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 pharmacist reviews a patient on tacrolimus post-kidney transplant who has started erythromycin. What action is MOST appropriate?
Answer: Contact the prescriber: erythromycin inhibits CYP3A4 and P-gp, likely causing tacrolimus toxicity
Erythromycin inhibits both CYP3A4 and P-glycoprotein, dramatically increasing tacrolimus blood levels and risk of nephrotoxicity and neurotoxicity.
A patient on pembrolizumab (Keytruda) presents with new-onset diarrhea and colitis symptoms. Which immune-related adverse event (irAE) management is MOST appropriate?
Answer: Hold pembrolizumab, evaluate severity, and initiate systemic corticosteroids for grade 2 or higher
Immune-mediated colitis from checkpoint inhibitors requires drug hold and systemic corticosteroids for grade 2+ symptoms, with severity guiding permanent discontinuation.
Which patient counseling point is MOST critical for a patient self-administering subcutaneous methotrexate at home for rheumatoid arthritis?
Answer: Take folic acid supplementation daily to reduce mucositis and liver toxicity
Daily folic acid (1 mg) or folinic acid supplementation substantially reduces methotrexate-related toxicities including mucositis and elevated transaminases.
A patient on imatinib (Gleevec) for CML has new labs showing elevated alkaline phosphatase and ALT (5× ULN). What is the recommended MTM approach?
Answer: Hold imatinib, assess for drug-induced liver injury, and notify prescriber for dose modification
Imatinib-associated hepatotoxicity with transaminase elevations greater than 5× ULN requires drug hold and prescriber notification for dose adjustment or alternative therapy.
A specialty pharmacy pharmacist counseling a patient on subcutaneous injectable evolocumab (Repatha) for familial hypercholesterolemia should emphasize which storage instruction?
Answer: Refrigerate at 36–46°F; if kept at room temperature, use within 30 days and do not re-refrigerate
Evolocumab must be refrigerated but may be stored at room temperature (below 77°F) for up to 30 days; once unrefrigerated, it cannot be returned to the refrigerator.
Which parameter requires routine monitoring when a patient is maintained on long-term nintedanib (Ofev) for idiopathic pulmonary fibrosis?
Answer: Liver function tests (ALT/AST) monthly for the first 3 months, then periodically thereafter
Nintedanib is associated with hepatotoxicity and requires liver function monitoring monthly for the first 3 months, then periodically, with dose modification if elevated.
A pharmacist providing MTM for a patient on oral posaconazole suspension for prophylaxis notes it is being administered without food. What is the clinical significance?
Answer: Food, especially high-fat meals, significantly increases posaconazole suspension bioavailability; without food, plasma levels may be subtherapeutic
Posaconazole oral suspension requires administration with food (preferably high-fat meal) or a nutritional supplement to achieve adequate therapeutic plasma levels.