A patient is about to begin therapy with fingolimod (Gilenya) to treat multiple sclerosis. The nurse learns that the patient has not had chickenpox or the varicella zoster virus (VZV) vaccine. What will the nurse do?
a. Advise the patient to avoid individuals with chickenpox.
b. Give the VZV vaccine with the initial dose of fingolimod.
c. Give the VZV vaccine and tell the patient to begin using fingolimod in 1 month.
d. Obtain an order for a VZV antibody test.
ANS: D
Patients who have not had chickenpox or the VZV vaccine should be tested for VZV antibodies before receiving fingolimod. It is not correct to advise patients to avoid people with chickenpox, because this disease is endemic. Patients who do not have VZV antibodies should receive the VZV vaccine 1 month before beginning the fingolimod. The VZV vaccine should be given only to those who do not have VZV antibodies.
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