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PHRM 845 > 40-41 Pharmacotherapy of MS > Flashcards

40-41 Pharmacotherapy of MS Flashcards

1
Q

diagnosis of MS requires having at least __ demyelination related episodes separated by ___ and ___

A

2, time, space

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2
Q

2017 McDonald Diagnostic Criteria Revision

Dissemination in Time (DIT) - ___ between evidence of new lesions in subsequent MRIs (30 days)
- damage that has happened more than ___

A

time
once

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3
Q

2017 McDonald Diagnostic Criteria Revision

Dissemination in Space (DIS) - need for > ___ T2 lesion appearing in at least two of four MS typical CNS regions - cortical, periventricular, infratentorial, and spinal cord
- damage that is in more than one ___

A

one
place

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4
Q

Types of MS

Clinically ___ Syndrome (CIS)
- descriptor of the ___ demyelinating event
- most will develop MS in 20 years

A

Isolated
first

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5
Q

Types of MS

Relapsing Remitting MS (RRMS)
- most ___
- consists of relapses with partial or complete ___ between relapses
- most will become ___ over time

A
  • common
  • remission
  • progressive
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6
Q

Types of MS

Secondary Progressive MS (SPMS)
- ___ % of RRMS patients will progress to SPMS
- ___ relapses with continuing disability

A
  • 80%
  • fewer
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7
Q

Types of MS

Primary Progressive MS (PPMS)
- 10-15% of patients
- progressive form from onset with ___ improvements or periods of ___
- more common in patients disagnosed in ___ years (> 50 years of age)

A
  • minor, stability
  • later
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8
Q

Types of MS

Progressive Relapsing MS (PRMS)
- ___ common
- ___ worsening disease from onset with later, clear, acute relapses
- may be some recovery from acute attacks, but no ___ between relapses

A
  • least
  • steadily
  • remission
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9
Q

disease modifying drug therapy is focused in the ___ type of MS, based upon current drug target of ___ vs neurodegeneration

A

RRMS, inflammation

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10
Q

Treatment of Acute Attacks

high dose ___ treatment is the first choice
- oral or intravenous treatment based on setting

most patients will be inpatient

A

corticosteroid

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11
Q

Treatment of Acute Attacks

methylprednisolone ___ - ___ mg IV daily for 3-7 days, with or without taper over 1-3 weels

A

500 - 1000 mg

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12
Q

Treatment of Acute Attacks

if outpatient:
- oral prednisone ____ mg every other day for 5 doses without need for taper

A

1250 mg

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13
Q

oral medications and brand names

cladribine
dimethyl fumurate
diroximel fumarate
monomethyl fumerate
fingolimod
ozanimod
ponesimod
siponimod
teriflunomide

A

Mavenclad
Tecfidera
Vumerity
Bafiertam
Gilenya, Tascenso ODT
Zeposia
Ponvory
Mayzent
Aubagio

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14
Q

injectable medications and brand names

interferon B1a
Peginterferon B1a
interferon B1b
glatiramire acetate
ofatumumab

A

Avonex, Rebif
Plegridy
Betaseron, Extavia
Copaxone
Kesimpta

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15
Q

infusion medications and brand names

alemtuzumab
mitoxantrone
natalizumab
ocrelizumab
ublituximab-xiiy

A

Lemtrada
Mitoxantrone
Tysabri
Ocrevus
Briumvi

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16
Q

progressive multifocal leukoencephalopathy

  • rare adverse event caused by reactivation of dormant JCV
  • causes myelin producing cells to break down, looks simialr to MS relapse
  • 50-80% or adults have antibodies to JCV, risk reactivation with some immunotherapies
  • ___ % mortality rate
  • **patients must be tested for JCV ___ ***

JCV = Human polyomavirus 2

A

50%
antibodies

17
Q

vaccines

  • ___ vaccines preferred
  • ___ , attenuated vaccines are not recommended because the ability to cause the disease is weakened, but not eliminated
  • ____ - no live virus vaccines
  • ___ vaccine should be considered by people with MS who have ___ had chicken pox, especially if they may start a MS medication that suppresses cell mediated immunity ( ___ and ___ )
A
  • inactivated
  • live
  • alemtuzumab
  • varicella, never, fingolimod, alemtuzumab
18
Q

dimethyl, diroximel, and monomethyl fumarate

  • capsule should not be opened
  • monitor ___ and CBC with differential ( ___ )
  • assocaited with ___
  • can cause ___, may take ASA 30 min prior to dose
A
  • LFTs, neutropenia
  • PML
  • flushing
19
Q

