06 Neurology Williams Flashcards
What are the Dopamine Agonists used for Parkinson Disease?
Bromocriptine. Pramipexole. Ropinirole. Apomorphine. Rotigotine
What is Multiple Sclerosis (MS)?
A chronic inflammatory and degenerative disease of the CNS in which destruction of oligodendrocytes leads to demyelination of neurons. Mean age of onset: 30 years
What are the 3 mains types of MS?
Relapsing-Remitting MS (80-90% when 1st diagnosed). Secondary-Progressive MS. Primary-Progressive MS
What are the first line agents used in MS?
Interferon Beta 1a (Avonex or Rebif). Interferon Beta 1b (Betaseron or Extavia). Flingolimod (Gilenya). Glatiramer (Copaxone)
What are the common ADRs when using Interferon Beta for MS?
Depression, flu-like symptoms, injection site reactions, liver injury
When does Fingolimod (Gilenya) for MS need to be avoided?
In patients with recent MI, angina, stroke, TIA, CHF. This drug causes bradycardia, increased BP, macular edema, and liver injury
What is Dimethyl Fumarate (Tecfidera) used for?
Relapsing MS. Dosed BID
What are the ADRs associated with Dimethyl Fumarate (Tecfidera)?
Dermatitis/irritation. Flushing (take w/ food, tolerance over time). GI (N/V/D). Hepatic effects (transaminase elevations)
What needs to be done when starting Dimethyl Fumarate (Tecfidera) to avoid Lymphopenia?
Baseline CCBC w/in 6 months prior to initiation. Obtain CBC annually. Mean lymphocyte decreased ~30% over the first year (then stabilized). Watch for patients having increased occurrance of infections
What is Teriflunomide (Aubagio) used for?
Relapsing MS. Taken PO QD
What is the MOA of Teriflunomide (Aubagio)?
Immunomodulatory agent that inhibits pyrimidine synthesis. Anti-proliferative and anti-inflammatory effects. May reduce the number of activated lymphocytes in the CNS
What is the BBW for Teriflunomide (Aubagio)?
Hepatotoxicity (do not administer in patients w/ chronic liver disease, or impairment. Discontinue if ALT > 3x ULN and start drug elimination procedures). Pregnancy/Teratogenicity (need two levels < 0.02mg/L, 14 days apart prior to becoming pregnant)
What is the drug elimination procedure for Teriflunomide (Aubagio)?
Cholestyramine 8mg Q8h x11 days (11 days do not need to be consecutive unless plasma concentrations need to be lowered rapidly). Activated charcoal 50mg Q12h x11 days. Both regimens are associated w/ > 98% decrease in concentrations
What are some common ADRs with Teriflunomide (Aubagio)?
Increased ALT. Alopecia. Diarrhea. Influenza. Nausea. HA. Hypophosphatemia
What are some counseling points for Teriflunomide (Aubagio)?
Up to date w/ all immunizations (avoid live vaccines). Use contraception at all times (both men and women). Can be taken w/ or w/o food