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NAPLEX 2024 > 20. Immunizations > Flashcards

20. Immunizations Flashcards

1
Q

___ are prepared by the CDC for each vaccine to explain benefits and risks

A

Vaccine Information Statements (VISs)

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2
Q

Federal law requires that a VIS be handed to patient/parent (before/after) a vaccination is administered

A

Before

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3
Q

What is the diff between active and passive immunity?

A

Active = person’s own immune system produces antibodies (in response to vaccine or infection)
Passive = antibodies are provided from someone else (e.g. mother to baby, IVIG)

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4
Q

What is the difference between live attenuated vs inactivated vaccines

A

Live attenuated - produced by modifying a disease-producing (“wild”) virus or bacterium in a lab; have the ability to replicate and produce immunity but usually do not cause illness; produce strong immunity

Inactivated vaccine - either killed whole virus or bacterium, or fractions of either; immunity diminish with time and boosters may be needed

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5
Q

Common live vaccine mneumonic MICRO-VY

A

MMR
Intranasal influenza
Cholera
Rotavirus
Oral typhoid
Varicella
Yellow Fever

Others: tuberculosis (BCG), dengue, small pox, ebola

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6
Q

___ vaccines do not produce good immune response in children < 2yo

A

Polysaccharide vaccines (ex. Pneumococcal Polysaccharide Vaccine (Pneumovax 23))

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7
Q

____ vaccines increases immune response in infants and antibody booster response to multiple doses of vaccine

A

Conjugation
Ex. Pneumococcal Conjugate vaccine (Prevnar 20), Meningococcal Conjugate vaccine (e.g. Menactra)

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8
Q

What is a limitation of live vaccines?

A

Not recommended in immunocompromised/pregnant patients (may not be able to halt replication and cause disease)

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9
Q

What is a limitation of inactivated vaccines?

A

Immunity is not as strong compared to live vaccines; boosters may be required

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10
Q

T/F: Most live and inactivated vaccines can be administered simultaneously

A

True

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11
Q

T/F: Increasing the interval between doses of a vaccine diminishes the effectiveness of the vaccine after completion of series

A

False - it does not but it may delay complete protection

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12
Q

T/F: Decreasing the interval between doses of a vaccine may expedite complete protection but it is not generally recommended

A

False - Decreasing the interval can interfere with antibody response and is generally avoided

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13
Q

What is the concern with live vaccines + antibody products (blood, IVIG)?

A

Antibodies can interfere with live vaccine replication and a separation period may be required

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14
Q

The interval between antibody-containing product and MMR or Varicella vaccine is minimum of ____ and up to ___

A

3 months, up to 11 months

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15
Q

Most live vaccines are withheld until a child is ___; at this time, the mother’s antibodies will be depleted. An exception is live ___ vaccine which is givent o infants.

A

12 mo
Rotavirus

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16
Q

How old do pediatric patients have to be to get inactivated vaccines

A

Inactivated vaccines can be given at any time
Hep B is started at birth, others are typically when baby is 2 months old

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17
Q

What is the concern with live vaccines + TB skin test?

A

Live vaccines can cause false negative TB skin test

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18
Q

Live vaccines can cause false negative TB skin test. What are options to reduce this risk?

A

Give the live vaccine on the same day as the TST
Wait 4 weeks after live vaccines to perform TST
Give TST first, wait 48-72 hrs to get result and then give live vaccine

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19
Q

Vaccines can usually be given at the same time (same visit or day). What are some exceptions?

A

Patients with asplenia
Prevnar and Menactra should be separated by 4 weeks

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20
Q

What is the spacing requirement for live vaccines + antibody?

A

Vaccine first, 2 weeks, antibody containing product
Antibody-containing product, 3 months or longer, vaccine

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21
Q

Simultaneous administration of vaccine and antibody is recommended for post-exposure ppx of certain diseases such as ____

A

Hep A and B, rbaies, tetanus

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22
Q

Patients should be monitored for at least ___ after vaccination to watch for allergic reaction, syncope, dizziness, or fall

A

15 min

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23
Q

Patient felt some systemic symptoms after a flu shot and came to the pharmacy saying the vaccine caused the flu. What is your response?

A

The flu shot is an inactivated (killed) vaccine and cannot cause disease

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24
Q

With live vaccines, mild systemic reactions can occur ___ after the vaccine is given (i.e. after an incubation period)

A

3-21 days

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25
Q

____ flu vaccine can replicate in the upper airways and cause cold cold-like symptoms such as a runny nose

A

Intranasal

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26
Q

Minor allergic reactions to vaccines typically resolve quickly and can be treated with ____ (OTC) and ___ (Rx)

A

Diphenhydramine
Hydroxyzine

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27
Q

T/F: Minor allergic reaction to vaccines is a contraindication to future vaccinations

A

False

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28
Q

How many adult Epipens should be available at the pharmacy in case of severe allergic reaction to vaccines?

