CSP EXAM TEST (SPECIALTY PHARMACY) WITH CORRECT ANSWERS!!
Question 1
In specialty pharmacy, the Proportion of Days Covered (PDC) is a preferred method for
calculating medication adherence. What is the correct formula for calculating PDC?
A) (Total days supply in a period / number of days in the period) x 100
B) (# of unique days with supply / number of days in a period) x 100
C) (Total refills in 6 months / 180 days) x 100
D) (Number of pills remaining / number of pills dispensed) x 100
E) (Days between first and last fill / number of fills) x 100
Correct Answer: B) PDC = (# of unique days with supply / number of days in a period) x 100
Rationale: PDC is the gold standard for adherence measurement because it accounts for
overlapping fills by looking at "unique days" covered by the medication. Unlike the
Medication Possession Ratio (MPR), which can exceed 100% and overestimate adherence,
the PDC is capped at 100% and provides a more accurate reflection of the patient's actual
coverage over a defined calendar period.
Question 2
Which of the following specialty medications is classified as a Janus kinase (JAK) inhibitor?
A) Humira (adalimumab)
B) Orencia (abatacept)
) Actemra (tocilizumab)
D) Xeljanz (tofacitinib)
E) Enbrel (etanercept)
Correct Answer: D) Xeljanz (tofacitinib)
Rationale: Xeljanz (tofacitinib) is an oral small-molecule inhibitor of the JAK pathway
(specifically JAK1 and JAK3). Unlike the other options listed, which are injectable
biologics (TNF inhibitors like Humira and Enbrel, IL-6 inhibitors like Actemra, or T-cell
costimulation blockers like Orencia), JAK inhibitors work intracellularly to block cytokine
signaling.
Question 3
A patient treated for Rheumatoid Arthritis presents with a significant increase in total cholesterol
and LDL. Which of the following biologics is most likely responsible for this laboratory finding?
A) Actemra (tocilizumab)
B) Enbrel (etanercept)
C) Simponi (golimumab)
D) Kineret (anakinra)
E) Cimzia (certolizumab pegol)
Correct Answer: A) Actemra (tocilizumab)
Rationale: Actemra (tocilizumab), an Interleukin-6 (IL-6) receptor antagonist, is well-
, 2
documented to cause elevations in lipid parameters, including total cholesterol, LDL, and
triglycerides. Specialty pharmacists must monitor lipid panels periodically (usually 4–8
weeks after initiation) and manage these elevations according to clinical guidelines.
Question 4
When a patient is receiving a TNF-alpha inhibitor (such as adalimumab or infliximab), which
shingles vaccine is considered safe to administer?
A) Adacel
B) Zostavax
C) Shingrix
D) Varivax
E) M-M-R II
Correct Answer: C) Shingrix
Rationale: TNF inhibitors are immunosuppressants, and live-attenuated vaccines (like
Zostavax and Varivax) are generally contraindicated due to the risk of vaccine-derived
infection. Shingrix is a recombinant, non-live adjuvanted vaccine. Because it contains no
live virus, it is safe and recommended for immunocompromised patients requiring shingles
protection.
Question 5
While most biologics used in dermatology and rheumatology increase the risk of general
infections, which of the following is specifically noted for increasing the risk of neutropenia?
A) Rituxin (rituximab)
B) Taltz (ixekizumab)
C) Remicade (infliximab)
D) Cimzia (certolizumab pegol)
E) Cosentyx (secukinumab)
Correct Answer: B) Taltz (ixekizumab)
Rationale: Taltz (ixekizumab), an IL-17A inhibitor, has been associated with a higher
incidence of neutropenia compared to other biologics. Specialty pharmacists should
monitor absolute neutrophil counts (ANC) if the patient presents with signs of infection, as
IL-17 inhibitors can suppress the production and recruitment of neutrophils.
Question 6
Which of the following medications used for the treatment of plaque psoriasis does NOT require
the patient to be screened for latent tuberculosis (TB) prior to initiation?
