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APhA Immunization Exam
What is the minimum needle length recommended for administering HepB vaccine to an adult patient weighing 130 lb? - Fixed 1-inch needles are acceptable for patients weighing 60 kg (132 lb) or less. HZV, MMR, rabies, typhoid, varicella, or yellow fever vaccine should not be administered to a patient with a history of anaphylaxis to: - Gelatin 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? - 1) Tdap
- Td 4 weeks later
- Td 6-12 months later Td booster every 10 years after 3rd dose Candidate for PPSV23? - 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 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. - Pertussis 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? - 9vHPV Which of the following key questions is important to ask a patient before administering IIV? - Are you sick today? *Mild illness is okay, but moderate to severe acute illness need to be resolved before getting vaccine. Live attenuated vaccines.. - 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. Inactivated vaccines... - are produced by killing the virus/bacteria includes polysaccharide vaccines (conjugated [protein altered] or unconjugated), toxoids, or cellular vaccines Which type of vaccine involves stimulation of B cells without the assistance of T helper cells? - A pure polysaccharide *not recommended for children <2 because of their immature immune system Conjugated vaccines.. - provide longer lasting protection the immune response that changes to a T cell mediated response allows children <2 to form an immune response T/F Both live attenuated vaccines and recombinant vaccines mimic natural infection and involve T cells in the immune response. - True The incubation period for influenza can range from: - 1 - 4 days What is the time interval for which the development of Guillain-Barré syndrome following influenza vaccination would result in a precaution for future influenza vaccines? - 6 weeks The monitoring system that health care providers should use to report serious adverse events after vaccination is: - VAERS Which of the following patients are appropriate candidates for the 2-dose schedule of HPV9? - 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 Why should refrigerated vaccines be stored in the middle of the refrigerator? - because the temperature in the middle does not fluctuate as much.
Which of the following patients is a candidate for both MenACWY and MenB vaccines? - 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 What must be documented for VIS? - - 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 Who should receive MMR vaccine? - 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 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? - 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. Which of the following best describes how to administer MMR vaccine to an adult patient weighing 210 lb? - SC at 45 degree angle *weight of patient does not matter in regards to route of administration HPV vaccine is recommended for.. - Both males and females ages 9-26 years *routinely recommended for 11 or 12 years of age
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? - 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 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? - Tdap MCV HPV Hep B influenza vaccine if flu season True regarding varicella-containing vaccines: - 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 Which disease is almost certain to cause death if infected patients do not receive postexposure prophylaxis? - Rabies *it affects the CNS If a patient with an egg allergy experiences hives following influenza vaccination, what is ACIP's recommendation for vaccinating this patient against influenza? - 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
*IIV is inactivated HZV is live inactivated do not interfere with live Interval between 2 live vaccines NOT given simultaneously: - 4 weeks Why was the live attenuated influenza vaccine (LAIV) removed from the ACIP's influenza vaccine recommendations? - Lower than expected efficacy in 2013- 2016 Epi doses: - 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 The majority of vasovagal syncope cases occur withinin: - 15min of vaccination Which of the following diseases has been successfully eradicated worldwide through vaccination efforts? - smallpox In 2014, which vaccination rate was lowest among adolescents 13 through 17 years of age?
- HPV How do vaccines evoke an immune response? - The antigen in the vaccine activates B cells, which produce antigen-specific antibodies and memory cells. *Pure polysaccharide vaccines do not activate B cells. What to do in case of anaphylaxis: - 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 True allergic reaction: - immediate hypersensitivity with itching, hives, redness, or symptoms of anaphylaxis
False allergic reaction: - fever, GI upset, red eyes, neurological events Can a women receive the flu vaccine if she is pregnant? - Yes, but it has to be the inactivated flu vaccine only during flu season What vaccine should women get every pregnancy? - Tdap, after 20 weeks of pregnancy What individuals are at an increased risk of adverse effects from live vaccines - Immunocompromised Minimum interval when a PPD skin test is followed by a live vaccine - Administer vaccine after PPD skin test has been read Minimum interval when a live vaccine is followed by a PPD skin test - 28 days Minimum interval when blood product is given before live vaccine - minimum varies (have to look up) Minimum interval for live vaccines followed by blood products - 2 weeks Minimum interval for inactivated vaccines and antibodies - no minimum Minimum interval for two live vaccines, if not simultaneous - 28 days 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 PCV 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? - 5th dose of DTaP 4th dose of IPV 2nd dose of MMR
1 dose of PCV 1 dose of DTaP 1 dose of IPV Which vaccines should Ava receive at today's visit? - 2nd Hib Rotavirus DTaP PCV IPV *3rd Hep B at 6 months too young for flu vaccine MMR/varicella are live and recommend at 1 year 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? - 3 dose series at 0, 1, and 6 months At what point during pregnancy is it recommended to administer the influenza vaccine? - Any trimester Which of the following statements about pharmacy-based vaccination programs is true? Feedback - Administratively, billing for vaccines covered by Medicare Part D may be easier for pharmacists than physicians. Which of the following is the best example of a group with which individual pharmacists can collaborate to increase immunization rates in their communities? - Local Health Departments 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? - Tdap if he has not received that and a Td booster every 10 years 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? - PPSV HPV
Influenza if flu season *PCV13 is for immunocompromised not asthma What is the type of immunity that occurs when a pregnant woman is vaccinated with Tdap to protect the infant from pertussis after birth? - Passive Immunity *antibodies are provided from another source Acquired immunity: - immunological memory *can be active or passive Active immunity: - an antigen from an invading pathogen triggers an immune response Which of the following statements would be accurate when responding to a patient's concerns about the safety of vaccines? - 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 If a patient is a candidate for revaccination with PPSV23, what is the ACIP-recommended interval between doses of this vaccine? - 1 - 3 doses with 5 years between under age of 65 who are immunocompromised or asplenia-2 doses with 5 years apart Which disease is characterized by the development of a membrane on the tonsils, pharynx, or larynx, leading to respiratory obstruction? - Diphtheria Which of the following best describes how to administer Tdap vaccine to an adult patient weighing 185 lb? - IM at 90 degrees *weight of patient is irrelevant in regards to route of administration 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
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? - Diagnosis of chickenpox/shingles by a health care provider. Born in U.S. before 1980 2 doses of varicella at least 4 weeks apart Vaccines as well as exposure to natural disease are both examples of which type of immunity? - Active immunity How vaccines evoke an immune response: - The antigen in the vaccine activates B cells, which produce antigen-specific antibodies and memory cells. *Pure polysaccharide vaccines do not activate B cells. If a vial of influenza vaccine is left out of the refrigerator on the pharmacy counter overnight, what should be done with the vaccine? - 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 Which vaccine does ACIP recommend for all college freshmen, aged 21 years or younger, living in dormitories, who have not been previously vaccinated? - One dose of MCV Prior to the introduction of a vaccine, what was the leading cause of bacterial meningitis in children younger than 5 years of age? - Hib
