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Exam 3 lecture 3 Flashcards

1
Q

Treatments for acute attacks of MS (relapses/exacerbations)

A

methylprednisolone
Prednisolone
Adrenocorticotropic hormone (ACTH)

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2
Q

What are DMDs for MS

A

Reduce relapse rates, may slow progression of disability (generally used to treat relapsing rather than progressive forms of MS)

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3
Q

1st line DMD for MS

A

Interferon B1a (avonex, rebixf)
Interferon B1b (betaseron, extavia)
Glatiramer acetate (copaxone)
Fingolimod (gilenya)

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4
Q

2nd line DMD for MS

A

Natalizumab (tysabri)
Mitoxantrone (novatrone)

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5
Q

New drugs for DMD of MS

A

Teriflumide (aubagio)
dimethyl fumarate (Tecfidera)
cladribine (mylinax)

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6
Q

What are primary corticosteroid treatments for acute attacks

A

Methylprednisolone (oral vs IV)
Prednisone (oral)
Adrenocorticotropic hormone (ACTH)

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7
Q

how do corticosteroids act

A

likely act by upregulating antiinflammatory genes downregulating pro inflammatroy and alleviating edema in demyelinating areas.

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8
Q

MOA of interferon B1a and interferon B1b for MS

A

acts in periphery and at BBB
Periphery- inhibition of autoreactive lymphocytes, T cells, Dendritic cells

BBB- Inhibition of BBB penetration by lowering matrix metalloprotenase (MMP)

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9
Q

clinical features of interferon B1a and B1b

A

first line
Efficacy reduced by neutralizing antibodies

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10
Q

Glatiramer acetate MOA for MS

A

synthetic polypeptide. mimics antigenic properties of myelin basic protein.

modulation of antigen-presenting cells such as dendritic cells, leading to lower T cell activation.

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11
Q

Clinical features of glatiramer acetate

A

1st line
delays the conversion of CIS to clinical MS

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12
Q

Name drugs that act only in periphery (including BBB)

A

Interferon-B
glatiramer acetate
natalizumab
mitoxantrone
teriflunomide
cladribine
rituximab
ATL 1102

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13
Q

drugs that act on periphery and CNS for MS

A

FIngolimod
siponimod
ozanimod
ponesimod
dimethyl fumarate
monomethyl fumarate

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14
Q

Drugs that act at BBB for MS

A

Interferon-B
Natalizumab
ATL 1102

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15
Q

What are drugs that act via a cytotoxic effect for MS

A

mitocantrone
Teriflunomide
Cladribine

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16
Q

Drugs that increase risk of PML for MS

A

Fingolimod
Natalizumab
dimethyl fumarate
Monomethyl fumarate
diroximel fumarate

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17
Q

Drugs that can be used to treat PPMS

A

Rituximab (ocrelizumab(

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18
Q

Drugs whos effectiveness may be limited by neutralizing antibodies

A

IF-B
Natalizumab
Rituximab

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19
Q

Recognize fingolimod structure

A

left long chain structure
attached to phenol ring
attached to two OH groups and an H2N group

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20
Q

MOA of fingolimod (MS)

A

sphingophosine-1-phosphate (s1P) receptor agonist

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21
Q

action of fingolimod on BBB (MS)

A

interference with lymphocyte movement out of lymphoid organs

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22
Q

action of fingolimod on periphery (MS)

A

stimulation of oligodendrocyte survival, remyelination

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23
Q

clinical features of fingolimod (MS)

A

first line

side effects include

progressive multifocal leukoencephalopathy
(PML), a potentially lethal brain infection

