Exam 3 lecture 4 (MS) Flashcards

1
Q

What is PML

A

Progressive multifocal leukoencephalopathy

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2
Q

Describe PML

A

A rare but serious effect of MS drugs

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3
Q

What must be tested before getting MS medications

A

Patients must be tested for JCV antibodies before getting medications

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4
Q

What type of vaccines preferred for people with MS

A

Inactivated vaccines preferred for people with MS

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5
Q

What vaccine type is not recommended in MS? Why?

A

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

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6
Q

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

A

Alemtuzumab

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7
Q

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

A

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

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8
Q

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

A

Fingolimod
Alemtuzub

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9
Q

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

A

No

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10
Q

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

A

monitor LFTs and CBCs

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11
Q

Side effects of Dimethyl fumarate, diroximel fumarate, monomethyl fumarate

A

PML
Flushing (take aspirin 30 min before dose)

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12
Q

WHat are some S-1-P receptor modulator drugs

A

Fingolimod, ozanimod, ponesimod, siponimod

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13
Q

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

A

No do not switch

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14
Q

When are Dimethyl fumarate, diroximel fumarate, monomethyl fumarate contraindicared

A

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)

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15
Q

What happens with S-1-P discontinuation

A

Could lead to significant worsening of MS symptoms

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16
Q

What should we avoid use with ozanimod

A

MAO-inhibitor

17
Q

What is required before siponimod prescription (!)

A

CYP2C9 genotype testing

18
Q

side effects of glatiramer acetate

A

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

19
Q

What occurs on injection site of glatiramer acetate (!)

A

Lipoatrophy that is likely permanent. Rotate injection sites.

20
Q

Glatiramer acetate and pregnancy

A

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

21
Q

Interferon side effects and how to handle them?

A

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

22
Q

monoclonal antibodies to treat MS

A

Alemtuzumab
Natalizumab
Ocrelizumab

23
Q

when to complete vaccinations before starting antibody therapy

A

Complete vaccinations atleast 6 weeks before starting tx

24
Q

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

A

Natalizumab

25
Which antibody treating MS is associated with malignancies
ocrelizumab and alemtuzumab
26
when is ocrelizumab contraindicated?
GI in Hepatitis B
27
When is alemtuzumab contraindicated?
In HIV patients
28
Which drug has an ABSOLUTE contraindication in pregnancy (!)
Teriflunomide
29
What if teriflunomide is ingested in a pregnanct woman (!)
Cholestyramine or activated charcoal for 11 days will cause accelerated elimination.
30
Much of the disability in MS is associated with (!)
ambulation, including gait abnormality and walking speed.
31
Which drug may improve walking speed? How does it do it? (!)
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.
32
What is a side effect of Dalfampridine? CI? (!)
Dose escalation associated with siezures CI in pts with history of seizures
33
Medical marijuana in MS pts (spasticity, central pain and bladder dysfunction)
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
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