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701 > Exam 2: Multiple Sclerosis > Flashcards

Exam 2: Multiple Sclerosis Flashcards

1
Q

MS definition

A
  • Multiple - multiple areas of lost myelin (from myelin sheath, which wraps around the axon)
  • Scleorosis - scarring

Autoimmune inflammatory disease affecting CNS

  • Imapairs nerve abiity to send electrical impuse
  • Inflammation and immune activity ( T and B lymphocytes, macrophages, destructie cytokines, Ab, and complement) → demyelination of axon
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2
Q

MS associated factors

A
  • Vit D deficiency
  • Smoking increases risk
  • Infectious factors (measles, canine distemper, herpes, epstein-barr, an chlamydia can trigger
  • Not being pregnant, somehow MS is less bitchy if youre pregnant
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3
Q

MS S/S

A
  • Visual symptoms (blurred or double vision)
  • Usnteady gait/balance issues
  • Pain/paresthesias
  • Emotional/cognitive disturbances
    • Concentration issues
    • Short term mempry loss
  • Fatigue
  • Sexual dysfunction
  • Speech
  • Swallong
  • Abnormal sensations (tingling, numbesss)
  • Senstiivity to heat
  • Blader and bowel problems (freqency adn control)
  • Charcot’s triad
    • Dysarthria
      • Difficult or unclear speach
      • Plaques in brainstem interfere with conscious and unconsciousness movement
    • Nystagmus
      • Involuntary eye movement
      • Plaques on nerves controlling eye movement
        • If optic nerve → loss of vision
    • Intention tremor
      • Plaques unlong motor pathways
      • Muscle weakness → ataxia and paralysis
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4
Q

What are the 4 types of MS

A

RRMS (relapsing remitting) - episodes with no increase in disability BETWEEN episodes, each episode just leaves pt a little worse off

SPMS (secondary progressive) - had a few episodes early on but is now just steadily worsening

PPMS (primary progressive) - no episodes, just steady worsening

PRMS (progressive-relapsing) - episodes with steady worsening in between

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5
Q

CIS

A

Cinically isolated syndrome - first episode of neurologic symptos lasting at least 24 hrs aused by inflmamtion and emyleination in onr or more sites in CNS, may not develop MS

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6
Q

MS DX

A
  • Alternative Dx considered then exlcuded
  • Pt must have at least 2 clinical exacerbations separted by timd and space as well as 2 distinct MRI lesions
  • DCSF tap - looking for high level of Abs
  • Visual evoked potential - measure response to visual stimuli
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7
Q

All of the following are common side effects of fumarate derivatives EXCEPT:
- nausea
- flushing
- diarrhea
- alopecia

A

Alopecia

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8
Q

Which of the following is not a fumarate derivative?
- Aubaigo
- Tecfidera
- Vulmerity
- Bafiertam

A

Aubagio

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9
Q

Which drug is approved for pseudobulbar affect disorder?

A

Neudexta (dextromethorphan/quinidine)

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10
Q

Which drug is approved for walking?

A

Ampyra (Dalfampridine)

to remember, think “amble”

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11
Q

Which S1P drug has a drug interactions with SSRIs, SNRIs, MAOis, and tyramine in its PI?

A

Ozonimod

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12
Q

Which 2C9 genotype requires dose adjustent with siponimod?

A

*1/ *3

*2/ *3

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13
Q

Which 2C9 genotype is contraindicated with siponimod?

A

*3/ *3

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14
Q

Which S1P drug requires genotyping

A

Siponimod

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15
Q

The first dose monitoring is to monitor for which of the following side effects of S1P drugs?

A

bradycardia, QTc prolongation, conduction abnormalities

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16
Q

Which S1P drug always requires at least 6 hour First dose monitoring?

A

Fingolimod

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17
Q

Which chemotherapeutic drug is given orally for 2 years, which 2 cycles/year?

A

Cladribine

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18
Q

Which chemotherapeutic drug is given as IV and has a cumulative lifetime dose of 100 mg/m2 due to cardiotoxicity?

