MTM Specialty Medication Management 3

Question 1

A patient with relapsing-remitting multiple sclerosis is starting natalizumab. Which laboratory test is MOST important to obtain prior to initiation?

Accepted Answer

JC virus antibody (JCV index)

Answer

JCV antibody status must be assessed before natalizumab initiation because JCV-positive patients have significantly higher risk of progressive multifocal leukoencephalopathy (PML).

Question 2

During an MTM session, a patient on trastuzumab (Herceptin) for HER2-positive breast cancer asks about heart-related risks. What monitoring is standard?

Accepted Answer

Echocardiogram or MUGA scan at baseline and every 3 months during therapy

Answer

Cardiac function (LVEF) must be assessed at baseline and every 3 months during trastuzumab therapy due to risk of cardiotoxicity.

Question 3

A patient on abiraterone acetate (Zytiga) for prostate cancer has a new prescription for prednisone. Why is concurrent corticosteroid use required?

Accepted Answer

To counteract mineralocorticoid excess caused by CYP17 inhibition

Answer

Abiraterone inhibits CYP17, causing mineralocorticoid accumulation leading to hypertension, hypokalemia, and fluid retention; low-dose corticosteroids counteract this effect.

Question 4

Which of the following is a BLACK BOX WARNING associated with fingolimod (Gilenya) for multiple sclerosis?

Accepted Answer

Bradycardia and AV block at initiation requiring first-dose observation

Answer

Fingolimod can cause bradycardia and AV block upon first dose, requiring 6-hour observation with cardiac monitoring in a healthcare setting.

Question 5

A patient on warfarin starts apremilast (Otezla) for psoriasis. What drug interaction concern should the pharmacist address?

Accepted Answer

Apremilast has no significant interaction with warfarin

Answer

Apremilast does not have significant pharmacokinetic interactions with warfarin and can be used without dose adjustment.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Specialty Medication Management 3