CSP EXAM TEST SPECIALTY PHARMACY 2025/2026 UPDATE | COMPREHENSIVE QUESTIONS
AND VERIFIED ANSWERS (COMPLETE SOLUTIONS) A+ GRADE!!
Question 1
In specialty pharmacy, the Proportion of Days Covered (PDC) is a key metric for adherence.
How is PDC calculated?
A) (Number of days in a period / Number of unique days with supply) x 100
B) (Total number of pills dispensed / Total days in a year) x 100
C) (Number of unique days with supply / Number of days in a period) x 100
D) (Number of refills / Number of prescribed days) x 100
E) (Days supply of first fill + Days supply of last fill) / 2
Correct Answer: C) (Number of unique days with supply / Number of days in a period) x 100
Rationale: PDC is the preferred method for measuring adherence in specialty pharmacy. It
calculates the proportion of time a patient has medication available based on the overlap of
days' supply. A PDC of 80% or higher is typically considered "adherent."
Question 2
Which of the following medications is classified as a Janus Kinase (JAK) inhibitor?
A) Humira (adalimumab)
B) Orencia (abatacept)
C) Actemra (tocilizumab)
D) Xeljanz (tofacitinib)
E) Enbrel (etanercept)
Correct Answer: D) Xeljanz (tofacitinib)
Rationale: Xeljanz is an oral small-molecule JAK inhibitor used for Rheumatoid Arthritis
and Psoriatic Arthritis. Adalimumab and etanercept are TNF inhibitors, abatacept is a T-
cell costimulation modulator, and tocilizumab is an IL-6 inhibitor.
Question 3
A patient starting therapy for Rheumatoid Arthritis is concerned about their lipid profile. Which
medication is specifically known to potentially elevate cholesterol levels?
A) Actemra (tocilizumab)
B) Enbrel (etanercept)
C) Simponi (golimumab)
D) Kineret (anakinra)
E) Humira (adalimumab)
Correct Answer: A) Actemra (tocilizumab)
Rationale: Actemra (an IL-6 receptor antagonist) is associated with increases in lipid
parameters, including total cholesterol, triglycerides, LDL, and HDL. Patients on Actemra
should have their lipids monitored 4–8 weeks after starting therapy.
, 2
Question 4
When a patient is on a Tumor Necrosis Factor (TNF) inhibitor, which shingles vaccine is
considered safe to administer?
A) Adacel
B) Zostavax
C) Shingrix
D) Varivax
E) Gardasil 9
Correct Answer: C) Shingrix
Rationale: Shingrix is a recombinant, non-live (inactivated) vaccine, making it safe for
immunocompromised patients or those on biologics. Zostavax and Varivax are live-
attenuated vaccines and are generally contraindicated with TNF inhibitors.
Question 5
While most biologics increase the general risk of infection, which of the following medications
also carries a specific increased risk of neutropenia?
A) Rituxan (rituximab)
B) Taltz (ixekizumab)
C) Remicade (infliximab)
D) Cimzia (certolizumab pegol)
E) Cosentyx (secukinumab)
Correct Answer: B) Taltz (ixekizumab)
Rationale: Taltz, an IL-17A inhibitor, has been associated with an increased risk of
neutropenia. Monitoring of absolute neutrophil count (ANC) may be required if signs of
infection occur.
Question 6
A patient with psoriasis is being screened for a new medication. Which of the following does
NOT require a baseline screening for tuberculosis (TB)?
A) Stelara (ustekinumab)
B) Otezla (apremilast)
C) Cosentyx (secukinumab)
D) Humira (adalimumab)
E) Enbrel (etanercept)
Correct Answer: B) Otezla (apremilast)
Rationale: Otezla is a PDE4 inhibitor, not a biologic. Unlike TNF inhibitors (Humira,
Enbrel) or IL-inhibitors (Stelara, Cosentyx), Otezla does not have a black box warning or
requirement for TB screening prior to initiation.
Question 7
What is the standard starting/loading dose for Taltz (ixekizumab) when used specifically to treat
, 3
psoriatic arthritis?
