Immunization Exam Flashcards by Sam Williams

What antibody class is the mediator of allergy and anaphylaxis?

IgE

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What is the role of helper T cells in mounting an immune response to a vaccine?

Produces cytokines that stimulate B cells to produce antibodies

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What is an advantage of passive immunity compared to active immmunity?

Passive immunity protects almost immediately

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What is administration of immune globulin not an example of active immunity?

The immune globulin is antibodies already produced by another person. It is therefore not a result of the patient’s own immune system.

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Which vaccination between Pneumococcal Polysaccaride vaccine (PPSV), Inactivated influeza vaccine (IIV), Measles and Tetanus-diptheria is most affected by a blood transfusion?

Measles (live vaccine)

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A US born 67 year old was recently diagnosed with diabetes. His vaccine records indicate that he received Tdap, Pneumococcal, and influenza one year ago. What vaccines would you recommend for him? (4 components)

Influenza
Zoster
PCV13
Heptatis B vaccine series

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What is true regarding the amount of time required to produce immunity with a live attenuated vaccines?

Usually produce immunity with one dose

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Joe is a 28 year olda ccountant who traveled to Bangkok for a two-month visit two years ago. He received a dose of Hep A vaccine. He received only a Tdap booster since his return. He seeks your advice regarding Hep A vaccine for another trip. What do you recommend?

He should recieve one dose of Hep A vaccine now to complete the series.

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What is a true contraindication for females to measles vaccine?

Vaccine candidate is pregnant.

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A 26 year old female received the second dose in varicella two weeks ago. Today shestepped on a rusty nail while working on her farm. Her last Td dose was 6 years ago. Which of the following strategies is most appropropriate?

Give TDap now.

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What medication is a true contraindication to receiving live vaccines?

Prednisone 40 mg daily

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True or false? Increasing the interval between multi-dose vaccinations does not diminish the effectiveness of the vaccine

True

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Which of the following is a candidate for the HPV4 vaccine? 27 year old female, 27 year old male on prenisone, 11 year old boy, 35 year old male.

11 year old boy

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True or false? Joe remembers having chicken pox when he was young. He is not a candidate for varicella vaccine.

False

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For a post-kidney transplant patient on chronic immunosuppression with no history of PPSV, what dosage is correct?

Single dose of PCV13 2. Followed by single dose of PPSV23 8 weeks later.

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True or False? Smoking cigarettes is an indication for the pneumococcal polysaccharide vaccine.

True

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True or False? A 65 year old female taking fluticasone MDI BID for asthma is not a candidate for the herpes zoster vaccine.

False

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What vaccination is recommended for all healthcare workers?

Annual influenza vaccine

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For what patients should the trivalent recombinate hemagglutinin influnza vaccine (RIV3) be administered?

Patients with a history of anaphylaxis to eggs.

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How long must temperature and freezer logs be kept?

3 years

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What is the liquid diluent for Zostavax vaccine?

Sterile water

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Can inactivated vaccines be frozen?

Inactivated vaccines must not be frozen.

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Which of the following must NOT be stored frozen? PPSV, Varicella, Zoster, MMR

PPSV (inactivated vaccine)

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What is an advantage of immunization in nontraditional settings, such as a pharmacy?

Increased access and convenience for the patient

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What is an advantage of using standing orders for immunization?

Increases immunization coverage among adults in a variety of practice settings

How should syringes not provided by the manufacturer be used in vaccinations?

Syringes other than those filled by manufacturer should only be used for IMMEDIATE administration (do not prepare ahead of time).

Refrigerator and freezer temperatures:

Must be maintained between 35-46 degrees Fahrenheit and -58-+5 Fahrenheit respectively.

What can be one to prevent vaccine storage problems?

Place containers of water labeled "do not drink" into refrigerator to stabilize temperatures.

True or False? If the date on the label of a vaccine or diluent has a specific month and year, the vaccine can be used only until the first day of the month listed

False (last day of the month)

What is the primary vaccine coordinator at a practice site responsible for?

1. Ensuring that vaccines are stored and handled correctly | 2. Ensuring that staff is adequately trained

What is true regarding Vaccine Information Statements (VIS)?

They are designed to provide information about vaccines, or in the case of a minor, the child's parent or guardian about the risks and benefits of each vaccine.

What is an appropriate strategy for giving the vaccine information statement to patients?

The VIS should be given to the patient prior to immunization so the patient has time to review it and ask questions

What items should be included on immunization records for vaccines administered in the pharmacy? (6 components)

1. Vaccine name 2. Date administered 3. Site of administration 4. Vaccine manufacturer and lot number 5. VIS publciation date, with date given to patient 6. Identification of person administering

What best describes immunization information systems?

