Chemotherapy is a foundational pillar of oncology treatment that requires an exceptional level of pharmacist expertise to manage safely and effectively. From understanding the cell cycle and complex mechanisms of action to managing severe toxicities and ensuring safe handling, the pharmacist’s role is indispensable. This quiz for PharmD students will test your knowledge of the major classes of cytotoxic agents, their clinical pearls, and the principles of supportive care that underpin the practice of oncology pharmacy.
1. What is the primary mechanism of action for alkylating agents like cyclophosphamide?
- They inhibit topoisomerase II.
- They bind to and cross-link DNA strands, leading to apoptosis.
- They inhibit the function of microtubules.
- They are antimetabolites that block DNA synthesis.
Answer: They bind to and cross-link DNA strands, leading to apoptosis.
2. Cisplatin is a platinum-based chemotherapeutic agent known for causing which major dose-limiting toxicities?
- Cardiotoxicity and mucositis.
- Myelosuppression and diarrhea.
- Severe nausea/vomiting and nephrotoxicity.
- Hand-foot syndrome and rash.
Answer: Severe nausea/vomiting and nephrotoxicity.
3. Methotrexate is an antimetabolite that works by inhibiting which enzyme?
- Thymidylate synthase
- Dihydrofolate reductase (DHFR)
- DNA polymerase
- Topoisomerase I
Answer: Dihydrofolate reductase (DHFR)
4. “Leucovorin rescue” is required after high-dose methotrexate therapy to:
- Increase the efficacy of the methotrexate.
- Replenish reduced folate stores in healthy cells to prevent severe toxicity.
- Treat chemotherapy-induced nausea.
- Prevent a drug-drug interaction.
Answer: Replenish reduced folate stores in healthy cells to prevent severe toxicity.
5. The vinca alkaloids (e.g., vincristine, vinblastine) exert their cytotoxic effect by:
- Inhibiting DNA gyrase.
- Cross-linking DNA.
- Inhibiting the polymerization of microtubules, arresting the cell in metaphase.
- Inhibiting the topoisomerase II enzyme.
Answer: Inhibiting the polymerization of microtubules, arresting the cell in metaphase.
6. Which of the following is a fatal error if it occurs during the administration of vincristine?
- Administering it intravenously.
- Administering it intrathecally.
- Administering it over 15 minutes.
- Administering it without a filter.
Answer: Administering it intrathecally.
7. The taxanes (e.g., paclitaxel, docetaxel) work by:
- Preventing the formation of microtubules.
- Promoting the polymerization and stabilization of microtubules, which inhibits mitosis.
- Blocking the synthesis of purines.
- Alkylating DNA.
Answer: Promoting the polymerization and stabilization of microtubules, which inhibits mitosis.
8. Anthracyclines, such as doxorubicin, are well known for causing which significant, cumulative, dose-limiting toxicity?
- Nephrotoxicity
- Ototoxicity
- Cardiotoxicity
- Pulmonary fibrosis
Answer: Cardiotoxicity
9. The lifetime cumulative dose of doxorubicin is generally limited to prevent:
- The development of irreversible cardiomyopathy.
- Severe myelosuppression.
- A severe skin rash.
- The risk of a secondary malignancy.
Answer: The development of irreversible cardiomyopathy.
10. Irinotecan is a topoisomerase I inhibitor that is associated with which unique and severe side effect?
- Hand-foot syndrome.
- Severe, life-threatening diarrhea (both acute and delayed).
- A hypertensive crisis.
- Severe constipation.
Answer: Severe, life-threatening diarrhea (both acute and delayed).
11. A patient with a specific UGT1A1 gene polymorphism is at a higher risk for severe diarrhea and neutropenia from which chemotherapeutic?
- Paclitaxel
- Cisplatin
- Irinotecan
- Doxorubicin
Answer: Irinotecan
12. “Myelosuppression” is a common toxicity of many chemotherapeutics and refers to the suppression of:
- The central nervous system.
- The adrenal gland.
- The bone marrow.
- The gastrointestinal tract.
Answer: The bone marrow.
13. The “nadir” is a term used to describe:
- The highest point of a drug’s concentration in the blood.
