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Pharm > CASE STUDY CONDITIONS: MS > Flashcards

CASE STUDY CONDITIONS: MS Flashcards

1
Q

Multiple Sclerosis: Overview & Cause

A
  • chronic inflammatory autoimmune disorder that damages the myelin sheath of neurons in the CNS
  • cause: genetically vulnerable people following exposure to environmental or microbial factor that intiaties autoimmune activity
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2
Q

MS Subtypes

Four

A
  1. relapse remitting (most common)
  2. secondary progressive
  3. primary progressive
  4. progessive relapsing
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3
Q

MS: Drugs employed to:

A
  1. modify disease process
  2. treat acute relapse
  3. manage symptoms

no drugs to cure MS

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4
Q

Disease Modifying Drugs

A
  • decrease the frequency and severity of relapse
  • decrease the development of brain lesions
  • decrease future disability
  • help maintain QOL
  • prevent damage to axons
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5
Q

MS: Classes of Disease Modifying Drugs

A
  1. immunomodulators
  2. immunosuppressants
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6
Q

MS Immune Modulators

names

A
  1. interferon beta
  2. dimethyl fimarate
  3. glatiramer acetate
  4. natalizumab
  5. finolimod
  6. terifulmonide
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7
Q

Routes of Admin: Immunomodulators

MS

A

IM or SubQ - interferon beta, glatiramer
PO - dimethyl fimarate, fingolimod, teriflumonide
IV - natalizumab

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8
Q

Side effects: dimethyl fumarate

MS

A
  • facial flushing (most common)
  • lymphopenia with inc. risk of infections (most serious)
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9
Q

Drug Interactions: dimethyl fumarate

MS

A
  • can decrease the body’s response to live virus vaccines
  • pts should not take live virus vaccines when taking drug
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10
Q

Glatiramer: overview

MS

A
  • less well tolerated than inf. b
  • requires more frequent injections
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11
Q

Glatiramer: Adverse Effects

MS

A
  • injection site reactions - pain, erythema, pruritus, induration (most common)
  • chest pain after injection (brief but severe)

does not cause flu-like effects like int. b

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12
Q

Adverse Effects: Interferon Beta

MS

A
  • flu like symptoms
  • liver injury
  • myelosuppression
  • injection site reactions
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13
Q

Fingolimod: Overview

Ms

A

binds with sphingosine 1-phosphate receptors to keep lymphocytes out of the brain , reducing axonal damage and inflammation

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14
Q

Fingolimod: Adverse Effects

MS

A
  • bradycardia
  • infection
  • macular edema
  • liver injury
  • fetal harm
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15
Q

Natalizumab: Adverse Effects

MS

A
  • progressive multifocal leukoencephalopathy, reactivation of JC virus
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16
Q

Natalizumab: Contraindications

MS

A
  • do not combine with other immunosuppressant drugs
  • do not give to pts with HIV or other conditions that compromise cell-mediated immunity

must be used in accord to TOUCH Prescribing Program

17
Q

Teriflumonide: Adverse Effects

MS

A
  • serious birth defects if taken by pregnant women
  • birth defects may occur in women impregnated by man taking terifulmonide
18
Q

Teriflumonide: Drug interactions

MS

A
  • pts taking teriflumonide should not take leflumonide - fatal combination
  • pateints taking teriflumonide should avoid live virus vaccines
19
Q

Mitoxantrone: Overview

MS

A
  • only immunosuppressant currently approved for MS
  • suppresses immune function more than modulators, but is more toxic
  • reserved for pateints who are unresponsive to, or intolerant of, immunomodulators
20
Q

Mitoxantrone: Adverse Effects

MS

A
  • myelosuppression
  • cardiotoxicity
  • fetal injury
21
Q

Preferred treatment for acute MS relapse

MS

A
  • short course of high dose IV glucocorticoids (methylprednisone)

OR

  • intravenous gamma globulin
22
Q

Interferon beta: baseline data

MS

A
  • CBC
  • LFT
23
Q

Interferon beta: Identifying high risk patients

MS

A
  • patients who use alcohol
  • pts with active liver injury
  • pts taking drugs that can cause liver injury or suppress bone marrow
24
Q

Mitoxantrone: Baseline Data

MS

A
  • pregnancy test
  • LFT
  • CBC
  • LVEF determination
25
Q

Mitoxantrone: High Risk pts/contraindications

MS

A
  • contraindicated during pregnancy
  • contraindicated in patients with abnormal LFTs or an LVEF < 50%
26
Q

Mitoxantrone: Administration

MS

A
  • infuse over 5-30min through free-flowing IV line. if extravasion occurs, discontinue infusion immediately and restart on different vein
  • do not mix with other drugs
27
Q

Mitoxantrone: Monitoring

MS

A
  • perform CBC before each dose, 10-14 days after each dose, and when signs of infection develop
  • perform LFTs before each dose
  • determine LVEF before each dose adn when signs of heart failure develop

Pharm (6 decks)

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