The value of immunizatino information system is that it allows healthcare providers to access immunization records to facilitate clinical decision making.

Where are recommendations for prevention of vaccine preventable diseases made by the Advisory Committee on Immunization Practices (ACIP)?

Morbidity and Mortality Weekly

Describe the federally-mandated tarining for employees with blood and body fluid exposure

1. Initial training | 2. Annual retraining

What is true regariding bloodborne pathogen exposure and immunizations in a pharmacy?

Every pharmacy providing immunizations must have a bloodborne pathogen exposure control plan

What should be completed in all pharmacies that provide immunizations?

1. Training employees about bloodborne pathogens | 2. Training employees on the pharmacy's bloodborne exposure control plan

How should the disposal of sharps containers be handled?

Arranged with the local waste management company

Why is the safety of vaccines held to a higher standard than for most medications?

They are administered to healthy people to prevent disease rather than to sick people to cure disease

Describe the Countermeasures Injury Compensation Program (CICP)

Provides benefits to seriously injured individuals that resulted from using certain antivirals

What scenarios are healthcare professionals encouraged to use VAERS for reporting?

Any clinical significant adverse event after vaccination

What is a VAERS reportable event for measles vaccine?

Encephalopathy

Describe the Vaccine Injury Compensation Program

Protects the immunization provider and vaccine manufacturer from personal liability

What is a VAERS reportable event for tetanus vaccine?

Brachial neuritis

True or False? The Clinical Immunization Safety Assessment (CISA) project's main goal is to serve as a vaccine safety resource for consultation on clinical vaccine safety issues.

True

Which manifestation of anaphylaxis is epinephrine used to treat?

Hypotension

True or False? Anaphylaxis generally will not occur until 1-2 hours after administration of a vaccine.

False

What is a reason that a second dose of measles vaccine is recommended for all college students?

The second dose provides another opportunity for seroconversion for those who failed to respond to the first dose.

True or False? A 5 year old who received DTaP four weeks ago is a candidate for varicella vaccine.

True

Which of the following is a conraindication to receipt of rotavirus vaccine?

History of intussusception

True or False? A 15 month old male who is also receiving a 3rd dose of Hepatatis B vaccine is a candidate for Hepatitis A.

True

True of False? A 68 year old with COPD treated with inhaled fluticasone/salmetrol is a candiate for zoster vaccine.

True

Describe Haemophilus influenzae type b vaccine

A polysaccaride vaccine conjugated to a protein to improve immunogenicity in infants

True or False? Human Papilloma vaccine is recommended for a 16 year old female who recently became sexually active.

True

True or False? Human Papilloma vaccine is recommended for a 28 year old male with a history of genital warts

False (recommended to age 27)

Which of the following is a risk factor for poor response to heptatis B vaccine?: newborn infant, asthma, paramedic, cadaveric kidney transplant.

Cadaveric kidney transplant

What is a limitation of the quadrivalent meningococcal conjugate vaccine?

No protection from Serogroup B

Which human papillomavirus vaccines is indicated for male patients?

HPV4 and HPV9

Name a vaccination that is a meningococcal serogroup B vaccine

Bexsero

What is true about the incidence of measles in the United States?

A majority of cases are a result of importation in unvaccinated populations

Describe the zoster vaccine (4 components)

1. Effective in reducing incidence of shingles 2. Decreases burden of disease in between 50-70% of patients vaccinated 3. Indicated in patients over age 50 4. ACIP recommends age 60+

What is the appropriate rotavirus vaccine recommendation for a child with a known latex allergy?

Rotateq (Rotarix is not for latex allergies) at 2, 4 and 6 months.

What are three important reasons the HPV vaccine is important for males? (3 components)

1. Prevents cervical, vulvar and vagina cancer in women; also protects against genital warts, anal cancer and other cancer strains 2. Benefits of protecting himself and protecting spread to others 3. HPV is most common sexually transmitted disease

What is true about hepatitis B? (4 four components)

1. Renal failure will decrease response to Hep B vaccine 2. Patients with diabetes are at an increased risk of Hep B due to sharing diabetic supplies, such as meters 3. Using needles which are not long enough will decrease response rates 4. Death commonly occurs as a result of cirrhosis and hepatocellular carcinoma

True or False? Inactivated Influenza Vaccine (IIV) is recommended for a 2 month healthy infant.

