APhA Immunization Exam, APhA Questions, APhA Immunization Exam
Which of the following statements best illustrates the affirmation skill in motivational interviewing?
"Thank you for sharing your concerns with me, I enjoyed speaking with you today"
Which of the following statements would be appropriate for a pharmacy technician to make?
"We are now offering herpes zoster vaccines in the pharmacy"
What must be documented for VIS?
-patient name -date vaccine was administered -vaccine manufacturer, lot number -name, address, title of the administer -date printed on VIS -date VIS was given to patient or guardian *signatures of patient/guardian not required by federal law, but some employers/companys may require signatures
Adolescents should be routinely vaccinated with MCV4 on the following schedule:
1 dose at 11 or 12 years booster at 16 years
When counseling the parent of a 1-year-old receiving the MMR vaccine, they should be told that their child may get a measles-like rash after how long from vaccination?
1 week
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?
1) Tdap 2) Td 4 weeks later 3) Td 6-12 months later Td booster every 10 years after 3rd dose
Which of the following is recognized by sociologists as a factor in a patient's decision whether to be vaccinated?
1) perceived susceptibility to a disease 2) perceived seriousness of a disease 3) perceived vaccine benefits 4) perceived vaccine barriers (e.g., adverse effects, access) 5) social influence (e.g., recommendation from a health care provider)
If a patient is a candidate for revaccination with PPSV23, what is the ACIP-recommended interval between doses of this vaccine?
1-3 doses with 5 years between under age of 65 who are immunocompromised or asplenia-2 doses with 5 years apart
The incubation period for influenza can range from:
1-4 days
Live Vaccines are:
1. Attenuated 2. Stimulates both humoral and cell-mediated immune response 3. May be interfered with by circulating antibodies 4. Not given to children less than 12 months of age due to presence of maternal antibodies
Screening Questions for All Patients
1. Current Health Status 2. Allergies and Past Reactions 3. Long-term Illness
Toxoid Vaccines
1. Inactivated Vaccine 2. Subunit (fractions) 3. Inactive or biological toxin 4. Tetanus toxoid
Cellular Vaccines
1. Inactivated Vaccines 2. Whole viruses or bacteria 3. Known as Subunits (fractions) 4. DTP/DTaP
Inactivated Vaccines are:
1. Killed virus or bacteria 2. Does not replicate 3. Stimulates humoral immunity (antibodies) 4. May be given to people who have received blood products or live vaccines, regardless of timing. 5. Predominantly given to infants (less than 12 months) because they may have circulating maternal antibodies which could reduce the effectiveness of a live vaccines.
What are two broad categories that vaccines are classified as?
1. Live attenuated vaccines 2. Inactivated vaccines
What clinical factors need to be considered before administering a lie attenuated vaccine?
1. Patients who currently are immunocompromised 2. Live attenuated vaccines administered in the previous 28 days.
What can a pharmacist do to reduce the risk of getting hepatitis B after exposure?
1. Post-exposure prophylaxis is needed right away 2. Give both Hep B immune globulin (HBIG) and Hepatitis B vaccine 3. HBIG contains antibodies that provide immediate protection via passive immunity 4. When a person is fully vaccinated, the hepatitis B vaccine provides long-term protection.
Recombinant Vaccine
1. Produced by genetic engineering 2. May contain no actual virus or a modified strain of a virus 3. HepB, HPV, RZV, RIV4
Steps when using Immunization schedules
1. start with patients age, which vaccines should they have and are they behind? 2. If patient has medical condition, check for precautions and contraindications 3. Refer to vaccine notes for types, frequencies, intervals and special considerations
Which of the following patients are appropriate candidates for the 2-dose schedule of HPV9?
11 or 12 year olds *if series has not been started by age 15, then a 3 dose series is needed *3 dose series recommended for immunocompromised patients *1st/2nd dose- given at 0 and 6-12 months *if 2nd dose is given sooner than 5 months after the first dose then a 3rd dose is needed
The advisory committee on immunization practices (ACIP) recommends routine vaccination with the meningococcal conjugated quadrivalent vaccine (MenACWY) which of the following age groups?
11-12 years of age
The ACIP recommends the hepatitis A vaccine be administered to all children starting at which age?
12 months
Although the primary series for Hib varies between 2-3 doses, all vaccines are recommended to have a booster dose at age:
12-15 months
How long does it take for the immune system to provide protection by producing disease-specific antibodies and memory cells?
14 days
The majority of vasovagal syncope cases occur withinin:
15min of vaccination
If an 11 year old child never got the hepatitis B vaccine series, what is the minimum amount of time that must occur between dose 1 and dose 3 when getting this child caught up?
16 weeks
An adolescent received his first meningococcal conjugate quadrivalent (MenACWY) vaccine at age 13 years, when should he receive his booster dose?
16 years
Epi doses:
1:1000 w/v 1mg/mL based on weight: 0.01mg/kg/dose max dose: 0.5mg/dose dose 5-15min for up to 3 doses
A child received the MMR vaccine when he was 9 months of age before moving out of the country with his parents. He is now 4 years old and about to enter Kindergarten. How many, if any, doses of MMR should the child receive now?
2
Rotarix (RV1) should be administered as a:
2 dose oral series at 2 and 4 months
Who should receive MMR vaccine?
2 dose series at 12-15 months and 4-6 years *no additional doses needed MMR is a live vaccine, not recommended until 12 months old Adults w/o immunity evidence (being born before 1957, documentation of MMR vaccine, lab evidence of disease) should receive one dose Healthcare professionals should receive 2 doses
Minimum interval for live vaccines followed by blood products
2 weeks
Live vaccines followed by blood products (contain antibodies) require ______minimum interval.
2 weeks.
Children less than what age do not mount an adequate immune response to t-cell independent immunity?
2 years.
DTaP is recommended to be administered using which of the following schedules?
2, 4, 6, 12-15 months, 4-6 years
Which of the following individuals are contraindicated from receiving the MMR vaccine?
