CSP EXAM TEST (SPECIALTY PHARMACY) WITH CORRECT ANSWERS!!
Question 1
Which of the following CDK4/6 inhibitors is the only agent in its class that is currently FDA-
approved for use as monotherapy in certain breast cancer settings?
A) Palbociclib (Ibrance)
B) Ribociclib (Kisqali)
C) Abemaciclib (Verzenio)
D) Trilaciclib (Cosela)
E) Alpelisib (Piqray)
Correct Answer: C) Verzenio (abemaciclib)
Rationale: Abemaciclib is unique among the CDK4/6 inhibitors because it has demonstrated
sufficient activity as a single agent to be approved for monotherapy in patients with
HR+/HER2- metastatic breast cancer that has progressed after prior endocrine therapy
and chemotherapy.
Question 2
A patient is starting Ibrance (palbociclib) capsules for metastatic breast cancer. What is the
correct counseling regarding administration with food?
A) Take on an empty stomach 1 hour before a meal.
B) Take with food.
C) Take at least 2 hours after a high-fat meal.
D) May be taken with or without food.
E) Take only with grapefruit juice to increase absorption.
Correct Answer: B) with food
Rationale: Ibrance (palbociclib) capsules must be taken with food to ensure consistent
absorption. However, the tablet formulation of Ibrance is different and may be taken with
or without food.
Question 3
What is the primary dose-limiting toxicity and most common Adverse Drug Event (ADE)
associated with palbociclib (Ibrance)?
A) Diarrhea
B) Hypertension
C) Myelosuppression
D) QTc prolongation
E) Hand-foot syndrome
Correct Answer: C) myelosuppression
Rationale: Neutropenia is the most common side effect of CDK4/6 inhibitors like
palbociclib. Unlike traditional chemotherapy-induced neutropenia, it is rapidly reversible
upon dose interruption.
, 2
Question 4
In addition to myelosuppression, which specific cardiac toxicity requires baseline and periodic
EKG monitoring for patients taking Kisqali (ribociclib)?
A) Left ventricular ejection fraction (LVEF) decrease
B) QTc prolongation
C) Tachycardia
D) Atrial fibrillation
E) Hypertension
Correct Answer: B) QTc prolongation
Rationale: Ribociclib is the only CDK4/6 inhibitor with a significant risk of QTc interval
prolongation. Monitoring EKGs and electrolytes (potassium, calcium, magnesium) is
mandatory at baseline and during treatment.
Question 5
Which of the following is the most significant and frequent non-hematologic Adverse Drug
Event associated with Verzenio (abemaciclib)?
A) Myelosuppression
B) Diarrhea
C) QTc prolongation
D) Hepatotoxicity
E) Nephrotoxicity
Correct Answer: B) diarrhea
Rationale: Diarrhea is the most common side effect of abemaciclib, occurring in the vast
majority of patients. It typically occurs early in the first cycle and is managed with
loperamide and dose adjustments.
Question 6
What is the standard dosing schedule for Sutent (sunitinib) in the treatment of advanced renal
cell carcinoma (RCC)?
A) 50mg daily continuously
B) 25mg daily for 2 weeks on, 1 week off
C) 50mg daily for 4 weeks on, 2 weeks off
D) 37.5mg daily for 4 weeks on, 4 weeks off
E) 12.5mg daily continuously
Correct Answer: C) 50mg PO once daily for 4 weeks on, and then 2 weeks off until
progression
Rationale: Sunitinib is traditionally dosed on a "4 weeks on, 2 weeks off" cycle. This allows
for recovery from side effects like fatigue, hypertension, and hand-foot syndrome.
Question 7
Votrient (pazopanib) carries a prominent Black Box Warning (BBW) for which of the following?
, 3
A) Arterial thrombosis
B) Myocardial infarction
C) Hepatotoxicity
D) Differentiation syndrome
E) Encephalopathy
Correct Answer: C) hepatotoxicity
Rationale: Pazopanib is associated with severe and potentially fatal hepatotoxicity. Liver
function tests (ALT, AST, and bilirubin) must be monitored frequently throughout
treatment.
Question 8
Which of the following oral oncology agents requires the patient to avoid the use of Proton Pump
Inhibitors (PPIs) and stagger administration with antacids by at least 2 hours?
A) Imatinib (Gleevec)
B) Bosutinib (Bosulif)
C) Palbociclib (Ibrance)
D) Abemaciclib (Verzenio)
E) Pomalidomide (Pomalyst)
Correct Answer: B) Bosulif (bosutinib)
Rationale: Bosutinib absorption is pH-dependent. PPIs can significantly decrease its plasma
concentrations and should be avoided. If an antacid or H2-antagonist is needed, dosing
must be separated.
Question 9
A patient with CML tests positive for the T315I mutation. Which of the following BCR-ABL
Tyrosine Kinase Inhibitors (TKIs) is indicated specifically for this mutation?
