PPP Fall 2024 Review Session Slides (1) PDF

Rho Chi Pharmacy Practice and Professionalism Review Session September 23rd, 2024 Please Sign-in to EngageSC! Review Session Schedule 1. Influenza and COVID-19 2. Pneumococcal and Meningococcal Disease & Vaccines 3. Varicella Zoster, Herpes Zoster, and Tdap/DTaP 4. MMR and Hepatitis 5. HPV and Patient Care Process Immunizations Inﬂuenza Onset of symptoms 2 days (1–4) after exposure Screening Questions Contagious Age? 1 day before becoming symptomatic and 5–7 days after onset of symptoms Pregnant? Currently sick with a high Symptoms High fever fever? Cough (can be severe) Egg allergy? (lower risk but still Fatigue Headache evaluate) Myalgias Any serious reactions after Potential Complications receiving a vaccination? Pneumonia Chronic medical conditions? Exacerbation of pulmonary and cardiac conditions Routine annual influenza vaccination is universally recommended to all people ≥ 6 months of age who do not have contraindications. Inﬂuenza Vaccines Available for the 2024-25 Season Number of Doses for Children Ages 6 Months - 8 Years Old For children aged 8 years old who require 2 doses, both doses should be administered even if the child turns age 9 years between dose 1 and dose 2. Flu Vaccine and Egg Allergy 1. Persons with a history of egg allergy should receive any licensed and recommended influenza vaccine that is otherwise appropriate for their age and health status. 2. Beginning with the 2024-2025 season, additional safety measures are no longer recommended for flu vaccination of egg-allergic persons beyond those recommended for receipt of any vaccine, regardless of the severity of previous reaction to egg. All vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of allergic reactions are available. 3. A previous severe allergic reaction to any component of a vaccine or to a previous dose of any influenza vaccine is a contraindication for future receipt of the vaccine. Two Flu Vaccines made without egg proteins: Flublok (Recombinant HA) Flucelvax (Cell culture-based, not egg-based) More Information About Select Flu Vaccines FLUCELVAX (CELL-CULTURED) ○ Use of mammalian cell lines (canine kidney cells) rather than chicken eggs to grow virus strains FLUBLOK (RECOMBINANT) ○ The gene for viral hemagglutinin (HA) protein is put into a baculovirus that infects cells of invertebrates and instructs the cells to rapidly produce the HA antigen. This antigen is grown in bulk, collected, purified, and then packaged as a recombinant flu vaccine. ○ No eggs FLUZONE HIGH DOSE ○ 4X dose of each strain or more antigen, which leads to a greater immune response ○ Approved for ≥ 65 y/o (greater immune response helps since as age increases, immunity decreases) LIVE ATTENUATED ○ Quadrivalent live attenuated (LAIV4) ○ Vaccination without a needle (intranasal spray) ○ Approved for 2 through 49 years of age ○ Need to consider timing and contraindications when using live flu vaccine Who Shouldn’t Get the Live Flu Vaccine? Flu Counseling Points The flu vaccine is a killed (inactivated) vaccine and cannot cause flu illness. Nasal spray vaccine is made with weakened (attenuated) live flu viruses and also cannot cause flu illness. It takes at least 2 weeks for the body to generate immunity to the flu after receiving the vaccine. Flu-like symptoms (fatigue, fever, nausea) are possible after receiving the vaccine. If appropriate, acetaminophen or ibuprofen may be used to treat mild symptoms, along with hydration. It is possible to get the flu even after receiving the vaccine. However, vaccination has shown to reduce the severity of the illness and is associated with a decreased risk in hospitalization. It is important for healthy adults to receive the flu vaccine to protect the younger and older people around them who are more susceptible to complications from the flu. Practice Question #1 A 30 year-old patient comes into the pharmacy to receive their flu vaccine for the first time in their life. You decided to select Afluria because that is all that the pharmacy has in stock. While you are asking the appropriate screening questions, the patient mentions that they think