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Pharm U3 > 10) Multiple Sclerosis > Flashcards

10) Multiple Sclerosis Flashcards

1
Q

What is the class for IFN-beta-1a (Avonex)

A

IFN-beta-1a

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2
Q

What is the mechanism for IFN-beta-1a (Avonex)

A

Many, potentially: inhibit T-cell activation, shift from Th1 to Th2, inhibit lymphocyte movement into CNS, anti-proliferative effect, apoptosis of T-cells, anti-viral, IFN-g antagonism

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3
Q

What are the therapeutics for IFN-beta-1a (Avonex)

A

RRMS

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4
Q

What are the important side effects for IFN-beta-1a (Avonex)

A

Mild anemia, increase LFT (monitor every 6 mo.), hypothyroid; least NAB formed

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5
Q

What are the other side effects for IFN-beta-1a (Avonex)

A

Flu-like, minor irritation at inject site, anemia

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6
Q

What are the miscellaneous for IFN-beta-1a (Avonex)

A

Doesn’t cross BBB; decreases relapse rate by 1/3 and reduces MRI lesions, with a trend toward decreasing disability and brain atrophy

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7
Q

What is the class for IFN-beta-1a (Rebif)

A

IFN-beta

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8
Q

What is the mechanism for IFN-beta-1a (Rebif)

A

Many, potentially: inhibit T-cell activation, shift from Th1 to Th2, inhibit lymphocyte movement into CNS, anti-proliferative effect, apoptosis of T-cells, anti-viral, IFN-g antagonism

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9
Q

What are the therapeutics for IFN-beta-1a (Rebif)

A

RRMS (high-dose); first-line treatment (more efficacious than Avonex in head-to-head trials)

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10
Q

What are the important side effects for IFN-beta-1a (Rebif)

A

Anemia, leukopenia, menstrual irregularities, depression, increase LFT and hypothyroidism (monitor every 3 mo.)

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11
Q

What are the other side effects for IFN-beta-1a (Rebif)

A

Flu-like, injection site reaction; neutropenia; thrombocytopenia

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12
Q

What are the miscellaneous for IFN-beta-1a (Rebif)

A

As with Avonex; significantly reduces new and enhancing MRI lesions, reduces disablity

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13
Q

What is the class for IFN-beta-1b (Betaseron)

A

IFN-beta

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14
Q

What is the mechanism for IFN-beta-1b (Betaseron)

A

Many, potentially: inhibit T-cell activation, shift from Th1 to Th2, inhibit lymphocyte movement into CNS, anti-proliferative effect, apoptosis of T-cells, anti-viral, IFN-g antagonism

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15
Q

What are the therapeutics for IFN-beta-1b (Betaseron)

A

RRMS (high-dose); more efficacious than Avonex in head-to-head trials

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16
Q

What are the important side effects for IFN-beta-1b (Betaseron)

A

Leukopenia, menstrual irregularities, depression, increase LFT and hypothyroidism (monitor every 3 mo.); more NAB formed than avonex

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17
Q

What are the other side effects for IFN-beta-1b (Betaseron)

A

Flu-like, inject site reaction, anemia

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18
Q

What are the miscellaneous for IFN-beta-1b (Betaseron)

A

As with Avonex, but no effect on disease progression

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19
Q

What is the class for IFN-beta-1b (Extavia)

A

IFN-beta

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20
Q

What is the mechanism for IFN-beta-1b (Extavia)

A

Many, potentially: inhibit T-cell activation, shift from Th1 to Th2, inhibit lymphocyte movement into CNS, anti-proliferative effect, apoptosis of T-cells, anti-viral, IFN-g antagonism

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21
Q

What are the therapeutics for IFN-beta-1b (Extavia)

A

RRMS (high-dose)

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22
Q

What are the important side effects for IFN-beta-1b (Extavia)

A

Leukopenia, menstrual irregularities, depression, increase LFT and hypothyroidism (monitor every 3 mo.)