A) Imatinib (Gleevec)
B) Dasatinib (Sprycel)
C) Nilotinib (Tasigna)
D) Ponatinib (Iclusig)
E) Bosutinib (Bosulif)
Correct Answer: D) Iclusig (ponatinib)
Rationale: Ponatinib was specifically designed to overcome the T315I "gatekeeper"
mutation, which confers resistance to all other currently available BCR-ABL TKIs.
Question 10
Iclusig (ponatinib) carries a Black Box Warning for which life-threatening toxicity?
A) Diarrhea
B) Myelosuppression
C) Arterial thrombosis
D) Pulmonary edema
, 4
E) Stevens-Johnson Syndrome
Correct Answer: C) Arterial thrombosis
Rationale: Ponatinib is associated with a very high risk of serious arterial thromboembolic
events (myocardial infarction, stroke) and hepatotoxicity, requiring strict risk-benefit
assessment.
Question 11
What is the correct administration counseling for Tasigna (nilotinib) regarding food intake?
A) Take with a high-fat meal.
B) Take with food.
C) Take on an empty stomach (1 hour before or 2 hours after food).
D) Take only with water during a meal.
E) Food has no effect on this medication.
Correct Answer: C) without food
Rationale: Nilotinib must be taken on an empty stomach. Food, especially high-fat meals,
significantly increases the bioavailability of nilotinib, which increases the risk of QTc
prolongation and sudden death.
Question 12
Which of the following medications is associated with a risk of "Differentiation Syndrome,"
requiring a Black Box Warning and monitoring for symptoms like fever and dyspnea?
A) Ibrutinib (Imbruvica)
B) Idelalisib (Zydelig)
C) Enasidenib (Idhifa)
D) Bosutinib (Bosulif)
E) Pazopanib (Votrient)
Correct Answer: C) Idhifa (enasidenib)
Rationale: Enasidenib and other IDH inhibitors (like Tibsovo and Xospata) can cause
differentiation syndrome, a potentially fatal condition caused by the rapid maturation and
proliferation of myeloid cells.
Question 13
Which proteasome inhibitor is administered orally and should be taken on an empty stomach at
least 1 hour before or 2 hours after a meal?
A) Bortezomib (Velcade)
B) Carfilzomib (Kyprolis)
C) Ixazomib (Ninlaro)
D) Panobinostat (Farydak)
E) Daratumumab (Darzalex)
Correct Answer: C) Ninlaro (ixazomib)
Question 1
Which of the following CDK4/6 inhibitors is the only agent in its class that is currently FDA-
approved for use as monotherapy in certain breast cancer settings?
A) Palbociclib (Ibrance)
B) Ribociclib (Kisqali)
C) Abemaciclib (Verzenio)
D) Trilaciclib (Cosela)
E) Alpelisib (Piqray)
Correct Answer: C) Verzenio (abemaciclib)
Rationale: Abemaciclib is unique among the CDK4/6 inhibitors because it has demonstrated
sufficient activity as a single agent to be approved for monotherapy in patients with
HR+/HER2- metastatic breast cancer that has progressed after prior endocrine therapy
and chemotherapy.
Question 2
A patient is starting Ibrance (palbociclib) capsules for metastatic breast cancer. What is the
correct counseling regarding administration with food?
A) Take on an empty stomach 1 hour before a meal.
B) Take with food.
C) Take at least 2 hours after a high-fat meal.
D) May be taken with or without food.
E) Take only with grapefruit juice to increase absorption.
Correct Answer: B) with food
Rationale: Ibrance (palbociclib) capsules must be taken with food to ensure consistent
absorption. However, the tablet formulation of Ibrance is different and may be taken with
or without food.
Question 3
What is the primary dose-limiting toxicity and most common Adverse Drug Event (ADE)
associated with palbociclib (Ibrance)?
A) Diarrhea
B) Hypertension
C) Myelosuppression
D) QTc prolongation
E) Hand-foot syndrome
Correct Answer: C) myelosuppression
Rationale: Neutropenia is the most common side effect of CDK4/6 inhibitors like
palbociclib. Unlike traditional chemotherapy-induced neutropenia, it is rapidly reversible
upon dose interruption.
, 2
Question 4
In addition to myelosuppression, which specific cardiac toxicity requires baseline and periodic
EKG monitoring for patients taking Kisqali (ribociclib)?
A) Left ventricular ejection fraction (LVEF) decrease
B) QTc prolongation
C) Tachycardia
D) Atrial fibrillation
E) Hypertension
Correct Answer: B) QTc prolongation
Rationale: Ribociclib is the only CDK4/6 inhibitor with a significant risk of QTc interval
prolongation. Monitoring EKGs and electrolytes (potassium, calcium, magnesium) is
mandatory at baseline and during treatment.