A) Stelara (ustekinumab)
B) Otezla (apremilast)
C) Cosentyx (secukinumab)
, 3
D) Humira (adalimumab)
E) Tremfya (guselkumab)
Correct Answer: B) Otezla (apremilast)
Rationale: Otezla (apremilast) is an oral phosphodiesterase-4 (PDE4) inhibitor. Unlike
biologics (monoclonal antibodies) that significantly suppress the immune system and can
reactivate latent TB, Otezla has a different safety profile and does not require baseline TB
screening according to its FDA labeling.
Question 7
What is the standard starting dose for Taltz (ixekizumab) when specifically indicated for the
treatment of psoriatic arthritis?
A) 160mg SC at week 0, then 80mg SC every 2 weeks
B) 160mg SC once, followed by 80mg SC every 4 weeks
C) 160mg SC at week 0, then 80mg every week for 4 weeks
D) 80mg SC every other week
E) 45mg SC at week 0 and 4, then every 12 weeks
Correct Answer: B) 160mg SC once, followed by 80mg SC every 4 weeks
Rationale: The dosing for Taltz differs by indication. For Psoriatic Arthritis (and
Ankylosing Spondylitis), the starting dose is 160mg (two 80mg injections) followed by 80mg
every 4 weeks. This differs from Plaque Psoriasis, which involves a more frequent
induction phase (every 2 weeks for the first 12 weeks).
Question 8
A 45-year-old patient weighing 200 lbs is diagnosed with severe atopic dermatitis that has failed
topical steroids. Which specialty biologic is the most appropriate recommendation for this
patient?
A) Protopic (tacrolimus)
B) Humira (adalimumab)
C) Stelara (ustekinumab)
D) Dupixent (dupilumab)
E) Enbrel (etanercept)
Correct Answer: D) Dupixent (dupilumab)
Rationale: Dupixent (dupilumab) is an IL-4 receptor alpha antagonist indicated for
moderate-to-severe atopic dermatitis. It is the first biologic approved for this condition.
While Protopic is used for dermatitis, it is a topical calcineurin inhibitor, not a systemic
biologic. Humira and Stelara are not indicated for atopic dermatitis.
Question 9
A 56-year-old patient weighing 140 lbs (approx. 63.5 kg) is starting Stelara (ustekinumab) for
, 4
psoriasis. What is the recommended dosing schedule?
A) 45 mg SC at weeks 0 and 4, then every 12 weeks
B) 90 mg SC at weeks 0 and 4, then every 12 weeks
C) 260 mg IV as a single dose, then 90 mg SC every 8 weeks
D) 520 mg IV as a single dose, then 90 mg SC every 8 weeks
E) 45 mg SC once, then 45 mg every 4 weeks
Correct Answer: A) Inject 45 mg SC at weeks 0 and 4, followed by 45 mg every 12 weeks
Rationale: Stelara dosing for plaque psoriasis is weight-based. Patients weighing 100 kg
(220 lbs) or less receive 45 mg. Patients weighing more than 100 kg receive 90 mg. Option C
and D refer to the Crohn's disease/Ulcerative Colitis weight-based IV induction and SC
maintenance schedule, which is not applicable to psoriasis.
Question 10
In the context of oral oncology, which of the following medications does NOT require dose
adjustments or extreme caution specifically due to hepatic impairment?
A) Votrient (pazopanib)
B) Ibrance (palbociclib)
C) Zytiga (abiraterone acetate)
D) Tykerb (lapatinib)
E) Nexavar (sorafenib)
Correct Answer: B) Ibrance (palbociclib)
Rationale: While many kinase inhibitors (Votrient, Tykerb, Nexavar) and antiandrogens
(Zytiga) have significant hepatotoxicity warnings or require dose reductions in hepatic
impairment, Ibrance (a CDK 4/6 inhibitor) does not require a dose adjustment for mild or
moderate hepatic impairment, making it relatively safer in this specific regard.
Question 11
Which of the following is NOT a recognized side effect associated with Zytiga (abiraterone
acetate) therapy?
A) Edema
B) Hot flush
C) Hepatotoxicity
D) Mucositis
E) Hypokalemia
Correct Answer: D) Mucositis
Rationale: Zytiga works by inhibiting CYP17, which results in decreased cortisol and
mineralocorticoid excess. This leads to common side effects like hypertension, edema, and
hypokalemia (often managed with prednisone). Hot flushes and hepatotoxicity are also
Question 1
In specialty pharmacy, the Proportion of Days Covered (PDC) is a preferred method for
calculating medication adherence. What is the correct formula for calculating PDC?
