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

Initiate loperamide and continue pembrolizumab at the current dose.

Answer

Administer a dose of infliximab and continue pembrolizumab.

Answer

Switch to a different immune checkpoint inhibitor, such as nivolumab.

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

The medication can be taken at any time of day, with or without food.

Answer

It is safe to take over-the-counter antacids concurrently for stomach upset.

Answer

Missed doses should be doubled up at the next scheduled time to maintain efficacy.

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

Trastuzumab (Herceptin)

Answer

Rituximab (Rituxan)

Answer

Paclitaxel (Taxol)

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

Dispense both medications as prescribed with a warning to monitor for liver toxicity.

Answer

Recommend increasing the dose of palbociclib to overcome the interaction.

Answer

Advise the patient to separate the administration times by at least 12 hours.

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

Performing diagnostic imaging to assess tumor response.

Answer

Administering intravenous supportive care medications in the clinic.

Answer

Prescribing the initial oral chemotherapy regimen.

Question 6

A patient receiving chemotherapy for colon cancer develops Grade 2 mucositis. Which of the following interventions would be an appropriate supportive care recommendation from the specialty pharmacist?

Accepted Answer

Advise a bland, soft diet and a 'magic mouthwash' containing lidocaine.

Answer

Initiate prophylactic systemic antibiotics.

Answer

Prescribe a potent opioid analgesic like fentanyl.

Answer

Immediately hold the next cycle of chemotherapy.