CSP Clinical Management: Immunology 2

Question 1

Which screening test is required before initiating adalimumab therapy?

Accepted Answer

Latent tuberculosis test (IGRA or TST)

Answer

TNF inhibitors carry a boxed warning for serious infections including TB reactivation, so latent TB screening is required before starting.

Question 2

A patient with psoriasis also has active Crohn's disease. Which drug class should generally be avoided?

Accepted Answer

IL-17A inhibitors

Answer

IL-17 inhibitors such as secukinumab and ixekizumab have been linked to new onset or worsening of inflammatory bowel disease.

Question 3

The ORAL Surveillance trial led to expanded boxed warnings for tofacitinib. What did they add?

Accepted Answer

MACE, thrombosis, malignancy, and mortality

Answer

Compared with TNF inhibitors in older RA patients with cardiovascular risk factors, tofacitinib showed more MACE, thrombosis, malignancy, and death.

Question 4

Why is certolizumab pegol often preferred for patients with immune-mediated disease during pregnancy?

Accepted Answer

It lacks an Fc region, so very little crosses the placenta

Answer

Without an Fc portion, certolizumab is not actively transported across the placenta by the neonatal Fc receptor.

Question 5

Ustekinumab exerts its effect by targeting which structure?

Accepted Answer

Shared p40 subunit of IL-12 and IL-23

Answer

Ustekinumab binds the p40 subunit shared by IL-12 and IL-23, blocking both cytokines.

CSP - Certified Specialty Pharmacist Practice Test