23-year-old in her 3rd trimester
What is the recommended timing for Tdap during pregnancy ?
27-36 weeks
Minimum interval for two live vaccines, if not simultaneous
28 days
Minimum interval when a live vaccine is followed by a PPD skin test
28 days
If two live vaccines are given simultaneously sly on the same day, then you must wait _____ minimum interval.
28-day minimum interval so that each vaccine can replicate properly.
Ava has arrived at the clinic for her well-child visit. She is 4 months old. Ava's immunization record reveals that she has received the following vaccines: 2 doses of HepB 1 dose of Hib 1 dose of rotavirus 1 dose of PCV13 1 dose of DTaP 1 dose of IPV Which vaccines should Ava receive at today's visit?
2nd Hib Rotavirus DTaP PCV13 IPV *3rd Hep B at 6 months too young for flu vaccine MMR/varicella are live and recommend at 1 year
Alex is a 32-year-old man who is scheduled to travel to a country where hepatitis A is endemic. He leaves in 3 weeks and will be gone a month. He received his first dose of hepatitis A vaccine today. Alex should be counseled to return for his second dose of hepatitis A vaccine:
2nd dose given at least 6 months after the first dose
Robert is a 48-year-old pharmacist who is preparing to provide immunizations in his pharmacy for the first time next fall. He has no documentation of receiving the hepatitis B vaccine and would like to be vaccinated before administering vaccines in his practice. What is the recommended routine schedule for vaccination against hepatitis B?
3 dose series at 0, 1, and 6 months
A 25-year old female comes to the pharmacy inquiring about the 9vHPV series. What would be the recommended vaccination series?
3 doses administered intramuscularly at 0, 1-2, 6 months
RotaTeq (RV5) should be administered as a:
3-dose series at 2,4,6 months
Refrigerated vaccines should be maintained at temperatures between:
35ºF and +46ºF
Interval between 2 live vaccines NOT given simultaneously:
4 weeks
According to ACIP recommendations, which of the following needle lengths would be appropriate for administering HZV to an adult patient?
5/8 in needle at 45 degrees in the outer upper arm (SC)
The herpes zoster vaccine is first recommended what age for immunocompetent adults
50
Based on the adult immunization schedule, at what age is the live attenuated influenza vaccine (LAIV) no longer recommended?
50 years
Kyle is a 5-year-old boy who is up to date with his vaccinations. He has never experienced any adverse effects from vaccinations. At his next well-child check-up, Kyle will be receiving the following vaccines: IPV, MMR, varicella vaccine, and a tetanus-containing vaccine. Which of the following tetanus-containing vaccines would be appropriate for him?
5th dose DTaP *one time dose of Tdap at 7 years Td booster every 10 years
David is a healthy 5-year-old boy who is scheduled to see his pediatrician for a checkup in July prior to starting kindergarten. David's immunization record reveals that he has received the following vaccines: 3 doses of HepB 4 doses of PCV13 2 doses of HepA 3 doses of IPV 2 doses of rotavirus 1 dose of MMRV 4 doses of DTaP 4 doses of Hib Which vaccines should David receive at this visit?
5th dose of DTaP 4th dose of IPV 2nd dose of MMR 2nd dose of varicella PCV13 Hib Hep A Hep B
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?
6 weeks
What percentage of HPV infections are cleared by the body and do not develop to CIN2 or CIN3?
70%
Which of the following vaccines may be administered to males and females aged 9 through 26 years to reduce the likelihood of acquiring genital warts?
9vHPV
Which of the following patients is a candidate for both MenACWY and MenB vaccines?
A 10 year old who just had his spleen removed *MenA can be administered at 2months, MenB not recommended until 10 yrs HIV infection and being in the military are risk factors for MenA
Which of the following patients is eligible to receive their first dose of the rotavirus vaccine?
A 10-week old presenting to the pediatrician for their 2 month well check
At what age can the 2-dose schedule of the human papillomavirus (HPV) Vaccine be given?
A 2 dose schedule is recommended for girls and boys who initiate the vaccination series at ages 9 through 14 years.
Which of the following patient scenarios regarding influenza vaccination is correct?
A 65-year-old patient with thimerosal allergy would be eligible to receive adjuvanted inactivated Fluad or high dose inactivated Fluzone
Which of the following statements best meets the definition of precaution?
A condition that may alter or diminish the patient's response or may increase the patient's risk of a serious reaction to a vaccine.
Which of the following best describes the definition of vaccine hesitancy?
A delay in the acceptance of, or refusal of, a vaccination despite availability of vaccination services.
Which of the following best describes a public health department?
A department which helps prevent the start and spread of disease
A contraindication to receiving a COVID-19 vaccination includes:
A known (diagnosed) allergy to a component of a COVID-19 vaccine
Which of the following best describes a standing order?
A preapproved document signed by a collaborating physician who authorizes the pharmacist to administer a vaccine/
Which type of vaccine involves stimulation of B cells without the assistance of T helper cells?
A pure polysaccharide *not recommended for children <2 because of their immature immune system
PPCP Step 2
ASSESS after collecting information and analyzing the need for vaccines following ACIP recommendations.
Which of the following are part of the four steps set by NVAC as the standards for Adult Immunization Practice?
ASSESS, RECOMMEND, ADMINISTER & DOCUMENT
Vaccines as well as exposure to natural disease are both examples of which type of immunity?
Active immunity
Which vaccine technology listed below is an ingredient added typically to inactivated vaccines to boost its immune response by targeting pathogen recognition receptors that are expressed on dendritic cells to trigger a pro-inflammatory response? Though this technology creates a more robust immune response, it can also increase local site reactions and systemic reactions, such as fevers, chills, and body aches.
Adjuvants
Which vaccine technol is an ingredient added typically to inactivated vaccines to boost its immune response by targeting pathogen recognition receptors that are expressed on dendritic cells to trigger a pro-inflammatory response? Though this technology creates a more robust immune response, it can also increase local site reactions and systemic reactions, such as fevers, chills, and body aches.
