MTM Specialty Medication Management 4

Question 1

A patient on cyclosporine for organ transplant is prescribed fluconazole for a vaginal yeast infection. What is the MTM pharmacist's BEST action?

Accepted Answer

Alert the prescriber: fluconazole inhibits CYP3A4 and can cause significant cyclosporine toxicity; suggest topical antifungal instead

Answer

Fluconazole strongly inhibits CYP3A4, significantly increasing cyclosporine levels and risk of nephrotoxicity; a topical antifungal is safer.

Question 2

Which specialty medication for hepatitis C requires genotype testing before prescribing to confirm efficacy?

Accepted Answer

Elbasvir/grazoprevir (Zepatier) — effective for genotypes 1 and 4 only

Answer

Elbasvir/grazoprevir is indicated only for HCV genotypes 1 and 4, making genotype testing essential before prescribing.

Question 3

A pharmacist identifies that a patient on mycophenolate mofetil (CellCept) has been started on cholestyramine. What is the clinical concern?

Accepted Answer

Cholestyramine binds to mycophenolic acid in the gut, reducing its absorption and potentially leading to transplant rejection

Answer

Cholestyramine interrupts enterohepatic recirculation of mycophenolic acid, significantly reducing drug exposure and risking organ rejection.

Question 4

A patient on vedolizumab (Entyvio) for Crohn's disease asks if they can receive live vaccines. What is the appropriate counseling?

Accepted Answer

Live vaccines are contraindicated; inactivated vaccines are preferred

Answer

Although vedolizumab is gut-selective, live vaccines are contraindicated in immunocompromised patients on biologics due to risk of vaccine-induced infection.

Question 5

During MTM, a patient on enzalutamide (Xtandi) for prostate cancer is noted to be on warfarin. What is the major drug interaction?

Accepted Answer

Enzalutamide induces CYP3A4 and CYP2C9, reducing warfarin exposure and INR

Answer

Enzalutamide is a potent CYP3A4 and CYP2C9 inducer, significantly reducing warfarin levels and requiring close INR monitoring with possible dose increases.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Specialty Medication Management 4