Exam 3 lecture 4 (MS) Flashcards
What is PML
Progressive multifocal leukoencephalopathy
Describe PML
A rare but serious effect of MS drugs
What must be tested before getting MS medications
Patients must be tested for JCV antibodies before getting medications
What type of vaccines preferred for people with MS
Inactivated vaccines preferred for people with MS
What vaccine type is not recommended in MS? Why?
Live attenuated vaccines not recommended. This is because the ability to cause the disease is weakened not eliminated
what drug that treats MS can we not give live vaccines for
Alemtuzumab
What vaccine should be considered by people with MS who have never had chicken pox? When should we strongly consider the vaccine?
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
What are the drugs that suppress cell immunity for MS that we should consider varicella vaccine
Fingolimod
Alemtuzub
Can we chew and crush capsules of Dimethyl fumarate, diroximel fumarate, monomethyl fumarate
No
What to monitor on Dimethyl fumarate, diroximel fumarate, monomethyl fumarate
monitor LFTs and CBCs
Side effects of Dimethyl fumarate, diroximel fumarate, monomethyl fumarate
PML
Flushing (take aspirin 30 min before dose)
WHat are some S-1-P receptor modulator drugs
Fingolimod, ozanimod, ponesimod, siponimod
Can we switch patients S-1-p if they fail on one of them?
No do not switch
When are Dimethyl fumarate, diroximel fumarate, monomethyl fumarate contraindicared
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)
What happens with S-1-P discontinuation
Could lead to significant worsening of MS symptoms
What should we avoid use with ozanimod
MAO-inhibitor
What is required before siponimod prescription (!)
CYP2C9 genotype testing
side effects of glatiramer acetate
Flushing, sweating, dyspnea, Chest pain, Anxiety, itching
What occurs on injection site of glatiramer acetate (!)
Lipoatrophy that is likely permanent. Rotate injection sites.
Glatiramer acetate and pregnancy
may be preferred if tx is necessary in pregnancy- teratogenic effects are unknown.
Interferon side effects and how to handle them?
Cause mental health side effects. (depression, suicidal thoughts)
Hold off until symptoms subside
monoclonal antibodies to treat MS
Alemtuzumab
Natalizumab
Ocrelizumab
when to complete vaccinations before starting antibody therapy
Complete vaccinations atleast 6 weeks before starting tx
Which antibody is associated with a risk of PML (MS)
Natalizumab
Which antibody treating MS is associated with malignancies
ocrelizumab and alemtuzumab
when is ocrelizumab contraindicated?
GI in Hepatitis B
When is alemtuzumab contraindicated?
In HIV patients
Which drug has an ABSOLUTE contraindication in pregnancy (!)
Teriflunomide
What if teriflunomide is ingested in a pregnanct woman (!)
Cholestyramine or activated charcoal for 11 days will cause accelerated elimination.
Much of the disability in MS is associated with (!)
ambulation, including gait abnormality and walking speed.
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.
What is a side effect of Dalfampridine? CI? (!)
Dose escalation associated with siezures
CI in pts with history of seizures
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