A

at least 3 adult (0.3mg) auto injectors
Most adults will require 1-3 doses administered every 5-15 mins

29
Q

T/F: Vaccinations cannot be given if pt has mild acute illness (slight fever, mild diarrhea)

A

False - may be given

30
Q

T/F: Any vaccinations may be given if pt is on abx

A

False - most can be given but exceptions include varicella, live influenza, and oral typhoid vaccines

31
Q

T/F: Vaccinations cannot be given if pt had previous local skin reaction (mild-moderate) from a vaccine

A

False - may be given

32
Q

What is the difference between DTap and Tdap vaccine ?

A

DTap is for children < 7yo
Tdap is given age 11-12 and adults

33
Q

HPV vaccine recommended age

A

11-12 yo

34
Q

HPV vaccine contraindicated with severe ___ allergy

A

yeast

35
Q

HPV vaccine regimen if started before age 15 = ___ doses

A

2 (month 0 and 6-12 months later)

36
Q

HPV vaccine regimen if started at age 15 or older or if immunocompromised = ___ doses

A

3 (months 0, 1-2, and 6)

37
Q

Influenza A virus has subtypes based on the 2 surface antigens, ___ and ___

A

hemagglutinin and neuraminidase

38
Q

Influenza vaccine is typically given to all pts age ≥6 mo and annually. When would 2 doses (4 weeks apart) be appropriate?

A

If age 6mo to 8yo and have not previously been vaccinated

39
Q

Which influenza vaccines are indicated only for pts age ≥65yo

A

Fluzone High-dose and Fluad

40
Q

Egg-free influenza vaccine includes ___ (approved only ≥18yo) and ___ (grown in cell culture approved for age ≥6 months)

A

Flublok
Flucelvax

41
Q

Which influenza vaccine is a live vaccine?

A

FluMist (approved for healthy ppl age 2-49yo)

42
Q

All influenza vaccines are administered ____ except FluMist is intranasally divided between 2 nostrils

A

IM

43
Q

Storage for all influenza vaccines

A

Refrigerator
Do NOT freeze

44
Q

Storage for MMR vaccines

A

M-M-R II: store in refrigerator or freezer
Priorix: store in refrigerator
MMRV: store vaccine in freezer only d/t varicella component

45
Q

How are MMR vaccines administered?

A

SC; MMR II and ProQuad may be given IM

46
Q

Which vaccines require reconstitution with a diluent before use?

A

Varicella, MMR, and MMRV

47
Q

Which vaccines require storage in the freezer?

A

Varicella (ProQuad, Varivax) and oral cholera vaccine

48
Q

Which vaccines are given to adults with asplenia?

A

Pneumococcal, meningococcal, Hib vaccines

49
Q

When is meningococcal vaccine recommended outside of routine vaccination as adolescents?

A

Travelers to certain countries such as meningitis belt in Sub-Saharan Africa
age 2mo and older with asplenia/sickle cell disease, HIV
Lab workers with N. meningitidis exposure
First-year college students living in resident housing if not up to day
During an outbreak

50
Q

Quadrivalent meningococcal conjugate vaccines (MCV4) include which serotypes?

A

ACWY

51
Q

MenB vaccine brand names

A

Bexesr, Trumenba

52
Q

Pneumococcal vaccine recommendation for children < 5yo

A

4 dose series of PCV13 or PCV15 given at age 2, 4, 6, and 12-15 months

53
Q

Pneumonoccal vaccine administration

A

PCV13, 15, 20 = IM
PPSV23 = IM or SC

54
Q

Rotavirus vaccine administration

A

oral

55
Q

Varicella vaccine administration

A

Varivax SC or IM
Shingrix IM

56
Q

What vaccine can cause a positive reaction to TB skin test?

A

BCG vaccine

57
Q

What vaccine is contraindicated with a severe (life-threatening) allergy to eggs or gelatin?

A

Yellow fever

58
Q

Read and document refrigerator and freezer temps at least ____. Keep logs for at least ___

A

twice each workday
3 years

59
Q

Which vaccines should be stored in the freezer?

A

Varicella
MMRV
Oral cholera vaccine
MMR II can be either refrigerator or freezer

60
Q

Which vaccines are SC only

A

Yellow fever
Other: dengue, smallpox, monkeypox

61
Q

Which vaccines are IM or SC

A

MMR, MMRV, varicella, PPSV23, IPV (IPOL)

62
Q

Which vaccines are PO

A

Thypoid (Vivotif) capsules
Oral solutions: cholera (Vaxchora), rotavirus (RotaTeq, Rotarix)

63
Q

Administration technique and needle length for SC vaccines

A

5/8” needle at 45 degree angle into fatty tissue over triceps

64
Q

Administration technique and needle length for IM vaccines

A

Adult: 1” needle at 90 degree into deltoid muscle above armpit level and below shoulder joint

Exceptions: weight <130 points use 5/8”-1” needle
Males >260lbs or females >200lbs use 1 1/2” needle

65
Q

T/F: You can mix vaccines that are refrigerated and clear in the same syringe

A

False - never mix in the same syringe

66
Q

MenB is indicated in certain patients ages ____

A

10-25yo

67
Q

Which hepatitis vaccines contain hep B only?

A

Engerix-B
Recombivax HB

68
Q

Varicella vaccines are contraindicated in pts with hx of severe allergic reaction to ___

A

gelatin or neomycin

NAPLEX 2024 (74 decks)

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