BCPS Oncology & Hematology Pharmacotherapy

Question 1

Methotrexate exerts its cytotoxic effect primarily by inhibiting which enzyme?

Accepted Answer

Dihydrofolate reductase (DHFR)

Answer

Methotrexate competitively inhibits DHFR, blocking reduction of folate to tetrahydrofolate and ultimately impairing DNA synthesis.

Question 2

A patient is diagnosed with Philadelphia chromosome-positive CML in chronic phase. Which of the following represents the most appropriate initial therapy?

Accepted Answer

A BCR-ABL tyrosine kinase inhibitor (TKI)

Answer

BCR-ABL TKIs (imatinib, dasatinib, nilotinib, or bosutinib) are the standard first-line therapy for chronic phase CML, targeting the fusion protein created by the Philadelphia chromosome.

Question 3

Which combination of laboratory abnormalities is characteristic of tumor lysis syndrome (TLS)?

Accepted Answer

Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia

Answer

TLS classically presents with hyperkalemia, hyperphosphatemia, hypocalcemia (from calcium-phosphate precipitation), and hyperuricemia from massive nucleic acid breakdown.

Question 4

For a patient receiving highly emetogenic chemotherapy (HEC) such as cisplatin, which antiemetic regimen is recommended for acute emesis prevention?

Accepted Answer

A 5-HT3 antagonist + NK1 receptor antagonist + dexamethasone

Answer

ASCO and NCCN guidelines recommend triple antiemetic therapy combining a 5-HT3 antagonist, NK1 receptor antagonist, and dexamethasone for highly emetogenic chemotherapy.

Question 5

A patient receiving chemotherapy develops a fever of 38.5°C with an absolute neutrophil count (ANC) of 400 cells/mm³. Which initial antibiotic regimen is most appropriate?

Accepted Answer

IV antipseudomonal beta-lactam monotherapy (e.g., piperacillin-tazobactam)

Answer

IDSA guidelines recommend IV antipseudomonal beta-lactam monotherapy as empiric first-line treatment for febrile neutropenia in high-risk patients.

(BCPS) Board Certified Pharmacotherapy Specialist Practice Test

(BCPS) Board Certified Pharmacotherapy Specialist Practice Test

BCPS Oncology & Hematology Pharmacotherapy