MTM Immunization & Preventive Care 4 — Questions and Answers
Question 1: A pharmacist counsels a patient who received varicella vaccine 3 weeks ago and is now prescribed a course of immunosuppressive therapy. What is the concern?
- No concern; inactivated vaccines are unaffected by immunosuppression
- Immunosuppression may blunt immune response but the vaccine-strain cannot cause disease
- The live vaccine-strain virus may reactivate or cause disseminated disease under immunosuppression (Correct answer)
- The vaccine should be repeated after immunosuppressive therapy is completed
Correct answer: The live vaccine-strain virus may reactivate or cause disseminated disease under immunosuppression
Because varicella vaccine is a live attenuated vaccine, subsequent immunosuppression can allow vaccine-strain virus to disseminate, which is a clinical concern to monitor.
Question 2: In an MTM consultation, which statin indication also serves a preventive cardiovascular role beyond lipid lowering for primary prevention?
- Statins are only indicated after a cardiovascular event
- USPSTF recommends statin use for adults 40-75 with ≥1 CVD risk factor and 10-year CVD event risk ≥10% (Correct answer)
- Statins for primary prevention require LDL >190 mg/dL regardless of risk
- Only high-intensity statins qualify for primary prevention use
Correct answer: USPSTF recommends statin use for adults 40-75 with ≥1 CVD risk factor and 10-year CVD event risk ≥10%
USPSTF recommends initiating statins for primary CVD prevention in adults 40-75 with one or more CVD risk factors and a calculated 10-year CVD risk of ≥10%.
Question 3: A 2-month-old infant is seen for well-child care. Which vaccines are typically administered at this visit per the ACIP childhood immunization schedule?
- DTaP, IPV, Hib, PCV15/20, RV, and Hepatitis B (if not given at birth) (Correct answer)
- MMR, varicella, Hep A, and influenza
- DTaP, MMR, IPV, and varicella
- Hepatitis B only, as other vaccines start at 4 months
Correct answer: DTaP, IPV, Hib, PCV15/20, RV, and Hepatitis B (if not given at birth)
At 2 months, the recommended vaccines include DTaP, IPV, Hib, PCV15/20, rotavirus (RV), and the third hepatitis B dose if the birth dose was given.
Question 4: An asymptomatic adult patient has a tuberculin skin test (TST) result of 10 mm induration. She was born in a high-prevalence country and has no symptoms. What is the appropriate interpretation?
- Negative result; no further evaluation needed
- Positive result indicating latent TB infection (LTBI) requiring further evaluation (Correct answer)
- Indeterminate result; repeat testing in 8-10 weeks
- Positive result only if induration ≥15 mm for non-high-risk patients
Correct answer: Positive result indicating latent TB infection (LTBI) requiring further evaluation
A TST induration ≥10 mm is considered positive (LTBI) for persons born in high TB-prevalence countries, warranting further evaluation and possible treatment.
Question 5: A pharmacist is completing an MTM comprehensive medication review and notes a 70-year-old patient has not received influenza vaccine this season. The patient declines, citing a past egg allergy with hives. What is correct guidance?
- Influenza vaccine is absolutely contraindicated with any egg allergy
- Patients with egg allergy causing only hives can receive any licensed influenza vaccine in any setting (Correct answer)
- The patient must receive RIV4 (Flublok) which is egg-free, administered only in an allergy clinic
- Pre-treat with diphenhydramine and epinephrine standby is required for all egg-allergic patients
Correct answer: Patients with egg allergy causing only hives can receive any licensed influenza vaccine in any setting
ACIP states that patients with egg allergy of any severity (including anaphylaxis) can receive any licensed, age-appropriate influenza vaccine without special precautions beyond standard vaccine administration.
Question 6: Which preventive care recommendation involves aspirin use for adults aged 40-59 per USPSTF guidelines?
- Aspirin is recommended for all adults 40-59 for general cardiovascular prevention
- Aspirin use for primary CVD prevention in adults 40-59 with ≥10% 10-year CVD risk is an individual decision (Correct answer)
- USPSTF recommends against aspirin for primary prevention in all adults
- Aspirin 325 mg daily is recommended for high-risk patients aged 40-59
Correct answer: Aspirin use for primary CVD prevention in adults 40-59 with ≥10% 10-year CVD risk is an individual decision
For adults 40-59 with ≥10% 10-year CVD risk, USPSTF recommends an individualized decision about initiating low-dose aspirin for primary prevention.
Question 7: A patient with a history of Guillain-Barré syndrome (GBS) within 6 weeks of a previous influenza vaccine asks about receiving this year's vaccine. What is appropriate?
- Influenza vaccine is absolutely contraindicated with any prior GBS history
- Annual influenza vaccination should continue because influenza disease itself carries greater GBS risk than the vaccine
- The patient should receive LAIV instead of IIV to reduce GBS risk
- GBS history is a precaution; vaccine decision should weigh risks and benefits with physician input (Correct answer)
Correct answer: GBS history is a precaution; vaccine decision should weigh risks and benefits with physician input
Prior GBS within 6 weeks of influenza vaccine is a precaution; healthcare providers should carefully consider the risks and benefits before administering influenza vaccine.
MTM Immunization & Preventive Care 4
A pharmacist counsels a patient who received varicella vaccine 3 weeks ago and is now prescribed a course of immunosuppressive therapy.
What is the concern?