Adjuvants (manufactured to produce a more robust immune response to the vaccine)
Minimum interval when a PPD skin test is followed by a live vaccine
Administer vaccine after PPD skin test has been read
Which of the following statements about pharmacy-based vaccination programs is true? Feedback
Administratively, billing for vaccines covered by Medicare Part D may be easier for pharmacists than physicians.
ACIP
Advisory Committee on Immunization Practices: -housed within the CDC -15 voting/30 nonvoting medical health experts -7 domains of framework that examines the vaccine
Candidate for PPSV23?
All adults 65+ years Immunocompromised (alcoholism, chronic liver; heart; lung disease, diabetics, cochlear implants, CSF leak) patients ages 19-64 Children with asthma only if theyre treated with high dose corticosteriods
Adaptive Immunity
Also known as acquired
When reconstituting a vaccine for injection, pharmacists should:
Always refer to the vaccine package insert for specific information
When preparing vaccines for administration, pharmacists should:
Always use aseptic technique
Which of the following is a potential long term complication from meningococcal disease?
Amputations
According to the Affordable Care Act, which of the following must be covered without cost-share to the patient?
An ACIP routinely recommended vaccine
Generalized urticaria following a vaccine is considered:
An allergic reaction
How often are the CDC immunization schedules published?
Annually
Passive Immunity
Antibodies from an external source
Which of the following is found in vaccines to evoke an immune response?
Antigens
At what point during pregnancy is it recommended to administer the influenza vaccine?
Any trimester
Which of the following key questions is important to ask a patient before administering IIV?
Are you sick today? *Mild illness is okay, but moderate to severe acute illness need to be resolved before getting vaccine.
In a patient experiencing anaphylaxis, pharmacists should administer epinephrine:
As a first-line treatment
A pharmacy technician may perform which of the following roles?
Ask patients to complete screening questionnaires
For which of the following conditions are both PCV13 and PPSV23 recommended?
Asplenia
During which step of the Pharmacists' Patient Care Process would a pharmacist analyze a patient's need for certain vaccines?
Assess
The community pharmacist, while filling discharge orders from the hospital, recognizes a patient's need for receiving the pneumococcal vaccine during a transition of care to a personal care home. This is an example of what part of the patient care process?
Assess
lISs have been shown to increase immunization rates and reduce vaccine-preventable diseases by:
Assisting in vaccination status assessment.
What is youngest age that hepatitis B vaccine is recommended in infants and children?
At birth
In the patient care process, how often should a pharmacist collect information on a patient?
At every clinical encounter
If a child is behind on the rotavirus vaccine, what is the interval of time between dose 1 & 2 to start getting the child caught up?
At least 4 weeks
Options to increase influenza vaccine effectiveness include:
Avoid vaccination in July and August to minimize chances of suboptimal immunity later in the season
Innate Immunity
Barrier defense mechanism
HPV vaccine is recommended for..
Both males and females ages 9-26 years *routinely recommended for 11 or 12 years of age
Which of the following are true regarding vaccine efficacy and safety for the live varicella vaccine and the recombinant zoster vaccine?
Both vaccines have over 90% effectiveness in prevention of disease after two doses
PPCP Step 1
COLLECT information to determine which vaccine and screen for any contraindications/precautions at every clinical encounter
Which of the following best describes how to roll with resistance?
Change strategies to avoid arguing with patients.
LAIV is contraindicated if child has asthma or wheezing for what age?
Children ages 2-4 with heart disease or chronic disease should still be vaccinated against influenza using INACTIVATED
Live attenuated vaccines (11)
Cholera HZV LAIV MMR MMRV Rotavirus TB (BCG) Typhoid (Ty21a) Vaccinia (smallpox) Varicella Yellow Fever *all others are inactivated
Which of the following is a clinical feature of hepatitis B but not hepatitis A?
Chronic infection
Why is spacing and timing of vaccines important?
Circulating antibodies may interfere with immune response
What type of vaccine is meningococcal quadrivalent vaccine?
Conjugate
Westend Pharmacy is launching an immunization program next month. The pharmacy manager, John, has a list of items that still need to be completed. Which item below is not required by OSHA to be completed before implementing the program?
Create a network with local physicians to refer patients to the new immunization program.
The OSHA exposure control plan is used by employers to achieve what goal?
Create a process of controls that aims to eliminate or minimize employee's potential exposure to bloodborne pathogens in the workplace
Star Pharmacy has been providing influenza vaccines for years and is now implementing a Hepatitis B vaccine program in their pharmacy next month. A crucial step in the Pharmacists' Patient Care Process for this vaccine is:
Create a reminder and recall system
Star Pharmacy has been providing influenza vaccines for years and is now implementing a Hepatitis B vaccine program in their pharmacy next month. A crucial step in the Pharmacists' Patient Care Process for this vaccine is:
Create a reminder and recall system.
Which of the following activities should only be performed by a pharmacist?
Decide whether a patient needs a vaccine.
PPCP Step 2 - Diagnosis Based Screening
Diagnosis Based Screening is when certain medical conditions may be indications for certain vaccines
According to the ACIP, which of the following would be considered adequate evidence of immunity to varicella, indicating that administration of varicella vaccine is unnecessary?
Diagnosis of chickenpox/shingles by a health care provider. Born in U.S. before 1980 2 doses of varicella at least 4 weeks apart
An electronic prescription for glipizide 10mg is received by a pharmacist for a new patient. The prescription indicates a diagnosis of E11, Type 2 diabetes mellitus. In addition to filling the prescription, the pharmacist could assess the patient for potential immunizations to recommend. What form of assessment is the pharmacist utilizing?
Diagnosis-based screening
Which of the following is considered a systemic symptom of anaphylaxis?
Diarrhea and vomiting
Which disease is characterized by the development of a membrane on the tonsils, pharynx, or larynx, leading to respiratory obstruction?
