Exam 3: MS

Question 1

Treatment of acute attacks

Answer 1

methylprednisolone
prednisone
ACTH

Question 2

Disease Modifying Therapies

Answer 2

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

Question 3

First Line DMTs

Answer 3

interferon B1a (Avonex, Rebif)
interferon B1b (Betaseron, Extavia)
glatiramer acetate (Copaxone)
fingolimod (Gilenya)

Question 4

Second Line DMTs

Answer 4

natalizumab (Tysabri)
mitoxantrone (Novantrone)

Question 5

New Drug DMTs

Answer 5

teriflunomide (Aubagio)
dimethyl fumarate (Tecfidera)
cladribine (Mylinax)

Question 6

Corticosteroids MOA

Answer 6

act by up-regulating anti-inflammatory genes, down regulating pro-inflammatory genes, and alleviating edema in demyelinated areas

Question 7

Interferons MOA

Answer 7

act in the periphery and at the BBB

periphery: inhibition of auto-reactive lymphocytes

BBB: inhibition of BBB penetration by decreasing matrix metalloproteinase (MMP)

Question 8

Interferons Clinical Feature

Answer 8

efficacy reduced by neutralizing antibodies

Question 9

Glatiramer Acetate MOA

Answer 9

synthetic polypeptide, mimics antigenic properties of myelin basic protein

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

Question 10

Fingolimod MOA

Answer 10

sphingosine-1-phosphate receptor agonist

stimulation of oligodendrocyte survival, remyelination (CNS)

interference with lymphocyte movement out of lymphoid organs (periphery)

Question 11

Fingolimod Clinical Features

Answer 11

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

superior to INF-B

Question 12

Natalizumab MOA

Answer 12

mab specific for alpha 4 integrin

alpha 4 integrin pairs with beta 1 integrin to produce very late antigen (VLA-4)

inhibition of VLA-4 binding to its ligand and interferes with B and T cell movement into the CNS