A

Mitoxantrone

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19
Q

Which MS mAb is reserved for patients who have failed 2 or more disease modifying therapies due to its side effect profile which includes one-third of patients developing thyroid issues?

A

Alemtuzumab

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20
Q

Which MS mAb can be given at home by SubQ injection?

A

Ofatunumab

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21
Q

Which MS mAbs work on CD20?

A

OCrelizumab

Ofatunumab

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22
Q

Which MS mAb blocks migration of Leukocytes across the BBB

A

Natalizumab

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23
Q

What are the ABCR therapies and which does not cause depression or Flu-like symptoms, is synthetic, and is safest to use in a woman of child bearing potential?

A

Avonex

Betaseron

Copaxone

Rebif

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24
Q

What medication is effective for PPMS

A

Ocrelizumab (Ocrevus)

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25
Q

Which MS meds have live vaccine considerations?

A

Ofatunumab (Kesimpta) - give vaccine 4+ wks before and/or 2+ after

Cladribine (Mavenlad) - give vaccine 4+ wks before and/or 3 mo. after

Fingolimod (Gilenya) - give zoster 30 days before and no live accines while on med

Mayzent/Siponimod give vaccine 4+ wks before and/or 4+ after

Zeposia/Ozonimod - give vaccine 1 mo before

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26
Q

Pseudobulbar affect definition

A

uncontrollable crying or laughig even if they are not feeling that emotion - in pts with ALS, MS, AD, PD, stroke, TBI

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27
Q

Dalfampridine (Ampyra) CI

A

CI in pts with mdoerate or severe renal impairment, hx of seizure

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28
Q

Dalfampridine (Ampyra) MOA

A

broad specturm K channel blocker → incrase conduction of action potentials in demyelinated axonx

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29
Q

Dalfampridine (Ampyra) dose

A

10mg BID (do not crush, chew or dissolve)

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30
Q

Dalfampridine (Ampyra) AE

A

asthenia
balance, dizziness
HA
insomnia
paresthesia
nasopharyngitis
pharyngolarneal pain
constipation
dyspepsia
nausea
back pain
UTI

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31
Q

Nuedexta (dextrometorphan HBr and Quindine sulfate) MOA

A
  • Dextrometorphan: may inhibit glutamatergic neurotransmitter vai action at vairety of lcoations including NMDA receptor and sigma-1 receptors
    • may play a role in behavior
  • Quinidine: helps with blocking metabolism of dextrometorphan (CYP2D6) → increase serum [ ]
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32
Q

Nuedexta (dextrometorphan HBr and Quindine sulfate) dose

A

Dose: 1C (20/10mg) PO QD 7D then titrate up to 1C BID

the quinidine dose is 1-3% of the dose needed for arrhymthias

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33
Q

Meds for general s/s of MS

A
  • baclofen
  • dantrolene
  • diazepam, clonazepam
  • tizanidine
  • gabapentin, tiagabine, pregabalin
  • botox
  • cannabinoids (insufficient data for or against)
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34
Q

Meds for cogntiive s/s in MS

A
  • amantadine
  • SSRI, SNRI
  • modafanil
  • methylphenidate
  • dextroamphetamine
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35
Q

Meds for sensory s/s in MS

A
  • CBZ, OxCBZ
  • phenytoin
  • TCAs
  • gabapentin, pregabalin
  • lamotrigine
  • duloxetine
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36
Q

Meds for bladder treatment in MS

A
  • propantehline
  • oxybutinin and co.
  • mirabegron
  • dicyclomine
  • desmopressin acetate
  • TCAs
  • prazosin
  • botox
  • catheter (not a med)
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37
Q

Monomethyl fumerate (Bafiertam) AE

A

flushing (asa325mg 30min prior to reduce)
transient increase in LFTS
transient eosinophilia
lymphopenia (consdier swithcing if lymphocytes <500 for 6mo)
PML
urinalysis

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38
Q

Monomethyl fumerate (Bafiertam) dosing in MS and storage

A

start 95mg BID 7D then 190mg BID (if not tolerated, trial lower dose for 4 weeks before increasing again, if still not tolerated, consider d/c)

store unopened bottle in refrigerator and opened bottle at room temp for up to 3 months

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39
Q

Monomethyl fumerate (Bafiertam) MOA

A

bioequiv to Tecfidera but lower dose → potential for les GI AE

Induce t helper 2-like cytokines (IL 4, 5 10) causing →
- apoptosis in active t cells
- downregulation of adhesion molecules → reduced migration of lymphocytes

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40
Q

Which forms of MS can monomethyl fumerate (Bafiertam) be used for?

