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PHRM 845 > L40-41 Pharmacotherapy of MS > Flashcards

L40-41 Pharmacotherapy of MS Flashcards

1
Q

a first demyelinating event involving the optic nerve, cerebrum, cerebellum, brainstem or spinal cord.
A. Clinically Isolated Syndrome (CIS)
B. Relapsing Remitting MS (RRMS)
C. Secondary Progressive MS (SPMS)
D. Primary Progressive MS (PPMS)
E. Primary Relapsing MS (PRMS)

A

A. Clinically Isolated Syndrome (CIS)

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2
Q

Most common type, consists of relapses with partial or complete remission between relapses, most will become progressive overtime
A. Clinically Isolated Syndrome (CIS)
B. Relapsing Remitting MS (RRMS)
C. Secondary Progressive MS (SPMS)
D. Primary Progressive MS (PPMS)
E. Primary Relapsing MS (PRMS)

A

B. Relapsing Remitting MS (RRMS)

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3
Q

80% of RRMS patients with progress to this, consisting of fewer relapses with continuing disability
progressive overtime
A. Clinically Isolated Syndrome (CIS)
B. Relapsing Remitting MS (RRMS)
C. Secondary Progressive MS (SPMS)
D. Primary Progressive MS (PPMS)
E. Primary Relapsing MS (PRMS)

A

C. Secondary Progressive MS (SPMS)

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4
Q

10-15% of pts. Progressive form from onset with minor improvements or periods of stability; more common in pts diagnosed in later years. (>50 yo)
A. Clinically Isolated Syndrome (CIS)
B. Relapsing Remitting MS (RRMS)
C. Secondary Progressive MS (SPMS)
D. Primary Progressive MS (PPMS)
E. Primary Relapsing MS (PRMS)

A

D. Primary Progressive MS (PPMS)

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5
Q

least common form; steadily worsening disease from onset with later, clear, acute relapses; may be some recovery from acute attacks, but no remission between relapses.
A. Clinically Isolated Syndrome (CIS)
B. Relapsing Remitting MS (RRMS)
C. Secondary Progressive MS (SPMS)
D. Primary Progressive MS (PPMS)
E. Primary Relapsing MS (PRMS)

A

E. Primary Relapsing MS (PRMS)

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6
Q

what is EDSS? what do we use it for?

A

the expanded disability status scale. Used in clinical trials and clinically to access effectiveness of drug therapy.

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7
Q

what is our target EDSS?

A

4 or lower

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8
Q

First choice for tx of acute attacks

A

high dose corticosteroid, oral or IV

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9
Q

what is the inpatient corticosteroid tx regimen (drug and duration)

A

methylprednisolone 500mg-1000mg IV daily for 3-7 days. with or without oral taper over 1-3 weeks.

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10
Q

what is the outpatient corticosteroid tx regimen (drug and duration)

A

oral prednisone 1250mg every other day for 5 doses without need for taper

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11
Q

oral medications for MS (you can just say the classes)

A

fumarates, -imods, teriflunomide

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12
Q

injectable MS meds (you can just say the classes)

A

interferons, glatiramer acetate

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13
Q

infusion MS meds

A

the -zumabs

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14
Q

what should pts get screened for prior to starting MS meds?

A

PML/ John Cunningham virus

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15
Q

what specific drug is highlighted for no live virus vaccines on the slide?

A

Alemtuzumab

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16
Q

T or F: Fumarates are associated with PML(just dimethly?)

A

False

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17
Q

what two things do you monitor for fumarates?

A

LFTs (hepatotoxicity) and CBC with differential (neutropenia)

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18
Q

What medication class can cause flushing?

A

fumarates

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19
Q

what do you do if fumarates make you flush?

A

take aspirin 30 min before

20
Q

what is the main contraindication for S1PR Ms?

A

past arrhythmia diagnosis

21
Q

what are the contraindications for S1Ps?

A

anything heart related at all

22
Q

what can d/c of S1Ps cause?

A

worsening of MS sxs

23
Q

Which S1P do you avoid use with an MAOi?

A

Ozanimod (Zeposia)

24
Q

which S1P requires CYP2C9 genotype testing before prescribing?
A. Fingolimod
B. Ozanimod
C. Ponesimod
D. Siponimod

A

D.Siponimod

25
Q

what drug class causes macular edema and should include eye exams after prescribing?

26
Q

what drug “may” be preferred in pregnancy even though its teratogenic effects are unknown?

A

Glatiramer acetate

27
Q

what drug class causes flu-like symptoms?

A

Interferons

28
Q

how do you decrease risk of flu-like symptoms from interferons?

A

Pre-treating with tylenol or an NSAID, at night

29
Q

psychiatric side effects of interferons

A

depression, suicidal ideation

30
Q

T or F: You hold interferons if a pt has suicidal ideation prior to treatment?

31
Q

what two things do you monitor on interferons?

A

LFTs and TSH

32
Q

how long before starting a monoclonal antibody should you complete all vaccinations?

33
Q

which of the following monoclonal antibodies are associated with REMS?
A. Alemtuzumab
B. Natalizumab
C. Ocrelizumab

A

A. Alemtuzumab
B. Natalizumab

34
Q

which of the following monoclonal antibodies are associated with increased risk of malignancies?
A. Alemtuzumab
B. Natalizumab
C. Ocrelizumab

A

A. Alemtuzumab
C. Ocrelizumab

35
Q

which of the following monoclonal antibodies are associated with possible fatal infusion reactions and autoimmune conditions?
A. Alemtuzumab
B. Natalizumab
C. Ocrelizumab

A

A. Alemtuzumab

36
Q

which of the following monoclonal antibodies are contraindicated in active hepatitis B?
A. Alemtuzumab
B. Natalizumab
C. Ocrelizumab

A

C. Ocrelizumab

37
Q

which of the following monoclonal antibodies are significantly associated with PML?
A. Alemtuzumab
B. Natalizumab
C. Ocrelizumab

A

B. Natalizumab

38
Q

which of the following monoclonal antibodies is the only one FDA-approved for PPMS?
A. Alemtuzumab
B. Natalizumab
C. Ocrelizumab

A

C. Ocrelizumab

39
Q

what is the MAIN MS drug that is super-duper contraindicated in pregnancy?

A

Teriflunomide (aubagio)

40
Q

what drug is associated with active charcoal for 11 days to test something for pregnancy?

A

teriflunomide

41
Q

what drug can cause gait abnormalities and increase walking speed

A

Dalfampridine (Ampyra)

42
Q

what is the MOA of how Dalfampridine (Ampyra) alters gait and walking speed?

A

blocks K+ channels and prevents repolarization which prolongs APs and nerve impulse transmission in the demyelinated axon

43
Q

T or F: IR formulations are preferred for Dalfampridine (Ampyra)

A

F, you want ER formulation

44
Q

in what case is the IR dosage form of Dalfampridine (Ampyra) contraindicated?

A

in pts with history of seizures

PHRM 845 (34 decks)

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