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1. Which of the following statements is TRUE about the burden of zoster in the United States (U.S.):

A. There is no evidence of an increase in the prevalence of herpes zoster (zoster) for persons 50 years of age and older B. 50% of the people who are 80 years of age and older will get zoster C. An increase in the aging U.S. population will also increase the prevalence of zoster D. B and C

2. Which of the following age groups had the lowest zoster vaccination rate in 2008:

A. 60 to 64 years of age B. 65 to 74 years of age C. 75 to 85 years of age D. Older than 85 years of age

3. Which of the following is a characteristic common to the profile of most older adults who receive zoster immunizations:

A. Hispanic female B. Non-Hispanic black female C. Non-Hispanic white female D. Females from all racial groups

4. Which of the following is TRUE once varicella zoster virus (VZV) infects a human:

A. Remains latent for decades in the nerve cells B. Disabled by zoster virus specific cell-mediated immune cells C. Reactivated from the natural decline in immunity that occurs with age D. All of the above

5. All of the following may be present during the acute phase of zoster, EXCEPT:

A. Rash on the back B. Flu-like symptoms C. Hemorrhage D. Pain

6. The primary complaint for which medical care is sought during the active stage of shingles is

A. Diarrhea B. Pain C. Fever D. Headache

7. Zoster rash (shingles) during the active stage of zoster

A. Is maculopapular with belt-like (band) pattern on the trunk or face B. Evolves into vesicles and blisters C. Produces a great deal of pain D. All of the above

8. Mrs. Smith approaches you with the chief complaint of pain around her back and arms. Other than long-standing hypertension, controlled with medication, she does not have any other chronic medical problems. She admits to having had urinary tract infection (UTI)-like symptoms a week earlier, which spontaneously resolved. She denied any recent traumatic injury and she will turn 67 years of age soon. Her physical exam reveals no rash and vital signs are within normal limits. Which of the following is the most likely diagnosis:

A. Diabetic neuropathy B. Zoster sine herpete C. Pneumonia D. Kidney disease

9. Which of the following treatment options would you initiate for Mrs. Smith (opinion question):

A. A course of antiviral therapy B. Lidocaine patch C. Oral analgesics D. All of the above

10. The risk of zoster reactivation is generally increased for patients with all of the following conditions, EXCEPT:

A. Hypertension B. HIV/AIDs C. Posttransplant status D. Cancer

11. Which of the following is the most common chronic complication of zoster:

A. Meningitis B. Keratitis C. Postherpetic neuralgia (PHN) D. Paralysis

12. The zoster vaccine has been given additional approval by the U.S. Food and Drug Administration (FDA) for use in persons

A. 50 to 59 years of age B. 60 to 69 years of age C. 70 to 79 years of age D. 80 to 89 years of age

13. The zoster vaccine is contraindicated in anyone with

A. Allergy to eggs B. Allergy to nuts C. Allergy to neomycin D. Allergy to morphine

14. Barriers to zoster immunization among older adults include all of the following, EXCEPT:

A. Lack of awareness B. Pain at the site of injection C. Vaccine shortage D. Cost and low reimbursement rates

15. A pharmacists' role(s) in the prevention of zoster may include which of the following:

A. Patient education B. Becoming a pharmacist immunizer C. Partnering with other health care providers and community groups to widen their ability to reach the older adult population D. All of the above

16. Which of the following tools will help pharmacists increase zoster immunization rates:

A. Telephone, mail and other social network technology B. Community outreach activities C. Including vaccination assessment with every medication utilization review D. All of the above

17. What are the main objectives in the management of zoster?

A. Treat the acute pain B. Prevent the occurrence of PHN C. Treat acute, reactivated infection D. All of the above

18. When antiviral therapy is initiated early (within 72 hours of zoster reactivation), therapy may

A. Lengthen the periods of acute pain B. Shorten the periods of virus shedding C. Substantially shorten the periods of acute and late onset complications D. B and C

19. Which of the following are possible side effects of therapy with anticonvulsants:

A. Suicidal thoughts or behavior B. Angioedema C. Stevens-Johnson syndrome D. All of the above

20. All of the following alternative and nonpharmacological modalities are useful for PHN, EXCEPT:

A. Electrocardiography B. Biofeedback C. Nerve block D. Transcutaneous Electric Nerve Stimulation (TENS)

Evaluation Questions

21. In an effort to better determine the overall impact of continuing education activities, the Postgraduate Institute for Medicine (PIM) is conducting measurements of educational effectiveness. Listed below are several demographic questions to better identify who is in the audience and several statements for which we would like you to rate your level of agreement/disagreement. All information obtained in this process will be used and reported in aggregate only, without individual attribution. Thank you for your participation. What is your profession?

A. Pharmacist B. Pharmacy Technician C. Other

22. What is your area of specialization?

A. Clinical pharmacy B. Managed Care C. Retail/Community Pharmacy D. Research E. Industry/Manufacturing F. Regulatory/Government G. Other

23. Approximately how many patients with herpes zoster does your practice see per week?

A. < 5 B. 5 -10 C. 11 – 20 D. > 20 E. Not applicable to my setting

24. How many years have you been in practice?

A. < 5 B. 5 -10 C. 11 – 20 D. > 20

25. To what extent do you agree with the following statement? Prior to administration of the varicella- zoster vaccine, it is not necessary to ask patients about their history of varicella infection or to conduct serologic testing for varicella immunity.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

26. To what extent do you agree with the following statement? Current evidence indicates that the lack of awareness and the cost of varicella-zoster vaccine are the most important barriers against vaccination.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

27. To what extent do you agree with the following statement? It is appropriate to administer the attenuated live varicella vaccine to a 53 year old man cohabitating with a woman who has not been vaccinated against chicken pox and who is 6 months pregnant.

A. Strongly Disagree B. Disagree C. Somewhat Disagree D. Somewhat Agree E. Agree F. Strongly Agree

28. Now that you have participated in this activity, how often do you plan to engage in the following practice behavior? Encourage all patients 50 years of age and older to get the attenuated live varicella virus vaccine, unless contraindicated.

A. Never B. Rarely C. Sometimes D. Very Often E. Always F. Not within my scope of practice

29. Assess for the varicella virus vaccination using the medication utilization evaluation for every patient 50 years of age or older.

A. Never B. Rarely C. Sometimes D. Very Often E. Always F. Not within my scope of practice