IIV.

C) PPSV23, Tdap, and IIV. Immunocompetent patients 2-64 with diabetes should receive 1 dose of PPSC23 before the age of 65

DV presents to her physician 1 week after she turned 65 years old. Her past medical history includes only hypertension and glaucoma. Which of the following is the correct series of pneumococcal vaccination? A) Prevnar 13 today B) Prevnar 13 today, Pneumovax 23 in 24 months C) Prevnar 13 today, Pneumovax 23 in 1 year D) Pneumovax 13 today, Prevnar 23 in 1 year E) Pneumovax 23 today, Prevnar 13 in 8 weeks

C) Prevnar 13 today, Pneumovax 23 in 1 year With her past medical history, she does not have an indication for pneumococcal vaccine before age 65, and none is noted.

Which type of vaccine involves stimulation of B cells without the assistance of T helper cells? A) Live attenuated vaccines B) Conjugated vaccines C) Pure polysaccharide vaccines D) Recombinant vaccines

C) Pure polysaccharide vaccines

LB is at the pharmacy today to get her annual flu vaccine. She has just turned 67 years old and never got a pneumococcal vaccine. She has never received the shingles vaccine and it is recommended. Can she get all three vaccines (influenza, pneumococcal, and Zostavax) today? A) Yes, and the two inactivated vaccines (influenza and pneumococcal) can be mixed in the same syringe. B) No, the shingles vaccine is live and this must be administered on a different day. C) She can get all three vaccines today as separate shots. D) She can get influenza today but needs to wait at least two weeks to receive the other vaccines. E) She is not a candidate for any of these vaccines due to her age.

C) She can get all three vaccines today as separate shots. Simultaneous administration (administration on the same day) is recommended whenever possible to increase immunization rates. If the patient is present, vaccinate if indicated. Although all the indicated vaccines for the patient can each be given, the individual vaccines cannot be mixed in the same syringe unless they are licensed for mixing by the FDA. If live parenteral (injected) vaccines (MMR, MMRV, varicella, Zostavax, and yellow fever) and live intranasal influenza vaccine (LAIV) are not administered at the same visit, they should be separated by at least 4 weeks. If more than one injection is given in the same limb, separate the injection sites by at least 1-2 inches. This way, any individual reactions can be observed. As of October 2017, a recombinant zoster vaccine, Shingrix, is also available for use. Please visit the Updates and Errata page on the RxPrep website for more information and criteria for use.

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 recieve 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. The CDC recommends giving the influenza vaccine as soon as it is available, rather than deferring until later in the season. The vaccine should be deferred if the patient has a moderate-severe illness. If the patient can walk into the pharmacy, they are likely a candidate for vaccination. Children age 6 months to 8 years who have never received the flu vaccine before require the 2-dose series described in answer E.

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. The temperature in the cold unit must be recorded twice during each workday and the log should be kept for at least three years. The cold unit temperature must be kept between 2 to 8 degrees Centigrade. Always check the expiration date on the vaccine prior to administration.

The shingles vaccine is used to prevent shingles outbreak. Children receive the chickenpox vaccine. Which of the following statements are correct? (Select ALL that apply.) A) Varivax vaccine is given to persons ages 60 years and older. B) If a patient has an outbreak and suffers pain, they can use lidocaine orally for pain relief. C) To prevent varicella (chickenpox) in children they can receive a combination vaccine for MMR and varicella (MMRV) called ProQuad. D) Another name for shingles is herpes simplex. E) Varicella vaccines are live vaccines.

C) To prevent varicella (chickenpox) in children they can receive a combination vaccine for MMR and varicella (MMRV) called ProQuad. E) Varicella vaccines are live vaccines. Shingles can cause severe nerve pain. The lidocaine patch (Lidoderm) is approved to treat the pain, or lidocaine viscous gel is used topically. Significant pain can linger in 5-10% of patients who have had shingles; this is called post-herpetic neuralgia. Another name for shingles is herpes zoster.

A patient who had a severe reaction to eggs (with facial swelling or trouble breathing) should not receive which of the following vaccines in a community pharmacy setting? A) Measles, Mumps and Rubella (MMR) B) FluBlok C) Yellow Fever vaccine D) Zostavax E) Bexsero

C) Yellow Fever vaccine The yellow fever vaccine is contraindicated with a true egg allergy.

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. D) Zostavax is recommended in patients who have had shingles before. E) This vaccine is administered subcutaneously in the fatty tissue over the triceps. This injection is given subcutaneously with a needle that is 5/8" long. Pinch up on the tissue to prevent injecting into muscle, although this is more of an issue with thin patients than the patient described in this question. The vaccine must be reconstituted prior to use with the supplied diluent. Zostavax will help protect the patient against a herpes zoster outbreak, also known as shingles, even in patients who have previously had an outbreak.

Children should receive how man doses of the DTap and are what ages should they be administered?

