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Therapeutics 3 Kappa Epsilon > Exam 3 - Ott (MS) > Flashcards

Exam 3 - Ott (MS) Flashcards

1
Q 
Route of Admin? 
Interferon B1a (Avonex)
A

IM once weekly

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2
Q 
Route of Admin?
Interferon B1a (Rebif)
A

SQ 3 x week

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3
Q 
Route of Admin?
Interferon B1b (Betaseron, Extavia)
A

SQ QOD

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4
Q 
Route of Admin?
Peginterferon B1a (Plegridy)
A

SQ q 14 days

needs titration!!

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5
Q

Route of Admin?

Glatiramer (Copaxone)

A

SQ QD

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6
Q

Route of Admin?

Fingolimod (Gilenya)

A

PO QD

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7
Q

Route of Admin?

Teriflunomide

A

PO QD

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8
Q 
Route of Admin?
Dimethyl Fumarate (Tecfidera)
A

PO BID

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9
Q

Route of Admin?

Natalizumab

A

IV q 4 weeks

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10
Q

Route of Admin?

Mitoxantrone

A

IV q 3 mos

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11
Q

Route of Admin?

Alemtuzumab

A

IV infusion over 4 hours
1st course x 5 days
2nd course x3 days (given 1 yr after first course)

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12
Q

Route of Admin?

Daclizumab

A

SQ once monthly

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13
Q

Route of Admin?

Ocrelizumab

A

IV at least 3.5 hours q 6 months

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14
Q

which MS drug should be premedicated with corticosteroids

A

alemtuzumab (lemtrada) done for 1st days of each course
also…
ocrelizumab

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15
Q

which MS drug is Pregnancy X/Contraindicated in pregnancy

A

Teriflunomide (Aubagio)

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16
Q

which MS drugs are given IM

A

interferon B1a (Avonex)

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17
Q

which MS drugs are given SQ

A 
Interferon B1a (Rebif)
Interferon B1b (Betaseron, Extavia)
Peginterferon B1a (Plegridy)
Glatiramer Acetate (Copaxone)
Daclizumab (Zinbryta)
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18
Q

which MS drugs are given orally

A

Fingolimd (Gilenya)
Teriflunomide (Aubagio)
Dimethyl Fumarate (Tecfidera)

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19
Q

which MS drugs are given IV

A

Natalizumab (Tysabri)
Mitoxantrone (Novantrone)
Alemtuzumab (Lemtrada)
Ocrelizumab (Ocrevus)

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20
Q

which drug has AV block as a risk

A

Fingolimod (Gilenya)

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21
Q

what is measured in MS drug clinical trials to measure impact/efficacy

A

EDSS - expanded disability status scale

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22
Q

EDSS:

what would 0 mean? and what would 10 mean?

A 
0  = normal neurological examiniation
10 = death from MS
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23
Q

in RRMS, progression ot SPMS is about _____ years

A

20 - 25

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24
Q

what type of MS typically starts in pts over 50 y.o

A

PPMS (primary progressive)

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25
Q

what is the most common MS type

A

RRMS

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26
Q

treating acute MS attacks:

__________ treatment is first choice

A

high dose corticosteroid

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27
Q

treating acute MS attacks:

Methylprednisolone dosing?

A

500 mg - 1000 mg IV daily x 3 - 7 days

w/ or w/out oral taper over 1 - 3 weeks

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28
Q

treating acute MS attacks:

if pt is output – use what drug and how to dose it?

A

use oral prednisone!
1250 mg every OTHER day x 5 days
(No need to taper!)

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29
Q

what drug is used for treatment resistant MS?

A

Alemtuzumab (Lemtrada)

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30
Q

Disease Modifying Therapies for MS:

what drugs are second line

A

Natalizumab (Tysabri)
and
Mitoxantrone (Novantrone)

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31
Q

Disease Modifying Therapies for MS:

what drugs are first line

A

the interferon drugs (B1a and B1b)
Glatiramer
Fingolimod

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32
Q

Disease Modifying Therapies for MS:

what drugs are first line (but newer drugs too)

A

teriflunomide
Dimethyl fumurate
Daclizumab

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33
Q

what drug is the only drug approved for PPMS

A

Ocrelizumab

can be used in RRMS tho*

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34
Q

which drug has to have 2 hour monitoring post administration? and why?

