What is the minimum needle length recommended for administering HepB vaccine to an adult patient weighing 130 lb?
answer
Fixed 1-inch needles are acceptable for patients weighing 60 kg (132 lb) or less.
question
HZV, MMR, rabies, typhoid, varicella, or yellow fever vaccine should not be administered to a patient with a history of anaphylaxis to:
answer
Gelatin
question
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?
answer
1) Tdap
2) Td 4 weeks later
3) Td 6-12 months later
Td booster every 10 years after 3rd dose
question
Candidate for PPSV23?
answer
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
question
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.
answer
Pertussis
question
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?
answer
9vHPV
question
Which of the following key questions is important to ask a patient before administering IIV?
answer
Are you sick today?
*Mild illness is okay, but moderate to severe acute illness need to be resolved before getting vaccine.
question
Live attenuated vaccines..
answer
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.
question
Inactivated vaccines...
answer
are produced by killing the virus/bacteria
includes polysaccharide vaccines (conjugated [protein altered] or unconjugated), toxoids, or cellular vaccines
question
Which type of vaccine involves stimulation of B cells without the assistance of T helper cells?
answer
A pure polysaccharide
*not recommended for children <2 because of their immature immune system
question
Conjugated vaccines..
answer
provide longer lasting protection
the immune response that changes to a T cell mediated response allows children <2 to form an immune response
question
T/F
Both live attenuated vaccines and recombinant vaccines mimic natural infection and involve T cells in the immune response.
answer
True
question
The incubation period for influenza can range from:
The monitoring system that health care providers should use to report serious adverse events after vaccination is:
answer
VAERS
question
Which of the following patients are appropriate candidates for the 2-dose schedule of HPV9?
answer
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
question
Why should refrigerated vaccines be stored in the middle of the refrigerator?
answer
because the temperature in the middle does not fluctuate as much.
question
A history of anaphylaxis caused by neomycin would be a contraindication to receiving which of the following vaccines?
answer
Hep A, IPV, MMR, Rabies, smallpox, varicella, zoster, influenza
question
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?
answer
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
question
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:
answer
Immediate protection
*its passive immunity so its short-lived, but provides protection right away
question
Contraindication of HZV
answer
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)
question
Viruses associated with the development of cancer:
answer
HPV and Hep B
question
There should be a flat hard surface in the area where vaccines will be administered to ensure:
answer
there is space to perform CPR
question
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?
answer
Td or Tdap
question
According to ACIP recommendations, which of the following needle lengths would be appropriate for administering HZV to an adult patient?
answer
5/8 in needle at 45 degrees in the outer upper arm (SC)
question
How often are the Healthy People targets for vaccination rates updated?
answer
every 10 years
question
Which of the following patients is a candidate for both MenACWY and MenB vaccines?
answer
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
question
What must be documented for VIS?
answer
-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
question
Who should receive MMR vaccine?
answer
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
question
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?
answer
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.
question
Which of the following best describes how to administer MMR vaccine to an adult patient weighing 210 lb?
answer
SC at 45 degree angle
*weight of patient does not matter in regards to route of administration
question
HPV vaccine is recommended for..
answer
Both males and females ages 9-26 years
*routinely recommended for 11 or 12 years of age
question
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?
answer
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
question
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?
answer
Tdap
MCV4
HPV
Hep B
influenza vaccine if flu season
question
True regarding varicella-containing vaccines:
answer
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
question
Which disease is almost certain to cause death if infected patients do not receive postexposure prophylaxis?
answer
Rabies
*it affects the CNS
question
If a patient with an egg allergy experiences hives following influenza vaccination, what is ACIP's recommendation for vaccinating this patient against influenza?
answer
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
question
The childhood/adolescent and adult immunization schedules are updated and published annually during which months?
answer
once a year at the end of January or early February
question
How is the live, cholera vaccine administered?
answer
single oral dose at least 10 days prior to potential exposure
*should not eat/drink for 1 hour before or after vaccine
question
RotaTeq (RV5) should be administered as a:
answer
3-dose series at 2,4,6 months
question
Rotarix (RV1) should be administered as a:
answer
2 dose oral series at 2 and 4 months
question
Diagnosis-based screening to identify people at risk for vaccine-preventable diseases:
answer
identifies patients in need of vaccines based on the presence of a particular diagnosis.
ex: diabetes
question
Procedure based screening to identify people at risk for vaccine-preventable diseases:
answer
involves assessing vaccine needs based on a patient's receipt of a surgical, medical, or pharmacy-based procedure.
ex: splenectomy
question
Occurrence based screening to identify people at risk for vaccine-preventable diseases:
answer
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
For a patient who needs to receive IIV and HZV, which of the following best describes appropriate administration of these vaccines?
answer
No minimum interval between doses
*IIV is inactivated
HZV is live
inactivated do not interfere with live
question
Interval between 2 live vaccines NOT given simultaneously:
answer
4 weeks
question
Why was the live attenuated influenza vaccine (LAIV) removed from the ACIP's influenza vaccine recommendations?
answer
Lower than expected efficacy in 2013-2016
question
Epi doses:
answer
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
question
The majority of vasovagal syncope cases occur withinin:
answer
15min of vaccination
question
Which of the following diseases has been successfully eradicated worldwide through vaccination efforts?
answer
smallpox
question
In 2014, which vaccination rate was lowest among adolescents 13 through 17 years of age?
answer
HPV
question
How do vaccines evoke an immune response?
answer
The antigen in the vaccine activates B cells, which produce antigen-specific antibodies and memory cells.