Diphtheria
If a patient received the first dose of HepB but did not return for the remaining doses in the series, under what circumstances should the HepB series be restarted?
Do not have to start series over (oral typhoid is the exception) *Increasing the interval between doses of a multi-dose vaccine series does not diminish the ultimate effectiveness of the vaccine, but it does delay protection for the patient.
What to do in case of anaphylaxis:
Do not offer water (do not want anything in the throat) check BP and pulse to see if it is decreasing (decreasing means less blood flow and more likely to faint) Administer epi pen when patient is wheezing and difficulty in breathing, give second dose if wheezing continues IM is more prompt than SC
The National Childhood Vaccine Injury Act of 1986 established national vaccine documentation requirements which include:
Edition date of the Vaccine Information Statement (VIS)
EUA
Emergency Use Authorizations - allow for medical countermeasures, such as medications or vaccines to be made available during a public health emergency ex: COVID-19
Which statement is true regarding gloves and handwashing?
Employers must make available to employees appropriately sized gloves and a hand washing facility or antiseptic hand cleansers for employees to use while providing immunizations
Antigens
Evoke the immune response and bind to specific antibodies
Which of the following is true about the pharmacy technicians' role in managing vaccine inventory?
Expiration dates and beyond use dates should be checked at least weekly
Why is it important to preserve the cold chain for vaccines?
Exposure to heat, cold, or light outside recommended ranges can reduce vaccine potency
T/F: Vaccines contain antibodies which are recognized by the immune system.
False
An adverse event that is considered a systemic reaction to a vaccine is:
Fever
Counseling on vaccine safety should include:
Fever, chills, malaise could occur within 6-12 hours post vaccination and may last up to 1-2 days.
What is the minimum needle length recommended for administering HepB vaccine to an adult patient weighing 130 lb?
Fixed 1-inch needles are acceptable for patients weighing 60 kg (132 lb) or less.
Which of the following is considered a print marketing strategy?
Flyers and brochures
PPCP Step 5
Follow-up with Patients, monitor and manage potential adverse events and schedule appt's for follow-up doses
HZV, MMR, rabies, typhoid, varicella, or yellow fever vaccine should not be administered to a patient with a history of anaphylaxis to:
Gelatin
Which of the following is the most common type of tetanus?
Generalized
A 10 year-old child received one dose of the hepatitis A vaccine at 1 year of age, but never returned for a second dose. Which of the following is true regarding the need for a second dose of the hepatitis A vaccine for this child?
Give 1 dose now as catch up
Using shared clinical decision-making, which of the following recommendation is most appropriate for a 65-year old living in a skilled nursing facility with multiple co-morbid conditions? This patient has no record of receiving either pneumococcal vaccine and is immune competent.
Give PCV13 now, then give PPSV23 one year later
A simple way to communicate information about risks and benefits of vaccines to all patients is to:
Give them the Vaccine Information Statements
In 2014, which vaccination rate was lowest among adolescents 13 through 17 years of age?
HPV
Viruses associated with the development of cancer:
HPV and Hep B
Which of the following factors does not need to be considered when utilizing shared decision making to evaluate the need to vaccinate an adult (27-45 years of age) with 9vHPV vaccine?
HPV antibody test results
True regarding varicella-containing vaccines:
HZV (Zostavax) contains 14 times more antigen than varicella vaccine the greater potency is necessary for an adequate immune response in older patients who have immunity to varicella because they had chicken pox
Contraindication of HZV
HZV is a live vaccine so its contraindicated in immunocompromised patients, pregnant women, and those who have experienced a severe allergic reaction to the vaccine components (neomycin, gelatin)
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?
HZV-SC, 0.65mL dose IIV-IM, 0.5mL
Health literacy is considered a part of which domain of social determinants of health?
Health care access
Post-vaccination testing for hepatitis B immunity is recommended for which of the following?
Health-care workers
Which of the following scenarios is an appropriate shared clinical decision making for meningococcal vaccine?
Healthy 16 year old who received meningococcal B vaccine
A history of anaphylaxis caused by neomycin would be a contraindication to receiving which of the following vaccines?
Hep A, IPV, MMR, Rabies, smallpox, varicella, zoster, influenza
Which vaccine is required by OSHA to be offered to all employees with potential exposure to bloodborne pathogens?
Hepatitis B vaccine
Which of the following vaccines contains a synthetic adjuvant?
Heplisav
Prior to the introduction of a vaccine, what was the leading cause of bacterial meningitis in children younger than 5 years of age?
Hib
Which of the below statements regarding Human papillomavirus (HPV) serotypes is true?
High risk serotypes are estimated to cause 99% of cervical precancers
If a patient with an egg allergy experiences hives following influenza vaccination, what is ACIP's recommendation for vaccinating this patient against influenza?
Hives only-can receive vaccine If patient experienced anaphylaxis or required an epi pen -CAN still receive vaccine but it must be in a medical setting where they can be supervised by medical professionals to assist with any complications
Which of the following vaccines is not recommended during pregnancy?
Human papillomavirus vaccine (HPV)
What type of code is used to identify the diagnosis for a patient receiving a vaccine?
ICD-10
Which of the following best describes how to administer Tdap vaccine to an adult patient weighing 185 lb?
IM at 90 degrees *weight of patient is irrelevant in regards to route of administration
A patient presents to the pediatric clinic for their 5-year-old well check before entering kindergarten. They received rotavirus at 2 and 4 months and Pentacel (DTaP/IPV/Hib) at 2 and 4 and 6 and 15 months. What vaccine should they need to receive today?
IPV
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:
If he has not had 2 doses of the flu vaccine then he needs 2 doses, 4 weeks apart
Which of the following statements is true when operating a mass vaccination clinic?
If multiple vaccines are available, they should be administered at different stations
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:
Immediate protection *its passive immunity so its short-lived, but provides protection right away
Which of the following organizations provides standing order templates?
Immunization Action Coalition
What is meant by the term "immunization neighborhood"?
