CSP NASP QUESTION BANK + CSP
HANDBOOK QUESTIONS & ANSWERS
RATED 100% CORRECT
RB is a 20 year old female recently approved for CF treatment with Trikafta®
(elexacaftor/tezacaftor/ivacaftor). She is homozygous for the F508 del mutation in the CFTR
gene and meets criteria for treatment with this medication. Her current medications include
inhaled albuterol, normal saline, tobramycin, Advair® and Pulmozyme®. She is also taking
buspirone, cetirizine, vitamin D3, insulin (regular and long acting), montelukast, omeprazole,
and Creon®. What is an important counseling point to cover with RB?
Trikafta® should be taken with a high fat containing meal and she should avoid food or drink
containing grapefruit.
Trikafta® is taken once a day with a high fat containing meal.
Patient can discontinue inhaled medications once she starts Trikafta®
None of the above
Trikafta® should be taken with a high fat containing meal and she should avoid food or drink
containing grapefruit.
AJ is a 32 year old female who presents to clinic 5 years post transplant. She and her husband
are considering starting a family and would like to know if it is safe for her to become pregnant.
Her post transplant immunosuppression regimen consists of tacrolimus 2mg BID,
mycophenolate mofetil 1000mg BID, and prednisone 5mg daily. Assuming she has no other
comorbidities, what recommendations would you make concerning her medication therapy if
she is wanting to conceive?
Patients cannot get pregnant post transplant
Discontinue tacrolimus and start cyclosporine modified
Discontinue mycophenolate mofetil and start Azathioprine
,No changes to medication therapy
Discontinue mycophenolate mofetil and start Azathioprine
MS is 45 yo African American Female with HCV thought to be acquired from a blood transfusion
during ASD repair in 1976. She has never been treated for HCV. She recently had an abdominal
ultrasound with shear wave elastography indicating a Metavir Score of F0-F1. PMH includes
migraines and hypertension. Recent pertinent labs include: GT 1A, HCV RNA 8,782,824 IU/ML,
baseline resistance testing not completed, AST 64, ALT 79, Plt 180, Hgb 13.2, CrCl 83ml/min.
Current medications include: multivitamin, lisinopril 10mg daily, sumatriptan 50mg prn
migraines. Which of the following regimens would you be most appropriate to treat MS's HCV?
Harvoni® (LDV/SOF) x8 weeks
Harvoni® (LDV/SOF) x12 weeks
Mavyret® (G/P) x12 weeks
Zepatier® (EBR/GZR) + RBV x12 weeks
Harvoni® (LDV/SOF) x12 weeks
Assuming she was treated with Harvoni® (LDV/SOF), when counseling MS, what is an important
topic to discuss with her regarding possible drug/drug interactions?
She must stop her sumatriptan when starting Harvoni® (LDV/SOF) due to significant drug/drug
interaction reducing efficacy of ledipasvir (LDV).
She must monitor her BP while on Harvoni® (LDV/SOF). Lisinopril concentrations can be
increased due to drug/drug interaction with ledipasvir (LDV) and she must monitor for
hypotension.
Ask MS if she takes any over the counter acid-reducing products not listed on her medication list
as these medications can decrease the absorption of ledipasvir (LDV), resulting in possible
effects on HCV treatment efficacy.
Tell her to stop all of her other medications now; Harvoni® (LDV/SOF) is the only medication
that matters anymore.
, Ask MS if she takes any over the counter acid-reducing products not listed on her medication list
as these medications can decrease the absorption of ledipasvir (LDV), resulting in possible
effects on HCV treatment efficacy.
AH is a 69 yo white M with HCV thought to be acquired via IVDU in the 1960s as well as multiple
prison tattoos. He is GT1a with a viral load of 17,586,502 IU/mL. He has never been treated for
his HCV. PMH includes CKD stage 5 on HD MWF, ischemic cardiomyopathy, MI x2, diabetes, and
HLD. His recent abdominal US with elastography reveals a Metavir score of F2. He recently
completed baseline resistance testing for NS5a resistance and this was unremarkable. Other
pertinent labs include: AST 60, ALT 55, Plt 274, Hgb 9.2, CrCl~13ml/min. Current medications
include: atorvastatin 10mg hs, pantoprazole 40mg qday, losartan 100mg daily, carvedilol 25mg
BID, Levemir 16units BID, SSI, Renvela 800mg TID, ASA 81mg daily. Which regimen would you
recommend to eradicate Mr. AH's HCV?
Harvoni® (LDV/SOF) x8 weeks
Epclusa® (SOF/VEL) + RBV x12weeks
Zepatier® (EBR/GZR) x12 weeks
Zepatier® (EBR/GZR) + RBV x12 weeks
Zepatier® (EBR/GZR) x12 weeks
AC is a 24 yo 80kg F with HCV that was diagnosed 8 months ago when she was admitted to
rehab for IVDU. Due to insurance requirements, she is set to start on Zepatier® (EBR/GZR) + RBV
in clinic tomorrow. Therapy is appropriate for her (GT1a, NS5A polymorphisms present,
treatment-naïve, F2) and all of her labs are WNL. She has no significant PMH and her
medications include norethindrone daily. Which of the following is true?
Ribavirin is teratogenic. AH must have a baseline pregnancy test and also be counseled
extensively on the use of 2 forms of contraception while on treatment and for 6 months after
treatment.
She must stop her current birth control pill as this is contraindicated with EBR/GZR due to risk
for increase in ALT.
