Pharmacology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

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1
Q

What is MS?

A

-autoimmune disorder marked by demyelination of neurons/axons

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2
Q

How do you diagnose MS?

A

dissemination of plaques in time and space

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3
Q

Name the four types of MS?

A
  1. RRMS-MCC
  2. PPMS
  3. SPMS
  4. PRMS
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4
Q

How do DMT’s work?

A
  • slow progression of disease
  • reduce severity of relapsing episodes
  • increase remitting episodes
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5
Q

What is MOA of 1st GEN DMT’s?

A
  • reduce relapse rate by 30%
  • reduces white matter lesions
  • IFN B1b immunomodulating properties
  • augment suppressor cell function
  • suppress T cell proliferation at blood brain barrier
  • decrease permeability of blood brain barrier
  • down regulate IFN-gamma by APC and MHC II
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6
Q

What are three broad tx categories of MS? (3)

A
  1. Tx of exacerbations-corticosteroids
  2. disease modifying therapies
  3. symptomatic tx for spasticity, bladder symptoms, fatigue
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7
Q

Name 3 IFN-B1a? What is MOA of INF-B1a?

A
  • Avonex
  • Plegridy
  • Rebif
  • alters expression and response to surface antigens enhancing immune cell activities
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8
Q

What are ADE of IFN-B1a (4)

A
  • Injection site rxn’s
  • Flu like symptoms
  • Leukopenia
  • depression
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9
Q

What should you monitor for patient’s taking 1st gen DMT’s? (5)

A

CBC, LFT’s, electrolytes, thyroid, depression

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10
Q

What is a contraindications for IFN-B1a?

A

depression

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11
Q

How long does it take for efficacy of IFN-B1a?What type of MS do they treat?

A
  • 1-2 years

- RRMS

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12
Q

What is administration route of iFN-B1a?

A

self injections

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13
Q

Name 1 IFN-B1b?

A

Betaseron

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14
Q

What is ADE of Betaseron?

A

increased injection site rxn’s

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15
Q

What are ADE of glatiramer acetate? (4)

A
  • chest tightness
  • urticaria
  • injection site rxn’s
  • infection
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16
Q

What is monitored for Glatiramer acetate?

A

post injection site rxn

  • MRI
  • tissue necrosis
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17
Q

What does Glatiramer acetate treat?

A

CIS

RRMS

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18
Q

Name 2 brand names of glatiramer acetate?

A

Glatopa

Copaxone

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19
Q

Name the 5 2nd gen DMT?

A

-Natalizumab
-Mitoxantrone
-Alemtuzumab
-Fingolimod
-Ocrelizumab
-Teriflunomide
-Acrelizumab
Dimethyl fumarate

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20
Q

What is MOA of mitoxantrone?

A

inhibits RNA and DNA synthesis

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21
Q

What is MOA of Natalizumab?

A
  • attaches to VL1 so it won’t attach to ligand on CNS

- blocks passage of active lymphocytes across blood brain barrier

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22
Q

What is MOA of alemtuzumab?

A

monoclonal ab that depletes expression of CD52 cells, T cells, B cells, monocytes, and NK killer cells

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23
Q

What is MOA of ocrelizumab?

