NAPLEX Question of the Week: Verifying Vaccines

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NAPLEX Question of the Week: Verifying Vaccines
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PB is a familiar 63 yo male who comes into your pharmacy inquiring about vaccines. The patient typically receives his influenza vaccine annually with his last dose 1 year ago and has received no other vaccines in the last 30 years but to his knowledge received normal childhood vaccinations. The patient has a past medical history of hypertension, hyperlipidemia, newly diagnosed HIV, and seasonal allergies. His current medications include Biktarvy one tablet QD , Lisinopril 5 mg QD, Lipitor 20 mg QD, and Zyrtec 10 mg PRN seasonal allergies.  The patient has no other known allergies.

Which of the following are vaccines the patient is eligible for? Select all that apply:

A. PCV20 once

B. PCV15 followed by PPSV23 in ≥  8 weeks

C. Fluzone High Dose Quadrivalent

D. Live attenuated influenza vaccine

E. Tdap (one dose)

Rationale:

Pharmacists play a huge role in vaccinations whether it be annual influenza vaccines, pneumococcal vaccines, COVID-19 vaccines, and more. It is incredibly important to first keep up-to-date with rapidly changing vaccine recommendations and secondly know which vaccines are appropriate for a patient. In order to keep up with changing vaccine recommendations a pharmacist should first know what resources they can utilize, which includes the CDC website with multiple resources for information regarding vaccine recommendations. 

Pneumococcal Vaccine: This patient is eligible for the pneumococcal vaccine, because he was recently diagnosed with HIV. Patients <65 years old are eligible for the pneumococcal vaccine if they meet one of the immunocompromising conditions, one of which is HIV. The patient also has no history of a pneumococcal vaccine so when looking at the most recent recommendations regarding the pneumococcal vaccine the patient is eligible for either the PCV20 once or PCV15 followed by PPSV23 in ≥8 weeks for patients with immunocompromising conditions (e.g. HIV), cochlear implants, or cerebrospinal fluid leak. All other patients should receive the PPSV23 at least one year after the PCV15 dose.  Of note, the PCV13 vaccine is no longer recommended for adult patients. 

Conjugate Vaccines: PCV13, PCV15, and PCV20

Polysaccharide Vaccine: PPSV23

Influenza Vaccine: The patient is eligible for the annual influenza vaccine, because his last dose was 1 year ago. The patient has no egg allergies and is <65 years old so is a candidate for the standard dose inactivated flu shot. Only at ≥65 years old patients are eligible for the high dose flu vaccine. The patient is also not eligible for the live attenuated vaccine because it is only approved for patients aged 2-49 yo. Patients with egg allergies should receive either Flucelvax Quadrivalent or Flublok Quadrivalent, because they are made without eggs. 

Others: The patient would also be eligible for a dose of Tdap and a 2 dose series of the Shingrix vaccine(patient is >50 years old) since he has not received any other vaccines in the last 30 years. 

Correct Answers: A, B, and E

A and B are correct answers, because the patient is eligible for the pneumococcal vaccine and answers A and B identify the correct pneumococcal vaccine options for this patient. Answers C and D are incorrect, because the patient is not eligible for either the high dose flu vaccine or the live attenuated vaccine. Answer E is correct because it has been >10 years since the patient last had a Tdap vaccine. 

Brand/Generics Covered: Biktarvy (Bictegravir, Emtricitabine, and Tenofovir Alafenamide), Lisinopril (Zestril), Lipitor(Atorvastatin), Zyrtec (Cetirizine), Fluzone-High Dose (High dose flu vaccine)

NAPLEX Core Competencies covered:

1.6(Risk factors or maintenance of health and wellness), 1.7(Evidence-based literature), 2.2(Brand-generic), 6.3(Disease prevention or screening programs; or stewardship)

Sources: 

https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#note-flu

https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf

https://www.cdc.gov/flu/prevent/qa_fluzone.htm

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