MTM Specialty Medication Management 5

Question 1

A pharmacist reviews a patient on tacrolimus post-kidney transplant who has started erythromycin. What action is MOST appropriate?

Accepted Answer

Contact the prescriber: erythromycin inhibits CYP3A4 and P-gp, likely causing tacrolimus toxicity

Answer

Erythromycin inhibits both CYP3A4 and P-glycoprotein, dramatically increasing tacrolimus blood levels and risk of nephrotoxicity and neurotoxicity.

Question 2

A patient on pembrolizumab (Keytruda) presents with new-onset diarrhea and colitis symptoms. Which immune-related adverse event (irAE) management is MOST appropriate?

Accepted Answer

Hold pembrolizumab, evaluate severity, and initiate systemic corticosteroids for grade 2 or higher

Answer

Immune-mediated colitis from checkpoint inhibitors requires drug hold and systemic corticosteroids for grade 2+ symptoms, with severity guiding permanent discontinuation.

Question 3

Which patient counseling point is MOST critical for a patient self-administering subcutaneous methotrexate at home for rheumatoid arthritis?

Accepted Answer

Take folic acid supplementation daily to reduce mucositis and liver toxicity

Answer

Daily folic acid (1 mg) or folinic acid supplementation substantially reduces methotrexate-related toxicities including mucositis and elevated transaminases.

Question 4

A patient on imatinib (Gleevec) for CML has new labs showing elevated alkaline phosphatase and ALT (5× ULN). What is the recommended MTM approach?

Accepted Answer

Hold imatinib, assess for drug-induced liver injury, and notify prescriber for dose modification

Answer

Imatinib-associated hepatotoxicity with transaminase elevations greater than 5× ULN requires drug hold and prescriber notification for dose adjustment or alternative therapy.

Question 5

A specialty pharmacy pharmacist counseling a patient on subcutaneous injectable evolocumab (Repatha) for familial hypercholesterolemia should emphasize which storage instruction?

Accepted Answer

Refrigerate at 36–46°F; if kept at room temperature, use within 30 days and do not re-refrigerate

Answer

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.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Specialty Medication Management 5