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Special Considerations for Special Conditions: The Community Pharmacist’s Guide to Specialty MedicationsEDUCATIONAL OBJECTIVES:After participating in this activity, pharmacists will be able to:Discuss the rapid growth of specialty pharmacy and the products most likely to be included in this category and provided by specialty-at-retailIdentify recent changes in oncology/neutropenia, rheumatologic conditions, and dermatology products provided in specialty-at-retail settingsDistinguish each FDA-approved product by condition it addressesMaximize the community pharmacist's role in specialty-at-retail product provision and counseling patients1. Approximately how much money was spent in the United States on specialty medications in 2016?a. $98 billionb. $115 billionc. $225 billion2. Which is among the drugs most commonly dispensed via specialty-at-retail programs?a. Drugs to treat cystic fibrosis and multiple sclerosisb. Drugs to treat hereditary hypercholesterolemiac. Drugs to treat rheumatologic and dermatologic conditions3. Among patients with psoriasis, how many can be expected to subsequently develop psoriatic arthritis?a. 10-30%b. 30-50%c. Nearly 100%4. Which of the following is a class of drugs that is administered orally to treat non-small cell lung cancer? a. Purine inhibitorsb. Tyrosine kinase inhibitorsc. TNF-a inhibitors5. When a cancer patient picks up a specialty-at-retail prescription for an oncology agent known to cause neutropenia, which of the following is the best approach?a. Suggest that they talk to their oncologist about an agent with lower risk of neutropeniab. Reinforce that they should have OTC remedies on hand to treat fever when it occursc. Reinforce that OTC remedies can lower fever but mask other symptoms of neutropenia6. What is the most common mechanism of action for rheumatoid arthritis treatment?a. JAK inhibitorsb. PDE-4 inhibitorsc. TNF-a inhibitors7. Which of the following is an advantage of the newer AutoTouch injector developed for etanercept administration?a. Lights and sounds to aid in administrationb. Faster injection speed to reduce painc. Device is reusable for up to 6 months8. Angela is 73 years old and has NSCLC. She comes to the pharmacy counter to pick up her specialty-at-retail prescription for crizotinib. She is also purchasing aspirin, loperamide, omeprazole, antiperspirant, and an orange juice. She says that her oral chemotherapy has been making her extra “run-down and tired” since yesterday, and she is visibly sweating. What should you do?a. Suggest that she purchase famotidine instead, as omeprazole interacts with crizotinibb. Suggest that she may be developing neutropenia and to seek medical attention promptlyc. Express empathy that chemotherapy has been tough on her and encourage bed rest9. Dwight is a patient with multiple myeloma. He arrives at the pharmacy to pick up his specialty-at-retail prescription and asks for a recommendation for OTC cold remedies for a dry cough. He has no other symptoms, so you suspect that it may be a side effect of his chemotherapy. Which of the following drugs is Dwight taking?a. Lenalidomideb. Pomalidomidec. Thalidomide10. Oscar is a 78-year-old patient on methotrexate for rheumatoid arthritis. He was previously taking methotrexate orally, but was switched to vial-and-syringe subcutaneous injections due to severe GI upset. As his arthritis worsens, so does his dexterity. This affects his ability to draw up methotrexate into a syringe and causes delays in therapy. What should you do for Oscar?a. Offer to draw up his methotrexate into syringes he can store for use so he remains adherentb. Offer to call his prescriber about switching to a methotrexate auto-injectorc. Offer to call his prescriber about switching back to oral methotrexate11. Pam is a patient with severe psoriasis who occasionally brings brownies to treat you and your pharmacy team. Her husband, Jim, arrives to the pharmacy to pick up Pam’s specialty-at-retail prescription. You ask Jim where Pam is today and to tell her you said “Hello!” He responds that Pam is at home “not feeling up to leaving the house” and “hopefully she cheers up soon.” If Pam is receiving one of the following drugs, which would be the greatest cause for concern?a. Adalimumabb. Brodalumabc. Certolizumab pegol12. It’s Wednesday at 8:59 PM and you are getting ready to close the pharmacy. Your patient, Phyllis, calls and tells your technician that she left her colony stimulating factor on the kitchen counter since Monday at 6PM. She was hospitalized all day Tuesday and was just released. What is the best way to help this patient?a. Advise Phyllis that the medication is still safe and effective and continue to use itb. Tell her to call the specialty pharmacy tomorrow to have a replacement shippedc. Provide Phyllis the phone number to the 24-hour specialty pharmacy hotline13. Meredith is a specialty-at-retail patient of your pharmacy. She arrives to pick up a refill of neratinib, and also purchases OTC loperamide. She has been on neratinib for three months and asks if you know where she can buy loperamide in bulk. She finds herself using 10 tablets (20 mg) daily, so buying smaller packages at your pharmacy is adding up. What should you do for Meredith?a. Remind her that the maximum daily amount of loperamide is 16 mgb. Talk to the manager about a bulk discount, as she will need to be on it long-termc. Call the specialty pharmacy and her prescriber ................
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