A

relpasing forms (CIS, RRMS, active SPMS)

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41
Q

Diroximel fumerate (Vulmerity) dosing in MS and admin

A

start 231mg BID 7d then 462mg BID (if not tolerated, trial lower dose for 4 weeks before increasing again, if still not tolerated, consider d/c)

do NOT ake with a high fat (>30g) or high calorie meal (>700 cal) d/t decreased peak [ ]; avoid EtOH at time of admin

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42
Q

Diroximel fumerate (Vulmerity) AE

A

flushing (asa325mg 30min prior to reduce)
transient increase in LFTS
transient eosinophilia
lymphopenia (consdier swithcing if lymphocytes <500 for 6mo)
PML
urinalysis

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43
Q

Diroximel fumerate (Vulmerity) MOA

A

(like Tecfidera) - but less GI irritation

Induce t helper 2-like cytokines (IL 4, 5 10) causing →
- apoptosis in active t cells
- downregulation of adhesion molecules → reduced migration of lymphocytes

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44
Q

Which form of MS is Diroximel fumerate (Vulmerity) used for?

A

relpasing forms (CIS, RRMS, active SPMS)

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45
Q

Dimehtyl fumarate (Tecfidera) monitoring

A

liver test prior to treatment and as clincially idicated after start

CBC needed 6 months before starting and Q3mo after

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46
Q

Dimehtyl fumarate (Tecfidera) AE

A

GI
flushing (asa325mg 30min prior to reduce)
transient increase in LFTS
transient eosinophilia
lymphopenia (consdier swithcing if lymphocytes <500 for 6mo)
PML
urinalysis

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47
Q

Dimehtyl fumarate (Tecfidera) dosing in MS and admin

A

DR tabs: start 120mg PO BID 7D then 240mg PO BID

(though admin with high fat, high protein food - yogurt, peanut butter) may decrease incidence of flushing and GI

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48
Q

Dimehtyl fumarate (Tecfidera) MOA

A

Induce t helper 2-like cytokines (IL 4, 5 10) causing →
- apoptosis in active t cells
- downregulation of adhesion molecules → reduced migration of lymphocytes

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49
Q

Whcih forms of MS is dimehtyl fumarate (Tecfidera) used for?

A

relpasing forms (CIS, RRMS, active SPMS)

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50
Q

Teriflunomide (Aubagio) monitoring

A
  • may decrease WBC - CBC within 6 months before starting
  • liver and bili tests within 6 months before and every month after start for at least 6 months
  • screen for latent TB
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51
Q

Teriflunomide (Aubagio) DDI

A

may increase exposure to drugs metabolised by CYP2C8, OAT3, BCRP, and OAT1B1/B3, and ethinylestradiol and levonortestrol
- cholestyramine increases eliination (lower [ ] by 98% has clinical use)
- activated charcoal increase elimination
- may decrease INR in warfarin ps
- crestor should NOT exceed 10mg

52
Q

Teriflunomide (Aubagio) AE and BBW

A

HA
nasopharyngitis
URI, UTI
alopecia
sensory disturnace
nasuea, diarrhea
insomnia
fatigue
incrased LFTs
back pain, arhtralgia, limb pain
parathessias

BBW: hepatotoxicity and teratogenicity

53
Q

Teriflunomide (Aubagio) preggers consideration

A

NOT FOR PREGGERS OR BREASTFEEDING (use cholestyramine and charcoal to washout quickly,if not used may be in system for up to 2 years after d/c)

54
Q

Teriflunomide (Aubagio) MOA

A

Blocks pyrimidine synthesis in rapidly dividing cells, inhibit proein tyrosine-kinase and COX2 actiivty, and decreases ability of antigen presenting cells to activate Tcells

selectively produces a cytostatic effect in proliferating T and B lymphocutes in periphery → reduces B lymphocye proliferation

55
Q

Which form sof MS is Teriflunomide (Aubagio) used in?

