1. The main source of immune globulin manufactured in the United States is from which of the following:
A. Whole blood donations
B. Recombinant plasma production
C. Lysis of hamster ovaries
D. Plasmapheresis
2. In addition to immune globulin, which of the following products is a human plasma derivative:
A. Factor VIII
B. alemtuzumab
C. Dextran
D. Anti-thymocyte immune globulin
3. Polyvalent immune globulin preparations used for the treatment of primary immunodeficiency are primarily composed of which of the following:
A. Immunoglobulin A (IgA)
B. IgG
C. IgM
D. IgE
4. Stabilizing agents are added to immune globulin preparations for which of the following reasons:
A. Prevent dimer formation
B. Increase the half-life
C. Reduce thrombotic risk
D. Inhibit hemolysis
5. Which of the following immune globulin stabilizing agents can show a falsely elevated blood glucose reading when tested with glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ) methodology:
A. Glycine
B. Proline
C. Maltose
D. Glucose
6. Which of the following is a step in the immune globulin manufacturing process intended to prevent transmission of virus:
A. Room temperature storage of plasma
B. Nucleic acid testing of plasma pools
C. Addition of stabilizers
D. Use of large donor plasma pools
7. Which of the following is the most common adverse event to occur after an immune globulin infusion:
A. Hepatitis C infection
B. Aseptic meningitis
C. Headache
D. Hyperlipidemia
8. Treatment with acetaminophen and diphenhydramine prior to an immune globulin infusion can help reduce the risk of which of the following adverse events:
A. Anaphylactoid reactions
B. Hemolysis
C. Acute renal failure
D. Infection
9. Which of the following stabilizing agents is most commonly associated with causing acute renal failure:
A. Glycine
B. Sucrose
C. Proline
D. Saline
10. Important laboratory monitoring parameters after a high dose (e.g., 2 g/kg administered over 2 days) sucrose-stabilized immune globulin infusion in a patient with blood type A include which of the following:
A. Hemoglobin and serum creatinine
B. Serum calcium and prothrombin time
C. Prothrombin time and hemoglobin
D. Serum creatinine and calcium
11. Which of the following patients is at high risk of hemolysis when receiving an immune globulin infusion:
A. A patient with blood type B receiving immune globulin at a dose of 2 g/kg for treatment of Kawasaki disease
B. A patient with blood type B receiving immune globulin at a dose of 0.4 g/kg for treatment of primary immunodeficiency
C. A patient with blood type O receiving immune globulin at a dose of 2 g/kg for treatment of idiopathic thrombocytopenia purpura
D. A patient with blood type O receiving immune globulin at a dose of 0.4 g/kg for treatment of demyelinating polyneuropathy
12. Which of the following increases the risk of thrombotic events in patients receiving immune globulin infusions:
A. Hyperviscous plasma at the time of infusion
B. Use of antiplatelet agents
C. IgA content of the product administered
D. Recipient ABO blood type
13. Immune globulin preparations have been associated with an increased risk of thrombotic events caused by which of the following product characteristics:
A. Maltose concentration
B. Cytokine levels
C. IgA content
D. Presence of activated Factor XI
14. Which of the following are advantages of the subcutaneous route of immune globulin administration versus the intravenous route:
A. Allows for administration of large single doses (1 g/kg or greater)
B. Reduces risk of anaphylactoid reactions
C. Decreases incidence of local infusion site reactions
D. Achieves higher peak serum immune globulin levels
15. Which of the following immune deficiencies is routinely treated with immune globulin:
A. Human immunodeficiency virus (HIV)
B. IgA deficiency
C. Common variable immune deficiency
D. Neutropenia
16. At high doses (1 to 2 g/kg) immune globulin treatments have which of the following desired therapeutic effects:
A. Vasodilatory
B. Anti-coagulation
C. Immunomodulatory
D. Prokinetic
17. Which of the following is an U.S. Food and Drug Administration (FDA)-approved indication for treatment with immune globulin:
A. Primary immune deficiency
B. Graft-versus-host disease
C. Idiopathic cardiomyopathy
D. Focal segmental glomerulosclerosis
18. The dose range of immune globulin most commonly administered over 2 to 5 days to elicit an immunomodulatory or antiinflammatory effect is best described as which of the following:
A. 0.1 to 2 g/kg
B. 0.3 to 0.6 g/kg
C. 1 to 2 g/kg
D. 4 to 5 g/kg
19. Proinflammatory effects of immune globulin include which of the following:
A. Complement activation
B. Down regulation of B lymphocytes
C. Binding to histamine receptors
D. T helper cell inhibition
20. Anti-inflammatory effects of immune globulin include which of the following:
A. Activation of superantigens
B. Elimination of autoreactive B lymphocytes
C. Release of cytokines
D. Memory T cell activation
Evaluation Questions
21. To what extent did the program meet objective #1?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
22. To what extent did the program meet objective #2?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
23. To what extent did the program meet objective #3?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
24. To what extent did the program meet objective #4?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
25. To what extent did the program meet objective #5?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
26. To what extent did the program meet objective #6?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
27. To what extent did the program meet objective #7?
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
28. Rate the effectiveness of how well the program related to your educational needs:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
29. Rate how well the active learning strategies (questions, cases, discussions) were appropriate and effective learning tools:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
30. Rate the quality of the faculty:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
31. Rate the effectiveness and the overall usefulness of the material presented:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
32. Rate the appropriateness of the examination for this activity:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
33. Rate the effectiveness of how well the activity related to your practice needs:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
34. Rate the effectiveness of how well the activity will help you improve patient care:
A. Excellent
B. Very Good
C. Good
D. Fair
E. Poor
35. Will the information presented cause you to change your practice?
A. Yes
B. No
36. Are you committed to making these changes?
A. Yes
B. No
37. As a result of this activity, did you learn something new?
A. Yes
B. No
38. What other topics related to immune globulin therapy would be of interest to you as a future educational program?
A. Primary Immune Deficiency Disorders
B. Peripheral Neuropathies (such as Multifocal Motor Neuropathy)
C. Monitoring and addressing immune globulin related severe adverse events (such as thrombotic events, hemolysis, and aseptic meningitides)
D. Manufacturing processes of immune globulin products
E. Collection, fractionation, and process of handling pooled plasma
F. Alpha-1 antitrypsin deficiency diagnosis and treatment
G. Fluid resuscitation options: albumin versus starch versus saline
39. What is your area of practice?
A. Community Pharmacy/Independent
B. Community Pharmacy/Chain
C. Hospital/Health Systems
D. Long-term Care
E. Managed Care/Pharmacy Benefits Management (PBM)
F. Oncology/Specialty Pharmacy
G. Research
H. Regulatory/Government
I. Industry/Manufacturing
40. How many years have you been in practice?
A. <5
B. 5-10
C. 11-20
D. >20