A

monoclonal ab that binds to CD20 marker of plasma cells

-depletes B cells

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24
Q

T/F All IFN exert there actions at the blood brain barrier

A

True

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25
What is MOA of glatiramer acetate? (3)
- similar to myelin basic protein/MBP and stops MBP binding to T cell receptor complexes - L-alanine, tyrosine, lysine and glutamic acid - reduced inflammation, demyelination, and axonal damage
26
Which interferon is low potency?
Avonex IFN-BIa
27
Which pregnancy category is Glatiramer acetate?
Category B
28
What are ADE of alemtuzumab? (7)
- nasopharyngitis - thyroid disorders - Herpes infections - URI - UTI - Good pasture syndrome - IM thromobocytopenia
29
What should you monitor on patients with alemtuzumab (2)?
- skin infections | - infusion rxn's
30
What is type of MS is tx with alemtuzumab?
RRMS
31
Which drugs are used to treat relapsing MS? (5)
- Natalizumab - Ocrelizumab - Fingolimide - Terifluonimide - Dimethyl fumarate
32
What are ADE of natalizumab? (6)
- arthralgias - liver toxicity - PML!! - depression - fatigue - respiratory infections
33
What should you monitor for Natalizumab? (2)
JCV antibodies | LFTS
34
What are ADE of Fingolimod? (4)
- lymphocytopenia - macular retinal edema - Av block - headache - infection
35
What does mitoxantrone tx? (3)
SPMS, PRMS, worsening RRMS
36
What are ADE of mitoxantrone? (7)
``` Bone marrow suppression AML Neutropenia Cardiotoxocity Nausea Diarrhea Alopecia ```
37
What should you monitor for pt taking Mitoxantrone? (4)
CBC, ECG, LFTs, LVEF
38
What is MOA of Fingolimide?
- sequesters circulating lymphocytes | - reduces infiltration of lymph and macrophages into the CNS
39
What is MOA of Teflurionimide?
- prevents the proliferation of peripheral lymphocytes | - reduces activation of lymphocytes in the CNS and decreases inflammation and demyelination
40
What is MOA of Dimethyl fumarate?
involved in cellular response to oxidative stress
41
What are ADE of Tefluronimide? (4)
- Steven Johnson Syndrome - reactivation of TB - Alopecia - pregnancy x rating
42
What do you monitor for Tefluronimide? (4)
- CBC - LFT's - pregnancy - TB test
43
What are ADE of Dimethyl fumarate (5)
``` Lymphocytopenia Albuminuria Flushing Rash Pruritus ```
44
What should you monitor for DM? (2)
CBC | LFTS
45
T/F taking food with DM will reduce flush
True
46
What is MOA of corticosteroids?
decrease edema at site of demyelination
47
T/F Corticosteroids has been shown to affect disease progression
False-does not affect disease progression
48
When is high dose IV corticosteroid tx initiated? what is high dose corticosteroid tx?
- within 2 weeks of symptom onset | - 500-1000 mgIV/day
49
When does improvement occur?
3-5 days
50
What are ADE of corticosteroids? (2)
metallic taste | -sleep issues
51
Which pt may experience elevated levels of high sugar in their blood with use of corticosteroids?
DM
52
What are long term ADE of corticosteroid use? (4)
- acne - GI hemorrhage - fungal infections - mood changes
53
Which med carries a pregnancy X rating?
Tefluronimide
54
Which medication has an active metabolite? Name the metabolite?
Tefluronimide; Leflunomide
55
How do you minimize the flushing seen with Dimethyl F?
take with food
56
What labs should be appropriate to monitor if taking Tefluronimide?
CBC, LFT, pregnancy, TB test
57
What therapy option might offer the patient a safer alternative?
Interferon IFN-B1a or IFN-B1b | Glatiramer
58
Which medication has an indication for CIS and RMMS?
Glatiramer
59
If our patient was a female which agent is a Category B Pregnancy?
Glatiramer
60
Our patient reports a past medical hx of depression. Which medication would be considered a possible contraindication?
INF_B1a and IFN-B1b
61
What are appropriate monitoring parameters for the interferon medications?
CBC, LFT's, electrolytes, thyroid, depression
62
Chest tightness can occur with flushing with which medication?
Glatiramer acetate
63
What are limitations to mitoxantrone? (3)
- lifetime dose of 140mg/nm2 - pregnancy category D - secondary leukemia
64
When is Fingolimod contraindicated?
- class I and III anti arrhythmic drugs - cardiac disease - 2nd and 3rd AV block
65
What is PML and the cause?
- Progressive multi focal leukoencephalopathy - virus attacks cells that make mylein - John Cunningham virus activated when body becomes immunosuppressed
66
What is mitoxantrone used?
worsening RRMS, SPMS, and PRMS
67
Describe the drug interaction with ketaconazole and fingolimod?
Ketaconazole increases fingolimod serum concentration
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