that they are allergic to eggs. They tell you that they usually experience hives after eating eggs. They donʼt think that they have any other reaction other than that from eggs. How should you proceed? A. Tell them that they will not get hives from Afluria because it has no egg product in it B. Tell them Flumist is a better option because it has no egg product in it C. Administer the Afluria vaccine D. Advise them to avoid the flu vaccine because it is contraindicated due to this allergy Practice Question #1 A 30 year-old patient comes into the pharmacy to receive their flu vaccine for the first time in their life. You decided to select Afluria because that is all that the pharmacy has in stock. While you are asking the appropriate screening questions, the patient mentions that they think that are allergic to eggs. They tell you that they usually experience hives after eating eggs. They donʼt think that they have any other reaction other than that from eggs. How should you proceed? A. Tell them that they will not get hives from Afluria because it has no egg product in it B. Tell them Flumist is a better option because it has no egg product in it C. Administer the Afluria vaccine D. Advise them to avoid the flu vaccine because it is contraindicated due to this allergy Practice Question #2 Which flu vaccines are indicated for a 57 year old patient? A. FluLaval and Fluarix B. FluMist and Fluarix C. Fluad and Fluzone High-Dose D. Fluad and FluMist Practice Question #2 Which flu vaccines are indicated for a 57 year old patient? A. FluLaval (>6 months) and Fluarix (>6 months) B. FluMist (2-49) and Fluarix (>6 months) C. Fluad (>65) and Fluzone High-Dose (>65) D. Fluad (>65) and Flumist (2-49) Practice Question #3 How long does it take for your body to generate immunity to the flu after receiving the vaccine? A. 2 Hours B. 2 Days C. 2 Weeks D. 2 Months Practice Question #3 How long does it take for your body to generate immunity to the flu after receiving the vaccine? A. 2 Hours B. 2 Days C. 2 Weeks D. 2 Months COVID Vaccines COVID Facts COVID-19 is caused by a virus called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Respiratory illness transmitted through respiratory droplets Disease ranges from mild to critical Symptoms include fever/chills, congestion, runny nose, fatigue, shortness of breath, sore throat, new loss of smell/taste, headache, cough, muscle/body aches, nausea/vomiting, and diarrhea. This is not an exhaustive list of all COVID-19 symptoms People with underlying conditions such as diabetes, heart disease, and lung disease are at higher risk for severe illness COVID-19 Vaccines COVID-19 Vaccine Removed from the Myths Debunked Market COVID-19 vaccines cannot cause COVID-19 infection and Johnson & Johnson’s Janssen illness viral vector vaccine COVID-19 vaccination will not Monovalent mRNA vaccines cause someone to test positive from both Moderna and Pfizer on antigen tests that test for current infection COVID-19 vaccines do not interact with patient’s DNA in any way Pﬁzer 2024-2025 mRNA COVID Vaccines (As of September 2024) * dilution with 1.1 mL 0.9% NaCl https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/downloads/vaccine-at-a-glance.pdf Moderna 2024-2025 mRNA COVID Vaccines (As of September 2024) https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/downloads/vaccine-at-a-glance.pdf Novavax Monovalent Adjuvanted Protein Subunit COVID Vaccine (As of September 2023) - still being updated Booster dose is available to: Individuals 18 years of age and older for whom an FDA-authorized mRNA bivalent COVID-19 booster vaccine is not accessible or clinically appropriate. Individuals 18 years of age and older who elect to receive the Novavax COVID-19 Vaccine, Adjuvanted because they would otherwise not receive a booster dose of a COVID-19 vaccine. https://www.cdc.gov/vaccines/covid-19/info-by-product/novavax/downloads/novavax-at-a-glance.pdf COVID-19 Vaccination Schedule Please note that the vaccine administration schedule and number of doses varies by age, vaccine, previous COVID-19 vaccines received, and the presence of moderate or severe immune compromise. It is the