Question 1 of 10
Medication Use Process (Prescribing, Transcribing and Documenting, Dispensing, Administering, and Monitoring)
Patient Profile
Community pharmacy profile| Item | Detail |
|---|
| Age / sex | 42-year-old woman |
| Height / weight | 165 cm / 68 kg |
| Allergies | Sulfonamide antibiotics (rash) |
| Diagnoses | Rheumatoid arthritis, moderate to severe, inadequate response to methotrexate |
| Note | Not pregnant; asks which vaccines she can receive at the pharmacy |
Current fill history| Drug | Directions |
|---|
| Methotrexate 2.5 mg tablets | 6 tablets (15 mg) by mouth once weekly on Mondays |
| Folic acid 1 mg tablets | 1 tablet by mouth daily |
New prescriptions presented today| Drug | Directions | Quantity |
|---|
| Adalimumab (FDA-licensed biosimilar) 40 mg/0.4 mL prefilled pen | Inject 40 mg subcutaneously every 2 weeks | 2 pens |
| Prednisone 10 mg tablets | 40 mg daily for 3 days, 30 mg daily for 3 days, 20 mg daily for 3 days, 10 mg daily for 3 days, then 5 mg daily for 4 days, then stop | Quantity sufficient |
Labs (1 week ago)| Test | Result | Reference range |
|---|
| WBC | 7.2 × 10³/mm³ | 4.5–11 × 10³/mm³ |
| Hemoglobin | 12.8 g/dL | 12–16 g/dL |
| Platelets | 260 × 10³/mm³ | 150–400 × 10³/mm³ |
| ALT | 24 units/L | 7–56 units/L |
| SCr | 0.8 mg/dL | 0.6–1.1 mg/dL |
| ESR | 42 mm/h | 0–20 mm/h |
Which vaccine is contraindicated for this patient once she is receiving adalimumab?