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Therapeutics P3 Fall > MS > Flashcards

MS Flashcards

1
Q

Relapsing Remitting MS (RRMS)

A

-Series of attacks that occur over months-years apart
-causing increase in level of disability
-most common form of MS

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2
Q

Secondary Progressive MS (SPMS)

A

Starts similar to RRMS but over time the immune attack becomes constant

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3
Q

Primary progressive MS (PPMS)

A

constant immune attack

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4
Q

Progressive relapsing MS (PRMS)

A

-constant immune attack + acute attacks superimposed
-most rare form

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5
Q

Charcot’s Neurologic Triad

A

Dysarthria (difficult/unclear speech)
-plaques in brainstem
Nystagmus (rapid involuntary eye movement)
-plaques in optic nerve
Intention tremor
-plaques in motor pathways in spinal cord

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6
Q

Lhermitte’s sign

A

Electric shock-like feeling that runs down the back and radiates to limbs when bending neck forward

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7
Q

MS diagnostic criteria

A
  • at least 2 documented clinical exacerbations separated by time and space
  • 2 distinct MRI lesions separated by time and space
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8
Q

Clinically Definite MS

A

2 attacks + 2 lesions

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9
Q

Laboratory Supported MS

A
  • 2 attacks + either clinical or paraclinical evidence of 1 lesion + CSF abnormalities

OR

-1 attack + clinical evidence of 2 lesions + CFSF abnormalities

OR

-Clinical evidence of 1 lesion + paraclinical evidence of another lesion + CSF abnormalities

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10
Q

Clinically Isolated Syndrome

A

1st MS attack

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11
Q

MS Relapse Treatment

A

Steroids:
- Methylprednisolone

For pats with poor IV access:
- Corticotropin acthar gel IM or SQ

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12
Q

Progressive Multifocal Leukoencephalopathy (PML)

A

A sometimes fatal opportunistic infection caused by the activation of latent John Cunningham polyoma virus in immunocompromised patients
- demyelinating disease similar to MS

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13
Q

Interferon Beta-1a

A

Avonex- IM
Rebif- SQ
Plegridy - SQ

Indication: CIS, RRMS, active SPMS

MOA: suppress T cell proliferation and decreases BBB permeability

ADE: FLU LIKE SX!, injection sight rxn, depression, myalgia, arthralgia, asthenia, malaise, diaphoresis, myasthenia, abdominal pain

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14
Q

Interferon Beta-1B

A

Betaseron (SQ)
Extavia (SQ)

Indication: CIS, RRMS, active SPMS

MOA: suppress T cell proliferation and decreases BBB permeability

ADE: FLU LIKE SX!, injection sight rxn, depression, myalgia, arthralgia, asthenia, malaise, diaphoresis, myasthenia, abdominal pain

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15
Q

Glatiramer Acetate (Copaxone, Glatopa)

A

SQ

Indication: CIS, RRMS, active SPMS

MOA: alteration of T cell activation and differentiation

ADE: INJECTION SITE RXN, transient flushing, vasodilation, chest pain, tightness, asthenia, N/V, pain, arthralgia, anxiety, palpitations, dyspnea, constriction of throat

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16
Q

Natalizumab (Tysabri)

A

IV

Indication: CIS, RRMS, active SPMS

MOA: prevents leukocyte adhesion, prevents transmigration of leukocytes across the endothelium into inflamed parenchymal tissue

ADE: PML, infusion rxn, respiratory tract infection, UTI, depression, HA, fatigue, diarrhea, cholelithiasis, arthralgia

17
Q

Alemtuzumab (Lemtrada)

A

IV

Indication: RRMS, SPMS (generally reserved for inadequate response to 2 or more meds)

MOA: target CD52 on immune cells causing long term reduction in T cells

ADE: AUTOIMMUNE THYROID DISORDERS, rash, HA, pyrexia, fatigue, pruritis, N/V/D, dizziness, chills, insomnia, chest discomfort, dyspnea, musculoskeletal pain, flushing, infections

Pearls: premedicate with corticosteroids (methylpred) + use antiviral prophylaxis from 1st day of treatment -> 2 months post treatment

Monitor: CBC, urinalysis, TSH, PML, HPV, skin screen

18
Q

Ocrelizumab (Ocrevus)

A

IV

Indication: PPMS!!!!, CIS, RRMS, SPMS

MOA: Binds CD20 on B cells -> depletes them from circulation

ADE: infusion rxns, UTI, URTI, HA, nausea, infection, malignancy, PML

CI: active HBV infection

19
Q

Ofatunumab (Kespimpta)

A

SQ

Indication: CIS, RRMS, SPMS

MOA: binds specifically the extracellular loops of the CD20 molecule -> depletes B cells from circulation

ADE: infection, injection rxn, PML, CI in pregnancy, back pain

20
Q

Mitoxantrone (Novantrone)

A

IV

Indication: PRMS!!!! SPMS, worsening RRMS

MOA: intercalates with DNA strands causing breaks and inhibits DNA repair through topoisomerase II

ADE: Cardiotoxicity, bone marrow suppression, stomatitis, esophagitis, oral ulceration, N/V, alopecia, HA, fatigue, hepatic dysfunction