responsibility of the pharmacist to ensure that people receive the age-appropriate vaccine product and dosage based on their age on the day of vaccination in accordance with the recommended intervals for that age group and health status. Practice Question #1 Which COVID vaccines are mRNA vaccines? Select all that apply. A. Pfizer B. Moderna C. Novavax Practice Question #1 Which COVID vaccines are mRNA vaccines? Select all that apply. A. Pfizer B. Moderna C. Novavax FYI: Brand Names Pfizer (COMIRNATY®); Moderna (SPIKEVAX®) Practice Question #2 True or False: The Novavax adjuvanted protein subunit vaccine protects against the COVID-19 Omicron subvariants. Practice Question #2 True or False: The Novavax adjuvanted protein subunit vaccine protects against the COVID-19 Omicron subvariants. TRUE! Practice Question #3 For individuals who are immunocompromised and receiving an additional COVID-19 dose, how long should they wait between doses? A. ≥ 2months B. ≥ 2 weeks C. ≥ 4 weeks Practice Question #3 For individuals who are immunocompromised and receiving an additional COVID-19 dose, how long should they wait between doses? A. ≥ 2months B. ≥ 2 weeks C. ≥ 4 weeks Pneumococcal 1. What is pneumococcal disease and why should we vaccinate? Disease & 2. What are the available vaccines and how do we administer it? Vaccines 3. What are the dosing schedules (Routine vs. Nonroutine)? PPSV 23 PCV 15 PCV 20 PCV 21 Pneumococcal Mode of transmission Disease Reservoir ○ Nasopharynx Transmission Streptococcus pneumoniae ○ Person-to-Person Frequent cause of secondary bacterial ○ Crowded living conditions pneumonia following inﬂuenza Infection Year-round threat ○ Nasopharyngeal Antibiotic resistance is common Can aﬀect sinuses, middle ear, and Clinical syndromes bloodstream ○ Disseminated Disease Common Serotypes Bacteremia ○ 1, 5, 6, 8, 14, 19, 23 Meningitis Arthritis Peritonitis Why vaccinate? ○ Lower respiratory tract High risk of invasive pneumococcal disease Pneumonia among elderly, especially with comorbidities ○ Upper respiratory tract Life-threatening clinical syndromes, higher Sinusitis mortality Otitis media Abx resistance common Available Pneumococcal Vaccines Dosing Schedule - Infants and Children PCV15 or PCV20 All infants younger than 2 years old (4 total doses) ○ 2 months, 4 months, 6 months, 12-15 months Healthy Children 24-59 months with incomplete PCV series should receive 1 dose PCV15 or PCV20. Additional considerations: Please review the childhood/adolescent immunization catch-up schedule for immunization recommendations for children over the age of 2 years old with or without certain medical conditions. Dosing Schedule - Ages 65 and older https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf Dosing Schedule - Ages 19 - 64 with Speciﬁed Immunocompromising Conditions https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf Dosing Schedule - Ages 19 - 64 with Cochlear Implants or CSF Leak https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf Dosing Schedule - Ages 19 - 64 with Chronic Health Conditions https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf Practice Question #1 A 45 y.o. female patient walks into your community pharmacy and she asks you about the pneumococcal vaccine. This patient has never received a pneumococcal vaccine. You pull up her medication list: Metformin 1,000 mg Insulin Aspart Insulin Detemir Rosuvastatin 40mg Aspirin 81mg Clopidogrel 75mg Lisinopril 10 mg Which of the following recommendations would you provide to the patient regarding the PCV20 vaccine? A. Do not recommend PCV20, the patient is not over the age of 65. B. Recommend 1 dose of PPSV23 today and 1 dose of PCV 15 in one year. C. Recommend 1 dose of PCV20 today, the patient has chronic health conditions that make her eligible for vaccination. D. Recommend 1 dose of PCV20 today and 1 dose of PCV15 in one year. Practice Question #1 A 45 y.o. female patient walks into your community pharmacy and she asks you about the pneumococcal vaccine. This patient has never received a pneumococcal vaccine. You pull up her medication list: Metformin 1,000 mg Insulin Aspart Insulin Detemir Rosuvastatin 