- The point at which blood cell counts are at their lowest after a cycle of chemotherapy.
- The peak of a drug’s therapeutic effect.
- The end of a chemotherapy infusion.
Answer: The point at which blood cell counts are at their lowest after a cycle of chemotherapy.
14. A patient receiving chemotherapy who develops a fever while their neutrophil count is very low has a condition known as ________, which is a medical emergency.
- Tumor Lysis Syndrome
- Febrile neutropenia
- Anemia
- Thrombocytopenia
Answer: Febrile neutropenia
15. Colony-stimulating factors (CSFs) like filgrastim are used in supportive care to:
- Treat chemotherapy-induced nausea.
- Stimulate the production of white blood cells (neutrophils) to reduce the duration of neutropenia.
- Treat anemia.
- Increase the platelet count.
Answer: Stimulate the production of white blood cells (neutrophils) to reduce the duration of neutropenia.
16. “Cell cycle-specific” chemotherapeutic agents are most effective against:
- Tumors with a low growth fraction (i.e., slow-growing).
- Tumors with a high growth fraction (i.e., rapidly dividing cells).
- All types of cancer cells, regardless of their rate of division.
- Cancer cells that are in the G0 (resting) phase.
Answer: Tumors with a high growth fraction (i.e., rapidly dividing cells).
17. Which of the following is an example of a cell cycle phase-nonspecific agent?
- Paclitaxel (M-phase)
- Methotrexate (S-phase)
- Cyclophosphamide (alkylating agent)
- Etoposide (G2-phase)
Answer: Cyclophosphamide (alkylating agent)
18. Mesna is a chemoprotectant agent that is always co-administered with ifosfamide (and sometimes high-dose cyclophosphamide) to prevent:
- Nephrotoxicity
- Cardiotoxicity
- Hemorrhagic cystitis (bladder toxicity)
- Neurotoxicity
Answer: Hemorrhagic cystitis (bladder toxicity)
19. A patient is receiving a highly emetogenic chemotherapy regimen. A pharmacist would recommend which type of antiemetic prophylaxis?
- A single agent, such as prochlorperazine.
- A combination of agents from different classes, such as a 5-HT3 antagonist, an NK1 antagonist, and a corticosteroid.
- A benzodiazepine only.
- An H1 antihistamine.
Answer: A combination of agents from different classes, such as a 5-HT3 antagonist, an NK1 antagonist, and a corticosteroid.
20. A pharmacist’s role in the “first response” to an extravasation of a vesicant chemotherapeutic involves:
- Immediately applying a warm compress.
- Stopping the infusion, following the specific protocol for that drug (which may include cold/warm compresses and an antidote), and notifying the provider.
- Continuing the infusion at a slower rate.
- Ignoring the event.
Answer: Stopping the infusion, following the specific protocol for that drug (which may include cold/warm compresses and an antidote), and notifying the provider.
21. A “vesicant” is a chemotherapeutic agent that can cause:
- Mild skin irritation.
- Severe tissue damage and necrosis if it leaks outside the vein.
- A harmless discoloration of the skin.
- No local reaction upon extravasation.
Answer: Severe tissue damage and necrosis if it leaks outside the vein.
22. Which of the following is a classic example of a vesicant?
- Methotrexate
- 5-Fluorouracil
- Doxorubicin
- Cisplatin
Answer: Doxorubicin
23. The “Leadership” principle of creating a “culture of safety” is paramount in an oncology pharmacy due to:
- The high risk and narrow therapeutic index of most chemotherapeutics.
- The low cost of the medications.
- The simple nature of the chemotherapy regimens.
- The lack of any potential for medication errors.
Answer: The high risk and narrow therapeutic index of most chemotherapeutics.
24. A pharmacist’s knowledge of “sterile compounding” and “pharmacy automation” is critical for the safe preparation of:
- Oral chemotherapy agents.
- Intravenous chemotherapeutic infusions.
- Topical chemotherapy creams.
- Over-the-counter analgesics.
Answer: Intravenous chemotherapeutic infusions.
25. A key principle of supportive care in oncology is to:
- Treat all side effects after they have become severe.
