Specialty Medication Management Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Specialty Medication Management flashcards as text
A patient with relapsing-remitting multiple sclerosis is starting natalizumab. Which laboratory test is MOST important to obtain prior to initiation?
Answer: JC virus antibody (JCV index)
JCV antibody status must be assessed before natalizumab initiation because JCV-positive patients have significantly higher risk of progressive multifocal leukoencephalopathy (PML).
During an MTM session, a patient on trastuzumab (Herceptin) for HER2-positive breast cancer asks about heart-related risks. What monitoring is standard?
Answer: Echocardiogram or MUGA scan at baseline and every 3 months during therapy
Cardiac function (LVEF) must be assessed at baseline and every 3 months during trastuzumab therapy due to risk of cardiotoxicity.
A patient on abiraterone acetate (Zytiga) for prostate cancer has a new prescription for prednisone. Why is concurrent corticosteroid use required?
Answer: To counteract mineralocorticoid excess caused by CYP17 inhibition
Abiraterone inhibits CYP17, causing mineralocorticoid accumulation leading to hypertension, hypokalemia, and fluid retention; low-dose corticosteroids counteract this effect.
Which of the following is a BLACK BOX WARNING associated with fingolimod (Gilenya) for multiple sclerosis?
Answer: Bradycardia and AV block at initiation requiring first-dose observation
Fingolimod can cause bradycardia and AV block upon first dose, requiring 6-hour observation with cardiac monitoring in a healthcare setting.
A patient on warfarin starts apremilast (Otezla) for psoriasis. What drug interaction concern should the pharmacist address?
Answer: Apremilast has no significant interaction with warfarin
Apremilast does not have significant pharmacokinetic interactions with warfarin and can be used without dose adjustment.
A patient newly prescribed ibrutinib for CLL asks about dietary restrictions. What is the MOST important counseling point?
Answer: Avoid grapefruit and grapefruit juice due to CYP3A4 inhibition
Grapefruit inhibits CYP3A4, the primary enzyme metabolizing ibrutinib, which can increase ibrutinib plasma concentrations and toxicity.
Which monitoring parameter should be prioritized during MTM for a patient on dupilumab (Dupixent) for atopic dermatitis?
Answer: Ophthalmologic evaluation for conjunctivitis
Conjunctivitis is the most common adverse effect of dupilumab, occurring in up to 10% of patients, requiring ophthalmologic monitoring.