40mg Aspirin 81mg Clopidogrel 75mg Lisinopril 10 mg Which of the following recommendations would you provide to the patient regarding the PCV20 vaccine? A. Do not recommend PCV20, the patient is not over the age of 65. B. Recommend 1 dose of PPSV23 today and 1 dose of PCV 15 in one year. C. Recommend 1 dose of PCV20 today, the patient has chronic health conditions that make her eligible for vaccination. D. Recommend 1 dose of PCV20 today and 1 dose of PCV15 in one year. Practice Question #2 Which of the following vaccinations could be given subcutaneously? Select all that apply. A. PPSV23 B. PCV13 C. MMR D. Varicella E. DTaP F. MenACWY G. MenB H. Tdap Practice Question #2 Which of the following vaccinations could be given subcutaneously? Select all that apply. A. PPSV23 * B. PCV13 C. MMR D. Varicella E. DTaP F. MenACWY G. MenB *IM preferred H. Tdap Practice Question #3 Maria Gonzalez is a 58-year-old woman with a medical history that includes rheumatoid arthritis. She is currently undergoing treatment with methotrexate and takes prednisone daily. Maria has no previous history of pneumococcal disease and has not received any pneumococcal vaccines in the past. During a routine check-up, which recommendation would be most appropriate today? A) Administer PCV20 only, as it offers sufficient protection for immunocompromised patients. B) Administer PPSV23 only, as it is the preferred vaccine for all adults over 65. C) Administer both PCV20 and PPSV23, with PCV20 given first followed by PPSV23 after 8 weeks. D) Administer PCV15 followed by PPSV23, as this is a newer recommended approach for immunocompromised patients. Practice Question #3 Maria Gonzalez is a 58-year-old woman with a medical history that includes rheumatoid arthritis. She is currently undergoing treatment with methotrexate and takes prednisone daily. Maria has no previous history of pneumococcal disease and has not received any pneumococcal vaccines in the past. During a routine check-up, which recommendation would be most appropriate today? A) Administer PCV20 only, as it offers sufficient protection for immunocompromised patients. B) Administer PPSV23 only, as it is the preferred vaccine for all adults over 65. C) Administer both PCV20 and PPSV23, with PCV20 given first followed by PPSV23 after 8 weeks. D) Administer PCV15 followed by PPSV23, as this is a newer recommended approach for immunocompromised patients. Meningococcal 1. What is meningococcal disease Disease & and why should we vaccinate? 2. What are the 5 available vaccines Vaccines and how do we administer it? 3. What are the dosing schedules Menactra, Menveo, MenQuadfi (Routine vs. Nonroutine)? Trumenba, Bexsero Meningococcal Mode of transmission Disease Transmission Person-to-person Neisseria meningitidis Crowded living quarters Serotypes B, C, Y cause most disease in the U.S. Saliva Respiratory secretions: cough, kissing, etc. Serotypes Infection Serogroup B Inﬂammation of tissue surrounding brain & spinal ○ Cause 60% of disease in children < 5 years cord, can aﬀect the bloodstream (sepsis), ○ Cause 40% of diseases in college respiratory tract/ lungs Serogroup C, W, Y ○ 73% cases in ages > 11 y.o. Clinical manifestations Meningitis Why vaccinate? ○ Pain, HA, neck stiﬀness Incidences are declining, but sporadic cases and Bacteremia outbreaks continue ○ Sepsis, rash Can lead to life-threatening clinical syndromes, Bacteremic pneumonia a/w higher mortality Available Meningococcal Vaccines Dosing Schedule - MCV4 (Menveo & MenQuadﬁ) Routine Dosing Schedule Age 16-18 years old 1 dose only with no vaccination history Dose #1: 11-12 years old Adults Dose #2: 16 years old. (booster) Only for certain medical conditions, NOT routine Catch-up ○ 2 doses at least 8 weeks apart Dose #1: 13-15 years old ○ Medical conditions: persistent complement component deficiency, anatomical or functional Dose #2: 16-18 years old (booster) asplenia, HIV Doses to be administered at least 8 weeks apart Revaccination with MCV4 Dosing Schedule - MenB, Serogroup B Vaccines (Trumenba, Bexsero) Child & adolescent routine vaccination? NO, only for those at increased risk for serogroup B meningococcal disease Trumenba 3 dose series: 0, 1-2 months, 6 months 2 dose series: 0, 6 months Interchangeable? No, must complete series with the SAME vaccine Bexsero Trumenba: 2-dose or 3-dose series? 