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PDAT4 > 32/33 - MS > Flashcards

32/33 - MS Flashcards

1
Q

Diagnosis of MS

A

McDonald Criteria
Clinical Attacts + MRI Results

Demonstration of
MS Lesions seperated in TIME & SPACE
Dissemination in Time & Space = DIT & DIS

Occurance of:
> 2 Seperate Neurological Events
representing:
Different sites of dmg in CNS

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2
Q

Definition of an

MS RELAPSE

A

New** or **Worsening
of previous symptoms lasting >24 hours

Has to be:
Seperated
from the previous relapse by >30 days

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3
Q

What is CIS?

A

Clinically Isolated Syndrome = CIS

First Clinical Episode
early neurological episode consistant w/ demyelinating process
must last >24 hours

does not completely fulfill diagnostic criteria

May or may NOT go on to develop MS

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4
Q

What is

RRMS

A

Relapsing / Remitting MS
85% of MS cases @ onset

Characterised by:
Acute Relapses
VVV
followed by periods of COMPLETE or PARTIAL remission

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5
Q

What is

SPMS

A

Secondary Progressive MS

ALWAYS BEGINS AS RRMS
most patients will progress to SPMS

Progressive Worsening of Neurological functioning over time

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6
Q

What is

PPMS?

A
  • *PRIMARY progressive MS**
  • typically do NOT experience RRMS*

15% of cases

Worsening of neurological symptroms
FROM ONSET

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7
Q

Acute Relapse Treatment for MS

Medication / Dose / Effect

A

METHYLPREDNISOLONE
500 - 1000 mg/d for 3-5 days
↓lymphocytes, ↓inflammation, ↓edema

no effect on disease progression
but better to start SOONER than later

Shortens Duration & Severity of attacks/relapses

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8
Q

INF-Beta

ARR% - Indications - MoA

A

30%

RRMS & CIS

Reduces inflammation by:

  • inhibiting T-cell*
  • *​Activation / Proliferation / migration into CNS**
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9
Q

ADR’s & Monitoring

INF-Betas

Rebif / Plegridy / Avonex

Betaseron / Extavia

A

Flu-Like Symptoms** + **Injection Site Reactions
use NSAIDS / Tylenol prior to injection
Depression

ELEVATED LFTS
need to monitor 1/3/6months

decreased RBC
cbc 1/3/6 months

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10
Q

AVONEX

Drug Class / Admin

A

INF-beta
for MS - 30%
LFT / CBC

  • *Weekly IM injection**
  • Flu-like symptoms + inj site reactions + depression*
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11
Q

PLEGRIDY

Drug Class / Admin

A

INF-beta
for MS - 30%
LFT / CBC

  • *SUBQ** - q14days
  • Flu-like symptoms + inj site reactions + depression*
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12
Q

Beteseron / Extavia

Drug Class / Admin

A

Betaseron = Extavia
SAME DRUG - different maufacturer

INF-beta
for MS - 30%
LFT / CBC

  • *SUBQ -> QOD**
  • Flu-like symptoms + inj site reactions + depression*
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13
Q

Rebif

Drug Class / Admin

A

INF-beta
for MS - 30%
LFT / CBC

  • *SUBQ** - TIW
  • *two titration schedules** due to ADRs
  • Flu-like symptoms + inj site reactions + depression*
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14
Q

Which DMT for MS

is administered IM?

A

AVONEX

INF-beta
for MS - 30%
LFT / CBC

Weekly IM injection
Flu-like symptoms + inj site reactions + depression

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15
Q

Which MS drugs require
LFTs?

A

“LFT = LE F-I-T”

Fingolimod

INF-Betas
Rebif / Plegridy / Avonex / Betaseron = Extavia

Teriflunomide = Aubagio
BBW -> severe liver injury

Daclizumab
BBW for hepatic injury –> REMOVED from market

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16
Q

Copaxone = Glatiramer Acetate

ARR% - Indications - MoA​

A

30%

CIS - RRMS

Synthetic Polypeptide mimicking myelin basic protein (MBP)
inhibits antigen presentation & T-cell Activation

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17
Q

Which MS drug is recommended for

WOMEN looking to get PREGNANT?

