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1. Which of the following is not a TNF-alpha inhibitor?

A. Golimumab B. Adalimumab C. Infliximab D. Rituximab

2. Which of the following is true regarding the efficacy of biologics?

A. The American College of Rheumatology guidelines did not include tofacitinib due to a lack of efficacy evidence supporting its use B. Though only compared by indirect evidence, tocilizumab and tofacitinib may be more effective than the anti-TNF biologics C. Though only compared by indirect evidence, golimumab appears to be the most effective TNF-alpha inhibitor D. Though only compared by indirect evidence, anakinra is expected to be more efficacious than other biologic DMARDs

3. Which of the following is available as both an intravenous and a subcutaneous product?

A. Golimumab B. Certolizumab pegol C. Infliximab D. Rituximab

4. Which of the following is true regarding dosing considerations of the biologics?

A. Tocilizumab is available in a twice-daily oral formulation B. Methotrexate must be taken concomitantly with infliximab C. Etanercept must be dosed based on the patient's ideal body weight D. Rituximab requires weekly infusions for the first month, then every 8 weeks thereafter

5. A patient with severe rheumatoid arthritis requires biologic treatment. She is unable to self-administer any medications due to the significant joint damage in her hands. She also takes St. John's wort and has a history of alcoholism. Which of the following is the best choice for this patient?

A. Adalimumab B. Tocilizumab C. Infliximab D. Tofacitinib

6. Which of the following is true regarding proper monitoring for the biologics for RA?

A. All patients must be screened for tuberculosis at baseline and prophylactically treated if positive results are found B. Monitoring for adverse events is most important when discontinuing therapy due to long half-lives of the biologics C. The American College of Rheumatology does not endorse any measures of disease activity over others D. All patients should be monitored for the efficacy of their biologic drugs 3 months after initiating therapy

7. Which of the following is true regarding progressive multifocal leukoencephalopathy (PML)?

A. PML is usually self-limiting and the offending agent need not be discontinued if symptoms arise B. Symptoms of PML include cough lasting over 3 weeks, hemoptysis, unexplained weight loss, fatigue, and fever C. The best outcomes with PML are found with early detection and prompt discontinuation of the offending agent D. Concerned patients should be counseled that rituximab causes PML less frequently than the other biologics DMARDs

8. TNF-alpha inhibitors likely increase the risk of which of the following malignancies?

A. Overall malignancy B. Nonmelanoma skin cancer C. Solid tumors D. Lymphoma

9. Which of the following is true regarding the management of adverse events related to biologics?

A. All patients who experience an increase in cholesterol secondary to tocilizumab initiation must be treated with lipid-lowering therapy. B. Patients with COPD should not be treated with etanercept due to a demonstrated increased risk of adverse events in this patient group. C. All vaccines should be avoided during treatment with biologic DMARDs due to the immunosuppressive effects of these agents. D. Injection site reactions seen with subcutaneously administered TNF-alpha inhibitors are typically self-limiting and do not usually require medical intervention.

10. Which of the following is true regarding biosimilars?

A. Once biosimilars enter the market, they are expected to lower overall health care costs similar to generics of small-molecule drugs. B. Biosimilars are highly similar versions of a reference biologic product and need only to show bioequivalence to become FDA approved. C. In Europe, no ill effects have been shown when switching patients from reference infliximab to biosimilar infliximab. D. None of the above statements is true.