CSP Specialty Drug Therapies & Disease Management 2 — Questions and Answers
Question 1: Imatinib exerts its therapeutic effect in chronic myeloid leukemia primarily by inhibiting which target?
- Janus kinase 2
- EGFR tyrosine kinase
- BCR-ABL tyrosine kinase (Correct answer)
- Bruton's tyrosine kinase
Correct answer: BCR-ABL tyrosine kinase
Imatinib inhibits the constitutively active BCR-ABL tyrosine kinase produced by the Philadelphia chromosome.
Question 2: Which oral chemotherapy agent carries a boxed warning for increased bleeding risk and INR elevation when given with warfarin?
- Temozolomide
- Abiraterone
- Anastrozole
- Capecitabine (Correct answer)
Correct answer: Capecitabine
Capecitabine can markedly raise INR in patients on warfarin, so frequent INR monitoring is required.
Question 3: Before lenalidomide can be dispensed, which requirement must be satisfied?
- Only a baseline CBC must be documented
- Prescriber, patient, and pharmacy must be enrolled in the lenalidomide REMS program (Correct answer)
- The patient must sign a generic manufacturer copay form
- The patient must have HLA-B*5701 testing
Correct answer: Prescriber, patient, and pharmacy must be enrolled in the lenalidomide REMS program
Lenalidomide is distributed under a REMS due to embryo-fetal toxicity, requiring certified prescribers, pharmacies, and enrolled patients.
Question 4: A patient with CLL on ibrutinib reports palpitations. Which adverse effect of ibrutinib is most likely responsible?
- Hypoglycemia
- Hypertensive crisis from tyramine
- Atrial fibrillation (Correct answer)
- QT shortening
Correct answer: Atrial fibrillation
Ibrutinib is associated with atrial fibrillation and bleeding risk.
Question 5: Osimertinib is preferred in non-small cell lung cancer harboring which mutation, including resistance mutations?
- KRAS G12C
- EGFR mutations including T790M (Correct answer)
- ALK rearrangement
- BRAF V600E
Correct answer: EGFR mutations including T790M
Osimertinib is a third-generation EGFR TKI active against sensitizing EGFR mutations and T790M resistance.
Question 6: In sickle cell disease, hydroxyurea reduces painful crises mainly by which mechanism?
- Binding hemoglobin S to prevent polymerization
- Stimulating erythropoietin receptors
- Increasing fetal hemoglobin production (Correct answer)
- Directly inhibiting P-selectin
Correct answer: Increasing fetal hemoglobin production
Hydroxyurea increases HbF, which reduces HbS polymerization and sickling.
Question 7: Which statement best describes emicizumab for hemophilia A?
- An IV recombinant factor IX product dosed daily
- A gene therapy given as a single IV infusion for hemophilia B
- An oral factor Xa inhibitor used for prophylaxis
- A subcutaneous bispecific antibody that mimics factor VIIIa and works with or without inhibitors (Correct answer)
Correct answer: A subcutaneous bispecific antibody that mimics factor VIIIa and works with or without inhibitors
Emicizumab bridges factors IXa and X to replace factor VIIIa function and is effective in patients with inhibitors.