A

COPAXONE
Glatiramer Acetate
30%

18
Q

ADRs & Monitoring

Copaxone
Glatiramer Acetate

A

LIPOATROPHY
@ injection site –> loss of SUBq fat

  • *Injection Site Reactions**
  • *SUBQ**
  • *Transient Post-Injection Reactions**
  • flushing / chest tightness / palpitation / anxiety*

ONLY PREGNANCY CLASS B DMT for MS

19
Q

Natalizuab
Tysabri

ARR% - Indications - MoA

A

68%
HIGHEST EFFICACY, typically last line

RRMS
Patients with poor response / failed alt therapies
IV Infusions Every Month

Humanized MAB
binds a4 subunit of integrin on surface of lymphocytes
prevents entry into CNS

20
Q

ADRs & Monitoring

Natalizumab
Tysabri

A

BBW - PML
demyelinating disease affecting CNS in IMS pts
TOUCH PROGRAM
3 Risk Factors
>2 years treatment + JCV ABs + Prior IMS therapy

Opportunistic Viral infection (by JC virus)
Death or Severe Disability

21
Q

What are RISK FACTORS for PML

when starting Natalizumab?

A
  • *Duration of Treatment**
  • *> 2 years**

+ JCV Antibodies

Prior IMS therapy
AZA - MTX

if any of these factors –> HUGE RISK for PML

22
Q

Which MS drugs have risk for

PML?

A

PML -> T-N-F
Tecfidera - Natalizumab - Fingolimod

Dimethyl Fumarate = Tecfidera

Natalizumab
BBW - Touch program

Fingolimod

23
Q

Fingolimod
Gilenya

ARR% - Indications - MoA​

A

54%

  • *RRMS**
  • *ORAL DAILY CAPSULE**
  • *S1P inhibitor**
  • *redues migration of peripheral lymphocyes –>CNS**
24
Q

Which MS drug is:

CONTRAINDICATED WITH CV ISSUES?

A

FINGOLIMOD
Oral - 54%

MI - Unstable Angina - Stroke - HF
within 6 months

2nd / 3rd degree AV block

Class 1 / 3 Antiarrythmatic Drugs

Qtc interval > 500

25
Q

ADRs

FINGOLIMOD

A
  • *PML REPORTED**
  • *Leukopenia + Lymphocytopenia**
  • *First dose BRADYcardia**
  • *Contraindicated for CV patients**
  • *Bronchitis**
  • mild reduction in* Lung FXN

Risk of HERPES viral infection
check VZ igG Ab

HT / Edema

2 Month elimination –> wait for pregnancy

26
Q

Monitoring for

FINGOLIMOD

A
  • *Initial Monitoring Procedures**
  • (MUST BE REPEATED IF TREATMENT IS INTERRUPTED)*
  • *CBC + LFT**
  • *Opthalmolgy Exam +** VZ IgG Titer ( Herpes )
  • *EKG Baseline**

First Dose Admin Monitoring
VS + Hourly BP/HR for 6 hours
Post-Dose EKG
Opthalmic exam + CBC + LFT

Repeat 1 Initial Monitoring if… After Medication Initiation:

  • *> 1 day during the first 2 weeks**
  • *> 7 days during weeks 3-4**
  • *> 14 days after > 1 month**
27
Q

Teriflunomide
Aubagio

ARR% - Indications - MoA​

A

30%

  • *RRMS**
  • *7 & 14 mg Tablet QD** ORAL
  • reduction is ONLY seen with 14mg/day*

MoA is not well known

28
Q

Which MS drugs have

~30% ARR?

