23. Immunizations Flashcards
Which of the following groups should receive the pneumococcal vaccine (Pneumovax)? (Select ALL that apply.)
A. 8 month old baby with patent ductus arteriosus
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 known medical conditions
E. 6 year old child receiving chemotherapy for lymphoma
B, C, D, E. Immunocompromised adults ages 19-64 years should receive Prevnarfollowed by Pneumovax at least 8 weeks later and then again years after the first Pneumovax dose.
Kate asks the pharmacist if her children should receive the annual influenza vaccination. She has a daughter, age 6 months, with no known illnesses, a daughter, 4 years, with asthma, and a son, 10 years, with ADHD. Which statement is correct?
A. Her 6 month old is too young to receive the influenza vaccine.
B. Her 6 month old should receive the nasal influenza vaccine.
C. Her four year old daughter should receive the influenza nasal mist.
D. None of the children should be receiving influenza vaccines until they are 12 years old.
E. Her 10 year-old son can receive the influenza nasal mist.
E. The influenza live nasal vaccine is for healthy people ages 2-49 years. Her son can get the nasal mist vaccine; the ADHD is not a contraindication. The older daughter cannot due to the asthma. The CDC prefers that all children 2-8 years of age should (preferably) be given the quadrivalent influenza vaccine.
Kate asks the pharmacist if her children will be protected from the scary H1N1 flu if they receive vaccine this year. Which of the following statements is true concerning the current influenza vaccine?
A. A current influenza vaccine (quadrivalent only) covers the H1N1 strain.
B. All of the current influenza vaccines cover the H1N1 strain.
C. The current influenza vaccine is bivalent; it covers two strains.
D. The H in H1N1 stands for haemophilus
E. The H1N1 is in a separate vaccine that is taken in addition to the influenza vaccine; a patient can request this at the pharmacy.
B. The current influenza vaccines are either trivalent (covers 3 strains) or quadrivalent (covers 4 strains). International experts convene to review which strains pose the largest threat and these are recommended for the upcoming vaccine production. The ones that are quadrivalent include an additional influenza type B, in addition to one type B and two type A’s (one of which is H1N1) in the trivalent vaccine.
Kimberly asks the pharmacist if her children should receive the annual influenza vaccination. She states that every time she gets the flu shot, she gets the flu, but is worried about her kids getting a bad strain of the virus. She notes that her ten-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. Kimberly home-schools her children. Which statements concerning the flu vaccine are correct?
A. You 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. It is impossible to get influenza from the nasal flu vaccine.
D. Her daughter can receive the nasal FluMist vaccine.
E. Her daughter cannot receive MMR due to the allergy, but she can receive the influenza vaccine.
D. A severely immune-compromised patient could get influenza from the live nasal influenza vaccine, but no one can get influenza from the shot-the virus in the shot has been inactivated.
Vanessa is pregnant with her second child. She is in the second trimester. Vanessa is not sure what childhood vaccines she received and is positive she has not been vaccinated for anything in at least fifteen years, since that is when she left her parents home and lost her medical insurance. Which vaccine is recommended for Vanessa during her pregnancy? (SelectALL that apply.)
A. Influenza shot, at any time of the year
B. Tdap
C. Measles, mumps and rubella
D. Shingles
E. Influenza shot, if during flu vaccination season
B, E. The influenza vaccine is recommended during any stage of pregnancy. FluMist is a live vaccine; live vaccines are not used during pregnancy. If rubella vaccine (in MMR) was administered during pregnancy the baby would suffer severe birth defects.
A 12-month old child was hospitalized two months ago and received immuneglobulin. Which vaccine/s would be adversely affected by this treatment if administered today? (Select ALL that apply.)
A. Pneumococcal conjugate vaccine
B. Inactivated polio vaccine
C. Measles, mumps, rubella vaccine
D. Influenza vaccine, inactivated
E. Varicella vaccine
C, E. Live vaccines are affected by immuneglobulins.
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.
Select the signs and symptoms of tetanus: (Select ALL that apply.)
A. Muscle rigidity
B. Painful muscle spasms
C. Hypotension
D. Bradycardia
E. High fever
A, B, E. Tetanus (lockjaw) is a serious disease that causes painful tightening of the muscles, usually all over the body. It can lead to “locking” of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in about 1 in 10 cases.
A 70 year old female enters the pharmacy and requests a vaccination against shingles (herpes zoster). Prior to administering the vaccine the following screening question must be asked:
A. Have you ever had a life-threatening allergic reaction to the antibiotic streptomycin?
B. Do you have a history of smoking?
C. Are you taking medication for thyroid disease?
D. Are you receiving more than 5 mg prednisone per day for at least the past two months?
E. Have you ever had a bad reaction to gelatin?
E. Shingles is a live vaccine and cannot be administered to severely immuno-compromised patients. Both shingles and chickenpox cannot be administered to anyone with a true allergy to neomycin or to gelatin (components of the vaccine). The steroid dose indicated here is not enough to cause immune-suppression. Review the steroid doses in the text that would be considered a contraindication to live vaccines.