A

alemtuzumab - b/c life threatening allergic rxn possible/anaphylaxis

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35
Q

what are ways to decrease injection site reactions from MS drugs

A

apply warm compress or ice (before/after injection)
warm medication to room temp
ensure needle completely penetrates the skin during injection

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36
Q

how to reduce flu-like symptoms that come from interferon injections?

A

do right before bed

take OTC med to alleviate symptoms (tylenol and benadryl)

37
Q

what are possible post- injection site reactions

A

facial flushing
chest tightness/dyspnea
palpitations/tachycardia
anxiety

38
Q

what is PML/ why does it happen?

A

a serious adverse event — caused by reactivation of dormant JCV

39
Q

what drugs are associated with PML

A

Natalizumab - black box warning)

recent report w/ fingolimod and dimethyl fumurate

40
Q

Sxs of PML

A 
neurobehavioral, motor, language, and cognitive changes
seizures
vision changes
tremor
hemiparesis
41
Q

what is pseduobulbar effect

A

frequent/inappropriate episodes of crying/laughin

42
Q

what drug is used for pseduobulbar effect

A

Neudexta (dextromethorphan and quinidine)

43
Q

explain the mechanism of Neudexta (how do the two drugs in it related to each other..)

A

DM – is an agonist for sigma-I receptors — will suppress excitatory neruotransmitters
DM –> Dextrophan in the periphery (not good bc DM needs to get through blood brain barrier — cant do that as dextrophan)

Quinidine used as P450 2D6 inhibitor to block conversion of DM –> Dextrophan (lets DM get to CNS!!!)

44
Q

what MS drug has to have the first done at a clinic due to decreased HR or AV block

A

fingolimod

45
Q

which MS drug is assoc. with cardiomyopathy, reduced LVEF, and irreversible CHF

A

Mitoxantrone

46
Q

which MS drug is contraindicated if Hx of autoimmune hepatitis/hepatic impairment

A

Daclizumab

47
Q

what MS drugs have increased risk of malignancies

A

Alemtuzumab (why for tx resistant MS)
and
Ocrelizumab

48
Q

which drug is contraindicated in HIV infection and why?

A

Alemtuzumab (will decrease CD4 counts)

49
Q

what drug can be used to help with gait abnormalities

A

Dalfampridine (Ampyra)

50
Q

Side Effects of Dalfampridine — depend on if ______

A

if its ER vs IR…. (they have diff ADE profiles)

51
Q

Dalfampridine ADEs:
ER —-
vs
IR —–

A

ER: UTIs, Insomnia, Dizziness, HA, nausea

IR: Seizures (CONTRAINDICATED in pts w/ hx of seizures)

52
Q

Pregnancy and MS:

What drug is Category X

A

Teriflunomide

53
Q

Pregnancy and MS:

which drug is category D

A

Mitoxantrone

54
Q

Pregnancy and MS:

what drug has to be stopped 2 years before pregnancy

A

Teriflunomide

use activated charcoal to get out of system faster

55
Q

Pregnancy and MS:

what drug has to be stopped at least 2 months before conception

A

Fingolimid

b/c half life is ~ 10 days

56
Q

Ott Chart:

Interferon ADEs?

A 
Flu Like Reactions
Injection Site Reactions
Depression
Worsening of CHF (preexisting)
Hepatotoxicty
Thyroid Dysfunction
Psychosis
Seizures
Thrombotic Microangiopathy
57
Q

Ott Chart:

Interferon monitoring?

A 
CBC
LFTs
LVEF
Thyroid
Depression/Mental State
Cirrhosis Monitoring..
AVOID IN SEVERE DEPRESSION
58
Q

Ott Chart:

Glatiramer ADEs?

A 
Infection
hypersensitvity
chest tightness
Flushing
uticaria
rash
59
Q

Ott Chart:

Glatiramer Monitoring?

A

MRI
Tissue Necrosis
Post injection reaction
(is Pregnancy Category B!)

60
Q

Ott Chart:

Fingolimod ADEs?

A 
Macular Retinal Edema
AV BLOCK/BRADYCARDIA 
Decrease lung function
HTN
infections
(maybe PML...test for JCV)
61
Q

Ott Chart:

Fingolimod Monitoring?

