high-dose immunosuppressive therapy and those who are cur- rently immune-compromised were excluded from efficacy stud - ies, the ACIP has not recommended the use of Shingrix in these patients. As additional data becomes available, the committee is expected to further discuss this topic (Dooling et al., 2018). Patients with chronic medical conditions Shingrix is recommended in patients with chronic medical con- ditions such as diabetes, chronic obstructive pulmonary disease, Conclusion Since shingles has the potential to affect over 30% of Americans, it is important to be aware of the disease process, treatment, and prevention of this common disease state. The Shingrix vaccine has demonstrated significant efficacy in preventing shingles out - breaks, and its high efficacy rates have prompted the Advisory References • Albrecht, M. A. (2019). Patient education: Shingles (beyond the basics). UpToDate . Retrieved October 19, 2021, from http://www.uptodate.com/contents/shingles-beyond-the-basics • Albrecht, M. A., & Levin, M. J. (2021). Epidemiology, clinical manifestations, and diagnosis of herpes zoster. UpToDate . Retrieved October 19, 2021 from https://www.uptodate.com/contents/ epidemiology- clinical-manifestations-and-diagnosis-of-herpes- zostersearch=shingles&source=search_ result&selectedTitle=2~150&usage_type=default&display_rank=2 • Centers for Disease Control and Prevention. (2019). About shingles. http://www.cdc.gov/shingles/about/index. html • Centers for Disease Control and Prevention. (2020). Adjuvants and vaccines. http://www.cdc.gov/ vaccinesafety/concerns/adjuvants.html • Centers for Disease Control and Prevention, Lopez, A., Harrington, T., & Marin, M. (2021). Chapter 22: Varicella. In E. Hall, A. P. Wodi, J. Hamborsky, V. Morelli, & S. Schillie (Eds.), Epidemiology and Prevention of Vaccine-Preventable Diseases . www.cdc.gov/vaccines/pubs/pinkbook/downloads/varicella.pdf
chronic renal failure, and rheumatoid arthritis (Dooling et al., 2018). Patients without a history of chicken pox There is no recommendation to screen for a history of chicken pox before administration of Shingrix. However, in patients who have no prior history of chicken pox or vaccination against chicken pox, the ACIP recommends following guidelines for the administration of the varicella vaccination. (Dooling et al., 2018). Committee on Immunization Practices (ACIP) to recommend it for the prevention of herpes zoster. Being aware of these recommen- dations allows pharmacy professionals to better serve and protect patients against this potentially harmful disease. • Dooling, K. L., Guo, A., Patel, M., Lee, G. M., Moore, K., Belongia, E. A., & Harpaz, R. (2018, January 26). Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, 67 (3), 103–108. http:// dx.doi.org/10.15585/mmwr.mm6703a5 • GlaxoSmithKline. (2021). Shingrix package insert. www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ ApprovedProducts/UCM581605.pdf • Kowalsky, D. S., & Wolfson, A. B. (2019). Corticosteroids for preventing postherpetic neuralgia after herpes zoster infection. NNT [Number-Needed-to-Treat]. https://www.thennt.com/nnt/corticosteroids- preventing- postherpetic-neuralgia-herpes-zoster-infection/ • Papadopoulos, A. J. (2020). Chicken pox treatment and management. Medscape. http://emedicine.medscape. com/article/1131785-treatment#showall • Shiraki, K., Takemoto, M., & Daikoku, T. (2021). Emergence of varicella-zoster virus resistance to acyclovir: epidemiology, prevention, and treatment. Expert Review of Anti-infective Therapy , 1–11. Advance online publication. https://doi.org/10.1080/14787210.2021.1917992
SHINGLES DISEASE PROCESS AND VACCINATION FOR PHARMACISTS Final Examination Questions Select the best answer for each question and then proceed to EliteLearning.com/Book to complete your final examination.
116. After initial exposure, the varicella zoster virus enters an incu- bation period of approximately _________ , while it replicates in the body.
122. Shingrix is a recombinant, adjuvanted vaccine for intra- muscular injection and is FDA approved for use in patients _____________ years of age and older.
a. 4 days. b. 7 days. c. 2 weeks. d. 4 weeks.
a. 40. b. 60. c. 55. d. 50.
117. Herpes zoster, commonly known as shingles, affects approx- imately one out of every _____________ Americans in their lifetime. a. Three. b. Two. c. Five. d. 10. 118. Around _______ of patients experience pain before develop- ing the shingles rash, known as prodromal pain.
123. The Shingrix pre-approval study that assessed vaccine ef- ficacy in subjects ages 50 and older found that two doses of Shingrix resulted in a significant reduction in the risk of developing shingles by _____________ when compared with placebo. a. 51 percent. b. 97.2 percent. c. 89 percent. d. 62 percent. 124. If not used immediately after reconstitution, Shingrix can be stored under refrigeration and used within __________.
a. 25%. b. 50%. c. 75%. d. 85%. 119. The most common complication of shingles is:
a. 60 minutes. b. 30 minutes. c. 12 hours. d. 6 hours.
a. Ramsey-Hunt syndrome. b. Post-herpetic neuralgia. c. Bacterial skin infections. d. Blindness. 120. In treating shingles, acyclovir is commonly administered at a dose of:
125. If the second dose of Shingrix is administered less than four weeks after the first dose, the Advisory Committee on Immu - nization Practices (ACIP) recommends: a. No further action. b. Restarting the series. c. Repeating the second dose. d. Drawing a titer to assess efficacy.
a. 500 mg three times daily for 7 days. b. 1000 mg five times daily for 10 days. c. 800 mg five times daily for 7 days. d. 800 mg three times daily for 10 days.
121. Shingrix must be stored properly to ensure viability of the virus component of the vaccine. It must be stored between:
a. -58°F and +5°F. b. 36°F and 46°F. c. 0°F and 25°F. d. 30°F and 50°F.
Course Code: RPTX01SH
EliteLearning.com/Pharmacy
Book Code: RPTX3024
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