Each of the following groups should receive hepatitis B vaccine except:
A. Unvaccinated adults with ESRD
B. Unvaccinated adults with asthma
C. Sexually-active adults who are not in a long-term, monogamous relationship (1 partner)
D. All infants, beginning at birth
E. Healthcare workers who work in hospitals
B.
A pharmacist is working in a hospital that requires hepatitis B vaccination. She received her 1st dose of a 3-dose series. She did not return for the 2nd dose, which was due one month later. It is now four months after the 1st dose. Select the correct recommendation:
A. She is more than 30 days late with the 2nd dose; she must start the series over.
B. She is more than 60 days late with the 2nd dose; she must start the series over.
C. She is more than 90 days late with the 2nd dose; she must start the series over.
D. She is no longer a candidate for hepatitis B vaccination.
E. She should get the 2nd dose now and return for the 3rd dose at the proper time.
E. Hepatitis B infection is the major infectious hazard for health-care personnel. Persons with chronic infection are at risk for chronic active hepatitis, cirrhosis, and primary liver cancer. There are different vaccines available, but the usual schedule is three doses, given by IM injection: 1st dose followed by a 2nd dose one month later and a 3rd dose six months after the 1st dose. It is acceptable to catch-up on doses if late (give them when the patient comes in), but recommended dosing schedules cannot be sped-up. It is best not to miss vaccines; the delay increases the risk of infection.
Evangelos 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. Evangelos does not believe he received many childhood vaccines. Which vaccine is preferable?
A. DTaP
B. DT
C. Td
D. Tdap
E. Menveo
D. 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, and for adults 65 and older.
The manager at Huntington Pharmacy has ordered 100 single-dose vials of Fluvirin. He found them in the store’s freezer. Choose the correct course of action:
A. The vaccine can be moved into the refrigerator if it has been frozen less than 1 hour.
B. The vaccine cannot be used; it must be safely discarded.
C. The vaccine can be used if administered within 24 hours.
D. The vaccine can be used if administered within 48 hours.
E. The vaccine can be used if administered within 72 hours.
B. Vaccine that requires refrigeration cannot be stored in the freezer. If it has been frozen in error, the vaccine has been wasted.
Which of the following groups ages 19-64 years should receive Prevnar followed by Pneumovax at least 8 weeks later and then again 5 years after the first Pneumovax dose? (Select ALL that apply.)
A. A patient with HIV infection.
B. A patient with chronic renal failure.
C. A solid organ transplant recipient.
D. A patient with lymphoma receiving treatment.
E. A patient with multiple myeloma receiving treatment.
A, B, C, D, E. These patients are immunocompromised and should receive this regimen.
Occasionally a patient receives a vaccine that is not administered in the proper location. Which of the following statements concerning intramuscular injection in an adult is incorrect?
A. Inject into the central and thickest portion of the deltoid muscle.
B. The injection site is above the level of the armpit and below the acromium.
C. Separate two injections in the deltoid by a minimum of one inch.
D. Td, Tdap, Hepatitis A, Hepatitis B, HPV, trivalent inactivated influenza, and meningococcal MCV4 are given by IM injection. Polio, IPV, and Pneumovax can be given SC or IM.
E. Always inject into the same arm to ensure consistent absorption.
E.
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 ALLthat 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 a herpes zoster outbreak.
D. The patient is not old enough to receive this vaccine.
E. This vaccine is administered subcutaneously in the fatty tissue over the triceps.
C, E. 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, which is shingles.
Select the correct statement concerning pneumococcal vaccination in patients 65 and older:
A. They should receive Pneumovax 23 unless received within the past 5 years.
B. They should receive Prevnar 13 unless received within the past 5 years.
C. They should receive Prevnar 13 x 1, followed by Pneumovax 23 five years later.
D. They should receive Prevnar 13 (if not given previously) followed by Pneumovax 23 6 to 12 months later by a dose of Pneumovax 23.
E. They should receive Pneumovax 23 x 1, followed by Prevnar 13 five years later.
D. Ages 65 and older require Prevnar 13 (if not given previously) followed by Pneumovax 23 6 - 12 months later by a dose ofPneumovax 23. If Pneumovax 23 was given first, wait at least 1 year before giving Prevnar 13.
Select the correct name for the chickenpox vaccine:
A. Zovirax
B. Varivax
C. Valtrex
D. Zostavax
E. Engerix-B
B. Look-alike drug names contribute to the most common error pharmacists make, which is dispensing the wrong medication.
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, E. Shingles can cause severe nerve pain. The lidocaine patch (Lidoderm) is approved to treat the pain, and other agents are as well, but the pain can remain significant in 5-10% of patients with shingles. Lidocaine viscous gel is used topically for pain relief. Another name for shingles is herpes zoster. Another name for the resultant chronic pain that may occur post-shingles outbreak is herpetic neuralgia.
Which of the following statements concerning the recombinant vaccine FluBlok are correct? (Select ALL that apply.)
