CSP - Certified Specialty Pharmacist Clinical Management: Oncology Questions and Answers

Question 1

A patient with metastatic non-small cell lung cancer is being treated with pembrolizumab (Keytruda), an immune checkpoint inhibitor. After several cycles, the patient reports severe, persistent diarrhea (Grade 3 toxicity). According to current clinical guidelines for managing immune-related adverse events (irAEs), what is the MOST appropriate initial action for the specialty pharmacist to recommend?

Accepted Answer

Hold pembrolizumab and initiate high-dose corticosteroids.

Answer

For Grade 3 or 4 immune-related adverse events (irAEs) such as severe colitis/diarrhea, standard management guidelines recommend holding or discontinuing the immune checkpoint inhibitor (ICI) and initiating high-dose corticosteroids (e.g., prednisone 1-2 mg/kg/day). Loperamide is insufficient for severe, immune-mediated diarrhea. Infliximab is typically reserved for steroid-refractory cases. Switching to another ICI is not recommended as irAEs are a class effect.

Question 2

A specialty pharmacist is counseling a patient newly diagnosed with Chronic Myeloid Leukemia (CML) who is starting oral imatinib. Which of the following is a critical counseling point to ensure optimal therapeutic outcomes?

Accepted Answer

Strict adherence to the prescribed regimen is crucial to prevent drug resistance and disease progression.

Answer

Adherence to tyrosine kinase inhibitors (TKIs) like imatinib is paramount for achieving and maintaining response in CML. Non-adherence is strongly correlated with loss of response and disease progression. Imatinib should be taken with a meal and a large glass of water to minimize gastrointestinal irritation. Antacids can decrease absorption and should be spaced out. Doubling up on missed doses is generally not recommended.

Question 3

Which of the following oncology medications requires enrollment in a Risk Evaluation and Mitigation Strategy (REMS) program with Elements to Assure Safe Use (ETASU) due to its significant teratogenic risk?

Accepted Answer

Lenalidomide (Revlimid)

Answer

Lenalidomide (Revlimid) has a well-documented, high risk of severe, life-threatening birth defects and is subject to a strict REMS program. This program includes Elements to Assure Safe Use (ETASU) such as prescriber and pharmacy certification, and mandatory patient registry and pregnancy testing to prevent fetal exposure. The other medications listed do not have REMS programs with such stringent requirements.

Question 4

A specialty pharmacy receives a new prescription for palbociclib (Ibrance) for a patient with HR+, HER2- metastatic breast cancer. The pharmacist notes the patient is also taking ketoconazole, a strong CYP3A4 inhibitor. What is the most appropriate clinical intervention?

Accepted Answer

Recommend discontinuing ketoconazole and starting a non-interacting antifungal.

Answer

Palbociclib is a substrate of the CYP3A4 enzyme. Co-administration with strong CYP3A4 inhibitors like ketoconazole can significantly increase palbociclib concentrations and the risk of toxicity, such as neutropenia. The prescribing information recommends avoiding concomitant use. The best intervention is to recommend an alternative agent that does not inhibit CYP3A4. Dose reduction of palbociclib is an option if concomitant use is unavoidable, but switching the interacting agent is preferred.

Question 5

Which of the following is a primary role of a specialty pharmacist in managing patients on oral chemotherapy?

Accepted Answer

Proactively monitoring for and managing treatment-related adverse events and adherence.

Answer

A key function of a specialty pharmacist in oncology is the ongoing management of patients on oral anticancer agents. This includes proactive patient education, monitoring for side effects, managing toxicities, assessing adherence, and communicating with the provider to optimize therapy. Prescribing, administering IV drugs, and ordering imaging are typically outside the pharmacist's scope of practice.

CSP - Certified Specialty Pharmacist Practice Test

CSP - Certified Specialty Pharmacist Practice Test

CSP - Certified Specialty Pharmacist Clinical Management: Oncology Questions and Answers