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PHM SCI 650 > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Herpes Zoster Epidemiology

A

-Commonly called shingles
-reactivation of latent varicella zoster virus ‘
-Incidence and severity increase with age
-Risk increased by immunosuppression

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2
Q

Herpes Zoster complications

A

Post-therapeutic neuralgia - persistent pain after skin lesions healed

May limit daily activities and decrease quality of life

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3
Q

Zoster vaccines

A

Live attenuated zoster vaccine (ZVL)
-Licensed for individual > 50 years
-No longer marketed in the US cause not as effective
-Zostavax

Recombinant zoster vaccine (RZV)
-contains recombinant glycoprotein E and adjuvant
-two dose series 0 and 2-6 months
-Shingrix

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4
Q

RZV vaccine complications

A

-About 91% effective in prevention of zoster

-Injection site reactions are common (78%)

Immunocompromised
70% in auHSCT and 87% in hematologic malignancy

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5
Q

ACIP recommendations Herpes Zoster

A

Recommended for all adults >50 years
-Recombinant zoster vaccine two doses 2-6 months apart

All immunosuppressed individuals aged 19 years and older
-0 and 2 months

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6
Q

Respiratory Syncytial Virus (RSV) epidemiology

A

-Common seasonal respiratory virus
-Very contagious
-Well known to cause hospitalization with bronchiolitis and wheezing in infants

-Considerable burden of illness in adults
*65 and older
*Chronic illness, heart, hematologic, neurologic, diabetes, kidney, liver, immunocompromise, others

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7
Q

Respiratory Syncytial Virus (RSV)

A

Infants
-Acute respiratory illness symptoms
**runny nose
**decreased oral intake

Adults
-Acute respiratory illness
**Rhinorrhea
**Pharyngitis
**Cough
**Headache
**Fatigue
**Fever

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8
Q

RSV vaccines

A

Pfizer bivalent RSVpreF (Abrysvo)
GSK adjuvanted RSVpreF3
(Abrexvy)
-single dose

Both demonstrated efficacy against lower respiratory tract RSV infection over at least 2 seasons in individuals aged 60+ years

ACIP:
1. Single dose all adults > 75 years old
2. Adults aged 60-74 years with certain chronic medical conditions or other factors that increase risk of severe RSV –> single dose

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9
Q

Risk factors RSV

A

-CV disease
-Lung disease
-End stage renal disease
-Diabetes with end-organ damage
-Severe obesity
-Liver disorders
-Neurologic or neuromuscular disorders
-Hematologic disorders
-Moderate to severe immunocompromise
-Frailty
-Long term care resident
-Chronic med conditions

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10
Q

Adverse reactions RSV

A

Injection site reactions
-Arthralgia, myalgia, fatigue, headache
-No difference in incidence of serious adverse effects compared to placebo

Guillain-Barre syndrome

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11
Q

RSV for pregnant person

A

RSV vaccine during pregnancy weeks 32-36 gestation (passive immunity for infant)
-Injection site and systemic adverse reactions resolved in 2-3 days
-No risk to to preterm birth

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12
Q

Nirsevimab for infants

A

-Long acting monoclonal antibody with efficacy in the prevention of lower respiratory tract RSV infection
-Administer just prior or during RSV season - October to March

-Eligible infants < 8 months born prior to or during RSV season
-Eligible children aged 8-19 months at increased prior to or during second RSV season

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13
Q

Covid-19 pathology

A

-Respiratory symptoms by SARS CoV2 virus

-Fevers or chills
-Cough
-Shortness of breath
-Fatigue
-Myalgia
-Headache
-New loss of taste or small
-Sore throat
-Congestion
-Nausea, vomiting, diarrhea

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14
Q

COVID-19 epidemiology

A

Risk is substantially lower compared to early in pandemic

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15
Q

COVID-19 vaccine

A

mRNA vaccine
Target virus in same lineage
Moderna/Pfizer > 6 months
Novavax > 12 years

ACIP recommendation
All individuals aged 6 months or older
*Updated in Fall 2024 to improve response to currently circulating variants

