Exam 3 - Ott (MS) Flashcards
Route of Admin? Interferon B1a (Avonex)
IM once weekly
Route of Admin? Interferon B1a (Rebif)
SQ 3 x week
Route of Admin? Interferon B1b (Betaseron, Extavia)
SQ QOD
Route of Admin? Peginterferon B1a (Plegridy)
SQ q 14 days
needs titration!!
Route of Admin?
Glatiramer (Copaxone)
SQ QD
Route of Admin?
Fingolimod (Gilenya)
PO QD
Route of Admin?
Teriflunomide
PO QD
Route of Admin? Dimethyl Fumarate (Tecfidera)
PO BID
Route of Admin?
Natalizumab
IV q 4 weeks
Route of Admin?
Mitoxantrone
IV q 3 mos
Route of Admin?
Alemtuzumab
IV infusion over 4 hours
1st course x 5 days
2nd course x3 days (given 1 yr after first course)
Route of Admin?
Daclizumab
SQ once monthly
Route of Admin?
Ocrelizumab
IV at least 3.5 hours q 6 months
which MS drug should be premedicated with corticosteroids
alemtuzumab (lemtrada) done for 1st days of each course
also…
ocrelizumab
which MS drug is Pregnancy X/Contraindicated in pregnancy
Teriflunomide (Aubagio)
which MS drugs are given IM
interferon B1a (Avonex)
which MS drugs are given SQ
Interferon B1a (Rebif) Interferon B1b (Betaseron, Extavia) Peginterferon B1a (Plegridy) Glatiramer Acetate (Copaxone) Daclizumab (Zinbryta)
which MS drugs are given orally
Fingolimd (Gilenya)
Teriflunomide (Aubagio)
Dimethyl Fumarate (Tecfidera)
which MS drugs are given IV
Natalizumab (Tysabri)
Mitoxantrone (Novantrone)
Alemtuzumab (Lemtrada)
Ocrelizumab (Ocrevus)
which drug has AV block as a risk
Fingolimod (Gilenya)
what is measured in MS drug clinical trials to measure impact/efficacy
EDSS - expanded disability status scale
EDSS:
what would 0 mean? and what would 10 mean?
0 = normal neurological examiniation 10 = death from MS
in RRMS, progression ot SPMS is about _____ years
20 - 25
what type of MS typically starts in pts over 50 y.o
PPMS (primary progressive)
what is the most common MS type
RRMS
treating acute MS attacks:
__________ treatment is first choice
high dose corticosteroid
treating acute MS attacks:
Methylprednisolone dosing?
500 mg - 1000 mg IV daily x 3 - 7 days
w/ or w/out oral taper over 1 - 3 weeks
treating acute MS attacks:
if pt is output – use what drug and how to dose it?
use oral prednisone!
1250 mg every OTHER day x 5 days
(No need to taper!)
what drug is used for treatment resistant MS?
Alemtuzumab (Lemtrada)
Disease Modifying Therapies for MS:
what drugs are second line
Natalizumab (Tysabri)
and
Mitoxantrone (Novantrone)
Disease Modifying Therapies for MS:
what drugs are first line
the interferon drugs (B1a and B1b)
Glatiramer
Fingolimod
Disease Modifying Therapies for MS:
what drugs are first line (but newer drugs too)
teriflunomide
Dimethyl fumurate
Daclizumab
what drug is the only drug approved for PPMS
Ocrelizumab
can be used in RRMS tho*
which drug has to have 2 hour monitoring post administration? and why?
alemtuzumab - b/c life threatening allergic rxn possible/anaphylaxis
what are ways to decrease injection site reactions from MS drugs
apply warm compress or ice (before/after injection)
warm medication to room temp
ensure needle completely penetrates the skin during injection
how to reduce flu-like symptoms that come from interferon injections?
do right before bed
take OTC med to alleviate symptoms (tylenol and benadryl)
what are possible post- injection site reactions
facial flushing
chest tightness/dyspnea
palpitations/tachycardia
anxiety
what is PML/ why does it happen?
a serious adverse event — caused by reactivation of dormant JCV
what drugs are associated with PML
Natalizumab - black box warning)
recent report w/ fingolimod and dimethyl fumurate
Sxs of PML
neurobehavioral, motor, language, and cognitive changes seizures vision changes tremor hemiparesis
what is pseduobulbar effect
frequent/inappropriate episodes of crying/laughin
what drug is used for pseduobulbar effect
Neudexta (dextromethorphan and quinidine)
explain the mechanism of Neudexta (how do the two drugs in it related to each other..)
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!!!)
what MS drug has to have the first done at a clinic due to decreased HR or AV block
fingolimod
which MS drug is assoc. with cardiomyopathy, reduced LVEF, and irreversible CHF
Mitoxantrone
which MS drug is contraindicated if Hx of autoimmune hepatitis/hepatic impairment
Daclizumab
what MS drugs have increased risk of malignancies
Alemtuzumab (why for tx resistant MS)
and
Ocrelizumab
which drug is contraindicated in HIV infection and why?