2 dose only: 0, 1-6 months Choice depends on risk of exposure and susceptibility to Men B disease MenB Booster Dose Individuals age 10 years or older with complement deficiency, complement inhibitor use, asplenia, or who are microbiologists: - ACIP recommends a booster dose 1 year following completion of MenB primary series, followed by MenB booster doses every 2-3 years thereafter for as long as the increased risk remains Persons age 10 years or older determined by public health officials to be at increased risk during an outbreak: - ACIP recommends a one-time booster if it has been ≥1 year since completion of a MenB primary series Practice Question #1 There is a campus-wide outbreak of meningococcal disease. As a competent future pharmacist, you know that there are vaccinations that could protect at-risk college students from this outbreak. Which vaccination(s) would you recommend during these university-based outbreaks of meningococcal disease? Select all that apply. A. Trumenba B. Menveo C. Bexsero D. Menactra Practice Question #1 There is a campus-wide outbreak of meningococcal disease. As a competent future pharmacist, you know that there are vaccinations that could protect at-risk college students from this outbreak. Which vaccination(s) would you recommend during these university-based outbreaks of meningococcal disease? Select all that apply. A. Trumenba FYI, posted on CDC website: B. Menveo C. Bexsero D. Menactra Soeters HM, McNamara LA, Blain AE, et al. University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018. Emerging Infectious Diseases. 2019;25(3):434-440. doi:10.3201/eid2503.181574. Practice Question #2 Jake is a 23-year-old graduate student who works in a laboratory handling meningococcus bacteria. He has never been vaccinated against meningococcal disease. Concerned about his exposure, he seeks your advice on vaccination. What vaccination regimen should you recommend for Jake? A) Administer MenACWY only. B) Administer MenB only. C) Administer both MenACWY and MenB. D) Recommend no meningococcal vaccine at this time. Practice Question #2 Jake is a 23-year-old graduate student who works in a laboratory handling meningococcus bacteria. He has never been vaccinated against meningococcal disease. Concerned about his exposure, he seeks your advice on vaccination. What vaccination regimen should you recommend for Jake? A) Administer MenACWY only. B) Administer MenB only. C) Administer both MenACWY and MenB. D) Recommend no meningococcal vaccine at this time. Practice Question #3 Liam is a 55-year-old male with a diagnosis of HIV. He has never received the meningococcal B vaccine. He visits the pharmacy for a vaccination inquiring about Penbraya. What vaccination strategy should the pharmacist recommend for Liam? A) Administer MenB only. B) Administer MenACWY only. C) Administer the MenABCWY vaccine to cover both MenB and MenACWY in one visit. D) Recommend no vaccination. Practice Question #3 Liam is a 55-year-old male with a diagnosis of HIV. He has never received the meningococcal B vaccine. He visits the pharmacy for a vaccination inquiring about Penbraya. What vaccination strategy should the pharmacist recommend for Liam? A) Administer MenB only. B) Administer MenACWY only. C) Administer the MenABCWY vaccine to cover both MenB and MenACWY in one visit. D) Recommend no vaccination. Varicella Zoster & Herpes Zoster Varicella Zoster Vaccine: Varivax Disease Type: live-attenuated virus vaccine Dose: 0.5 mL SC Primary infection: varicella (i.e. chicken pox) Number of doses: 2 Transmission: respiratory droplets or contacts Dosing schedule: with lesions - very contagious! ○ Children: Symptoms: 1st dose: 12 months ○ Fever 2nd dose: 4-6 years ○ Headache ○ Fatigue ○ Adults without evidence of ○ Rash (lasting 5-10 days) immunity: Complications: 2 doses four to eight weeks ○ Secondary bacterial infection apart ○ Encephalitis CI: pregnancy (since this is a live vaccine) ○ Pneumonia Storage: