Exam 3 lecture 4 (MS)

Question 1

What is PML

Answer 1

Progressive multifocal leukoencephalopathy

Question 2

Describe PML

Answer 2

A rare but serious effect of MS drugs

Question 3

What must be tested before getting MS medications

Answer 3

Patients must be tested for JCV antibodies before getting medications

Question 4

What type of vaccines preferred for people with MS

Answer 4

Inactivated vaccines preferred for people with MS

Question 5

What vaccine type is not recommended in MS? Why?

Answer 5

Live attenuated vaccines not recommended. This is because the ability to cause the disease is weakened not eliminated

Question 6

what drug that treats MS can we not give live vaccines for

Answer 6

Alemtuzumab

Question 7

What vaccine should be considered by people with MS who have never had chicken pox? When should we strongly consider the vaccine?

Answer 7

Should be considered by people with MS who have never had chicken pox, especially if they start an MS medication that suppresses cell-mediated immunity

Question 8

What are the drugs that suppress cell immunity for MS that we should consider varicella vaccine

Answer 8

Fingolimod
Alemtuzub

Question 9

Can we chew and crush capsules of Dimethyl fumarate, diroximel fumarate, monomethyl fumarate

Answer 9

No

Question 10

What to monitor on Dimethyl fumarate, diroximel fumarate, monomethyl fumarate

Answer 10

monitor LFTs and CBCs

Question 11

Side effects of Dimethyl fumarate, diroximel fumarate, monomethyl fumarate

Answer 11

PML
Flushing (take aspirin 30 min before dose)

Question 12

WHat are some S-1-P receptor modulator drugs

Answer 12

Fingolimod, ozanimod, ponesimod, siponimod

Question 13

Can we switch patients S-1-p if they fail on one of them?

Answer 13

No do not switch

Question 14

When are Dimethyl fumarate, diroximel fumarate, monomethyl fumarate contraindicared

Answer 14

COntraindicated with past arrhythmias or any of the following CV diagnoses in the past 6 months (MI, unstable angona, stroke/TIA, Class III/IV HF)

Question 15

What happens with S-1-P discontinuation

Answer 15

Could lead to significant worsening of MS symptoms

Question 16

What should we avoid use with ozanimod

Answer 16

MAO-inhibitor

Question 17

What is required before siponimod prescription (!)

Answer 17

CYP2C9 genotype testing

Question 18

side effects of glatiramer acetate

Answer 18

Flushing, sweating, dyspnea, Chest pain, Anxiety, itching

Question 19

What occurs on injection site of glatiramer acetate (!)

Answer 19

Lipoatrophy that is likely permanent. Rotate injection sites.

Question 20

Glatiramer acetate and pregnancy

Answer 20

may be preferred if tx is necessary in pregnancy- teratogenic effects are unknown.

Question 21

Interferon side effects and how to handle them?

Answer 21

Cause mental health side effects. (depression, suicidal thoughts)
Hold off until symptoms subside

Question 22

monoclonal antibodies to treat MS

Answer 22

Alemtuzumab
Natalizumab
Ocrelizumab

Question 23

when to complete vaccinations before starting antibody therapy

Answer 23

Complete vaccinations atleast 6 weeks before starting tx

Question 24

Which antibody is associated with a risk of PML (MS)

Answer 24

Natalizumab

Question 25

Which antibody treating MS is associated with malignancies

Answer 25

ocrelizumab and alemtuzumab

Question 26

when is ocrelizumab contraindicated?

Answer 26

GI in Hepatitis B

Question 27

When is alemtuzumab contraindicated?

Answer 27

In HIV patients

Question 28

Which drug has an ABSOLUTE contraindication in pregnancy (!)

Answer 28

Teriflunomide

Question 29

What if teriflunomide is ingested in a pregnanct woman (!)

Answer 29

Cholestyramine or activated charcoal for 11 days will cause accelerated elimination.

Question 30

Much of the disability in MS is associated with (!)

Answer 30

ambulation, including gait abnormality and walking speed.

Question 31

Which drug may improve walking speed? How does it do it? (!)

Answer 31

Dalfampridine (Ampyra))

Blocks K+ channels and prevents repolarization of the cell which prolongs action potentials and nerve impulse transmission in demyelinated axon, which may improve walking speed.

Question 32

What is a side effect of Dalfampridine? CI? (!)

Answer 32

Dose escalation associated with siezures

CI in pts with history of seizures

Question 33

Medical marijuana in MS pts (spasticity, central pain and bladder dysfunction)

Answer 33

Spasiticity- Oral/THC decreases pt reported scores, bt is not effective to decrease objective scores

Central pain/painful spasms- OCE- decreases central pain
THC decreases painful spasms

Tremor/bladder dysfunction- both ineffective