Lecture 1 - MS/MG Flashcards

Question

Tecfidera (Dimethyl-Fumarate) Monitoring

Answer 1

screen TB CBC D/c therapy if lymphocyte count < 0.5 X 10^9 > 6 month BL LFTs, D/c if liver injury suspected

Answer 2

95mg DR PO BID for 7 days, then 2 caps (190mg) DR BID **swallow whole, dont crush**

Answer 3

Lympgocytopenia LFTs Flushing GI after 1 month Anaphylaxis Angioedemia

Answer 4

Take with food consider non-EC ASA of < 325mg 30min prior

Answer 5

231mg DR PO BID for 7 days, then inc to 2 cap (462mg) DR PO BID Avoid w/ high-fat, high calories meal/snack, alc

Answer 6

Less chance of GI (1% vs 5% Tecfidera)

Answer 7

7-14mg PO QD

Answer 8

Hepatotoxicity Pregnancy/women use reliable Birth control

Answer 9

Warfarin = dec INR Avoid Live vaccines Rosuvastatin max dose = 10mg

Answer 10

Cholestyramine 8gram Q8H X 11 days or activated charcoal 50gram Q12 X 11 days days dont need to be consecutive

Answer 11

0.5mg QD PO > 40kg 0.25mg QD PO < 40kg

Answer 12

Headache infections diarrhea QTc prolong* Macular edema* HTN* cough LFT elevation

Answer 13

observe 6hrs after 1st dose for Bradycardia w/ hourly HR/BP inc risk of major congenital malformations women on BC during and 2 months after med, same rules for live vaccines

Answer 14

Rare cases of PRES CI in pts w/ preexisting Heart conditions, stroke, or on class Ia or III anti arrhythmic meds

Answer 15

CYP1C9 Genotype

Answer 16

0.25mg daily on Day 1+2, 0.5mg Day 3, 0.75mg Day 4, and 1mg after **other alleles, dosing inc to 2mg at end of titration**

Answer 17

Approved for RRMS, active SPMS and clinically isolated syndrome

Answer 18

pretty much same as Fingolimod (Gilenya)

Answer 19

if more than 24hrs, treatment needs to be reinitiated with Day 1 of the titration regimen

Answer 20

CYP2C9 3*/3*

Answer 21

also avoid live vaccines during n 1 month after monitor if history of bradycardia for 1st dose women also need to be on BC during and 10 days after

Answer 22

Rare PRES Rare PML CI w/ Heart conditions, Stroke, TIA

Answer 23

Day 1-4 = 0.23mg PO QD Day 5-7 = 0.46mg PO QD Day 8+ = 0.92mg PO QD

Answer 24

Upper Resp tract infection Orthostatin HTN

Answer 25

MI, unstable angina, stroke, TIA, HF hospitalization, C3-4 HF in last 6 months, untreated severe sleep apnea, dont use with MAOI

Answer 26

MAOI SSRI, SNRIs, TCA, opioids Strong CYP2C8 inducers/inhibitors

Answer 27

starts at 2mg QD X 2 days, day 15 is 20mg QD maintenance dose Monitoring 1st dose if Hr < 55BPM

Answer 28

Cumulative dose of 3.5mg/kg PO and divided into 2 txm courses (1.75mg/kg each) Each txm course is divided into 2 txm cycles *Dont admin cladribine during following 2 yrs after therapy* ** Not 1st line, for those who cant tolerate others**

Answer 29

avoid antiviral or antiretroviral drugs ( Lamivudine, ribavirin, zidovudine) separate other oral drugs by atleast 3hrs during the 4-5 day treatment cycles

Answer 30

May inc malignancy, CI if currently have CI in preg women and men/women not on effective contraceptives

Answer 31

CBC/LFT Cancer screen Preg test Latent infections MRI to exclude PML < 200 Lymphocyte count at months 2/6...herpes prophylaxis considered if < 200

Answer 32

20mg SC injection weekly for 3 doses, then 20mg Q monthly

Answer 33

Active HBV infection careful if active infection, recent vaccine admin

Answer 34

IV infusion 12mg IV QD X 5 days (60mg total) 12mg QV X 3 days 12months after initial (36mg)

Answer 35

pts w/ relapsing form of MS or inadequate response to 2+ MS therapies

Answer 36

Has REMS program Monitor: Infusion reaction, CBC/Scr/UA QM n 48M after

Answer 37

acyclovir 200mg BID > 28days after last infusion or until CD4 count > 200 (whichever is last)

Answer 38

Bactrim SS QD, during txm n several weeks after

Answer 39

300mg IV X 1, then 300mg IV X 1 2 weeks later (max 180ml/hr, >2.5hr infusion) then 600mg IV every 6 months (max 200ml/hr, >3.5hr infusion) premed and monitor 1hr post infusion

Answer 40

300mg IV q4 weeks

Answer 41

REMS Black box for PML monitor infections, LFTs

Answer 42

screening for PML

Answer 43

IV infusion 1st dose = 150mg IV over 4hrs 2nd dose = 450mg IV over 1hr, 2 weeks after first Later doses = 450mg over 1hr 24weeks after 1st infusion and every 24 weeks after premedicate

Answer 44

dec vaccine efficacy screen for Hep B

Answer 45

inc walking speed in pts by 25%...clinically meaningful?

Answer 46

10mg BID ~ 12hr apart

Answer 47

Seizue history Crcl < 50, 51-80 = inc seizure risk

Answer 48

Days 1-7 = 1 QAM Days 8+ = 1 BID (AM/PM) dont double if missed, take ~12hr apart used for random laughing/crying/etc (Pseudobulbar effect)

Answer 49

Digoxin = monitor lvls Cardiac abnormalities

Answer 50

1 = less severe 5 = most severe

Answer 51

1st line MS Dosing highly individualized PO = bunch of forms, IV/IM = 2mg Q2-3hr or 1/30th PO dose in crisis

Answer 52

Salivaton urinary incontinence diarrhea sweating can manage with Glycopyrrolate or Hyoscyamine TID

Answer 53

start low n titrate

Answer 54

Fluoroquinolones Macrolides Aminoglycosides Beta-blockers Statins

Answer 55

add after AChE inhibitor Azatthioprine = 1st choice, delayed onset of action....start with red for faster effect

Answer 56

CI to Glucocorticoids Liver disease = avoid Azathioprine Renal disease = avoid cyclosporine Leukopenia = avoid azathioprine & mycophenolate