Vaccine must be stored in 2-8° C ○ Hospitalization (refrigerate) ○ Death Herpes Zoster (Shingles) Disease Vaccine: Shingrix* Primary infection: varicella (occurs at Type: recombinant, adjuvanted zoster second infection) vaccine (RZV) → requires reconstitution Establishes latency in cells of dorsal root Dose: 0.5 mL IM ganglia, then reactivates and travels Number of doses: 2 along neuronal cell axons - appears as Dosing schedule: 0 and 2-6 months localized rash FDA approval: 50 years and older Complications: ACIP recommendation: ○ Postherpetic neuralgia (PHN) ○ Immunocompetent adults ≥50 years ○ Scarring ○ Immunocompromised adults ≥19 years ○ Bacterial infection CI: pregnancy (not enough clinical data) ○ Ocular abnormalities Storage: Vaccine must be stored in 2-8° C (refrigerate) *ZVL (Zostavax) has been D/C from US Market Practice Question #1 A mother brings her child into the pharmacy who just had their fourth birthday yesterday. Which vaccine is the child indicated for today? A. Varivax 0.5 mL IM B. Varivax 0.5 mL SC C. Shingrix 0.5 mL IM D. Shingrix 0.5 mL SC Practice Question #1 A mother brings her child into the pharmacy who just had their fourth birthday yesterday. Which vaccine is the child indicated for today? A. Varivax 0.5 mL IM B. Varivax 0.5 mL SC C. Shingrix 0.5 mL IM D. Shingrix 0.5 mL SC Practice Question #2 BL is a 67 y/o male who received one Zostavax dose 2 years ago. What is your recommendation for this patient? A. BL requires a second dose of Zostavax B. BL doesn’t require further vaccination against herpes zoster since he had Zostavax C. Patient needs one dose of Shingrix to be considered fully vaccinated against herpes zoster D. Patient needs a two dose series of Shingrix - 1 dose today and 1 dose in two to six months Practice Question #2 BL is a 67 y/o male who received one Zostavax dose 2 years ago. What is your recommendation for this patient? A. BL requires a second dose of Zostavax B. BL doesn’t require further vaccination against herpes zoster since he had Zostavax C. Patient needs one dose of Shingrix to be considered fully vaccinated against herpes zoster D. Patient needs a two dose series of Shingrix - 1 dose today and 1 dose in two to six months Practice Question #3 A 55 yo M immunocompetent adult presents to the pharmacy for a shingles vaccine. Which of the following statements about the Shingrix (Recombinant Zoster Vaccine) is true? A. The vaccine should be stored at -20°C B. The recommended dosing schedule is 0 and 1 month C. Shingrix is contraindicated in pregnancy D. It is FDA-approved for adults ≥60 years old Practice Question #3 A 55 yo M immunocompetent adult presents to the pharmacy for a shingles vaccine. Which of the following statements about the Shingrix (Recombinant Zoster Vaccine) is true? A. The vaccine should be stored at -20°C B. The recommended dosing schedule is 0 and 1 month C. Shingrix is contraindicated in pregnancy D. It is FDA-approved for adults ≥60 years old Tetanus, Diphtheria, & Pertussis Pertussis Tetanus Diphtheria (whooping cough) Caused by: Clostridium Caused by: Corynebacterium tetani Caused by: Bordetella pertussis diphtheria Transmission: Transmission: Transmission: ○ Cuts or wounds ○ Very contagious ○ Respiratory Complications: Symptoms: ○ Contact w/ lesions ○ Unable to open ○ Paroxysmal cough (violent, Complications: mouth (trimus) uncontrollable coughing fits) ○ Difficulty breathing ○ Muscle rigidity ○ Whooping sound d/t person ○ Heart failure ○ Trouble gasping for air after cough fit ○ paralysis swallowing/breathing Complications: ○ Death ○ Death ○ Infants and children: Pneumonia, brain damage, death ○ Teens and adults: Persistent cough, weight loss, passing out, rib fractures Tetanus, Diphtheria, & Pertussis Vaccines Tetanus, Diphtheria, & Pertussis Vaccines Vaccine Route Age Schedule Notes DTaP/DT 0.5 mL IM 65 yo) Age 11-12 Adolescents (11-12 Booster given yo) Pregnancy Adacel: 11-64 yo every 10 years (27-36 weeks) (or 5 years if severe dirty wound/burn) CDC Recommendations Patient Group Dosing Recommendation Children

PPP Fall 2024 Review Session Slides (1) PDF

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