Immunization stakeholders collaborate to meet community immunization needs.
Even though state laws may have specific mandates, how long should pharmacists maintain records of immunizations?
Immunizations should become part of the patient's permanent record and should be kept for the patient's lifetime.
What individuals are at an increased risk of adverse effects from live vaccines
Immunocompromised
Screening Questions: Live Vaccines in immunocompromised
Immunocompromised - Cancer, Leukemia, AIDS These individuals may be a contraindication for live vaccines such as MMR, VAR, LAIV4
PPCP Step 4
Implement - communicate and collaborate with other providers as part of the immunization neighborhood, VIS form to educate patients about the vaccine they might be getting and counseling patients on risks and benefits to all patients receiving vaccinations.
An important benefit of standing orders and protocols is that they:
Improve patient access to vaccines and efficiency of services
Screening Questions: Live Vaccines, Immunosuppressive Therapy
In the past 3 months, have you taken medications that affect your immune system like Prednisone or other steroids, anticancer drugs or treatment of rheumatoid arthritis, Crohn's disease or psoriasis, or radiation treatments? Immunosuppression may reduce vaccine efficacy or pose a risk for disseminated infection
Pneumococcal polysaccharide vaccine (PPSV23) is best categorized as what type of vaccine?
Inactivated Polysaccharide Vaccine
Which of the following statements would be accurate when responding to a patient's concerns about the safety of vaccines?
Inactivated is killed so cannot cause influenza intranasal is live but modified so cannot cause disease No vaccine is 100% effective If illness does occur its often less severe in those who were vaccinated No evidence that Thimerosal has caused any short or long term harm Several vaccines on the same day in immunocompetent people will not overload their immune system people are exposed . to more antigens every day from food or bacteria than from vaccines
Pneumococcal polysaccharide vaccine (PPSV23) is best categorized as what type of vaccine?
Inactivated polysaccharide vaccine
Which of the following is not a benefit of a reminder and recall system?
Incentivizes patients to make a primary care appointment.
Under the direction of the U.S. Department of Health and Human Services, the Healthy People initiative has identified the following as a goal for 2030:
Increase the proportion of persons who are vaccinated annually against seasonal influenza
Which of the following is true regarding transmission of SARS-CoV-2?
Infected individuals who may be presymptomatic, asymptomatic, or symptomatic can transmit the virus.
Which of the following is a source of free print materials that can be used to market vaccination services?
Infectious Diseases Society of America
Which of the following vaccines would be best delivered in a mass vaccination clinic?
Influenza vaccine
Post-vaccination counseling for patients should include:
Information about adverse reactions that require contact with the health care system
The National Vaccine Advisory Committee 2013 Standards for Adult Immunization Practice and the 2016 International Pharmaceutical Federation global report identify pharmacists as:
Integral to increasing vaccination rates
Which of the following statements is true regarding forming relationships with other immunization stakeholders?
It can enhance your marketing efforts
Which of the following is true regarding the recombinant herpes zoster vaccination?
It is indicated for prevention of herpes zoster and its complications in patients ≥50 years of age
Which of the following are true regarding the influenza virus?
It is transmitted through respiratory droplets that contain the virus.
A potential advantage of accommodating walk-in vaccines, compared with only scheduling appointments, is that:
It may allow greater flexibility and convenience for the patient
A 16-year old patient presents to the pharmacy for her first dose of 9vHPV. The patient is instructed to wait in the pharmacy for 15 minutes after receiving the dose. Three minutes after receiving the dose, the patient experiences syncope. What is the recommended response to treat the patient's syncope?
Lay the patient flat on the ground and elevate her legs. Monitor the patient's vitals and initiate emergency services if the patient does not regain consciousness
LAIV4 is the abbreviation for:
Live Attenuated Influenza Vaccine
Which of the following is the best example of a group with which individual pharmacists can collaborate to increase immunization rates in their communities?
Local Health Departments
Active Immunity
Long-term protection but takes 2 weeks to work
Why was the live attenuated influenza vaccine (LAIV) removed from the ACIP's influenza vaccine recommendations?
Lower than expected efficacy in 2013-2016
The presence of fever, diffuse maculopapular rash, and Koplik spots are characteristic of which of the following diseases?
MMR
Which of the following vaccines is contraindicated for an adult patient with HIV and a CD4 count <200 mm2?
MMR
When administering measles, mumps, rubella (MMR) and pneumococcal conjugate vaccine (PCV13) to a patient at their 15-month appointment, what must be considered regarding vaccine spacing?
MMR and PCV13 may be administered simultaneously or at any interval between doses.
When administering measles, mumps, rubella (MMR) and pneumococcal conjugate vaccine (PCV13) to a patient at their 15-month appointment, what must be considered regarding vaccine spacing?
MMR and PCV14 may be administered simultaneously or at any interval between doses
If patient is pregnant then which vaccines should be avoided?
MMR, VAR, HPV but can be given immediately after she gives birth. Influenza should be inactivated.
A standing order or protocol should include information about:
Managing medical emergencies that may occur after administration of a vaccine
Which of the following is TRUE of the emergency use authorization process?
Manufacturers must include a plan for safety monitoring
PPCP Step 2 - Mass Screening
Mass Screening can help identify candidates for vaccines based on a common factor, review child's vaccination status prior to school entry
MMR is the abbreviation for:
Measles, mumps, rubella
Which of the following vaccines is contraindicated for an adult patient with HIV and a CD4 count <200 mm2?
Measles, mumps, rubella (MMR)
MMRV is the abbreviation for:
Measles, mumps, rubella, varicella
Which of the following is a government-run volunteer organization for medical and public health professionals?
Medical Reserve Corps
Which of the following requires no cost-share for the patient and is mainly for those 65 years and older?
Medicare Part B
Opportunities for Advocacy and Collaboration include:
Membership in state Immunization coalition to serve as an expert on policy and practice issues affecting pharmacy
Opportunities for Advocacy and Collaboration include:
Membership in state immunization coalition to serve as an expert on policy and practice issues affecting pharmacy
A 9 year-old was just diagnosed with asplenia. This child is up to date on all routinely recommended vaccines. Which additional vaccine does this child need?