Reduction in Annualized Relapse Rate

A

INF-beta
LFT / CBC / Depression

Copaxone
SC - Glatiramer Acetate - Pregnancy Cat B

Teriflunomide = Aubagio
Oral / BBW - LFT / Enterohepatic recycling

29
Q

Which MS drugs have

intermediate (47-54%) ARR?

Reduction in Annualized Relapse Rate

A
  • *Tecfidera = Dimethyl Fumurate**
  • *53%** - ORAL - PML

Fingolimod = Gilenya
54% - ORAL - PML
contraindicated in CV patients & lot of monitoring

Ocrelizumab = Ocrevus
47% - only drug for PPMS
IV+ needsHEP B

30
Q

Which MS drugs have

HIGH EFFICACY but pose Significant Risks?

A

Natalizumab = Tysabri
68% - HIGHEST ARR
But has TOUCH - BBW for PML

Alemtuzumab
49-55% - BBW - cause many issues
Skin Exam / TSH / MALIGNANCIES
Autoimmune disease / Infusion reaction

31
Q

ADRs & Monitoring

Teriflunomide = Aubagio

A

“TERRIBLE = TERiflunomide”

  • *Severe Liver Injury = BBW**
  • *LFTs**
  • *Enterohepatic Recycling**
  • *Pregnancy Category X –> need to treat for pregnancy**

TB INFECTION

Renal Fxn + CBC + BP

Other ADRs:
ALOPECIA + GI ISSUES + Leukopenia & Lymphopenia

32
Q

Which MS drug requires a

TB TEST

A

TERIFLUNOMIDE
Aubagio

TB Test - CBC - Renal Fxn - BP

BBW –> LFT

Pregnancy Cat X - Enterophpatic Recycling

Other ADR:
Alopecia / GI issues / Leukopenia

33
Q

Dimethyl Fumarate = Tecfidera

ARR% - Indications - MoA​

A

53%

  • *RRMS**
  • *Oral –> 120 BID f7d –> 240mg BID**

exact MoA is not known

34
Q

ADR & Monitoring

Dimethyl Fumarate = Tecfidera

A

has the LEAST ADR
Flushing - GI Problems - ↓Lymphocytes

CBC monitoring

but has:
PML
patients with prolong lymphopenia ( <500 lymph count ) > 6 months

35
Q

Which MS drug is indicated for:

PRIMARY PROGRESSIVE MS

A

Ocrelizumab = Ocrevus

47%

RRMS + PPMS
IV Administration

MoA:
humanized MAB –> binds CD20 on B-lymphocytes

36
Q

Which DMT for MS requires

HEPATITIS B Screening?

A

OCRELIZUMAB
CD20 - works on PPPMS

HEPATITIS B
need to screen for HBV b4 starting

Significant Infusion RXNs
premedicate with MPD + APAP + Antihistamine

IV administration

37
Q

Alemtuzumab = Lemtrada

ARR% - Indications - MoA​

A

49-55%

  • *RRMS**
  • *2+ Inadequate Responses to OTHER DMTs**
  • *Only 2 IV infusions in lifetime**

MoA:
MAB –> CD52 on
T + B lymphocytes + monocytes + nK cells

38
Q

Which DMT drug requires

TSH Test?

Thyroid Cancer / Malignancies

A

ALEMTUZUMAB
CD52

  • *BBW**
  • *autoimmune disease** = immune thrombocytopenia
  • *infusion rxns** = serious & life threatening
  • *MALIGNANCIES** + srs infections

Monitoring
CBC + SCr + UA
TSH / Skin Exam

39
Q

What MS drugs are

ORAL?

A

“Oral - DTF”

Dimethyl Fumarate = Tecfidera

Teriflunomide = Aubagio

Fingolimod = Gilenya

40
Q

What MS drugs are

IV
intravenous

A

Ocrelizumab
Ocrevus

Natalizumab
Tysabri

Alemtuzumab
lemtrada

PDAT4 (34 decks)

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