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

Question 1

A patient with rheumatoid arthritis, who has failed methotrexate monotherapy, is being started on a Janus kinase (JAK) inhibitor.
Which of the following represents a class-wide black box warning for JAK inhibitors that the specialty pharmacist must counsel the patient on?

Accepted Answer

Increased risk of serious infections, malignancy, and thrombosis

Answer

New or worsening heart failure

Answer

Progressive multifocal leukoencephalopathy (PML)

Answer

Severe infusion-related reactions

Question 2

A 45-year-old male with Crohn's disease is receiving an infliximab infusion at an infusion center. 15 minutes into the infusion, he complains of flushing, itching, and shortness of breath. The nurse stops the infusion. What is the most appropriate immediate next step?

Accepted Answer

Administer intravenous corticosteroids and antihistamines

Answer

Administer epinephrine immediately

Answer

Restart the infusion at a slower rate

Answer

Obtain trough and anti-drug antibody levels

Question 3

A specialty pharmacist is reviewing a new prescription for ocrelizumab for a patient with relapsing-remitting multiple sclerosis. Which of the following baseline screenings is essential before the patient can receive their first dose?

Accepted Answer

Hepatitis B virus (HBV) screening

Answer

Ophthalmologic exam including optical coherence tomography (OCT)

Answer

Tuberculosis (TB) skin test or interferon-gamma release assay (IGRA)

Answer

Lipid panel and liver function tests (LFTs)

Question 4

Which of the following biologic DMARDs used for rheumatoid arthritis works by inhibiting T-cell activation through binding to CD80 and CD86?

Accepted Answer

Abatacept

Answer

Adalimumab

Answer

Rituximab

Answer

Tocilizumab

Question 5

A patient with severe plaque psoriasis has been stable on adalimumab for two years. They call the specialty pharmacy to report that their symptoms have been worsening over the last three months despite adherence to their injections. What is the most likely immunological reason for this secondary loss of response?

Accepted Answer

Formation of anti-drug antibodies (ADAs)

Answer

Tachyphylaxis due to receptor downregulation

Answer

Increased drug clearance due to metabolic changes

Answer

Disease progression to a non-TNF-mediated pathway

Question 6

A specialty pharmacist is counseling a patient starting on an interleukin-6 (IL-6) inhibitor, such as tocilizumab or sarilumab, for rheumatoid arthritis. In addition to the risk of serious infections, which of the following laboratory parameters requires routine monitoring with this class of medication?

Accepted Answer

Absolute neutrophil count (ANC) and liver function tests (LFTs)

Answer

Serum uric acid

Answer

Creatine phosphokinase (CPK)

Answer

Serum creatinine and BUN

A patient with rheumatoid arthritis, who has failed methotrexate monotherapy, is being started on a Janus kinase (JAK) inhibitor.Which of the following represents a class-wide black box warning for JAK inhibitors that the specialty pharmacist must counsel the patient on?

A patient with rheumatoid arthritis, who has failed methotrexate monotherapy, is being started on a Janus kinase (JAK) inhibitor.
Which of the following represents a class-wide black box warning for JAK inhibitors that the specialty pharmacist must counsel the patient on?