A. If a patient wishes to receive FluBlok and they have had a severe reaction to eggs (anaphylaxis) they cannot receive FluBlok in the pharmacy.
B. FluBlok is produced with recombinant DNA techniques and is completely free of egg products.
C. FluBlok is given subcutaneously.
D. FluBlok is preferred in children E. Flublok can be administered to patients 18 years and older.
B, E. If a patient wishes to receive FluBlok and they have had a severe reaction to eggs (anaphylaxis) they can certainly receiveFluBlok in the pharmacy; FluBlok is a recombinant vaccine and is not produced in hen embryos. FluBlok is 100% egg-free. Children 6 months to 8 years should be receiving FluMist, the quadrivalent nasal spray, per the CDC.
Pharmacists have sometimes dispensed the wrong hepatitis vaccines. It is helpful to know some of the names in order to make sure the correct vaccine is chosen. Vaccines can be kept in labeled bins in the refrigerator with warnings for agents that are likely to be involved in mix-ups. Which vaccine contains combined Hepatitis A and B vaccines?
A. Engerix-B
B. Recombivax-B
C. Comvax
D. Pediarix
E. Twinrix
E. The name Twinrix is a clue (“twin’) that two vaccines are included.
Which of the following statements concerning an intramuscular (IM) injection are correct? (Select ALL that apply.)
A. Separate two IM injections by at least one inch.
B. Meningococcal (MCV) is given by IM injection.
C. Varivax is SC only; Zostavax is IM or SC.
D. Inactivated polio vaccine is either SC or IM.
E. Pneumovax is SC only.
A, B, D. Pneumococcal polysaccharide (Pneumovax) and the inactivated polio vaccine (IPV) are either SC or IM; no preference is stated by ACIP.
Epinephrine injection now comes in a “talking” injection device that can help guide patients how to administer the injection. What is the name of this device?
A. Evzio
B. Copaxone
C. Lemtrada
D. Arixtra
E. Auvi-Q
E. Auvi-Q is a newer device that is easy to use; however, the EpiPen is also simple to use.
Evzio (naloxone auto-injector) for opioid overdose
Copaxone (glatiramer acetate) for multiple sclerosis
Lemtrada (alemtuzumab) treats leukemia
Arixtra (fondaparinux) prevents blood clots, factor Xa inhibitor
Benjamin is a 54 year-old male who enters the pharmacy to get his annual flu shot, but he is coughing and sneezing. He has a cold and says his cough kept him up all night. Select the correct statement:
A. He should get the flu shot today.
B. He should wait until the illness symptoms have cleared.
C. He should wait at least a month before he challenges himself with a flu vaccine.
D. He should get FluMist; it is better to avoid a painful shot when you are ill.
E. He should get the intradermal flu shot which causes less swelling than the IM injection.
A. Mild illness is not a contraindication to vaccination.
Many types of medications are self-administered by patients. These require careful instruction by the pharmacists on how to safely store and administer the injection devices or syringes, and how to dispose of the used material. Which of the following statements is correct?
A. The skin where the patient injects is rubbed after an EpiPen injection but is not rubbed after an enoxaparin injetion.
B. The EpiPen is only for use by a trained healthcare professional.
C. The EpiPen can only be self-administered once for each episode.
D. The EpiPen is administered in the abdomen.
E. The EpiPen is kept refrigerated prior to use.
A. Both enoxaparin (Lovenox) and the EpiPen are stored at room temperature. Many self-injectables require refrigeration. It is important to rub the skin after using an EpiPen to help the medication reach the lungs quickly. Do not rub after injecting an anticoagulant; bruising/bleeding could occur in that location.
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) at -15 degrees Centigrade.
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 is administered SC with a 5/8” needle.
B, C, E.
A 12 month old child was hospitalized two months ago and received immuneglobulin. Which vaccine would be adversely affected by this treatment?
A. Pneumococcal conjugate
B. Polio vaccine
C. Measles
D. Influenza vaccine, shot, inactivated
E. Hepatitis B vaccine
C. Immunoglobulin administration must be separated from live vaccines, including measles and varicella, for at least three months.
A child was not vaccinated for meningococcal disease. The child is at risk for severe disease and complications, including death. Which of the following is true regarding meningococcal disease/vaccine? (Select ALL that apply.)
A. MCV is given IM, MPSV is given SC.
B. Patients who are 2 months-55 years old who are considered high disease risk and should be vaccinated include those living in college dormitories.
C. Patients who are 2 months-55 years old who are considered high disease risk and should be vaccinated include those in the military.
D. Some patients will require repeat vaccination.
E. Meningitis is no longer a routine childhood vaccination.
A, B, C, D. Anyone can get meningitis but it is most common in infants less than one year of age and in people ages 16-21 years. Up to age 55 MCV4 (the conjugate version) is preferred. After age 55 only the polysaccharide version is licensed for use (MPSV4). The redness and pain at the injection site affects about half the patients being vaccinated and dissipates in 1-2 days.