A

Relapsing forms of (RRMS and SPMS)

56
Q

Zeposia/Ozonimod monitoring

A
  • CBC at baseline and at 6 moths
  • bilirubin and liver enzymes at baseline at at 6mo
  • ECG baseline, HR, BP, s/s of bradycardia
  • eye tests
57
Q

Zeposia/Ozonimod ddi

A
  • BCRP
  • CYP2C8
  • CYP3A4 (minor)
58
Q

Zeposia/Ozonimod CI

A

CI: heart problems, severe unobstrcted sleep apmea and MAOI

59
Q

Zeposia/Ozonimod AE

A

AV block
bradycardia
hepatotoxicity
HTN and orthostatic hypotension
ifection; URI; UTI
lymphpenia
macular edema
neurotoxicity
PML
respiratory
CV; QT prolongation

60
Q

Zeposia/Ozonimod preggers consideration

A

Use effectve contraception during and 3 months after

61
Q

Zeposia/Ozonimod dosing in MS

A

start 0.23mg QD 4D then 0.46mg 2D then 0.92mg QD
- if dose missed during tiration, restart

62
Q

Zeposia/Ozonimod MOA

A

high affinity for S1P receptors 1 and 5 → block lymphocytes’ ability to emerge form lymph nodes → deccrase lymphocytes in CNS

63
Q

Mayzent/Siponimod monitoring

A
  • CBC at baseline, and within 6 months
  • eye exam
  • ECG prior to start
  • baseline LFTs and within 6 monthsz

If pt has

  • sinus bradycardia <55bpm
  • Mobitz type 1 first or second degree AV block
  • hx MI
  • HF

additional monitoring for the 6hrs following dose admin

  • monitor pt 6hrs post 1st dose for bradycardia (HR and BP)
  • continue observing if bpm <45 or if HR is still at lowest after 6hrs
64
Q

Mayzent/Siponimod AE

A

infection
PML
macular edema
bradycardia
AV conduction delay
QTc prolongation
CV disease
respiratory effects
hepatic effects
HTN
neurotoxicity
malignancy
HA
fallin

65
Q

Mayzent/Siponimod CI

A
  • MI in past 6 months
  • unstable angina
  • stroke, TIA
  • HF requiring hospilazing or calss III or IV HF
  • Mobitz type 2 second ro third degree AV block
  • sick sinus syndrome (unless pacemaker)
66
Q

Mayzent/Siponimod preggers consideration

A

use effective contraception during and for 10 days after last dose

67
Q

Mayzent/Siponimod dosing in MS and storage

A

available as 0.25 or 2mg tabs

store unopened in fridge and opned in room temp for <3 mo.

CYP2C9 genotype 1/1, 1/2, or 2/2
- start 0.25mg QD 2D, then 0.5mg 1D, then 0.75mg 1D, then 1.25mg 1D, then 2mg QD

CYP2C9 genotype 1/3 or 2/3
- start 0.25mg QD 2D, then 0.5mg 1D, then 0.75mg 1D, then 1mg QD

CYP2C9 genotype 3/3
- contraindicated

if dosed msised for more than 24hrs during titration, start over

if 4+ consecutive days missed during maintenance, restart titration

68
Q

Mayzent/Siponimod MOA

A

S1P receptor moduator, binds to receptors 1 and 5 → block lymphocytes’ ability to emerge from lymph nodes 0> decrease amount of lymphocytes in CNS → decrease central inflammation

69
Q

Which forms of MS is Mayzent/Siponimod used for?