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16
Q

Precaution

A

A condition in a vaccine recipient which may result in a problem if a vaccine is administered or a condition which could compromise the ability of a vaccine to induce immunity

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17
Q

Pregnancy

A

Benefit and risk assessment for vaccines
*risk cannot be ruled out by benefit may justify the risk
Routine prenatal care includes immunization history

Refer for prenatal care
*avoid live vaccines
*defer HPV immunization till after pregnancy
*Tdap in late 2nd or 3rd trimester

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18
Q

Influenza vaccine in pregnancy

A

Pregnant individuals at high risk for morbidity associated with influenza infection

4 fold increased risk of hospitalization and death

*vaccine recommended for pregnant individuals

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19
Q

RSV vaccine for pregnant individuals

A

RSV vaccine (Abrysvo) during pregnancy weeks 32-36
*passive immunity for infant
*Don’t use adjuvanted RSV
*Only vaccinate when gestation lines up seasonally (September to January)

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20
Q

Post partum (post birth) immunization

A

Rubella and/or varicella vaccines for seronegative
Tdap at hospital discharge if unimmunized
Influenza vaccine in season and unimmunized

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21
Q

Is lactation a contraindication?

A

No for mother and infant immunization

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22
Q

Immunosuppression

A

Two pronged risk
*risk of vaccine induced mortality or morbidity
*risk of poor host response to vaccine

Various diseases
*HIV, cancer, generalized malignancy

Various meds
*alkylating agents, antimetabolites, radiation
*corticosteroids (>20 mg/day) or prednisone (> 2 mg/kg/day) for more than 2 weeks
-Biologics, transplant meds

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23
Q

Immunosuppressed recommendations

A

-No lives vaccines
-OPV and small pox vaccines should not be administered to a household contact (risk of developing live disease)
-LAIV not administered to contacts of those requiring protective environment
-Can do the pneumococcal vaccine, or zoster vaccine series

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24
Q

Asplenia

A

Increased risk for fulminant bacteremia
Give meningococcal and pneumococcal vaccines if under 2
Hib vaccine

*If the splenectomy is elective (meaning you have time) immunize two weeks prior to surgery
*Annual influenza vaccination recommended

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25
Q

Liver disease

A

-No viral hepatitis or other liver disease
*Need hep A, hep B, annual infuenza, pneumococcal

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26
Q

HIV

A

-Need pneumococcal, MenACWY, no annual activated influenza, Tdap, hep B
-Consider MMR or varicella

*Avoid live vaccines

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27
Q

Cancer patients

A

-Avoid immunization during chemo
-Annual LAIV should not be administered

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28
Q

Solid Organ Transplant

A

-Immunize while waiting
-Annual LAIV, pneumococcal, Tdap, Hep B (might need booster) vaccine needed

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29
Q

High Risk medical conditions

A

Diabetes: Hep B series (19-59 years), pneumococcal, annual inactivated influenza

Renal failure: pneumococcal, hepatitis B series, LAIV, Td/Tdap

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30
Q

Healthcare workers

A

-Up to date with adult immunizations
-Two doses of MMR
-Varicella if not immune (born before 1980 doesn’t count as immune)
-Hep B
-Pertusis
-Annual Influenza

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31
Q

Adolescents

A

-Important access point for many preventative health needs

Immunization
-11/12 years and 16 years
Tdap, MenACWY, MenB, HPV

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32
Q

Elderly

A

-Pneumococcal and annual influenza
-Tdap
-RZV
-RSV for >75 years and risk based for 60-74 years
-Decreased immune response to Hep B vaccine

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33
Q

Concurrent illness

A

-Mild illness not a contraindication
-Antibiotic therapy not a contraindication
-Wait till after moderate or severe illness is resolved

*Well enough to be in the pharmacy, well enough to be immunized

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34
Q

RZV

A

Recommended for immunosuppressed age 19 or older
Recommended for normal > 50 years
Revaccinate those who receive ZVL