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23
Q

What are the other side effects for IFN-beta-1b (Extavia)

A

Flu-like, inject site reaction, anemia

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24
Q

What are the miscellaneous for IFN-beta-1b (Extavia)

A

As with Avonex, but no effect on disease progression

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25
Q

What is the class for Glatiramer acetate (Copaxone)

A

Myelin basic protein analog

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26
Q

What is the mechanism for Glatiramer acetate (Copaxone)

A

Mixture of 4 AAs in myelin basic protein; causes T-cell apoptosis (looks like MBP), induces anti-inflammatory Th2 cells (cytokine shift from Th1), induces Treg with induction of anergy

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27
Q

What are the therapeutics for Glatiramer acetate (Copaxone)

A

RRMS

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28
Q

What are the important side effects for Glatiramer acetate (Copaxone)

A

Mild: injection site reaction, anxiety attack-like reaction

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29
Q

What are the miscellaneous for Glatiramer acetate (Copaxone)

A

Active in CNS (not peripherally); try to use early; reduce relapse by 1/3, modest reduction in MRI lesion and reduction of atrophy, but no effect on disease progression

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30
Q

What is the class for Natalizumab (Tysabri)

A

Monoclonal antibody

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31
Q

What is the mechanism for Natalizumab (Tysabri)

A

Binds VLA4 (integrin subunit), inhibiting leukocyte migration across BBB

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32
Q

What are the therapeutics for Natalizumab (Tysabri)

A

RRMS (2nd line)

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33
Q

What are the important side effects for Natalizumab (Tysabri)

A

PML (JC virus); acute urticaria, systemic hypersensitivity infusion reaction

34
Q

What are the other side effects for Natalizumab (Tysabri)

A

Headache, dizziness, fatigue, arthralgia, rigors

35
Q

What are the miscellaneous for Natalizumab (Tysabri)

A

Decrease relapse rate by 2/3, greatly reduce MRI lesions; once/month; antibodies to natalizumab cause it to stop working; side effects more common in patients positive for neutralizing antibodies

36
Q

What is the class for Fingolimod (Gilenya)

A

Sphingosine-1-phosphate analog

37
Q

What is the mechanism for Fingolimod (Gilenya)

A

Prodrug; sequesters circulating lymphocytes in secondary lymphoid organs via induction of intracellular internalization of receptors on lymphocytes (no effect on lymphocyte induction, proliferation, or memory function)

38
Q

What are the therapeutics for Fingolimod (Gilenya)

A

RRMS

39
Q

What are the important side effects for Fingolimod (Gilenya)

A

Bradycardia and heartblock (EKG for first 6 hours); macular edema (need opthalmology exam before and after 3 months)

40
Q

What are the other side effects for Fingolimod (Gilenya)

A

Reduced FEV1, increased LFTs, lymphopenia, leukopenia, asthenia, back pain, blurred vision, headache dizziness, infections

41
Q

What are the miscellaneous for Fingolimod (Gilenya)

A

Patients must be VZV immune before prescription; oral daily

42
Q

What is the class for Teriflunomide (Aubagio)

A

Immunosuppressants

43
Q

What is the mechanism for Teriflunomide (Aubagio)

A

Selective dihydro-orotate dehydrogenase inhibitor; blocks de novo pyramidine synthesis, reducing T- and B-cell proliferation and function against autoantigens; preserves replication and function of cells living on salvage pathway (e.g., hematopoietic cells, memory cells)

44
Q

What are the therapeutics for Teriflunomide (Aubagio)

A

RRMS

45
Q

What are the important side effects for Teriflunomide (Aubagio)

A

Hepatotoxicity; teratogenicity (animal data)

46
Q

What are the miscellaneous for Teriflunomide (Aubagio)

A

Oral daily

47
Q

What is the mechanism for Dimethyl fumarate (Tecfidera)

A

Enhances Nrf2 pathway; some Th1 -> Th2 sgift

48
Q

What are the important side effects for Dimethyl fumarate (Tecfidera)

A

N & V; diarrhea; stomach pain; flushing

49
Q

What are the other side effects for Dimethyl fumarate (Tecfidera)