Children should get 5 doses of DTap at ages 2, 4, 6, 12-18 months and 4-6 years, then the Tdap x 1 at age 11-12 years Tap series should be given to children younger than 7 years of age.

Who is indicated for Hepatitis A vaccine?

Children: Routine vaccination for children at age 1 year (2 doses) Adults: men who have sex with sen, illicit drug users, chronic liver disease, clotting factor disorders, travelers to countries with high Hep A incidence, or anyone else who asks for it.

If a patient is a candidate for revaccination with PPSV23, what is the ACIP-recommended interval between doses of this vaccine? A) 1 year. B) 2 years. C) 3 years. D) 5 years.

D) 5 years.

Barbara is a 60-year-old woman who presents to the pharmacy for two vaccines: HZV and IIV. Which of the following are the appropriate doses and routes for administering these vaccines to this patient? A) HZV 0.50 mL intramuscularly; IIV 0.65 mL subcutaneously. B) HZV 0.65 mL intramuscularly; IIV 0.5 mL subcutaneously. C) HZV 0.50 mL subcutaneously; IIV 0.65 mL intramuscularly. D) HZV 0.65 mL subcutaneously; IIV 0.5 mL intramuscularly.

D) HZV 0.65 mL subcutaneously; IIV 0.5 mL intramuscularly.

Which of the following best describes how to administer Tdap vaccine to an adult patient weighing 185 lb? A) Inject subcutaneously at a 45° angle in the outer aspect of the upper arm. B) Inject intramuscularly at a 45° angle in the deltoid muscle. C) Inject subcutaneously at a 90° angle in the outer aspect of the upper arm. D) Inject intramuscularly at a 90° angle in the deltoid muscle.

D) Inject intramuscularly at a 90° angle in the deltoid muscle.

Select the correct information for the shingles vaccines as well as the chickenpox vaccine (Zostavax and Varivax): 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. Live vaccines should not be given in pregnancy. Both vaccines are stored in the freezer. The diluent can be stored at room temperature or in the refrigerator. It should be reconsituted immediately when removed from the freezer and once reconstituted, administer by SC injection right away. As of October 2017, a recombinant zoster vaccine, Shingrix, is also available. Please visit the Updates and Errata page on the RxPrep website for more information and criteria for use.

A health care provider who has not been vaccinated against hepatitis B is stuck by a contaminated needle after administering an immunization to a hepatitis B-positive patient. In addition to hepatitis B vaccine, the health care provider also should receive hepatitis B Immunoglobulin (HBIG) as postexposure prophylaxis because the HBIG provides: A) Long-term protection B) Both short- and long-term protection C) A booster effect for the vaccine D) Prompt immunity

D) Prompt immunity

Which disease is almost certain to cause death if infected patients do not receive postexposure prophylaxis? A) Hepatitis B. B) Measles. C) Meningococal disease. D) Rabies.

D) Rabies.

EG is a 50 year-old male who approaches the counter to ask for the best option to treat a cut he received on his foot while working in his garden. EG does not believe he received many childhood vaccines. Which vaccine is preferable? A) DTaP B) DT C) Td D) Tdap E) Menveo

D) Tdap A person who gets a cut or burn might need a dose of Td or Tdap to prevent tetanus infection. Tdap should be used for anyone who has never had a dose previously. Td should be used if Tdap is not available, or for anybody who has already had a dose of Tdap.

Alan is a 47-year-old man who has no documentation of a primary series of tetanus-containing vaccine. Which of the following would be an appropriate primary series for Alan? A) DTaP today; Td in 4 weeks; Td 6 months after the second dose. B) Tdap today; Tdap in 4 weeks; Tdap 6 months after the second dose. C) DTaP today; DTaP in 4 weeks, DTaP 6 months after the second dose. D) Tdap today; Td in 4 weeks; Td 6 months after the second dose.

D) Tdap today; Td in 4 weeks; Td 6 months after the second dose.

Which of these vaccines is an inactivated vaccine? A) LAIV. B) Varicella. C) MMR. D) Tdap.

D) Tdap.

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 most childhood vaccines, it is not linked to autism. C) Occurence of vaccine-preventable diseases has declined 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) A link between vaccines and autism has been shown to be invalid; pharmacists should promote vaccination to reduce disease spread.

D) Thimerosal may be present in multi-dose influenza vaccines, and can be avoided upon request. E) A link between vaccines and autism has been shown to be invalid; pharmacists should promote vaccination to reduce disease spread. Herd immunity results from high vaccination rates, and can help protect patients who are unable to be vaccinated. A link between vaccines and autism has been well-studied and has not been shown in legitimate medical literature. Thimerosal is a preservative that contains a very small amount of mercury has been removed from most childhood vaccines. 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.

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.