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35
Q

Shared Clinical Decision Making

A

MenB - 16-18
HPV - 27-45
PCV20/21 for >65 years who previously had PCV13 +PPSV23

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36
Q

MenB series for 18-18

A

Uncommon disease
Serious disease
Availability of vaccines
Unknown degree of protection and duration of protection

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37
Q

HPV for 27-45 year olds

A

Very common no consequence
Infection most common in adolescents and young adult
New Sex partner –> risk

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38
Q

PCV20/21 for >65 years

A

Only if previously received PCV13 and PPSV23 after age 65
If decide to use PCV20/21 administer at least 5 years after last dose

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39
Q

Shared clinical decision making documentation

A

-As a practice group decide which patients you will have convo with
-Document the conversation in pharmacy notes

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40
Q

Hard to reach populations

A

Also called marginalized populations
Defined by barriers to vaccination

Difficult to vaccinate due to -Distrust
-Religious beliefs
-Lack of awareness
-Poverty or low SES
-Lack of time to access vaccine services
-Gender based discrimination

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41
Q

Vaccine Hesistancy

A

Three drivers
Complacency
Covienience
Confidence

*Don’t disparage patients who are vaccine hesitant; engage with them and answer their questions

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42
Q

Vaccine denier

A

Focus on countering arguments
Importance of recognizing that the audience is the public who are present not the vaccine denier

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43
Q

Pre travel counseling

A

Patients medication history
-Health status
-Medications
-Allergies
-Vaccine history

Patient’s itinerary/behavior
-duration of travel
-rural vs urban
-Planned or unplanned activities
-Visiting friends or relatives
-patient’s risk tolerance

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44
Q

Food and water precautions

A

Avoid Tap water and anything washed or made from it
-Uncooked meat
-unpasteurized stuff

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45
Q

Insect precautions

A

Use an EPA approved repellant
DEET and Picaridin are safe for children > 2 months of age and for pregnant women
Apply sunscreen then repellant

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46
Q

Dengue Fever pathology

A

Flavivirus infection transmitted through mosquitoes

-Endemic to tropics and subtropics
-Acute febrile illness with headache, retro-orbital pain, muscle/joint aches, rash

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47
Q

Dengue fever vaccine

A

Dengvaxia
For children 9-16 years old living in areas endemic

*Not approved for US travelers who are visiting but not living in areas where dengue is endemic

48
Q

Zika Virus

A

Flavivirus infection from mosquitoes
-Intrauterine, perinatal, and sexual transmission

Endemic in tropics and subtropics found in rural and urban areas

Most infections are asymptomatic or mild

49
Q

Congenital Zika virus infection

A

Microcephaly with brain anomalies and fetal loss

*Pregnant woman should avoid areas with Zika

50
Q

Chikungunya Virus

A

Viral infection from mosquitoes
Endemic in tropics and subtropics and rural/urban areas
Acute febrile illness with headache, muscle/joint aches, conjunctivitis, nausea, vomiting, rash

*Joint pain can be severe and last from months to years

*New vaccine available in the US

51
Q

Chikungunya Vaccine

A

Live attenuated vaccine for adults >18 years of age
One dose

May be considered to persons traveling to area with Chikungunya virus in last 5 years who are:
- above 65 years old with underlying medical conditions
- Persons who stayed for longer than 6 months

52
Q

Chikungunya vaccine contraindications

A

Immunocompromising condition, history of allergic reaction

Precautions: Pregnancy and breast feeding

Some side effects are tenderness, fatigue, muscle and joint aches, etc.

53
Q

Cholera

A

An acute bacterial intestinal disease that causes bacteria

*Transmitted through ingestion of contaminated water or food in endemic areas

Treatable with rehydration +/- antibiotics

54
Q

Cholera Vaccine

A

Live attenuated single dose oral vaccine
Approved for 2-64 years old
Vaccine ingested orally by patient

55
Q

Japanese B Encephalitis

A

Mosquito borne flavivirus infection
Most infections are asymptomatic, but when it fully develops it has high fatality rate

Occurs in Asia and parts of Australia

56
Q

Japanese Encephalitis Vaccine

A

Recommended for long term travelers or for short term travelers
Inactivated Vero cell culture-derived vaccine
Approved for >2 months
2 dose series on day 0 and 28

