CSP Clinical Patient Management & Counseling 2

Question 1

Before a patient starts adalimumab for rheumatoid arthritis, which screening test is required?

Accepted Answer

Latent tuberculosis test (TST or IGRA)

Answer

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

Question 2

A patient starting ledipasvir/sofosbuvir takes omeprazole 20 mg daily. What is the most appropriate counseling?

Accepted Answer

Take omeprazole 20 mg or less at the same time as ledipasvir/sofosbuvir on an empty stomach

Answer

Ledipasvir solubility drops as gastric pH rises, so PPIs up to the equivalent of omeprazole 20 mg can be taken at the same time as the DAA under fasting conditions.

Question 3

Which drug interaction with sofosbuvir-containing HCV regimens can cause serious symptomatic bradycardia?

Accepted Answer

Amiodarone

Answer

Giving amiodarone with sofosbuvir-based regimens has caused serious symptomatic bradycardia, including fatal cases.

Question 4

Before a patient starts a direct-acting antiviral for hepatitis C, which additional screening is recommended because of a boxed warning?

Accepted Answer

HBsAg and anti-HBc for hepatitis B

Answer

HCV DAAs carry a boxed warning for hepatitis B reactivation, so all patients need HBV screening before treatment.

Question 5

A patient with multiple sclerosis is starting fingolimod. What monitoring is required after the first dose?

Accepted Answer

At least 6 hours of observation for bradycardia, with an ECG before dosing and at the end of observation

Answer

Fingolimod can cause bradycardia and AV block after the first dose, so 6-hour first-dose observation with ECGs is required.

CSP - Certified Specialty Pharmacist Practice Test

CSP - Certified Specialty Pharmacist Practice Test

CSP Clinical Patient Management & Counseling 2