HS is a healthy 67-year-old female who received Pneumovax 23 last August and has no recollection of prior vaccinations besides those given when she was a child. She comes into the pharmacy the following February and asks what vaccines she should receive at this time. Which vaccines should the pharmacist recommend that she get at this visit? A) FluMist, Tdap, and Zostavax B) Flublock, Tdap, and Prevnar 13 C) Fluzone Intradermal, Tdap, and Prevnar 13 D) Fluzone High Dose, Tdap, and Prevnar 13 E) Fluzone High Dose, Tdap, and Zostavax

E) Fluzone High Dose, Tdap, and Zostavax She will need to get Prevnar 13 as well, but it should be spaced 1 year from the Pneumovax 23.

A 70 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 life-threatening allergic reaction to the antibiotic streptomycin? B) Does she have a history of smoking? C) Has she ever had shingles before? 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 gelatin?

E) Has she ever had a bad reaction to gelatin? Shingles and chickenpox vaccines should not be administered to anyone with a true allergy to neomycin or to gelatin (components of the vaccine). Zostavax is a live vaccine and cannot be administered to severely immunocompromised patients. The steroid dose indicated here is not enough to cause immunosuppression. Patients with a history of shingles can receive the vaccine.

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.

A pharmacist is instructing an intern how to administer the EpiPen. Which of the following instructions are important in properly administering the injection? A) Do not remove the safety cover until after the injection is administered; removing the cover "caps" the needle. B) Inject in the abdomen for best absorption, through clothes if necessary. C) Hold the injector firmly against the skin over the deltoid for 10 seconds to give the medicine time to disperse. D) Keep at least one pen in both adult and junior sizes in the emergency kit at the pharmacy. E) Inject into the thigh, hold against the skin while slowly counting to 3.

E) Inject into the thigh, hold against the skin while slowly counting to 3. Inject into the outer thigh, through clothes if necessary, after removing the safety cap. The area should be massaged for 10 seconds after injecting the medication. If an epinephrine injection is needed, or with any serious reaction, call 911 and follow up with the patient's primary care provider. Any pharmacy administering vaccines must have a protocol that outlines steps to take in the event of an allergic reaction. Three injections must be kept in the pharmacy if administering injections. Administration technique for the EpiPen is found in the Drug Allergies and ADRs chapter of the 2018 RxPrep Course Book, pages 151.

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, Pneumovax 23, Menveo, Trumenba, Hiberix and Fluzone Everyone 6 months of age and older should receive an influenza vaccine. Fluvirin and Fluzone are both shots (inactivated virus vaccines). His asthma alone would make him a candidate for Pneumovax 23, but because he is also asplenic, he should receive Prevnar 13 first. The splenectomy is an indication for both quadrivalent and serogroup B meningococcal vaccines and H. influenzae (Hiberix).

A physician wishes to administer the 3rd dose of a vaccine series that protects against both Hepatitis A and B to a 6 month old male infant. Which vaccine contains antigens for both Hepatitis A and B? A) Engerix-B B) Recombivax-B C) Gardasil 9 D) Pediarix E) Twinrix

E) Twinrix The name Twinrix is a clue ("twin') that two vaccines are included.

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 the Vaccine and Adverse Event Reporting System (VAERS), which is run by the FDA and the CDC. The pharmacist may also wish to notify the manufacturer, but must notify VAERS.

What is the Pneumococcal vaccine sequence and interval for a immunocompromised patient age 6-64 years old?

Give Prevnar 13 x 1, then 8 weeks later start Pneumovax 23 x 2 doses (5 years apart)

MMR and varicella, both of which are live vaccines are contraindicated in what patients?

HIV patients with CD4+ T lymphocyte counts < 200 cells/mm3

Who is indicated for Hepatitis B vaccine?

Healthcare workers; patients with ESRD, chronic liver disease (including HCV), HIV, diabetes (age 19-59 yrs); IV drug users, men who have sex with men, anyone with multiple sex partners, some travelers. 3-dose series given at months 0, 1 and 6 (can be completed in 4 months if necessary, but requires a booster at 1 year if the series is accelerated)

What is the influenza vaccine regimen for patients age 6 months to 8 years?

If never vaccinated, should receive 2 doses (given 4 weeks apart)

What are the 9 Live Vaccines?

Injections - MMR - MMRV - Varicella - Zoster - Yellow fever Other routes - Influenza intranasal (Flumist) - Rotavirus - Cholera - Typhoid (Vivotif)

Anyone receiving large doses (≥ 20mg prednisone or prednisone equivalent (or 2 mg/kg) for 14 days or longer) of systemic steroids should not receive what kind of vaccines?

Live Vaccines

Which vaccines cannot be administered to pregnant patients?

Live Vaccines

Influenza vaccine is recommended in all patient of what age?

Patient ≥ 6 months unless there is a contraindication

When is Hepatitis B vaccine given to children?

Routinely given within 24 hours after birth (3 doses)

A pregnant patient delivered her baby and has not received a Tdap, what should she receive the vaccine?

She should receive it post-delivery

What 5 vaccines are stored in the freezer?

Varicella Zoster MMR MMRV = MMR + Varicella Cholera