57
Q

Tick borne Encephalitis

A

Single stranded RNA virus
Transmitted to humans through Tick bite or by ingesting unpasteurized dairy products

Symptoms range from non-specific febrile illness to acute non-invasive disease

58
Q

TBE vaccine

A

Inactivated whole virus vaccine with formulations for children and adults

3 dose schedule with third dose 5-12 months after 2nd dose

Booster >3 years after completion of primary immunization then every 3-5 years

59
Q

Typhoid Fever

A

An acute febrile illness caused by bacteria
Transmission is through contaminated food and water and person to person contact

60
Q

Typhoid vaccines

A

Injectable inactivated vaccine
2 years of protection
Approved for >2 years of age

Oral live attenuated vaccine
4 capsules 1 taken every other day, refrigerate
Duration of protection is 5 years
Approved for > 6 years
*NO LIVE VACCINE TO IMMUNOSUPPRESSED

61
Q

Yellow fever

A

Single stranded RNA virus transmitted by mosquitoes

Symptoms are influenza like syndrome to severe hepatitis, hemorrhagic fever, and death

Proof of vaccination required in some African countries

62
Q

Yellow fever vaccine

A

Live attenuated vaccine approved for > 9 months
Single dose
Prioritize unvaccinated vs. traveler who’s there longer but has been previously vaccinated

63
Q

Medications for travelers

A

Travelers diarrhea
-OTC meds
-Antibiotics
Malaria Prophylaxis
Altitude illness
-acetazolamide
Motion sickness
-scopolamine patch
-OTC medicines (meclizine, dimenhydrinate)
Flight anxiety/sleep meds

64
Q

Malaria pathology

A

Caused by parasites in mosquitoes

Symptoms include fever, chills, headache, body aches, generalized malaise

Severe disease can lead to seizures, mental confusion, kidney failure, acute respiratory distress, coma, death

Prevention
Avoid Mosquitoes when possible
Chemoprophylaxis

65
Q

Malaria Medicine

A

Chloroquine: Areas w Chloroquine-Sensitive mosquitoes
Doxycycline: All areas
Atovaquone-proguanil: All areas
Mefloquine: All areas except SE Asia

66
Q

Responding to vaccine denier

A
  1. Identify the technique used
  2. Disentangle the core points and address each separately
  3. Respond with evidence based message
67
Q

Adverse events

A

Predictable based on pharmacology of vaccine

Unpredictable based on properties of vaccine
(alopecia after hep B vax)

68
Q

Seizures following immunization

A

Stable controlled seizure disorder no effect on immunization
*Caution for MMRV vaccine if have personal or family seizure history

69
Q

Acetaminophen effect on vaccines

A

Fever is a common adverse event following immunization

*Recent study found lower antibody response to pediatric vaccines in those who received prophylactic acetaminophen

Discourage use of prophylactic antipyretics

70
Q

Vaccine associated paralytic polio

A

Reversion of vaccine virus to more neurovirulent phenotypes
Very rare in healthy vaccinees or their contacts

71
Q

Gullain Barre Syndrome

A

-Neurological syndrome characterized by loss of reflexes and symmetric paralysis with recovery

-Immune response directed at myelin sheath of peripheral nerves or axon

-May be triggering event (acute infection, vaccination)

72
Q

GBS epidemiology

A

Common in later adolescents to older adults
Seasonally in late summer
Associated with campylobacter infection

73
Q

Vaccine associated GBS

A

Tetanus toxoid–> extremely low risk
Hepatitis B vaccine and polio vaccine –> no association established
Influenza vaccine –> very low
RSV vaccine in individuals >60 –> very low risk
MenACWY–> no increased risk

74
Q

Thimerosal in vaccines

A

FDA Modernization Act of 1997 called for review of mercury containing food and drugs
Thimerosal preservative contains very low levels of mercury

75
Q

Thimerosal bottom line

A

Thimerosal free preparations now available in U.S
Risk of vaccine preventable disease much higher than the unknown, probably much smaller risk of thimerosal exposure