S1P receptor modulators

4 drugs:
- CI with past ___ diagnosis (or MI, unstable angina, stroke/TIA, class III-IV HF within past 6 months)
- D/C can result in significant ___ of MS symptoms
- ___: avoid use with an MAO inhibitor
- ___: CYP2C9 genotype testing required before prescribing
- must be monitored 6 hours after first dose, monitor CBC

if they fail one, they fail all

A

fingolimod, ozanimod, ponesimod, siponimod
- arrhythmia
- worsening
- ozanimod
- siponimod

20
Q

glatiramer acetate

  • injection SE: flushing, sweating, dyspnea, chest pain, anxiey, itching
  • ___ may occur at injection site that is likely permanent, rotate
  • ___ may occur outside of injection, usually not clinically significant
  • may be preferred if treatment is necessary in ___ (teratogenic effects are unknown)
A
  • lipoatrophy
  • chest pain
  • pregnancy
21
Q

interferons

  • can be dosed SC or IM every other day to every 2 weeks depending
  • ___ like symptoms can occur after injection (can pretreat with APAP or NSAID)
  • psychiatric SE: depression and ___ thinking
  • elevated liver function tests and thyroid dysfunction - monitor ___ and ___
A
  • flu
  • suicidal
  • LFT, TSH
22
Q

monoclonal antibodies

alemtuzumab
- ___ program
- possible fatal infusion reactions and autoimmune conditions
- associated with increased risk of ___
- CI in ___ infection - prolonged decreased CD4 count

A
  • REMs
  • malignancies
  • HIV
23
Q

monoclonal antibodies

natalizumab
- ___ program
- significant association with ___

A
  • REMs
  • PML
24
Q

monoclonal antibodies

ocrelizumab
- only drug FDA approved for ___
- CI in active ___
- associated with increased risk of ___

A
  • PPMS
  • hepatitis B
  • malignancies
25
Q

monoclonal antibodies

  • complete vaccinations at least ___ weeks before starting treatment
  • can premedicate with steroid, antihistamine, APAP prior to dose
A

6

26
Q

Pregnancy

teriflunomide
- ** ___ **
- accelerated elimination via activated charcoal /cholestyraline for 11 days

mitoxantrone
- contraception required and ___ before each infusion

cladribine
- contraception + barrier method for at least ___ months after D/C
- CI in ___

A
  • CI
  • pregnancy test
  • 6, breastfeeding

toxic, not just teratogenic

27
Q

Pregnancy

contraception required during treatment
- fingolimod: ___ months after D/C
- ozanimod: ___ months after D/C
- ponesimod: ___ days after D/C
- siponimod: ___ days after D/C
- ocrelizumab: ___ months after D/C

A

2
3
7
10
6

28
Q

pregnancy

  • rates of relapse ___ during pregnancy, increase for first ___ months post-partum, then return to normal pre-pregnancy rate
  • MS therapy should be D/C prior to conception
  • not advised to ___ if treatment is restarted
A
  • decrease, 3
  • breastfeed
29
Q

pseudobulbar affect

inappropriate episodes of crying, laughing, both unrelated to actual mood
- ___ (dextrimethorphan/quinidine) used for this

A

Neudexta
- DM = sigma-1 receptor agonist; supress release of excitatory neurotransmitters, NDMA receptor antagonist

30
Q

Gait abnormalities/Walking speed

___ (Ampyra)
MOA: blocks ___ channels and prevents ___ of cell, causing prolonged action potentials and nerve impulse transmission
- improve 25 foot walking speed by ___ seconds
- ___ dosage form assocaited with seizures; CI in patients with history of seizures
- ___ formulation preferred (SE: UTIs, insomnia, dizziness, headache, nausea)

A

dalfampridine
- K, repolarization
- 3
- IR
- ER

31
Q

symptomatic management

  • ___ for bladder dysfunction may worsen cognitive function
  • ___ is indicated for treatment of spasticity
A
  • anticholinergics
  • baclofen
32
Q

marijuana in MS

Spasticity: OCE/THC decreased patient reported scores, but not ___ scores

Pain: ___ effective for central pain, ___ probably effective to decrease painful spasms

Tremor, bladder dysfunction: OCE and THC probably ineffective

A

objective
OCE, THC

PHRM 845 (62 decks)

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