A) (Total days supply in a period / number of days in the period) x 100
B) (# of unique days with supply / number of days in a period) x 100
C) (Total refills in 6 months / 180 days) x 100
D) (Number of pills remaining / number of pills dispensed) x 100
E) (Days between first and last fill / number of fills) x 100
Correct Answer: B) PDC = (# of unique days with supply / number of days in a period) x 100
Rationale: PDC is the gold standard for adherence measurement because it accounts for
overlapping fills by looking at "unique days" covered by the medication. Unlike the
Medication Possession Ratio (MPR), which can exceed 100% and overestimate adherence,
the PDC is capped at 100% and provides a more accurate reflection of the patient's actual
coverage over a defined calendar period.
Question 2
Which of the following specialty medications is classified as a Janus kinase (JAK) inhibitor?
A) Humira (adalimumab)
B) Orencia (abatacept)
) Actemra (tocilizumab)
D) Xeljanz (tofacitinib)
E) Enbrel (etanercept)
Correct Answer: D) Xeljanz (tofacitinib)
Rationale: Xeljanz (tofacitinib) is an oral small-molecule inhibitor of the JAK pathway
(specifically JAK1 and JAK3). Unlike the other options listed, which are injectable
biologics (TNF inhibitors like Humira and Enbrel, IL-6 inhibitors like Actemra, or T-cell
costimulation blockers like Orencia), JAK inhibitors work intracellularly to block cytokine
signaling.
Question 3
A patient treated for Rheumatoid Arthritis presents with a significant increase in total cholesterol
and LDL. Which of the following biologics is most likely responsible for this laboratory finding?
A) Actemra (tocilizumab)
B) Enbrel (etanercept)
C) Simponi (golimumab)
D) Kineret (anakinra)
E) Cimzia (certolizumab pegol)
Correct Answer: A) Actemra (tocilizumab)
Rationale: Actemra (tocilizumab), an Interleukin-6 (IL-6) receptor antagonist, is well-
, 2
documented to cause elevations in lipid parameters, including total cholesterol, LDL, and
triglycerides. Specialty pharmacists must monitor lipid panels periodically (usually 4–8
weeks after initiation) and manage these elevations according to clinical guidelines.
Question 4
When a patient is receiving a TNF-alpha inhibitor (such as adalimumab or infliximab), which
shingles vaccine is considered safe to administer?
A) Adacel
B) Zostavax
C) Shingrix
D) Varivax
E) M-M-R II
Correct Answer: C) Shingrix
Rationale: TNF inhibitors are immunosuppressants, and live-attenuated vaccines (like
Zostavax and Varivax) are generally contraindicated due to the risk of vaccine-derived
infection. Shingrix is a recombinant, non-live adjuvanted vaccine. Because it contains no
live virus, it is safe and recommended for immunocompromised patients requiring shingles
protection.
Question 5
While most biologics used in dermatology and rheumatology increase the risk of general
infections, which of the following is specifically noted for increasing the risk of neutropenia?
A) Rituxin (rituximab)
B) Taltz (ixekizumab)
C) Remicade (infliximab)
D) Cimzia (certolizumab pegol)
E) Cosentyx (secukinumab)
Correct Answer: B) Taltz (ixekizumab)
Rationale: Taltz (ixekizumab), an IL-17A inhibitor, has been associated with a higher
incidence of neutropenia compared to other biologics. Specialty pharmacists should
monitor absolute neutrophil counts (ANC) if the patient presents with signs of infection, as
IL-17 inhibitors can suppress the production and recruitment of neutrophils.
Question 6
Which of the following medications used for the treatment of plaque psoriasis does NOT require
the patient to be screened for latent tuberculosis (TB) prior to initiation?
