View Exam | PowerPak

1. Please use this CASE to answer the test questions:
MW is a 74-year-old male with CLL on observation since diagnosis in 2016 who has now progressed to Rai Stage 3 with notably enlarged lymph nodes on imaging and on palpation and worsening anemia. Earlier this month, fluorescence in situ hybridization (FISH) revealed a cytogenetic abnormality of del(13q) with no detection of del(11q) or del(17p) noted. MW’s past medical history is significant for hypercholesterolemia, gastroesophageal reflux disease (GERD), deep vein thrombosis (May 2018, followed by 3 months of apixaban), and benign prostatic hyperplasia. He underwent a right total hip replacement in September 2019 and has ongoing dental problems, which necessitate oral surgery 1 to 2 times annually.

Current home medication list:
- Atorvastatin 40 mg by mouth (PO) nightly
- Ezetimibe 10 mg PO daily
- Pantoprazole 20 mg PO daily
- Calcium carbonate 1 g PO three times daily as needed (PRN) for indigestion
- Finasteride 5 mg PO daily
- Amoxicillin 1 g PO x1 PRN dental procedures
- Daily multivitamin
- Vitamin D3 2000 units PO daily

Which of the following is the BEST first-line treatment option for MW?

A. Venetoclax + rituximab B. FCR C. Ibrutinib D. Venetoclax + obinutuzumab E. Unsure

2. MW's hematologist chooses acalabrutinib 100 mg tablets PO twice daily as first-line treatment. Which of the following is an appropriate counseling point to review with MW?

A. Acalabrutinib requires a 4-week dose ramp-up before reaching the maintenance dose B. Many other medications and supplements can affect the blood levels of acalabrutinib; therefore, MW should consult his hematologist or pharmacist before starting anything new C. MW should discontinue pantoprazole and calcium carbonate, as these cannot be taken with acalabrutinib tablets D. MW must take acalabrutinib on an empty stomach for appropriate absorption E. Unsure

3. MW requires a revision to some dental work, for which he will be anesthetized and unfortunately have multiple teeth extracted. The procedure is planned for 3 weeks from now. What, if anything, should MW do regarding his ongoing acalabrutinib therapy?

A. Continue taking acalabrutinib as prescribed and do not miss any doses prior to surgery B. Reduce the dose to 100 mg PO once daily starting 7 days prior to the procedure C. Discontinue acalabrutinib and switch to ibrutinib given its lower risk of bleeding D. Discontinue acalabrutinib 3 days before the procedure and resume 3 days after assuming no signs of bleeding E. Unsure

4. Following 3 years of treatment with acalabrutinib, MW presents to the outpatient leukemia clinic with worsening palpable lymphadenopathy (cervical, axillary, left groin). His hematologist initiates second-line therapy with venetoclax monotherapy. Which of the following is NOT an appropriate counseling points for patients initiating venetoclax?

A. Take venetoclax on an empty stomach, 1 hour before or 2 hours after a meal B. Ramping up the venetoclax dose over the course of 4 weeks decreases the risk for tumor lysis syndrome (TLS) C. You may initiate venetoclax inpatient or outpatient, depending upon your individual TLS risk D. Venetoclax is metabolized via a common enzyme pathway, therefore it is known to interact with many other medications E. Unsure

5. Six months after starting venetoclax MW is diagnosed with COVID-19 and his general practitioner prescribes a 5-day course of nirmatrelvir + ritonavir. He is currently taking venetoclax 400 mg PO daily. Ritonavir is a strong CYP3A4 inhibitor. Which statement is TRUE regarding MW's COVID-19 treatment regimen?

A. MW may continue taking venetoclax at the current dose with nirmatrelvir + ritonavir B. MW cannot take nirmatrelvir + ritonavir secondary to a major interaction with venetoclax C. MW should switch back to acalabrutinib for the 5 days of nirmatrelvir + ritonavir treatment D. MW should take nirmatrelvir + ritonavir as prescribed and reduce his venetoclax dose to 100 mg daily for 7 days E. Unsure

Maintenance is scheduled for 08/28/2024 6:00 AM EST - 08/28/2024 5:00 PM EST.

{{recommendationsA.Title}}

{{recommendationsB.Title}}

2. MW's hematologist chooses acalabrutinib 100 mg tablets PO twice daily as first-line treatment. Which of the following is an appropriate counseling point to review with MW?

3. MW requires a revision to some dental work, for which he will be anesthetized and unfortunately have multiple teeth extracted. The procedure is planned for 3 weeks from now. What, if anything, should MW do regarding his ongoing acalabrutinib therapy?

« Return to Activity

Maintenance is scheduled for 08/28/2024 6:00 AM EST - 08/28/2024 5:00 PM EST.

The shopping cart is empty

Customers who Purchasedthis Activity also Purchased

{{recommendationsA.Title}}

{{recommendationsB.Title}}

2. MW's hematologist chooses acalabrutinib 100 mg tablets PO twice daily as first-line treatment. Which of the following is an appropriate counseling point to review with MW?

3. MW requires a revision to some dental work, for which he will be anesthetized and unfortunately have multiple teeth extracted. The procedure is planned for 3 weeks from now. What, if anything, should MW do regarding his ongoing acalabrutinib therapy?

« Return to Activity

Customers who Purchased
this Activity also Purchased