Alemtuzumab (will decrease CD4 counts)
what drug can be used to help with gait abnormalities
Dalfampridine (Ampyra)
Side Effects of Dalfampridine — depend on if ______
if its ER vs IR…. (they have diff ADE profiles)
Dalfampridine ADEs:
ER —-
vs
IR —–
ER: UTIs, Insomnia, Dizziness, HA, nausea
IR: Seizures (CONTRAINDICATED in pts w/ hx of seizures)
Pregnancy and MS:
What drug is Category X
Teriflunomide
Pregnancy and MS:
which drug is category D
Mitoxantrone
Pregnancy and MS:
what drug has to be stopped 2 years before pregnancy
Teriflunomide
use activated charcoal to get out of system faster
Pregnancy and MS:
what drug has to be stopped at least 2 months before conception
Fingolimid
b/c half life is ~ 10 days
Ott Chart:
Interferon ADEs?
Flu Like Reactions Injection Site Reactions Depression Worsening of CHF (preexisting) Hepatotoxicty Thyroid Dysfunction Psychosis Seizures Thrombotic Microangiopathy
Ott Chart:
Interferon monitoring?
CBC LFTs LVEF Thyroid Depression/Mental State Cirrhosis Monitoring.. AVOID IN SEVERE DEPRESSION
Ott Chart:
Glatiramer ADEs?
Infection hypersensitvity chest tightness Flushing uticaria rash
Ott Chart:
Glatiramer Monitoring?
MRI
Tissue Necrosis
Post injection reaction
(is Pregnancy Category B!)
Ott Chart:
Fingolimod ADEs?
Macular Retinal Edema AV BLOCK/BRADYCARDIA Decrease lung function HTN infections (maybe PML...test for JCV)
Ott Chart:
Fingolimod Monitoring?
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
Contraindications of Fingolimod
Recent MI/Stroke
2nd or 3rd degree AV block
QT prolongation
decompensated CHF
which drug do people have to stay in clinic for 6 hours post dose
Fingolimod
what is the REMS for fingolimod
Bradycardia
AV Block
Ott Chart:
Teriflunomide ADEs?
SJS liver failure neutropenia Respiratory infection Activation of TB Alopecia Neuropathy
Ott Chart:
Teriflunomide Monitoring?
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)
Ott Chart:
Dimethyl Fumurate ADEs
Flushing rash pruritis diarrhea increase LFTs Lymphocytopenia infections
Ott Chart:
Dimethyl Fumurate Monitoring?
if serious infection — hold drug
take with food decrease incidence of flushing
monitor CBC and LFTs
what drug should be taken with food to decrease incidence of flushing
dimethyl fumurate
Ott Chart:
Natalizumab ADEs?
PML
Depression
Ott Chart:
Natalizumab Monitoring?
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
what drug has risk of IRIS (Immune reconstitution inflammatory syndrome) and why?
Natalizumab — risk happens with you discontinue the drug because PML happened
Ott Chart:
Mitoxantrone ADEs?
Bone marrow suppression
neutrophenia
cardiotoxicity (decrease LVEF/irrever. CHF/cardiomyopathy)
Acute Leukemia
Ott Chart:
Mitoxantrone Monitoring?
Pregnancy Test before each infusion
for lifetime dose: do NOT exceed 140 mg/m^2
(Monitor: LVEF, CBC, EKG, LFTs)
what drug can not exceed 140 mg/m^2 in a lifetime
Mitoxantrone
Mitoxantrone can’t surpass _______ as a lifetime dose
140 mg/m^2
which drug has PML monitoring but no need for JCV testing
Ocrelizumab
which drug needs Heb B screen before the first dose
ocrelizumab
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?
Alemtuzumab
which drug causes bone marrow suppression
mitoxantrone
which drugs should have LVEF monitored
mitoxantrone
Interferons
which drugs need thyroid monitoring
interferons; Alemtuzumab
which drugs have REMS?
fingolimod
Natalizumab
Alemtuzumab
Daclizumab
which drugs should you avoid live vaccines with
Alemtuzumab daclizumab ocrelizumab fingolimod teriflunomide
which drug needs a washout period between certain drugs
natalizumab
For Natalizumab:
Wash-Out Period for what drugs and how long?
14 days for GLATIRAMER or INTERFERON
6mos for Mitoxantrone
Ott Chart:
what are the ADEs of Daclizumab
diaphoresis shivering/flu like symptoms skin reactions mouth ulcers seizures loss of appetite/mood changes N/V
what drug has a CI of AST/ALTs 2x normal limit
daclizumab