MenACWY
A 9 year-old was just diagnosed with asplenia. This child is up to date on all routinely recommended vaccines. Which additional vaccine does this child need?
MenACWY - Meningococcal ACWY
Which COVID-19 vaccination has 2 doses administered 28 days apart?
Moderna
A young adult presenting with swelling of the parotid glands most likely has which of the following diseases:
Mumps
The cold chain for vaccines
Must be maintained from manufacture until the vaccine is administered to the patient
Which of the following over-the-counter medications may be recommended to treat systemic reactions after vaccination?
NSAIDs and acetaminophen
Which of the following awareness campaigns is typically conducted in December?
National Influenza Vaccination Week
NVAC
National Vaccine Advisory Committee established standards for adult immunization practice: ASSESS, RECOMMEND, ADMINISTER & DOCUMENT
For a patient who needs to receive IIV and HZV, which of the following best describes appropriate administration of these vaccines?
No minimum interval between doses *IIV is inactivated HZV is live inactivated do not interfere with live
A healthy 70-year old female who received PPSV23 at 65-years of age is inquiring about pneumococcal vaccination. Which of the following should you recommend?
No pneumococcal vaccination is recommended
Can inactivated vaccines replicate?
No. It does not cause disease.
Which of the following is the correct answer and reason for a 64-year old patient who asks you if it is better to get their shingles vaccine now or wait til it is covered by Medicare at 65 years?
Now, because it must be covered at no cost be commercial insurance
PPCP Step 2 - Occurrence Based Screening
Occurrence-Based Screening is when Patients who may have health conditions that warrant vaccination at a hospital visit
Which of the following is true regarding risk for COVID-19?
Older adults and people with underlying medical conditions are some of the patients at highest risk for severe disease and complications
Which setting best facilitates the delivery of a mass vaccination clinic for the general population?
On-site community event
Tom is a 9-year old boy who has never had an influenza vaccine. Tom's mother shows you his up-to-date immunization record and reports that he has never had any adverse reactions to vaccinations. What dose and schedule of IIV should be administered to Tom?
One dose during flu season *influenza vaccine can be given beginning at 6 months 6 months-8 years who have not previously been vaccinated need 2 doses, 4 weeks apart 9 years-one dose during flu season 6 months-2 years 0.25mL dose 3+ years- 0.5mL dose
Which vaccine does ACIP recommend for all college freshmen, aged 21 years or younger, living in dormitories, who have not been previously vaccinated?
One dose of MCV4
When looking at the schedule for vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications, what does the orange bar represent?
Orange-indicates theres a precaution for the vaccine * Yellow-vaccine recommended according to routine schedule Purple-recommended for people with an additional risk factor for which the vaccine would be indicated Yellow/black- vaccine recommended, additional doses may be necessary based on medical condition White-no recommendation Red-vaccine is contraindicated
Which of the following functions should be performed prior to the mass vaccination clinic?
Ordering of adequate inventory of vaccines and supplies
Which of the following best describes immunization coalitions?
Organizations that bring together vaccination stakeholders to improve vaccination rates
A 3-yearmold child recently underwent a splenectomy. Previous to the surgery, the child was up to date on all pediatric vaccinations. According to the CDC, which of the following vaccines should be recommended?
PPSV23
Kate is a 24-year-old woman with asthma. She requests a refill of her albuterol inhaler on November 1st. Kate's immunization record indicates that she completed the primary series of MMR, varicella, DTaP, HepA, and HepB vaccines, and she received a dose of Tdap 2 years ago. For complete coverage, which of the following vaccines should she receive?
PPSV23 HPV Influenza if flu season *PCV13 is for immunocompromised not asthma
Which of the following is true for the 23-valent pneumococcal polysaccharide vaccine (PPSV23)?
PPSV23 should not be given to children less than 2 years of age
Screening Questions: Live Vaccines, Family history
Parent, brother/sister with immune system problem? Heredity immunodeficiency should be screened
The whooping cough associated with pertussis occurs in this stage of disease:
Paroxysmal
What is the type of immunity that occurs when a pregnant woman is vaccinated with Tdap to protect the infant from pertussis after birth?
Passive Immunity *antibodies are provided from another source
Screening Questions: Live Vaccines, Blood Products
Past year, have you received transfusion of blood/blood products or given Immune (gamma) globulin Blood or blood products may contain antibodies that reduce vaccine efficacy.
A male patient presents to the pharmacy for a shingles vaccine appointment. The patient is a new patient to the pharmacy. Which of the following information would be most appropriate to collect as part of the patient care process?
Patient's age, current health, vaccine history, and allergies
Which of the following best describes the preparation stage of the Transtheoretical Model of Health Behavior Change?
Patients intend to take action in the next month to change their behavior.
Which of the following is true regarding varicella zoster transmission?
Period of contagiousness: 1-2 days before rash to 4-7 days later
Which of the following is the reason for the most recent hepatitis A outbreaks?
Person-to-person transmission
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.
Pertussis
PPCP
Pharmacist Patient Care Process
Which of the following is true regarding professional liability?
Pharmacists should educate and inform patients and their caregivers about the benefits and risks of vaccination.
Which of the following statements is true regarding how pharmacy technicians can gather information about a patient's vaccination history?
Pharmacy technicians can review electronic health records
EUA Process
Phase 1/2 have to be completed Phase 3 - long term so monitor safety and FDA may allow it to move forward.
When administering a subcutaneous injection, pharmacists should
Pinch a fold of skin over the triceps muscle
PPCP Step 3
Plan - pharmacists creates an individualized patient-centered care plan with clear and strong evidence based recommendations
Which disease state(s) can potentially lead to meningitis?
Polio and Haemophilus influenzae
Which of the following complications are correctly matched to the associated condition?