False

What is an appropriate response to a patient who tells you that she is concerned that she will get influenza from the inactivated influenza vaccine (IIV)?

Other than a higher incidence of sore arm, influenza vaccine has a side effect profile similar to placebo.

For which individuals is it acceptable to use live attenuated influenza vaccine (LAIV)?

Healthy individuals aged 2-49.

When is the appropriate timing for influenza vaccine administration for a clinic?

Influenza vaccine should be administered as soon as the clinician has a supply and if possible by October and should continue throughout the season.

What is a benefit of annual influenza immunization of school-aged children?

Decrease the magnitudes of influenza epidemics in the community

What is the appropriate schedule for polio immunization in the United States? (4 components)

Childhood immunization series with IPV at 1. 2 months 2. 4 months 3. 6-18 months 4. 4-6 years of age

Which age groups with immunocompromising conditions should receive one dose of pneumococcal conjugate vaccine (PCV13)?

Adults and children > 6 years of age (this question may trick you and say only adults 19-64 or all adults)

What is a difference between Tdap and DTaP?

Tdap has a lower dose of diptheria toxoid for use in individuals aged 10-11 years and older.

Optimally, All women should receive one dose of Tdap when?

Between 27 and 36 weeks gestation of each pregnancy

True or False? Vaccinate organ transplant patients three months after transplantation

.False

True or False? Vaccinate cancer patients immediately upon completion of chemotherapy or radiation

False

True or False? Vaccinate premature infants based on gestational age rather than chronological age

False

True or False? Vaccinate two weeks before elective splenectomy or after acute recovery from splenectomy.

True

Which influenza vaccine is produced using no eggs and no influenza virus?

Flublok (RIV3)

True or False? Polio is currently considered eradicated worldwide.

False

Describe the process of "cocooning" against pertussis

Process of vaccinating close contacts including mother, father, siblings, grandparents and out of home care providers.

True or False? A condition which would compromise the ability of vaccine to produce immunity or protection from infection is a permanent contraindication to vaccination.

False

True or False? Per Occupational Safety and Health Administration (OSHA), bloodborne pathogen training must be completed every 2 years.

False (every 1 year)

How are vaccinations covered under Medicare Part D?

Reimbursement based on negotiated amount based on vaccine, dispensing fee, sales tax, and vaccine administration fee.

A vaccine related error should be reported to which program?

Vaccine Error Reporting Program (VERP)

What skill is among the standards of practice among immunizing pharmacists?

Basic Life Support (CPR)

What is a permanent contraindication common to receiving any vaccine?

Previous anaphylaxis from that vaccine.

What is true regarding student pharmacist immunization?

Interns who provide immunizations must be current in 1. CPR 2. Bloodborne pathogens training

How should you proceed if vaccine arrives from manufacturer under questionable conditions? (2 components)

1. Store vaccine separately from other stock | 2. Call the manufacturer's quality control office for advice

What is the least effective strategy for a pharmacist to employ regarding community vaccination rates?

Recommend that a patient return for a vaccine at a later time when it is less busy

What is a CDC best practice in regards to vaccine storage and handling, specifically regarding temperature monitoring?

A bio-safe glycol-based or buffered thermometer should be used to monitor the temperature of the refrigerator.

True or False? Employers must offer the Hepatitis B vaccine series to immunizing employees free of charge.

True

For which of the following individuals is Tdap recommended? 12 year old female who completed DTap, 30 year old pregnant 32 weeks gestation, 65 year old female.

All of the above

55 year old male has received no vaccinations since childhood. Which of the following are recommended?

1. IIV3 2. Tdap 3. Hepatitis B. NOT: HPV4 (too old), Zoster (too young), LAIV (too old), Td (start with TDap first dose)

13 year old male needs vaccinations. Has not been vaccinated since 6 years old. What are recommendations?

1. Tdap 2. HPV4 3. MCV4 4. IIV3

68 year old female seeking vaccinations. No vaccinations since childhood. What are recommendations?

1. Zoster 2. IIV3 3. Tdap 4. PCV13 NOT: PPSV23 (start with PCV13)

Which vaccination is commonly administered via the subcutaneous route?

Zoster

For patients age 65 years and older who are indicated to receive both PCV13 and PPSV23, what is recommended separation period of doses?

1 year

Describe the procedure for intramuscular administration of a vaccine to an adult patient

22 gauge, 1 inch needle

According to iowa rules, protocols to authorize administration are allowed for patients of what age?

6 years and older

What is the waiting period between live attenuated vaccines administered on separate days?

4 weeks.