*Pure polysaccharide vaccines do not activate B cells.
question
What to do in case of anaphylaxis:
answer
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
question
True allergic reaction:
answer
immediate hypersensitivity with itching, hives, redness, or symptoms of anaphylaxis
question
False allergic reaction:
answer
fever, GI upset, red eyes, neurological events
question
Can a women receive the flu vaccine if she is pregnant?
answer
Yes, but it has to be the inactivated flu vaccine only during flu season
question
What vaccine should women get every pregnancy?
answer
Tdap, after 20 weeks of pregnancy
question
What individuals are at an increased risk of adverse effects from live vaccines
answer
Immunocompromised
question
Minimum interval when a PPD skin test is followed by a live vaccine
answer
Administer vaccine after PPD skin test has been read
question
Minimum interval when a live vaccine is followed by a PPD skin test
answer
28 days
question
Minimum interval when blood product is given before live vaccine
answer
minimum varies (have to look up)
question
Minimum interval for live vaccines followed by blood products
answer
2 weeks
question
Minimum interval for inactivated vaccines and antibodies
answer
no minimum
question
Minimum interval for two live vaccines, if not simultaneous
answer
28 days
question
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?
answer
5th dose of DTaP
4th dose of IPV
2nd dose of MMR
2nd dose of varicella
PCV13
Hib
Hep A
Hep B
question
Purpose of adjuvants
answer
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
question
The presence of fever, diffuse maculopapular rash, and Koplik spots are characteristic of which of the following diseases?
answer
MMR
question
Which of the following is recognized by sociologists as a factor in a patient's decision whether to be vaccinated?
answer
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)
question
In the event that a young child is fussy following the receipt of a vaccine, pharmacists should advise parents to:
answer
quiet activites and comfort them
*Can use acetaminophen/ibuprofen for discomfort
Aspirin is not recommended
question
During which step of the Pharmacists' Patient Care Process would a pharmacist analyze a patient's need for certain vaccines?
answer
Assess
question
After completion of a primary vaccine series and documentation of a one-time dose of Tdap, Td booster doses are recommended every:
answer
every 10 years
question
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?
answer
one dose of Tdap
question
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?
answer
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
question
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?
answer
3 dose series at 0, 1, and 6 months
question
At what point during pregnancy is it recommended to administer the influenza vaccine?
answer
Any trimester
question
Which of the following statements about pharmacy-based vaccination programs is true?
Feedback
answer
Administratively, billing for vaccines covered by Medicare Part D may be easier for pharmacists than physicians.
question
Which of the following is the best example of a group with which individual pharmacists can collaborate to increase immunization rates in their communities?
answer
Local Health Departments
question
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?
answer
Tdap if he has not received that
and a Td booster every 10 years
question
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?
answer
PPSV23
HPV
Influenza if flu season
*PCV13 is for immunocompromised not asthma
question
What is the type of immunity that occurs when a pregnant woman is vaccinated with Tdap to protect the infant from pertussis after birth?
answer
Passive Immunity
*antibodies are provided from another source
question
Acquired immunity:
answer
immunological memory
*can be active or passive
question
Active immunity:
answer
an antigen from an invading pathogen triggers an immune response
question
Which of the following statements would be accurate when responding to a patient's concerns about the safety of vaccines?
answer
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
question
If a patient is a candidate for revaccination with PPSV23, what is the ACIP-recommended interval between doses of this vaccine?
answer
1-3 doses with 5 years between
under age of 65 who are immunocompromised or asplenia-2 doses with 5 years apart
question
Which disease is characterized by the development of a membrane on the tonsils, pharynx, or larynx, leading to respiratory obstruction?
answer
Diphtheria
question
Which of the following best describes how to administer Tdap vaccine to an adult patient weighing 185 lb?
answer
IM at 90 degrees
*weight of patient is irrelevant in regards to route of administration
question
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:
answer
2nd dose given at least 6 months after the first dose
question
Adolescents should be routinely vaccinated with MCV4 on the following schedule:
answer
1 dose at 11 or 12 years
booster at 16 years
question
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?
answer
5th dose DTaP
*one time dose of Tdap at 7 years
Td booster every 10 years
question
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?
answer
HZV-SC, 0.65mL dose
IIV-IM, 0.5mL
question
What is meant by the term "immunization neighborhood"?
answer
Immunization stakeholders collaborate to meet community immunization needs.
question
Even though state laws may have specific mandates, how long should pharmacists maintain records of immunizations?
answer
Immunizations should become part of the patient's permanent record and should be kept for the patient's lifetime.
question
All Medicare Part B enrollees are covered for which vaccines?
answer
both pneumococcal vaccines
influenza vaccine
question
All Medicare Part D enrollees are covered for which vaccines?
answer
Td/Tdap
HZV
question
Arthus reactions, which are exaggerated local reactions that can occur if a patient is vaccinated too frequently, are most commonly reported after which vaccine?
answer
Td or Tdap
question
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:
answer
If he has not had 2 doses of the flu vaccine then he needs 2 doses, 4 weeks apart
question
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?
answer
Diagnosis of chickenpox/shingles by a health care provider.
Born in U.S. before 1980
2 doses of varicella at least 4 weeks apart
question
Vaccines as well as exposure to natural disease are both examples of which type of immunity?
answer
Active immunity
question
How vaccines evoke an immune response:
answer
The antigen in the vaccine activates B cells, which produce antigen-specific antibodies and memory cells.
*Pure polysaccharide vaccines do not activate B cells.
question
If a vial of influenza vaccine is left out of the refrigerator on the pharmacy counter overnight, what should be done with the vaccine?
answer
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
question
Which vaccine does ACIP recommend for all college freshmen, aged 21 years or younger, living in dormitories, who have not been previously vaccinated?
answer
One dose of MCV4
question
Prior to the introduction of a vaccine, what was the leading cause of bacterial meningitis in children younger than 5 years of age?
answer
Hib
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