A) 160mg SC at week 0, then 80mg every 2 weeks
B) 160mg SC at week 0, then 80mg every 4 weeks
C) 80mg SC at week 0, then 80mg every 4 weeks
D) 160mg SC at week 0, then 80mg at weeks 2, 4, 6, 8, 10, and 12
E) 45mg SC at weeks 0 and 4, then every 12 weeks
Correct Answer: B) 160mg SC at week 0, then 80mg every 4 weeks
Rationale: For psoriatic arthritis (and ankylosing spondylitis), the recommended dose is a
160 mg loading dose (two 80 mg injections) followed by 80 mg every 4 weeks. Note that the
dosing for plaque psoriasis is more frequent during the induction phase (every 2 weeks).
Question 8
A 45-year-old, 200lb patient presents with severe atopic dermatitis. Which biologic medication is
the primary recommendation for this condition?
A) Protopic (tacrolimus)
B) Humira (adalimumab)
C) Stelara (ustekinumab)
D) Dupixent (dupilumab)
E) Xeljanz (tofacitinib)
Correct Answer: D) Dupixent (dupilumab)
Rationale: Dupixent is an IL-4 receptor alpha antagonist indicated specifically for
moderate-to-severe atopic dermatitis. Protopic is a topical ointment, not a systemic
biologic.
Question 9
A 56-year-old patient weighing 140 lbs (approx. 63.5 kg) is starting Stelara (ustekinumab) for
psoriasis. What is the correct dosing schedule?
A) 45 mg SC at weeks 0 and 4, followed by 45 mg every 12 weeks
B) 90 mg SC at weeks 0 and 4, followed by 90 mg every 12 weeks
C) 260 mg IV single dose, followed by 90 mg SC every 8 weeks
D) 45 mg SC every 4 weeks for life
E) 90 mg SC at weeks 0 and 4, followed by 45 mg every 12 weeks
Correct Answer: A) 45 mg SC at weeks 0 and 4, followed by 45 mg every 12 weeks
Rationale: For plaque psoriasis, Stelara is weight-based. Patients weighing ≤100 kg (220 lbs)
receive 45 mg. Patients weighing >100 kg receive 90 mg. The schedule is weeks 0, 4, and
then every 12 weeks.
Question 10
Which of the following oral oncology medications does NOT require specific dose adjustments
or extreme caution in patients with hepatic impairment?
A) Votrient (pazopanib)
AND VERIFIED ANSWERS (COMPLETE SOLUTIONS) A+ GRADE!!
Question 1
In specialty pharmacy, the Proportion of Days Covered (PDC) is a key metric for adherence.
How is PDC calculated?
A) (Number of days in a period / Number of unique days with supply) x 100
B) (Total number of pills dispensed / Total days in a year) x 100
C) (Number of unique days with supply / Number of days in a period) x 100
D) (Number of refills / Number of prescribed days) x 100
E) (Days supply of first fill + Days supply of last fill) / 2
Correct Answer: C) (Number of unique days with supply / Number of days in a period) x 100
Rationale: PDC is the preferred method for measuring adherence in specialty pharmacy. It
calculates the proportion of time a patient has medication available based on the overlap of
days' supply. A PDC of 80% or higher is typically considered "adherent."
Question 2
Which of the following medications is classified as a Janus Kinase (JAK) inhibitor?
A) Humira (adalimumab)
B) Orencia (abatacept)
C) Actemra (tocilizumab)
D) Xeljanz (tofacitinib)
E) Enbrel (etanercept)
Correct Answer: D) Xeljanz (tofacitinib)
Rationale: Xeljanz is an oral small-molecule JAK inhibitor used for Rheumatoid Arthritis
and Psoriatic Arthritis. Adalimumab and etanercept are TNF inhibitors, abatacept is a T-
cell costimulation modulator, and tocilizumab is an IL-6 inhibitor.
Question 3
A patient starting therapy for Rheumatoid Arthritis is concerned about their lipid profile. Which
medication is specifically known to potentially elevate cholesterol levels?
A) Actemra (tocilizumab)
B) Enbrel (etanercept)
C) Simponi (golimumab)
D) Kineret (anakinra)
E) Humira (adalimumab)
Correct Answer: A) Actemra (tocilizumab)
Rationale: Actemra (an IL-6 receptor antagonist) is associated with increases in lipid
parameters, including total cholesterol, triglycerides, LDL, and HDL. Patients on Actemra
should have their lipids monitored 4–8 weeks after starting therapy.