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24
Q

side effects of fingolimod

A

Could cause PML

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25
what is PML
a potentially life threatening brain infection progressive multifocal leukoencephalopathy
26
Natalizumab MOA (MS)
Monoclonal antibody specific for a-4 integrin
27
Natalizumab effect on periphery (MS)
a-4 integrin pairs with B1 integrin to produce very late antigen (VLA-4)
28
What does natalizumabs inhibition of VLA-4 lead to
inhibition of VLA-4 binding to its ligand leads to interference with B and T cell movement into CNS
29
Clinical features of Natalizumab
2nd line a key side effect is the development of PML - induces the development of neutralizing antibodies → allergic reactions
30
Mitoxantrone MOA (MS)
anthracenidone with cytotoxic activity
31
effect of mitoxantrone on periphery (MS)
reduces lymphocyte numbers
32
How does mitoxantrone reduce lymphocyte numbers
Cause DNA strand breakage by intercalation delaying DNA repair via inhibition of topoisomerase II
33
Clinical features of mitocantrone
2nd line
34
Teriflunomide MOA (MS)
Cytotoxic agent that inhibits dihydroorotate dehydrogenase
35
effect of teriflunomide on periphery (MS)
Inhibits proliferation of peripheral lymphocytes (activated and T cells)
36
What are the fumarate drugs used to treat MS
Dimethyl fumarate diroximal fumarate monomethyl fumarate
37
Dimethyl fumarate, diroximal fumarate, monomethyl fumarate MOA
metabolized by esterases in GI tract, blood, tissues
38
Dimethyl fumarate, diroximal fumarate, monomethyl fumarate effects on periphery
activate Nrf2- mediated cellular antioxidant responses and anti-inflammatory pathways suppresses activated T cells, dendritic cells in periphery
39
Dimethyl fumarate, diroximal fumarate, monomethyl fumarate effects on BBB
may promote remyelination
40
side effects on Dimethyl fumarate, diroximal fumarate, monomethyl fumarate
PML
41
recognize dimethyl fumarate structure
42
Recognize cladribine structure
(same as adenosine but has Cl attached)
43
Siponimod, ozanimod, ponesimod MOA
S1P receptor agonist (same as fingolimod)
44
Cladribine MOA
- taken up in cells by purine nucleoside transporters - in cells with a high ratio of deoxycytidine kinase to deoxynucleotidase (e.g. lymphocytes, monocytes), cladribine is phosphorylated to the triphosphate form, 2-chloro-dATP. - 2-chloro-dATP damages DNA and interferes with DNA metabolism, resulting in cell death -> lymphocyte depletion
45
What are antibody therapies for MS
Rituximab (ocrelizumab)
46
Use of rituximab (ocrelizumab)
PPMS pts
47
Rituximab (ocrelizumab) (MS) MOA
- humanized monoclonal antibody that targets CD20, a marker of mature B-cells - doesn’t bind CD20 on stem cells or plasma cells, so that key immune functions are unperturbed. - decreased disease progression in PPMS (first example) - decreased relapse rate in RRMS
48
What are some experimental MS drugs
Antisense oligonucleotide (ATL 1102)
49
ATL 1102 MOA
ASO targeting VLA 4, predicted to have the same outcome as natalizumab
50
Which drug is active in both peripher and CNS
dimethyl fumarate
51
What is a single diagnostic feature or criteria to diagnose MS
No single feature or diagnostic criteria is sufficient to diagnose on clinical features or presentations
52
What are other disorders to rule out when diagnosing MS
Neuromyelitis Optica spectrum disorder
53
What is DIT (!)
Dissemination in time Time between evidence of new lesions in subsequent MRIs (30 days). Damage that has happened more than once.
54
What is DIS (!)
Dissemination in space Need for more than 1 lesion to appear in atleast 2 of the 4 MS typical CNS regions (damage is in more than one place) In summary- 1 lesion is not enough, 2 lesions at different areas of brain in different times.
55
What are the types of MS
CIS RRMS SPMS PPMS PRMS
56
define CIS (!)
Clinically isolated syndrome descriptor of a 1st demyelinating event involving the optic nerve, cerebrum, cerebellum, brainstem or spinal cord. most will develop MS within 20 yrs
57
Define RRMS (!)
most common (80-90% of diagnosis) Consists of relapses with partial or complete remission between relapses. most will become progressive over time
58
Define SPMS (!)
80% of RRMS pts will progress to SPMS. consists of fewer relapses with continuing disability
59
Define PPMS (!)
10-15% of pts progressive form from onset with minor improvements or periods of stability more common in patiets diagnosed in later years (greater than 50 years of age)
60
Define PRMS (!)
least common form. steadily worsening disease from onset with later, clear, acute relapses; may be some recovery from acute attacks, but no remission between relapses
61
treatment of acute attacks of MS (!)
1. High dose corticosteroid treatment is 1st choice (oral vs IV setting) 2. Methylprednisolone 500 mg-1000mg IV daily for 3-7 days, with or without an oral taper over 1-3 weeks 3. If outpatient- oral prednisone 1250 mg every other day x 3 doses
62
Oral medications for MS (!)
Dimethyl fumarate Diroximel fumarate Fingolimod Ozanimod Punesimod Siponimod Teriflunomide
63
Injectible medications for MS (!)
interferon B 1a Peginterferon beta-1 a Interferon beta-1 b glatiramer acetate
64
Infusion medications for MS (!)
Alemtuzumab Natalizumab Ocrelizumab (only one approved for PPMS)

Therapeutics (38 decks)

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