A

Stays in system for 2 mos after stopping (Pregnancy Caution)

CONTRAINDICATIONS - multiple (on diff.note card…)

Must stay in clinic for 6 hours post dose
Do not start in pts with active infection
Avoid live attenuated vaccins during tx and 2 mos after
REMS - bradycardia/AV block

62
Q

Contraindications of Fingolimod

A

Recent MI/Stroke
2nd or 3rd degree AV block
QT prolongation
decompensated CHF

63
Q

which drug do people have to stay in clinic for 6 hours post dose

A

Fingolimod

64
Q

what is the REMS for fingolimod

A

Bradycardia

AV Block

65
Q

Ott Chart:

Teriflunomide ADEs?

A 
SJS
liver failure
neutropenia
Respiratory infection
Activation of TB
Alopecia 
Neuropathy
66
Q

Ott Chart:

Teriflunomide Monitoring?

A

Pregnancy – CONTRAINDICATED (2 years after stopping too)
do not start in pts with active infection
screen for TB
avoid live vaccines
(TB Test, Pregnancy Test)

67
Q

Ott Chart:

Dimethyl Fumurate ADEs

A 
Flushing
rash
pruritis
diarrhea
increase LFTs
Lymphocytopenia
infections
68
Q

Ott Chart:

Dimethyl Fumurate Monitoring?

A

if serious infection — hold drug
take with food decrease incidence of flushing
monitor CBC and LFTs

69
Q

what drug should be taken with food to decrease incidence of flushing

A

dimethyl fumurate

70
Q

Ott Chart:

Natalizumab ADEs?

A

PML

Depression

71
Q

Ott Chart:

Natalizumab Monitoring?

A 
MONOTHERAPY ONLY 
Test for JCV Abs
Washout period: 14 days for Interferon or Glatiramer
and
6 mos for Mitoxantrone
Risk of IRIS due to d/cing due to PML
REMS --- limited availability
72
Q

what drug has risk of IRIS (Immune reconstitution inflammatory syndrome) and why?

A

Natalizumab — risk happens with you discontinue the drug because PML happened

73
Q

Ott Chart:

Mitoxantrone ADEs?

A

Bone marrow suppression
neutrophenia
cardiotoxicity (decrease LVEF/irrever. CHF/cardiomyopathy)
Acute Leukemia

74
Q

Ott Chart:

Mitoxantrone Monitoring?

A

Pregnancy Test before each infusion
for lifetime dose: do NOT exceed 140 mg/m^2
(Monitor: LVEF, CBC, EKG, LFTs)

75
Q

what drug can not exceed 140 mg/m^2 in a lifetime

A

Mitoxantrone

76
Q

Mitoxantrone can’t surpass _______ as a lifetime dose

A

140 mg/m^2

77
Q

which drug has PML monitoring but no need for JCV testing

A

Ocrelizumab

78
Q

which drug needs Heb B screen before the first dose

A

ocrelizumab

79
Q

what drug needs an antiviral agent for herpetic prophylaxis starting on day 1 of dosing then do for at least 2 mos once treatment is done?

A

Alemtuzumab

80
Q

which drug causes bone marrow suppression

A

mitoxantrone

81
Q

which drugs should have LVEF monitored

A

mitoxantrone

Interferons

82
Q

which drugs need thyroid monitoring

A

interferons; Alemtuzumab

83
Q

which drugs have REMS?

A

fingolimod
Natalizumab
Alemtuzumab
Daclizumab

84
Q

which drugs should you avoid live vaccines with

A 
Alemtuzumab
daclizumab
ocrelizumab
fingolimod
teriflunomide
85
Q

which drug needs a washout period between certain drugs

A

natalizumab

86
Q

For Natalizumab:

Wash-Out Period for what drugs and how long?

A

14 days for GLATIRAMER or INTERFERON

6mos for Mitoxantrone

87
Q

Ott Chart:

what are the ADEs of Daclizumab

A 
diaphoresis
shivering/flu like symptoms
skin reactions
mouth ulcers
seizures
loss of appetite/mood changes
N/V
88
Q

what drug has a CI of AST/ALTs 2x normal limit

A

daclizumab

Therapeutics 3 Kappa Epsilon (20 decks)

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