, 2
Question 4
When a patient is on a Tumor Necrosis Factor (TNF) inhibitor, which shingles vaccine is
considered safe to administer?
A) Adacel
B) Zostavax
C) Shingrix
D) Varivax
E) Gardasil 9
Correct Answer: C) Shingrix
Rationale: Shingrix is a recombinant, non-live (inactivated) vaccine, making it safe for
immunocompromised patients or those on biologics. Zostavax and Varivax are live-
attenuated vaccines and are generally contraindicated with TNF inhibitors.
Question 5
While most biologics increase the general risk of infection, which of the following medications
also carries a specific increased risk of neutropenia?
A) Rituxan (rituximab)
B) Taltz (ixekizumab)
C) Remicade (infliximab)
D) Cimzia (certolizumab pegol)
E) Cosentyx (secukinumab)
Correct Answer: B) Taltz (ixekizumab)
Rationale: Taltz, an IL-17A inhibitor, has been associated with an increased risk of
neutropenia. Monitoring of absolute neutrophil count (ANC) may be required if signs of
infection occur.
Question 6
A patient with psoriasis is being screened for a new medication. Which of the following does
NOT require a baseline screening for tuberculosis (TB)?
A) Stelara (ustekinumab)
B) Otezla (apremilast)
C) Cosentyx (secukinumab)
D) Humira (adalimumab)
E) Enbrel (etanercept)
Correct Answer: B) Otezla (apremilast)
Rationale: Otezla is a PDE4 inhibitor, not a biologic. Unlike TNF inhibitors (Humira,
Enbrel) or IL-inhibitors (Stelara, Cosentyx), Otezla does not have a black box warning or
requirement for TB screening prior to initiation.
Question 7
What is the standard starting/loading dose for Taltz (ixekizumab) when used specifically to treat
, 3
psoriatic arthritis?
A) 160mg SC at week 0, then 80mg every 2 weeks
B) 160mg SC at week 0, then 80mg every 4 weeks
C) 80mg SC at week 0, then 80mg every 4 weeks
D) 160mg SC at week 0, then 80mg at weeks 2, 4, 6, 8, 10, and 12
E) 45mg SC at weeks 0 and 4, then every 12 weeks
Correct Answer: B) 160mg SC at week 0, then 80mg every 4 weeks
Rationale: For psoriatic arthritis (and ankylosing spondylitis), the recommended dose is a
160 mg loading dose (two 80 mg injections) followed by 80 mg every 4 weeks. Note that the
dosing for plaque psoriasis is more frequent during the induction phase (every 2 weeks).
Question 8
A 45-year-old, 200lb patient presents with severe atopic dermatitis. Which biologic medication is
the primary recommendation for this condition?
A) Protopic (tacrolimus)
B) Humira (adalimumab)
C) Stelara (ustekinumab)
D) Dupixent (dupilumab)
E) Xeljanz (tofacitinib)
Correct Answer: D) Dupixent (dupilumab)
Rationale: Dupixent is an IL-4 receptor alpha antagonist indicated specifically for
moderate-to-severe atopic dermatitis. Protopic is a topical ointment, not a systemic
biologic.
Question 9
A 56-year-old patient weighing 140 lbs (approx. 63.5 kg) is starting Stelara (ustekinumab) for
psoriasis. What is the correct dosing schedule?
A) 45 mg SC at weeks 0 and 4, followed by 45 mg every 12 weeks
B) 90 mg SC at weeks 0 and 4, followed by 90 mg every 12 weeks
C) 260 mg IV single dose, followed by 90 mg SC every 8 weeks
D) 45 mg SC every 4 weeks for life
E) 90 mg SC at weeks 0 and 4, followed by 45 mg every 12 weeks
Correct Answer: A) 45 mg SC at weeks 0 and 4, followed by 45 mg every 12 weeks
Rationale: For plaque psoriasis, Stelara is weight-based. Patients weighing ≤100 kg (220 lbs)
receive 45 mg. Patients weighing >100 kg receive 90 mg. The schedule is weeks 0, 4, and
then every 12 weeks.
Question 10
Which of the following oral oncology medications does NOT require specific dose adjustments
or extreme caution in patients with hepatic impairment?
A) Votrient (pazopanib)