Question 5
Which of the following is the most significant and frequent non-hematologic Adverse Drug
Event associated with Verzenio (abemaciclib)?
A) Myelosuppression
B) Diarrhea
C) QTc prolongation
D) Hepatotoxicity
E) Nephrotoxicity
Correct Answer: B) diarrhea
Rationale: Diarrhea is the most common side effect of abemaciclib, occurring in the vast
majority of patients. It typically occurs early in the first cycle and is managed with
loperamide and dose adjustments.
Question 6
What is the standard dosing schedule for Sutent (sunitinib) in the treatment of advanced renal
cell carcinoma (RCC)?
A) 50mg daily continuously
B) 25mg daily for 2 weeks on, 1 week off
C) 50mg daily for 4 weeks on, 2 weeks off
D) 37.5mg daily for 4 weeks on, 4 weeks off
E) 12.5mg daily continuously
Correct Answer: C) 50mg PO once daily for 4 weeks on, and then 2 weeks off until
progression
Rationale: Sunitinib is traditionally dosed on a "4 weeks on, 2 weeks off" cycle. This allows
for recovery from side effects like fatigue, hypertension, and hand-foot syndrome.
Question 7
Votrient (pazopanib) carries a prominent Black Box Warning (BBW) for which of the following?
, 3
A) Arterial thrombosis
B) Myocardial infarction
C) Hepatotoxicity
D) Differentiation syndrome
E) Encephalopathy
Correct Answer: C) hepatotoxicity
Rationale: Pazopanib is associated with severe and potentially fatal hepatotoxicity. Liver
function tests (ALT, AST, and bilirubin) must be monitored frequently throughout
treatment.
Question 8
Which of the following oral oncology agents requires the patient to avoid the use of Proton Pump
Inhibitors (PPIs) and stagger administration with antacids by at least 2 hours?
A) Imatinib (Gleevec)
B) Bosutinib (Bosulif)
C) Palbociclib (Ibrance)
D) Abemaciclib (Verzenio)
E) Pomalidomide (Pomalyst)
Correct Answer: B) Bosulif (bosutinib)
Rationale: Bosutinib absorption is pH-dependent. PPIs can significantly decrease its plasma
concentrations and should be avoided. If an antacid or H2-antagonist is needed, dosing
must be separated.
Question 9
A patient with CML tests positive for the T315I mutation. Which of the following BCR-ABL
Tyrosine Kinase Inhibitors (TKIs) is indicated specifically for this mutation?
A) Imatinib (Gleevec)
B) Dasatinib (Sprycel)
C) Nilotinib (Tasigna)
D) Ponatinib (Iclusig)
E) Bosutinib (Bosulif)
Correct Answer: D) Iclusig (ponatinib)
Rationale: Ponatinib was specifically designed to overcome the T315I "gatekeeper"
mutation, which confers resistance to all other currently available BCR-ABL TKIs.
Question 10
Iclusig (ponatinib) carries a Black Box Warning for which life-threatening toxicity?
A) Diarrhea
B) Myelosuppression
C) Arterial thrombosis
D) Pulmonary edema
, 4
E) Stevens-Johnson Syndrome
Correct Answer: C) Arterial thrombosis
Rationale: Ponatinib is associated with a very high risk of serious arterial thromboembolic
events (myocardial infarction, stroke) and hepatotoxicity, requiring strict risk-benefit
assessment.
Question 11
What is the correct administration counseling for Tasigna (nilotinib) regarding food intake?
A) Take with a high-fat meal.
B) Take with food.
C) Take on an empty stomach (1 hour before or 2 hours after food).
D) Take only with water during a meal.
E) Food has no effect on this medication.
Correct Answer: C) without food
Rationale: Nilotinib must be taken on an empty stomach. Food, especially high-fat meals,
significantly increases the bioavailability of nilotinib, which increases the risk of QTc
prolongation and sudden death.
Question 12
Which of the following medications is associated with a risk of "Differentiation Syndrome,"
requiring a Black Box Warning and monitoring for symptoms like fever and dyspnea?
A) Ibrutinib (Imbruvica)
B) Idelalisib (Zydelig)
C) Enasidenib (Idhifa)
D) Bosutinib (Bosulif)
E) Pazopanib (Votrient)
Correct Answer: C) Idhifa (enasidenib)
Rationale: Enasidenib and other IDH inhibitors (like Tibsovo and Xospata) can cause
differentiation syndrome, a potentially fatal condition caused by the rapid maturation and
proliferation of myeloid cells.
Question 13
Which proteasome inhibitor is administered orally and should be taken on an empty stomach at
least 1 hour before or 2 hours after a meal?
A) Bortezomib (Velcade)
B) Carfilzomib (Kyprolis)
C) Ixazomib (Ninlaro)
D) Panobinostat (Farydak)
E) Daratumumab (Darzalex)
Correct Answer: C) Ninlaro (ixazomib)