She will need to start on a lower dose of ribavirin and titrate up as tolerated due to her young
age
HANDBOOK QUESTIONS & ANSWERS
RATED 100% CORRECT
RB is a 20 year old female recently approved for CF treatment with Trikafta®
(elexacaftor/tezacaftor/ivacaftor). She is homozygous for the F508 del mutation in the CFTR
gene and meets criteria for treatment with this medication. Her current medications include
inhaled albuterol, normal saline, tobramycin, Advair® and Pulmozyme®. She is also taking
buspirone, cetirizine, vitamin D3, insulin (regular and long acting), montelukast, omeprazole,
and Creon®. What is an important counseling point to cover with RB?
Trikafta® should be taken with a high fat containing meal and she should avoid food or drink
containing grapefruit.
Trikafta® is taken once a day with a high fat containing meal.
Patient can discontinue inhaled medications once she starts Trikafta®
None of the above
Trikafta® should be taken with a high fat containing meal and she should avoid food or drink
containing grapefruit.
AJ is a 32 year old female who presents to clinic 5 years post transplant. She and her husband
are considering starting a family and would like to know if it is safe for her to become pregnant.
Her post transplant immunosuppression regimen consists of tacrolimus 2mg BID,
mycophenolate mofetil 1000mg BID, and prednisone 5mg daily. Assuming she has no other
comorbidities, what recommendations would you make concerning her medication therapy if
she is wanting to conceive?
Patients cannot get pregnant post transplant
Discontinue tacrolimus and start cyclosporine modified
Discontinue mycophenolate mofetil and start Azathioprine
,No changes to medication therapy
Discontinue mycophenolate mofetil and start Azathioprine
MS is 45 yo African American Female with HCV thought to be acquired from a blood transfusion
during ASD repair in 1976. She has never been treated for HCV. She recently had an abdominal
ultrasound with shear wave elastography indicating a Metavir Score of F0-F1. PMH includes
migraines and hypertension. Recent pertinent labs include: GT 1A, HCV RNA 8,782,824 IU/ML,
baseline resistance testing not completed, AST 64, ALT 79, Plt 180, Hgb 13.2, CrCl 83ml/min.
Current medications include: multivitamin, lisinopril 10mg daily, sumatriptan 50mg prn
migraines. Which of the following regimens would you be most appropriate to treat MS's HCV?
Harvoni® (LDV/SOF) x8 weeks
Harvoni® (LDV/SOF) x12 weeks
Mavyret® (G/P) x12 weeks
Zepatier® (EBR/GZR) + RBV x12 weeks
Harvoni® (LDV/SOF) x12 weeks
Assuming she was treated with Harvoni® (LDV/SOF), when counseling MS, what is an important
topic to discuss with her regarding possible drug/drug interactions?
She must stop her sumatriptan when starting Harvoni® (LDV/SOF) due to significant drug/drug
interaction reducing efficacy of ledipasvir (LDV).
She must monitor her BP while on Harvoni® (LDV/SOF). Lisinopril concentrations can be
increased due to drug/drug interaction with ledipasvir (LDV) and she must monitor for
hypotension.
Ask MS if she takes any over the counter acid-reducing products not listed on her medication list
as these medications can decrease the absorption of ledipasvir (LDV), resulting in possible
effects on HCV treatment efficacy.
Tell her to stop all of her other medications now; Harvoni® (LDV/SOF) is the only medication
that matters anymore.
, Ask MS if she takes any over the counter acid-reducing products not listed on her medication list
as these medications can decrease the absorption of ledipasvir (LDV), resulting in possible
effects on HCV treatment efficacy.
AH is a 69 yo white M with HCV thought to be acquired via IVDU in the 1960s as well as multiple
prison tattoos. He is GT1a with a viral load of 17,586,502 IU/mL. He has never been treated for
his HCV. PMH includes CKD stage 5 on HD MWF, ischemic cardiomyopathy, MI x2, diabetes, and
HLD. His recent abdominal US with elastography reveals a Metavir score of F2. He recently
completed baseline resistance testing for NS5a resistance and this was unremarkable. Other
pertinent labs include: AST 60, ALT 55, Plt 274, Hgb 9.2, CrCl~13ml/min. Current medications
include: atorvastatin 10mg hs, pantoprazole 40mg qday, losartan 100mg daily, carvedilol 25mg
BID, Levemir 16units BID, SSI, Renvela 800mg TID, ASA 81mg daily. Which regimen would you
recommend to eradicate Mr. AH's HCV?
Harvoni® (LDV/SOF) x8 weeks
Epclusa® (SOF/VEL) + RBV x12weeks
Zepatier® (EBR/GZR) x12 weeks
Zepatier® (EBR/GZR) + RBV x12 weeks
Zepatier® (EBR/GZR) x12 weeks
AC is a 24 yo 80kg F with HCV that was diagnosed 8 months ago when she was admitted to
rehab for IVDU. Due to insurance requirements, she is set to start on Zepatier® (EBR/GZR) + RBV
in clinic tomorrow. Therapy is appropriate for her (GT1a, NS5A polymorphisms present,
treatment-naïve, F2) and all of her labs are WNL. She has no significant PMH and her
medications include norethindrone daily. Which of the following is true?
Ribavirin is teratogenic. AH must have a baseline pregnancy test and also be counseled
extensively on the use of 2 forms of contraception while on treatment and for 6 months after
treatment.
She must stop her current birth control pill as this is contraindicated with EBR/GZR due to risk
for increase in ALT.
She will need to start on a lower dose of ribavirin and titrate up as tolerated due to her young
age