A) Stelara (ustekinumab)
B) Otezla (apremilast)
C) Cosentyx (secukinumab)
, 3
D) Humira (adalimumab)
E) Tremfya (guselkumab)
Correct Answer: B) Otezla (apremilast)
Rationale: Otezla (apremilast) is an oral phosphodiesterase-4 (PDE4) inhibitor. Unlike
biologics (monoclonal antibodies) that significantly suppress the immune system and can
reactivate latent TB, Otezla has a different safety profile and does not require baseline TB
screening according to its FDA labeling.
Question 7
What is the standard starting dose for Taltz (ixekizumab) when specifically indicated for the
treatment of psoriatic arthritis?
A) 160mg SC at week 0, then 80mg SC every 2 weeks
B) 160mg SC once, followed by 80mg SC every 4 weeks
C) 160mg SC at week 0, then 80mg every week for 4 weeks
D) 80mg SC every other week
E) 45mg SC at week 0 and 4, then every 12 weeks
Correct Answer: B) 160mg SC once, followed by 80mg SC every 4 weeks
Rationale: The dosing for Taltz differs by indication. For Psoriatic Arthritis (and
Ankylosing Spondylitis), the starting dose is 160mg (two 80mg injections) followed by 80mg
every 4 weeks. This differs from Plaque Psoriasis, which involves a more frequent
induction phase (every 2 weeks for the first 12 weeks).
Question 8
A 45-year-old patient weighing 200 lbs is diagnosed with severe atopic dermatitis that has failed
topical steroids. Which specialty biologic is the most appropriate recommendation for this
patient?
A) Protopic (tacrolimus)
B) Humira (adalimumab)
C) Stelara (ustekinumab)
D) Dupixent (dupilumab)
E) Enbrel (etanercept)
Correct Answer: D) Dupixent (dupilumab)
Rationale: Dupixent (dupilumab) is an IL-4 receptor alpha antagonist indicated for
moderate-to-severe atopic dermatitis. It is the first biologic approved for this condition.
While Protopic is used for dermatitis, it is a topical calcineurin inhibitor, not a systemic
biologic. Humira and Stelara are not indicated for atopic dermatitis.
Question 9
A 56-year-old patient weighing 140 lbs (approx. 63.5 kg) is starting Stelara (ustekinumab) for
, 4
psoriasis. What is the recommended dosing schedule?
A) 45 mg SC at weeks 0 and 4, then every 12 weeks
B) 90 mg SC at weeks 0 and 4, then every 12 weeks
C) 260 mg IV as a single dose, then 90 mg SC every 8 weeks
D) 520 mg IV as a single dose, then 90 mg SC every 8 weeks
E) 45 mg SC once, then 45 mg every 4 weeks
Correct Answer: A) Inject 45 mg SC at weeks 0 and 4, followed by 45 mg every 12 weeks
Rationale: Stelara dosing for plaque psoriasis is weight-based. Patients weighing 100 kg
(220 lbs) or less receive 45 mg. Patients weighing more than 100 kg receive 90 mg. Option C
and D refer to the Crohn's disease/Ulcerative Colitis weight-based IV induction and SC
maintenance schedule, which is not applicable to psoriasis.
Question 10
In the context of oral oncology, which of the following medications does NOT require dose
adjustments or extreme caution specifically due to hepatic impairment?
A) Votrient (pazopanib)
B) Ibrance (palbociclib)
C) Zytiga (abiraterone acetate)
D) Tykerb (lapatinib)
E) Nexavar (sorafenib)
Correct Answer: B) Ibrance (palbociclib)
Rationale: While many kinase inhibitors (Votrient, Tykerb, Nexavar) and antiandrogens
(Zytiga) have significant hepatotoxicity warnings or require dose reductions in hepatic
impairment, Ibrance (a CDK 4/6 inhibitor) does not require a dose adjustment for mild or
moderate hepatic impairment, making it relatively safer in this specific regard.
Question 11
Which of the following is NOT a recognized side effect associated with Zytiga (abiraterone
acetate) therapy?
A) Edema
B) Hot flush
C) Hepatotoxicity
D) Mucositis
E) Hypokalemia
Correct Answer: D) Mucositis
Rationale: Zytiga works by inhibiting CYP17, which results in decreased cortisol and
mineralocorticoid excess. This leads to common side effects like hypertension, edema, and
hypokalemia (often managed with prednisone). Hot flushes and hepatotoxicity are also