- Proactively manage and prevent the toxicities of chemotherapy to maintain the patient’s quality of life and ability to tolerate treatment.
- Focus only on the anti-tumor efficacy of the drugs.
- Use the lowest possible dose of supportive care medications.
Answer: Proactively manage and prevent the toxicities of chemotherapy to maintain the patient’s quality of life and ability to tolerate treatment.
26. The “antidotal therapy” for high-dose methotrexate toxicity is:
- Leucovorin
- Glucarpidase
- Sodium bicarbonate for urine alkalinization
- All of the above are used in management.
Answer: All of the above are used in management.
27. A key “human resources” consideration for an oncology pharmacy is:
- Ensuring all staff handling hazardous drugs have received specialized training in accordance with USP <800>.
- The pharmacy’s marketing budget.
- The design of the employee break room.
- The brand of computer used for dispensing.
Answer: Ensuring all staff handling hazardous drugs have received specialized training in accordance with USP <800>.
28. An “analytics and reporting system” in an oncology pharmacy could be used to:
- Track adherence to supportive care guidelines.
- Monitor rates of chemotherapy-related adverse events.
- Manage the high cost of the drug inventory.
- All of the above.
Answer: All of the above.
29. A “Clinical Decision Support” alert in an EHR would be critical to warn a prescriber who attempts to order a dose of doxorubicin that would exceed a patient’s:
- Daily sodium limit.
- Lifetime cumulative dose limit.
- Recommended daily fluid intake.
- Annual insurance cap.
Answer: Lifetime cumulative dose limit.
30. The ultimate goal of chemotherapeutic treatment for a non-curable, metastatic cancer is often:
- To extend life and palliate symptoms, improving quality of life.
- To achieve a complete cure.
- To use the most aggressive and toxic regimen possible.
- To stop all treatment.
Answer: To extend life and palliate symptoms, improving quality of life.
31. Bleomycin is a chemotherapeutic agent known for its unique dose-limiting toxicity of:
- Cardiotoxicity
- Nephrotoxicity
- Pulmonary fibrosis
- Hepatotoxicity
Answer: Pulmonary fibrosis
32. “Hand-foot syndrome” (palmar-plantar erythrodysesthesia) is a common skin toxicity associated with which oral chemotherapeutic?
- Methotrexate
- Tamoxifen
- Capecitabine
- Imatinib
Answer: Capecitabine
33. A pharmacist’s role in managing “chemo brain,” a common complaint of cognitive fogginess, includes:
- Recommending a stimulant medication.
- Providing education and counseling on coping strategies.
- Dismissing the patient’s complaint as not real.
- There is no role for the pharmacist.
Answer: Providing education and counseling on coping strategies.
34. A “forging ahead” mindset in oncology pharmacy involves:
- Staying up-to-date with the rapidly evolving landscape of new targeted and immunotherapies.
- Sticking only to traditional chemotherapy regimens.
- Resisting the use of pharmacogenomics.
- Focusing only on the dispensing of medications.
Answer: Staying up-to-date with the rapidly evolving landscape of new targeted and immunotherapies.
35. A “business plan” for a new oncology service would need to detail the high costs of the drugs and the complex _________ associated with them.
- Marketing
- Billing and reimbursement
- Legal structure
- Mission statement
Answer: Billing and reimbursement
36. A pharmacist’s “negotiation” skills are used when:
- Advocating with a payer for coverage of an expensive but necessary chemotherapeutic.
- Discussing a dose adjustment with an oncologist.
- Helping a patient and caregiver agree on a plan for managing side effects.
- All of the above.
Answer: All of the above.
37. In which “practice setting” is a pharmacist most likely to be exclusively dedicated to managing chemotherapeutics?
- A community pharmacy.
- A hospital inpatient oncology unit or an outpatient infusion center.
- A mail-order pharmacy.
- A supermarket pharmacy.
Answer: A hospital inpatient oncology unit or an outpatient infusion center.
38. The “regulation” governing the safe handling of hazardous drugs like chemotherapeutics is:
- The Controlled Substances Act.
- OBRA ’90.
- USP <800>.
- The Kefauver-Harris Amendment.
Answer: USP <800>.