76
Q

SIRVA

A

shoulder injury related to vaccine administration
-Injury to musculoskeletal structures of the shoulder
-Should pain, limited range of motion
-Inflammatory reaction resulting from unintended injection of vaccine or needle trauma

77
Q

Allergic reaction

A

Risk of anaphylaxis following immunization is very low
Mediated IgE
Occur within minutes to hours of the vaccine
Require medical attention

78
Q

Materials associated with Anaphylaxis

A

Vaccine antigen
Animal or yeast protein
Antibiotics
Preservatives
Stabilizers
Packaging

79
Q

Anaphylaxis

A

Occurs shortly after exposure
Exposed to antigen previously
Mediated by IgE
IgE antigen complex attach to receptors on basophils and mast cells
Basophils and mast cells release mediators

80
Q

Mortality due to Anaphylaxis

A

Direct
-Upper airway obstruction
-bronchial dysfunction
-Hypotension
Indirect
-myocardial infarction
-cerebral injury
-ischemia, hypoxia
-epinephrine use

81
Q

Epinephrine

A

Indications: bronchospasm, laryngeal edema, urticaria, angioedema, hypotension

Goals:
maintain airway, reduce fluid, extravasation, reduce pruritis, maintain SBP

Complications:
Arrythmias, hypertension, nervousness, tremor

82
Q

Epinephrine

A

Adult dose
Epinephrine 1:1000
0.3-0.5 mL sq or im
Pediatric dose
Epinephrine 1:1000
0.01 mL/kg sq or im

May repeat dose in 15 minutes if necessary

83
Q

Antihistamines

A

Indication: urticaria

Goals: reduce pruritis, antagonize H1 effects of histamine

Complications:
Drowsiness, dry mouth, urniary retention

Dose
1-2 mg.kg im or iv
Typically 50-100 mg

84
Q

How to prepare for anaphylaxis

A

Make an anaphylaxis kit
*Epinephrine auto injector
*Diphenhydramine syringe
*Alcohol wipes
*Tourniquet
*Management protocol

85
Q

Fainting

A

Vasovegal reaction consisting of sympathetic nervous system stimulation
Often in a setting of fear or emotional distress
Sudden onset of hypotension

Assist to lying down
*don’t confuse with stroke

86
Q

Legal requirements for immunization delivery by a pharmacist

A

Wisconsin Act 68 and 24:
No prescription
-Age 6 or older
-ACIP recommended vaccine
Pharmacy techs may administer vaccines
Students must complete course and be supervised by a healthcare provider authorized to administer vaccines

Prescription
-Any vaccine
-Age 0-5 years

87
Q

A plan for implementing immunization services in a pharmacy

A

Screening
Vaccine ordering and storage
Record keeping
Reimbursement

88
Q

Private insurance or managed care

A

Beneficiaries must check with their plans to determine if immunization must be obtained within the HMO

89
Q

Medicare Part D

A

Covers vaccines for adults with Medicare Part D plans
*Used for zoster and RSV vaccine

90
Q

Medicaid

A

Will pay for influenza or pneumococcal vaccines administered in pharmacies

91
Q

Vaccines for Children program

A

VFC
Federal program provides vaccine at no cost to uninsured, underinsured or American Indian or Alaska native children 0-18 years
*No charge for vaccine but might have administration fee

92
Q

Roster billing

A

simplified billing method for immunization
One CMS 1500 submitted with a list of claims
Roster billing can be used for mass immunization clinics

93
Q

Exposure plan

A

Document that contains information about what to do in the case of an exposure
Contains:
-Facility name
-Determination of employee exposure
-Implementation of various methods of exposure control
*Universal precautions
*Engineering and work practice controls
*PPE
*Housekeeping
-Hep B vaccine
-Post exposure evaluation and follow-up
Communication of hazards to employees and training
-Recordkeeping
-Procedures for evaluating circumstances surrounding exposure incidents

*Person or department responsible for different aspects of program adminsitration

94
Q

Promote immunization services in a locality

A

Educate other pharmacist staff to serve as vaccine educators and recommend immunizations
-Posters, flyers, bag stuffers
-Press release
-Local immunization coalition

*Immunize patients
consider process
continue immunization efforts all year long
*Share success

95
Q

Medicare part B

A

covers annual influenza vaccine, pneumococcal vaccine, CMS priority to increase immunization rates

*covered in any setting
*No deductible

96
Q

What to charge?