A

relapsing forms of MS (CIS, RRMS, and active SPMS)

70
Q

Fingolimod (Gilenya) AE

A

prolonged qTC → DDI and CI in pts wtih hx of cardio disease

HA
lymphopenia, leukopenia
URI
macular edema (get baseline eye exam and 3-4 months after)
increase in bp, HTN
elevated LFTs
pain
diarrhea
decreased HR

71
Q

Fingolimod (Gilenya) monitoring

A
  • ECG before initaing
  • monitor pt 6hrs post 1st dose for bradycardia (HR and BP)
    • continue observing if bpm <45 or if HR is still at lowest after 6hrs
    • monitor overnight if pt at incrased risk for torsades
    • monitor 1st dose again
      • if pt misses 1 day in first 2 weeks
      • 7 days in 34d and 4th weeks
      • 14 days after 1 month
  • Eye exam at base line and 3-4 months after starting
72
Q

Fingolimod (Gilenya) dosing in MS

A

0.5 mg QD

no food effect, no adjustment for renal, hepatic, age, gender or race

73
Q

Fingolimod (Gilenya) MOA

A

acts on S1P1 and S1P 3-5 on the surface of lymphocytes → deplete Cd4 and CD8 in baseline and inhibit lymphocyte release from lyphatic organs

74
Q

Which forms of MS is Fingolimod (Gilenya) used in

A

relapsing forms of MS (RRMS and active SPMS) in pts 10+ y/o

75
Q

Cladribine (Mavenlad) monitoring

A
  • Liver function
  • CBC at start of each treatment and 2 and 6 months after each yearly course
76
Q

Cladribine (Mavenlad) DDI

A

DDI
- BBCRP/ABCG2
- PGP/ABCB1
- immunosuppresants
- decreased effectiveness of contraceptives

77
Q

Cladribine (Mavenlad) AE

A

bone marrow suppression
infecetion, URI
PML
graft versus host disease; hypersensitivity reaction
hepatotoxic
cardiotoxic
CNS (HA)
GI
lymphocytopenia
thrombocytopenia

78
Q

Cladribine (Mavenlad) CI

A

CI in pts with current malignancy or in preggers or in breastfeeding

  • effective contraception during dosing and for 6 months after last dose
79
Q

Cladribine (Mavenlad) MOA

A
  • chemo agent

Purine nucleoside anaglue → incorporated into DNA → breakage of DNA strand → shutdown of DNA syntesis and repair → may have cytotoxic effects on B and T lymphocytes

Also depletes ATP

Cell-cycle non-speific

80
Q

Whihc forms of MS is Cladribine (Mavenlad) used in

A

for relapsing forms of MS (RRMS and active SPMS) in adults who have had inadquate response or are intolerant to other therapies

81
Q

Mitoxantrone (Novantrone) AE

A

cardiotoxicity
bone marrow suprresion, get CBC before each infusion
stomatitits, esophagitis, oral ulceration
N/V
alopecia
HA
fatigue
hepatic dysfunction

82
Q

Mitoxantrone (Novantrone) preggers consideration

A

Preggers D; significant [ ] can also remain in breast milk for 28 days

83
Q

Mitoxantrone (Novantrone) dosing in MS

A

IV Q3mo. ; each dose is 12mg/m^2

  • life-time dose: of 100mg/m^2 (d/t cardio tox)
84
Q

Mitoxantrone (Novantrone) MOA

A

chemo agent

Intercalates with DNA strands → breaks in DNA → inhibit DNA repair through topoisomerase II

Affects rapidly dividing cells (chemo agent) with secndoary effects on immune system
- antigen presentation
- pro-inflammatory cytokine expresion
- decreased leukocyte migration

85
Q

Which forms fo MS is Mitoxantrone (Novantrone) use din

A

SPMS, PRMS, or worsening or RRMS to reduce neurologic disability and/or frequency of relapse

  • NOT indicated for PPMS, really just reserved for rapdily-advacning refractory MS
86
Q

Ofatunumab (Kesimpta) monitoring

A
  • LFTs
  • HepB screen (d/t contraindication)
  • monitor Ig levvels
87
Q

Ofatunumab (Kesimpta) AE

A

URI
UTI
SQ= systemic and local inj reactions
PML
HA
increased LFTS

88
Q

Ofatunumab (Kesimpta) preggers consideration

A

Females of reproductive potential should use effective contraception during adn for 6 months after alst dose

89
Q

Ofatunumab (Kesimpta) dosing in MS, storage, and amdin

A

Sq 20mg QW for 3 weeks, then maintenance of 20mg SQ Qmo.