Postherpetic neuralgia-herpes zoster
Precautions vs. Contraindications
Precautions - conditions that may diminish response to vaccine and increases risk of serious reaction Contraindications - when a conditions exists that will result in a severe, life-threatnening event if patient receives this vaccine. ex: severe allergy/reaction to previous dose or vaccine component.
Screening Questions: Pregnant Women
Pregnant women should receive IIV4 and Tdap vaccinations Some live vaccines may be contraindicated in pregnancy
Which of the following is one of the five guidelines identified by the APhA Board of Trustees in 2019 to assist pharmacists in incorporating immunization activities into their practice?
Prevention
Which of the following is one of the five guidelines identified by the APhA Board of Trustees in 2019 to assist pharmacists in incorporating immunization activities into their practice?
Prevention, Partnership, Quality, Documentation and Empowerment
PPCP Step 2 - Procedure Based Screening
Procedure Based screening is when certain procedures might indicate the need for specific vaccines
Which disease is almost certain to cause death if infected patients do not receive postexposure prophylaxis?
Rabies *it affects the CNS
Screening Questions: Live Vaccines, Vaccine Timing
Received vaccinations in the last 4 weeks? Vaccines should be given BEFORE initiation of immunosuppressive therapies
Which if the following is a non-governmental organization that participates in disaster relief efforts?
Red Cross
Documentation requirements for COVID-19 vaccinations include:
Report administration data to your jurisdiction's system (e.g. IIS) within 72 hours after administration
How is streptococcus pneumoniae primarily transmitted?
Respiratory droplets or secretions
RV1, RV5 is the abbreviation for:
Rotavirus
Which vaccination is NOT part of a combined antigen vaccine?
Rotavirus
Which of the following best describes how to administer MMR vaccine to an adult patient weighing 210 lb?
SC at 45 degree angle *weight of patient does not matter in regards to route of administration
The first step in AHRQ's "SHARE" approach to vaccines is to:
Seek your patient's participation in a discussion
Screening Questions: Patients considering tetanus-containing vaccines
Seizure, brain or other nervous system problem Guillain-Barre syndrome (GBS) may be a precaution
Preparing a vaccine for administration may include which of the following tasks?
Selecting the needle for administering the vaccine
When promoting a mass immunization clinic it is helpful to:
Share appointment scheduling instructions, if applicable
If a vial of influenza vaccine is left out of the refrigerator on the pharmacy counter overnight, what should be done with the vaccine?
Should be quarantined in fridge/freezer and marked "do not use" and contact manufacturer for further instructions *RPh should document each step anytime theres a break in the cold chain
Which of the following diseases have been eradicated worldwide, allowing vaccination to be discontinued?
Smallpox
Which of the following diseases have been eradicated worldwide, allowing vaccination to be discontinued?
Smallpox - eradicated in 1980 by WHO
If patients believe that influenza vaccines can cause influenza because they were ill after receiving the vaccine last year, pharmacists should educate them that:
Some people experience systemic reactions to influenza vaccine that include mild flu-like symptoms
Which of the following facility features is most important for maintaining the cold chain?
Space for vaccine storage and temperature monitoring
Which of the following statements about standing orders and protocols is true?
Standing orders and protocols must consider which vaccines may be administered by pharmacists according to state laws and regulations.
Which of the following issues affecting international access to vaccines is best aligned to efforts by pharmacist volunteers?
Suboptimal levels of health care providers
Schedule for Children up to 18 years
Table 1 - Age Table 2 - Catch-up schedule for pts. behind on vaccines Table 3 - Medical indication
Which of the following vaccines is used as a booster every 10 years?
Td
Arthus reactions, which are exaggerated local reactions that can occur if a patient is vaccinated too frequently, are most commonly reported after which vaccine?
Td or Tdap
If pharmacists are called upon to assist with vaccination efforts following a natural disaster, which vaccine is likely to be needed by many of the victims?
Td or Tdap
All Medicare Part D enrollees are covered for which vaccines?
Td/Tdap HZV
Emily is a 16-year-old high-school student with no chronic medical conditions. Emily's immunization record shows that she completed the primary series for IPV, HepA, Hib, DTaP, and MMR, and she had a physician-diagnosed case of chickenpox at 2 years of age. Which of the following would be the most appropriate recommendation for her today?
Tdap MCV4 HPV Hep B influenza vaccine if flu season
A 69 year-old man received Td vaccination 4 years ago. He is preparing to travel to see his newborn granddaughter next month. Which of the following vaccines containing tetanus, diphtheria, and/or pertussis would be most appropriate for him?
Tdap if he has not received that and a Td booster every 10 years
What vaccine should women get every pregnancy?
Tdap, after 20 weeks of pregnancy
How do vaccines evoke an immune response?
The antigen in the vaccine activates B cells, which produce antigen-specific antibodies and memory cells. *Pure polysaccharide vaccines do not activate B cells.
How vaccines evoke an immune response:
The antigen in the vaccine activates B cells, which produce antigen-specific antibodies and memory cells. *Pure polysaccharide vaccines do not activate B cells.
Which of the following statements is false regarding polysaccharide and conjugated vaccines?
The conjugate protein used, such as diphtheria, can also provide adequate protection against itself in addition to the polysaccharide
Vaccine hesitancy is defined as:
The delay in acceptance or refusal of a vaccination despite the availability of vaccination services
After the routine administration of a vaccine, the pharmacy technician should send documentation of the vaccination to:
The patient's primary care physician
Which of the following is true regarding 3rd dose and booster doses for COVID-19?
The third dose and booster dose recommendations for immunocompromised patients are only for mRNA vaccines
The Vaccine for Children (VFC) program pays for which of the following?
The vaccine
Which of the following correctly describes current ACIP recommendations?
The varicella zoster vaccine should be given at 12-15 months and 4-6 years of age
T/F Both live attenuated vaccines and recombinant vaccines mimic natural infection and involve T cells in the immune response.
True
T/F: Inactivated vaccines are not affected by live vaccines and visa versa.