A

Must charge all patients the same price

97
Q

Small Pox epidemiology

A

Globally eradicated in 1980
Biological warfare
-French and Indian wars

Storage of virus stocks in Russia and US

98
Q

Small Pox vaccine

A

Live vaccine
Live, non replicating

Cross protection for Orthopoxviruses
(monkey, cow, variola)

99
Q

Small pox vaccination procedure

A

Vaccine vial contains about 100 doses
Vaccinator wears gloves
Remove aluminum seal and rubber stopper
Choose vaccine sit
Cleaning site unnecessarily
Bifurcated needles supplied with vaccine
(scratch surface of skin)

100
Q

Scarification

A

vaccination process that involves scratching the skin
Needle at right angle to skin
Strokes vigorous enough to cause trace of blood to appear

101
Q

Small pox vaccine response

A

Primary vaccination
-Pustular lesion must be present on day 6-8
Revaccination
-Pustular lesion or significant induration surrounding a central lesion on day 7

102
Q

Public health approach in case of bioterrorism?

A

Mass preexposure not in plan
-Risks outweigh benefits (people can die from getting vaccine induced small pox)
Surveillance and containment strategy

103
Q

Small pox vaccine strategy

A

Ring vaccination
Focused contact tracing
Deliver vaccine to those who are at highest risk
Avoid adverse effects associated with mass immunization
Limited vaccine and VIG supplies

104
Q

Monkeypox

A

vaccine recommended for
-People having contact with someone with M. Pox
-Sexual partner had M. Pox
-Multiple sexual partners in area with M. Pox

Vaccine:
2 doses separated by 4 weeks
Subcutaneous administration

105
Q

Anthrax vaccine description

A

Cell free filtrate of anthrax culture
*No dead or live bacteria

Vaccine schedule:
-Vaccine doses administered intramuscularly
-Primary vaccination at 0,1,6,12, 18 months
-Maintain immunity with annual boosters for people at risk

106
Q

Anthrax postexposure prophylaxis

A

Three doses (0,2,4, weeks) in combo with antimicrobials

107
Q

contraindications for anthrax vaccine

A

History of anthrax infection
Anaphylaxis following dose
Postpone for moderate to severe illness

108
Q

Adverse events for Anthrax

A

Local reactions
Systemic symptoms
Safety assessed extensively in military populations

109
Q

Ebola epidemiology and pathology

A

Rare deadly viral infection
Transmitted through contact with infected body fluids
Fever, myalgia, internal hemorrhage, vomiting, or coughing blood
-70-90% fatal
-Supportive care

110
Q

Ebola vaccine

A

Live recombinant
prevents infection
*not effective in outbreaks

-Healthy non pregnant, non lactating adults with occupational exposure
Adverse effects (anaphylaxis, arthritis)

111
Q

CASE

A

Corroborate
About Me
Science
Explain + advise

112
Q

VAERs

A

Report adverse events requiring medical attention occurring within 30 days of getting vaccine

Purpose:
Designed to generate, not test vaccine safety hypotheses

Detect possible signals of adverse events associated with vaccien

113
Q

What vaccine is required to gain entry into Saudi Arabia during the the Hajj?

A

Meningococcal vaccine

114
Q

Personal Liability insurance

A

$1 million per occurrence and $2 million per year

115
Q

Sub Q vaccine

A

5/8 in and 25-37 gauge needle
1 mL and/or 3 mL syringe
45 degrees

116
Q

IM vaccine

A

1 to 1 1/2 in with 22-25 gauge needle
1 mL and/or 3 mL syringe
90 degrees

PHM SCI 650 (3 decks)

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