  • stored in fridge, allow to warm up (15-30min) before admin (can be given at home)
  • SQ in abdomen, thigh or uter opper arm in unmarred scin
90
Q

Ofatunumab (Kesimpta) MOA

A

Binds to extracellular loops of CD20 → potent complement-dependent cell lysis and Ab-dependneted cell-ediated toxicity in cells that overexpress CD20

91
Q

Ocrelizumab (OCrevus) monitoring

A

LFTs

92
Q

Ocrelizumab (OCrevus) AE

A

infusion reaction
- premeidcate with steroids (methylprednisolone 100mg IV 30min prior)
- antipyretic (APAP)
- antihistamines (diphenhdramine 30-60mi prior)

UTI
URI
HA
nausea
incrased LFTS

93
Q

Ocrelizumab (OCrevus) CI

A

HBV infection → screen befores starting

94
Q

Ocrelizumab (OCrevus) dosing in MS

A

start with 300mg IV, then 14D later another 300mg
then 6 mo after first dose, 600mg; and 600mg Q6mo therafeter

95
Q

Ocrelizumab (OCrevus) MOA

A

humanized mAb

binds to CD20 n surface of B cells and deplete them from circulation

may play a role in immune system mediataed amage to brain and spinal cord tissues

96
Q

Which forms of MS is Ocrelizumab (OCrevus) use din

A
  • PPMS and relapsing forms of MS (CIS, RRMS, and active SPMS)
    • reduces relapse rates, disability progression and disease acitivity in pts with RRMs and SPMS
    • reduces disability progression, volume of brain lesions, and whole brain volume loss in PPMS
97
Q

Alemtuzuma (Lemtrada) AE

A

Development of autoimmune thyroid disorders (including graves)

rash
HA
pyrexia
fatigue
pruritis, uritcaria
N/V, diarrhea, dyspepsia
neurologic problems, paresthesia, dizziness
chills
insomnia
dyspnea, nasopharyngitis
musculoskeletal pain
flushing
infections (UTI, URI, sinusitis, fungal infection)
incrased LFTS → LFT monitoring

98
Q

Alemtuzuma (Lemtrada) bbw

A
  • automimmune condiitions (including immune thrombocytopenia)
  • infusion rectoin increased risk of malignancy
99
Q

Alemtuzuma (Lemtrada) monitoring

A
  • urinalysis
  • TSH at baseline and Q3mo until 2 years afer last infusion
  • ECG prior to treatment
  • annual HPV
  • baseline adn annual skin exams
  • s/s of PML
  • LFT monitoring

Observe pt 2 hrs after infusion

100
Q

Alemtuzuma (Lemtrada) dosing in MS

A

12mg IV over 4 hrs for 5 days, then a 3 day course at month 12

can be treated for another 3 days after 12 months

admin antiviral ppx beginning on the first day of treatment adn continue for at least 2 months after completion and unti CD4 count is >200

premedicate with corticosteroids (1000mg methylprednisolone or equiv)
- give immediately proir for first 3 days of treatment
- can consider antihistamins or antipyretics

101
Q

Alemtuzuma (Lemtrada) MOA

A

humanzied mAb

targets CD52 on T nd B lymphocytes, NK cells, macrophages, and monocytes → long term reduction of ciruclating T cells

102
Q

Which forms of MS is Alemtuzuma (Lemtrada) use din?

