Question - MKSAP18 Extension

Question - MKSAP18 Extension

A 51-year-old woman is evaluated before starting tumor necrosis factor α inhibitor therapy. She has a 3-year history of moderately severe rheumatoid arthritis with persistent disease activity despite appropriate oral therapy. Current medications are methotrexate, folic acid, hydroxychloroquine, prednisone, and alendronate. The patient is an advanced practice registered nurse. On physical examination, vital signs are normal. The patient cannot fully close all fingers, and decreased grip is noted bilaterally. Joint examination reveals seven swollen joints and nine tender joints. Results from an interferon-γ release assay and hepatitis B and C virus serologies are negative. Radiographs of the hands show erosive damage.

Which of the following vaccinations should be given before initiating therapy?


A. Hep B Vaccine

B. Inactivated Influenza Vaccine

C. Pneumococcal Conjugate and polysaccharide vaccine

D. Recombinant Herpes Zoster Vaccine
 
Answer:

D. The recombinant herpes zoster vaccine should be given before initiating biologic therapy. All adults aged 50 years or older, including those with a previous episode of zoster, should receive the recombinant (inactivated) herpes zoster vaccine to reduce the incidence of zoster and postherpetic neuralgia. The recombinant vaccine has demonstrated 97% efficacy in persons aged 50 to 69 years and 91% efficacy in those aged 70 years and older. Ideally, patients' vaccinations should be updated before initiating biologic therapy, but most non-live vaccines can be administered either before or after starting biologic therapy. However, the 2019 Advisory Committee on Immunization Practices makes no recommendation regarding the recombinant zoster vaccine in immunocompromised patients; its use in immunocompromised patients is under review. Therefore, it would be prudent to administer the recombinant herpes zoster vaccine. The hepatitis B vaccine should be provided to patients on biologic therapy if high-risk factors are present (in this case, the patient is a health care worker), but it can be given before or after starting biologic therapy. There are currently three different types of influenza vaccines available in the United States: inactivated influenza vaccine (IIV), live attenuated influenza vaccine, and recombinant trivalent influenza vaccine. IIV is approved for use in all adults, including immunosuppressed persons and pregnant women. Pneumococcal vaccination is indicated for all adults aged 65 years and older and for high-risk persons younger than 65 years. Two vaccines are currently available: pneumococcal polysaccharide vaccine (PPSV23) and the pneumococcal conjugate vaccine (PCV13).
 
Question - MKSAP18 Extension

A 51-year-old woman is evaluated before starting tumor necrosis factor α inhibitor therapy. She has a 3-year history of moderately severe rheumatoid arthritis with persistent disease activity despite appropriate oral therapy. Current medications are methotrexate, folic acid, hydroxychloroquine, prednisone, and alendronate. The patient is an advanced practice registered nurse. On physical examination, vital signs are normal. The patient cannot fully close all fingers, and decreased grip is noted bilaterally. Joint examination reveals seven swollen joints and nine tender joints. Results from an interferon-γ release assay and hepatitis B and C virus serologies are negative. Radiographs of the hands show erosive damage.

Which of the following vaccinations should be given before initiating therapy?


A. Hep B Vaccine

B. Inactivated Influenza Vaccine

C. Pneumococcal Conjugate and polysaccharide vaccine

D. Recombinant Herpes Zoster Vaccine
OMG 😃
 

Harold

Member
Question - MKSAP18 Extension

A 51-year-old woman is evaluated before starting tumor necrosis factor α inhibitor therapy. She has a 3-year history of moderately severe rheumatoid arthritis with persistent disease activity despite appropriate oral therapy. Current medications are methotrexate, folic acid, hydroxychloroquine, prednisone, and alendronate. The patient is an advanced practice registered nurse. On physical examination, vital signs are normal. The patient cannot fully close all fingers, and decreased grip is noted bilaterally. Joint examination reveals seven swollen joints and nine tender joints. Results from an interferon-γ release assay and hepatitis B and C virus serologies are negative. Radiographs of the hands show erosive damage.

Which of the following vaccinations should be given before initiating therapy?


A. Hep B Vaccine

B. Inactivated Influenza Vaccine

C. Pneumococcal Conjugate and polysaccharide vaccine

D. Recombinant Herpes Zoster Vaccine
Do you know the answer and just testing us?
 
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