True
T/F: Inactivated vaccines do NOT have minimum intervals between administered vaccines
True
T/F: MMR is a live attenuated vaccine.
True
Which of the following is a law or program that may grant immunity from civil liability during emergencies for covered activities?
U.S. Public Readiness and Emergency Preparedness Act
Which of the following is the primary reason we have measles outbreaks in the U.S.?
Unvaccinated people with measles coming to the U.S.
When administering an intramuscular injection, pharmacists should:
Use a 22- to 25- gauge needle
When storing vaccines in the refrigerator, pharmacists should:
Use water bottles to help stabilize temperatures
The monitoring system that health care providers should use to report serious adverse events after vaccination is:
VAERS
The program which collects data regarding errors of vaccine handling and administration is called:
VERP
What is the name of the document published by the CDC that describes the risks and benefits of a vaccine in lay terms?
VIS - Vaccine Information Statement
Which of the following vaccines are best suited to a mass immunization clinic?
Vaccines to address a pandemic pathogen
VAR is the abbreviation for:
Varicella
Which of the following vaccines listed is a live attenuated vaccine?
Varicella (VAR)
When does Active Immunity occur?
When a patient is exposed to an antigen that triggers the body's immune system to produce it's own disease-specific antibodies and memory cells.
Which of the following is an example of a common vaccine administration error?
Wrong vaccine, route, site, or dosage; or improperly prepared.
Can a women receive the flu vaccine if she is pregnant?
Yes, but it has to be the inactivated flu vaccine only during flu season
During a public health declared mumps outbreak, a 21-year old college student with a history of 2 MMR vaccine doses as a child wants to know if she needs a dose of MMR now. Which of the following is the best response?
Yes, since there is a declared mumps outbreak
Which of the following vaccines must be frozen?
Zostavax
CDC Immunization Schedules
age, # of doses, time between doses, indications, precautions - UPDATED ANNUALLY
Active immunity:
an antigen from an invading pathogen triggers an immune response
Inactivated vaccines...
are produced by killing the virus/bacteria includes polysaccharide vaccines (conjugated [protein altered] or unconjugated), toxoids, or cellular vaccines
Which of the following is true regarding the use of mRNA in vaccine technology? a.) mRNA is extremely stable in a host's body. b.) mRNA is the genetic blueprint that tells your body how to make a particular protein subunit of a virus which, after being produced, will elicit an immune response. c.) mRNA vaccine technology requires replication similar to a live attenuated vaccine. d.) mRNA vaccine technology elicits its immune response and protects the host by altering the host's DNA.
b.) mRNA is the genetic blueprint that tells your body how to make a particular protein subunit of a virus which, after being produced, will elicit an immune response.
Why should refrigerated vaccines be stored in the middle of the refrigerator?
because the temperature in the middle does not fluctuate as much.
All Medicare Part B enrollees are covered for which vaccines?
both pneumococcal vaccines influenza vaccine
Which of the following symptoms are usually associated with influenza?
chills
Which of the following is an example of passive immunity? a.) Contracting measles b.) Hep B Vaccine c.) Skin Barrier d.) Maternal antibodies
d.) Maternal antibodies
Which of the following vaccines listed is a live attenuated vaccine? a.) Hep B b.) Hep A c.) RZV d.) VAR
d.) VAR
After completion of a primary vaccine series and documentation of a one-time dose of Tdap, Td booster doses are recommended every:
every 10 years
How often are the Healthy People targets for vaccination rates updated?
every 10 years
False allergic reaction:
fever, GI upset, red eyes, neurological events
Diagnosis-based screening to identify people at risk for vaccine-preventable diseases:
identifies patients in need of vaccines based on the presence of a particular diagnosis. ex: diabetes
True allergic reaction:
immediate hypersensitivity with itching, hives, redness, or symptoms of anaphylaxis
Acquired immunity:
immunological memory *can be active or passive
Procedure based screening to identify people at risk for vaccine-preventable diseases:
involves assessing vaccine needs based on a patient's receipt of a surgical, medical, or pharmacy-based procedure. ex: splenectomy
Purpose of adjuvants
it strengthens the response to the antigen and the immune response is much greater because the adjuvant results in an inflammatory response *adjuvants are added to recombinant vaccines
Minimum interval when blood product is given before live vaccine
minimum varies (have to look up)
Minimum interval for inactivated vaccines and antibodies
no minimum
The childhood/adolescent and adult immunization schedules are updated and published annually during which months?
once a year at the end of January or early February
Which of the following tetanus booster vaccines would be most appropriate for administration to a 12-year-old boy who has completed a primary series with DTaP and has no known allergies?
one dose of Tdap
Live attenuated vaccines..
produced by weakening the virus or bacteria to reduce the likelihood that it can cause disease end to produce more persistent, longer-lasting immunity than inactivated vaccines must replicate in order for the body to produce an immune response could cause disease in immunocompromised patients Circulating antibodies may interfere with a live attenuated vaccine's ability to replicate.
Conjugated vaccines..
provide longer lasting protection the immune response that changes to a T cell mediated response allows children <2 to form an immune response
In the event that a young child is fussy following the receipt of a vaccine, pharmacists should advise parents to:
quiet activites and comfort them *Can use acetaminophen/ibuprofen for discomfort Aspirin is not recommended
To prevent errors of vaccine administration, pharmacists should:
select the appropriate needle length
How is the live, cholera vaccine administered?
single oral dose at least 10 days prior to potential exposure *should not eat/drink for 1 hour before or after vaccine
Which of the following diseases has been successfully eradicated worldwide through vaccination efforts?
smallpox
Occurrence based screening to identify people at risk for vaccine-preventable diseases:
takes advantage of an event, such as a hospital admission, clinic visit, or emergency department visit to identify people who need to be vaccinated ex: discharge counseling
There should be a flat hard surface in the area where vaccines will be administered to ensure:
there is space to perform CPR
What does attenuated mean?
weakened