DSA 36 Drugs for Multiple Sclerosis Flashcards
which drug is usually used to stop MS attacks in progress?
high dose corticosteroids
what is the action of corticosteroids on phospholipase A2 (PLA2) and what is the result?
corticosteroids block PLA2 → decreased leukotriene and prostaglandin formation
what is the treatment of choice for an acute MS attack?
3-5 day cource of high dose IV steroids
fill in the blank: do not use _______ antagonists in MS.
TNF
what are untoward effects of dimethyl fumarate?
some GI distress, some allergy phenomena, depression of circulating lymphocytes
which disease-modifying drugs are orally active?
fingolimod, teriflunomide, and dimethyl fumarate
which drugs have flu-like syndrome (fever, myalgias) as a side effect?
beta interferons, fingolimod, teriflunomide
what might occur during treatment of MS with beta interferons?
development of neurtralizing antibodies to beta interferon (Nab), particular to interferon beta-1b drugs
what is the effect of Nab with beta interferon treatment?
antibody production is associated with higher rates of MRI lesions
which drug mimics myelin basic protein?
glatiramer
what are some transient reactions seen with glatiramer treatment?
flushing, chest pain, dyspnea, urticaria
identify: sphingosine-1-receptor modulator.
fingolimod
what are common untoward effects of fingolimod?
influenza type syndrome, headache, diarrhea, elevated AST/ALT, cough
what are concerning side effects of fingolimod?
shortness of breath and bradycardia, macular swelling with optic neuritis syndrome
what is the mechanism of action of teriflunomide?
reversibly inhibits dihydroorotate dehydrogenase → reduces T cell and B cell proliferation/function
identify: drug reported as having hemophagocytic syndrome as side effect.
fingolimod
what is mechanism of action of natilizumab?
monoclonal antibody that reduces movement of immune cells into CNS, traps them in spleen and lymph nodes
identify: drug treatment related to increased incidence of progressive multifocal leukoencephalopathy in patients with previous infection of JC virus.
natilizumab
what is the mechanism of action of mitoxantrone?
intercalates with DNA and RNA → inhibits topoisomerase II → reduces activity of T cells, B cells, and macrophages
what are the black box warnings for mitoxantrone?
cardiotoxicity (including heart failure) and acute myelogenous leukemia
identify: this drug is prohibited from being given to patients with ejection fraciton less than 50% or with significant cardiac disease.
mitoxantrone
what is the mechanism of action of natalizumab?
blocks entry of immune cells into the CNS. traps cells in the spleen
what is a rare but deadly side effect of natalizumab?
progressive multifocal leukoencephalopathy
what risk factor most determines the likelihood of developing PML when taking natalizumab?
antibody titer against JC virus.
another risk factor is recent history of immunosuppressant therapy.
what should you monitor in patient taking dimethyl fumarate?
leukopenia
interferon beta intereferes predominantly with?
virus replication
what is expected outcome concerning relapses with infliximab?
increase number of attacks, increase severity of attacks
patient presents with remitting MS. what is reasonable expectation of interferon beta 1a therapy?
reduced number of attacks per year
with beta interferon therapy, shortly after every treatment patient is most likely to experience?
flu-like syndrome
patient less likely to experience what side effect if taken interferon beta 1a instead of interferon beta 1b?
production of neutralizing antibodies
patient on MS therapy experiences significant relapse including loss of vision in right eye. proper therapy is to add?
corticosteroid (e.g. methylprednisone)–all flares of MS have to be brought under control as quickly as possible
patient switched to fingolimod. initial dose of this drug must be monitored carefully because it causes?
bradycardia
what agent might be substituted over interferon beta 1a that has advantage of modifying disease without causing production of neutralizing antibodies?
glatiramer
what are typical side effects of glatiramer?
injection site reaction, flush, tachycardia, dyspnea
mitoxantrone is effective in multiple sclerosis because it?
intercalates with DNA → slows B cell and T cell formation
what coexisting disease would contraindicate mitoxantrone treatment?
systolic heart failure