A

Itching, redness, rash

50
Q

What are the miscellaneous for Dimethyl fumarate (Tecfidera)

A

Oral BID

51
Q

What is the class for Mitoxantrone (Novantrone)

A

Anthracenedione

52
Q

What is the mechanism for Mitoxantrone (Novantrone)

A

Broad immune suppression and modulation of B cells, T cells and macrophages; decreases frequency of clinical relapse, reduces disease progress, and reduces disability

53
Q

What are the therapeutics for Mitoxantrone (Novantrone)

A

SPMS; RRMS (2nd line)

54
Q

What are the important side effects for Mitoxantrone (Novantrone)

A

Dose-dependent cardiac toxicity (decreased LVEF, irreversible CHF); induction of acute leukemia

55
Q

What are the other side effects for Mitoxantrone (Novantrone)

A

Nausea and vomiting, alopecia, menstrual irregularities, increased susceptibility to infection

56
Q

What are the miscellaneous for Mitoxantrone (Novantrone)

A

IV; once/3 months

57
Q

What is the class for Azathioprine (Imuran)

A

Immunosuppressants

58
Q

What is the mechanism for Azathioprine (Imuran)

A

Immunosuppressive

59
Q

What are the therapeutics for Azathioprine (Imuran)

A

SPMS (resistant, or as combination with other therapies)

60
Q

What are the important side effects for Azathioprine (Imuran)

A

Systemic toxicity: monitor blood for changes

61
Q

What is the class for Methotrexate (Trexall)

A

Immunosuppressants

62
Q

What is the mechanism for Methotrexate (Trexall)

A

Immunosuppressive

63
Q

What are the therapeutics for Methotrexate (Trexall)

A

SPMS (resistant, or as combination with other therapies)

64
Q

What are the important side effects for Methotrexate (Trexall)

A

Systemic toxicity: monitor blood for changes

65
Q

What is the class for Cyclophosphamide (Cytoxan)

A

Immunosuppressants

66
Q

What is the mechanism for Cyclophosphamide (Cytoxan)

A

Immunosuppressive

67
Q

What are the therapeutics for Cyclophosphamide (Cytoxan)

A

SPMS (resistant, or as combination with other therapies)

68
Q

What are the important side effects for Cyclophosphamide (Cytoxan)

A

Systemic toxicity: monitor blood for changes

69
Q

What is the class for Mycophenolate mofetil (CellCept)

A

Immunosuppressants

70
Q

What is the mechanism for Mycophenolate mofetil (CellCept)

A

Immunosuppressive

71
Q

What are the therapeutics for Mycophenolate mofetil (CellCept)

A

SPMS (resistant, or as combination with other therapies)

72
Q

What are the important side effects for Mycophenolate mofetil (CellCept)

A

Systemic toxicity: monitor blood for changes

73
Q

What are the miscellaneous for Mycophenolate mofetil (CellCept)

A

Oral

74
Q

What is the class for Methylprednisone (MTP)

A

Corticosteroid (immunosuppressant)

75
Q

What is the mechanism for Methylprednisone (MTP)

A

Unclear mechanism (suppress both B and T cells, may reduce cytokine release)

76
Q

What are the therapeutics for Methylprednisone (MTP)

A

Acute MS attack, SPMS; shortens acute attack duration,speeds recovery

77
Q

What are the other side effects for Methylprednisone (MTP)

A

Short-term: insomnia, mood changes, fluid retention, epigastric pain, hypertension; long-term: osteoporosis, cushingoid, secondary malignancies

78
Q

What are the miscellaneous for Methylprednisone (MTP)

A

Given IV with oral prednisone taper

79
Q

What are the therapeutics for ACTH

A

Acute MS attack (if patient allergic to corticosteroids, poor IV access); or if MTP doesn’t work

80
Q

What is the mechanism for Plasmapharesis

A

Unclear mechanism

81
Q

What are the therapeutics for Plasmapharesis

A

Acute MS attack not responsive to MTP

Pharm U3 (13 decks)

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