A

relapsing forms of MS (RRMS and SPMS) ;

though generally reservved for pts with inadequate response to 2 or mroe meds d/t safety profile

103
Q

Natalizumab (Tysabri) monitoring

A

LFT monitoring

104
Q

Natalizumab (Tysabri) AE

A

infusion reactio
hypersensiitivy reaction
respiratory tract infectio
UTI
depression
HA
fatigue
diarrhea
cholelithases
arthralgia
PML
incrased LFTS

105
Q

Natalizumab (Tysabri) dosing in MS

A

300mg IV Q4W

106
Q

Natalizumab (Tysabri) MOA

A

antagonizes alpha 4-itegrin of the adhesion molecule ver late activating antigen (VLA)-4 on leukocyes → prevents transmigration of leukocytes across the andothelium into inflamed parenchymal tissue

107
Q

WHich forms of MS is Natalizumab (Tysabri) used in

A

relapsing forms (CIS, RRM, active SPMS)

108
Q

Copaxone, Glatopa AE

A

Injection site reactions (including indurations, masses, and welts)

transient flusing
vasodilation (feels like a heart attack)

constriction of throat

asthenia
N/V
pain
arthralgia
anx
palpitations
dyspnea

109
Q

Copaxone, Glatopa dosing in MS

A

20mg SQ QD or 40mg TIW

110
Q

Copaxone, Glatopa MOA

A

glatiraer acetate

though to be related to alteration of Tcell activation and differentiation

111
Q

Which forms of MS is Copaxone, Glatopa use in

A

relapsing forms (CIS, RRM, active SPMS)

112
Q

interferon beta-1a AE

A

flu-like symptoms → pre and psot medciate y a day with ibuprofen or APAP, dissipates with continued use; generally worse in females and those with low TBW

inj site reaction

depression
myalgia
arthralgia
asthemnia
malaise
diaphoresis
myastehnia

113
Q

Betaseron, Etaviab MOA

A

Inteferon beta-1a

May augment suppressor T-cell function

May decrease macrophage activating effect

May decrease interferon gamma secretion by activating lymphocytes

May down-regulate expression of MHC gene production on atigen preseting cells

May suppress T cell proliferation adn decrease BBB permeabiity

114
Q

Which forms of MS is Betaseron (Extavia) used in

A

relapsing forms (CIS, RRM, active SPMS)

115
Q

Rebif MOA

A

Inteferon beta-1a:

May augment suppressor T-cell function

May decrease macrophage activating effect

May decrease interferon gamma secretion by activating lymphocytes

May down-regulate expression of MHC gene production on atigen preseting cells

May suppress T cell proliferation adn decrease BBB permeabiity

116
Q

Which forms of MS is Rebif use din

A

relapsing forms (CIS, RRM, active SPMS)

117
Q

Plegridy MOA

A

Inteferon beta-1a: pegylated form → maintain effects longer in body

May augment suppressor T-cell function

May decrease macrophage activating effect

May decrease interferon gamma secretion by activating lymphocytes

May down-regulate expression of MHC gene production on atigen preseting cells

May suppress T cell proliferation adn decrease BBB permeabiity

118
Q

Which forms of MS is Plegridy used in

A

relapsing forms (CIS, RRM, active SPMS)

119
Q

Avonex MOA

A

Inteferon beta-1a:

May augment suppressor T-cell function

May decrease macrophage activating effect

May decrease interferon gamma secretion by activating lymphocytes

May down-regulate expression of MHC gene production on atigen preseting cells

May suppress T cell proliferation adn decrease BBB permeabiity

120
Q

Whch form of MS is Avonex use di

A

relapsing forms (CIS, RRM, active SPMS)

121
Q

Corticotropin Acthar gel dosing in MS

A

IM or SQ 80-120 U/day for 2-3 weeks

122
Q

Corticotropin Acthar mOA

A

Stimuate adrenal cortex to secete adrenal steroids (including cortissol), weakly androgenic substances, and aldosterone

123
Q

What is Corticotropin Acthar used for in MS

A

acute exacerbation

124
Q

Corticosteroid AE

A

insomnia

mood changes (irratibility)

GI upset (give H2 bblocker or PPI)

125
Q

Corticosteroid dosing in MS

A

Methylprednsoline 1gm IV QD 3-5D

may be followed by prednosone taper (60mg QD 7D, then 60mg QOD 7D, then 40mg QOD 7D, then 20mg QOD 7D)

126
Q

What are corticosteroids used for in MS

A

Acute exaceration

127
Q

corticosteroid MOA

A

Decreases nflammation by preventing migration of polymorphonuclear leukcytes and reversal of capillary permeability

701 (16 decks)

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