39. A key part of the “Introduction to Pharmacy Informatics” is understanding how an EHR:
- Can improve the safety of chemotherapy prescribing through the use of standardized order sets and CDS.
- Makes the prescribing of chemotherapy more dangerous.
- Is not used in oncology practice.
- Is only used for billing.
Answer: Can improve the safety of chemotherapy prescribing through the use of standardized order sets and CDS.
40. The “human factors” principle of “forcing functions” is applied in CPOE systems for chemotherapy by:
- Allowing providers to enter any dose they want.
- Requiring certain data, like height and weight for BSA calculation, before an order can be completed.
- Making the system difficult to use.
- Hiding important patient information.
Answer: Requiring certain data, like height and weight for BSA calculation, before an order can be completed.
41. The use of a “Closed System Transfer Device” (CSTD) is a best practice in chemotherapy preparation to:
- Prevent microbial contamination of the final product.
- Prevent the escape of hazardous drug vapor or liquid, protecting the healthcare worker.
- Make the compounding process faster.
- Fulfill a marketing requirement.
Answer: Prevent the escape of hazardous drug vapor or liquid, protecting the healthcare worker.
42. A pharmacist’s understanding of “health disparities” is critical in oncology because:
- There are often significant differences in cancer incidence, treatment, and outcomes among racial and ethnic minority populations.
- Cancer affects all populations equally.
- It is not a relevant concept in cancer care.
- It helps in choosing the most profitable drugs.
Answer: There are often significant differences in cancer incidence, treatment, and outcomes among racial and ethnic minority populations.
43. A pharmacist providing care to a patient and their “caregiver” after a new chemotherapy infusion should:
- Provide education on when to call the clinic for side effects like fever or uncontrolled nausea.
- Focus only on the patient.
- Assume the caregiver does not need any information.
- Use complex medical terminology.
Answer: Provide education on when to call the clinic for side effects like fever or uncontrolled nausea.
44. “Palliative chemotherapy” is a service that is intended to:
- Cure the cancer.
- Relieve symptoms and improve quality of life when a cure is not possible.
- Be used before surgery to shrink a tumor.
- Be the first-line treatment for all cancers.
Answer: Relieve symptoms and improve quality of life when a cure is not possible.
45. Which of the following is a key safety double-check in the chemotherapy workflow?
- Having two pharmacists independently verify the dose calculation and the final prepared product.
- Having the technician who prepared the product also verify it.
- Relying solely on the computer system’s verification.
- Asking the patient to verify their own dose.
Answer: Having two pharmacists independently verify the dose calculation and the final prepared product.
46. A pharmacist’s “leadership” is demonstrated when they:
- Take the initiative to develop a new protocol to reduce chemotherapy-related errors in their institution.
- Ignore a safety concern raised by a technician.
- Follow all existing procedures without question.
- Focus only on their own dispensing tasks.
Answer: Take the initiative to develop a new protocol to reduce chemotherapy-related errors in their institution.
47. The “financial” burden of chemotherapy on a patient (“financial toxicity”) is a real concern that a pharmacist can help address by:
- Connecting the patient with manufacturer assistance programs or foundations.
- Ignoring the patient’s financial concerns.
- Recommending they take out a loan.
- Suggesting they stop treatment.
Answer: Connecting the patient with manufacturer assistance programs or foundations.
48. An “Electronic Health Record” (EHR) improves the safety of chemotherapy by:
- Providing a clear, legible, and standardized record of complex treatment regimens.
- Increasing the risk of transcription errors.
- Hiding a patient’s lab results.
- Making it harder to communicate with the care team.
Answer: Providing a clear, legible, and standardized record of complex treatment regimens.
49. A key “policy” issue affecting oncology pharmacy is:
- The high cost of new chemotherapeutics and the challenges with reimbursement.
- The over-the-counter availability of chemotherapy.
- The lack of any new drugs being developed.
- The DEA scheduling of these drugs.
Answer: The high cost of new chemotherapeutics and the challenges with reimbursement.
50. The most important principle for a pharmacist managing chemotherapeutics is an unwavering commitment to:
- Patient safety.
- Speed of dispensing.
- Profitability.
- Following tradition.
Answer: Patient safety.

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com