21
Q

Mavenclad (cladribine)

A

PO

Indication: RRMS, active SPMS
- NOT CIS

MOA: prodrug -> incorporates into DNA -> breakage + shutdown of DNA repair -> depletion of lymphocytes

ADE: Malignancy, teratogenicity, bone marrow suppression, infection, PML, hepatotoxicity, cardiotoxicity, HA, Nausea, fever, insomnia, HTN, alopecia

Monitor: CBC, infection status, VZV antibody status, pregnancy, LFT, MRI, cancer screening

22
Q

Mavenclad (cladribine) dosing

A

3.5 mg/kg over 2 years.
Administered as 1.75 mg/kg each year
- in 2 4-5 day cycles
- start second day cycle 23-27 days after the last dose of the second cycle
- start 2nd year treatment course >/= 43 weeks after last dose

23
Q

Fingolimod (Gilenya)

A

PO

Indication: CIS, RRMS, + SPMS in pats >/=10

MOA: acts on Sphingosine 1 phosphate -> depletes T lymphocytes in blood stream, inhibits lymphocyte release from lymphatic organs

ADE: bradycardia, QTc prolongation, HA, lymphopenia, leukopenia, infection, macular edema, inc BP, HTN, inc LFTs, abdominal pain, back pain, diarrhea

CI: pats w/ heart conditions

Monitoring: ECG, monitor for bradycardia 6 hrs pos 1st dose

24
Q

Mayzent / Siponimod

A

PO

Indication: CIS, RRMS, active SPMS

MOA: acts on Sphingosine 1 phosphate -> depletes T lymphocytes in blood stream, inhibits lymphocyte release from lymphatic organs

ADE: infection, PML, macular edema, bradycardia, AV block, QT prolongation, CVD, reduced forced expiratory volume, inc LFTs, HTN, neurotoxicity, malignancy, discontinuation syndrome, HA, macular edema

CI in CYP2C9 3/3

Monitor: CBC, LFT, ECG, ophthalmologic exam, respiratory function (FEV), VZV antibodies, blood pressure, 1st dose monitoring for pats with sinus bradycardia (HR < 55), AV block, Hx of MI or HF

25
Q

Mayzent / Siponimod dosing:
CYP2C9 1/1, 1/2, 2/2

A

0.25mg QD -> titrate -> 2mg QD

26
Q

Mayzent / Siponimod dosing:
CYP2CP 1/3, 2/3

A

0.25mg QD -> titrate -> 1mg QD

27
Q

Zeposia / Ozonimod

A

PO

Indication: CIS, RRMS, active SPMS

MOA: acts on Sphingosine 1 phosphate -> depletes T lymphocytes in blood stream, inhibits lymphocyte release from lymphatic organs

ADE: similar to IFN B1A, infection , HTN, orthostatic HTN, upper abdominal pain, lymphocytopenia, inc ULN, back pain, macular edema

Monitor: CBC, baseline bilirubin + LFTs, ECG, ophthalmologic exam, less need for 1st dose monitoring

28
Q

Teflunomide (Aubagio)

A

PO

Indication: RRMS, SPMS

MOA: blocks pyrimidine synthesis in rapidly dividing cells -> selectively produces a cytostatic effect on proliferating T and B lymphocytes in the periphery

ADE: HA, infections, alopecia, sensory disturbances, nausea, paresthesias, insomnia, inc LFTs, back pain, diarrhea, arthralgia

Monitor: CBC, LFT, screen for latent TB

BBW: hepatotoxicity, teratogenicity

29
Q

Dimethyl fumarate (Tecfidera)

A

PO

Indication: CIS, RRMS, active SPMS

MOA: induces T-helper 2- like cytokines -> apoptosis of activated T cells and down regulation of intracellular adhesion molecules

ADE: GI SX, flushing, inc LFTs, transient eosinophilia, lymphopenia, PML

30
Q

Diroximel Fumarate (Vulmerity)

A

PO

Indication: CIS, RRMS, active SPMS

MOA: induces T-helper 2- like cytokines -> apoptosis of activated T cells and down regulation of intracellular adhesion molecules

ADE: GI SX, flushing, inc LFTs, transient eosinophilia, lymphopenia, PML

Pearl: high fat meals may significantly decrease max concentration

31
Q

Monomethyl Fumarate (Bafiertam)

A

PO

Indication: CIS, RRMS, active SPMS

MOA: induces T-helper 2- like cytokines -> apoptosis of activated T cells and down regulation of intracellular adhesion molecules

ADE: GI SX, flushing, inc LFTs, transient eosinophilia, lymphopenia, PML

32
Q

Treatment for Spasticity in MS

A
  • Baclofen
  • Dantrolene
  • Diazepam, clonazepam
  • Tizanidine
  • Gabapentin, tiagabine, pregabalin
  • Botox
  • Dalfampridine
33
Q

Treatment for bladder symptoms in MS (overactive bladder / retention)

A
  • Propantheline
  • Oxybutynin
  • Dicyclomine/Bentyl
  • DDAVP
  • catheterization
  • imipramine / amitriptyline
  • prazosin
  • botox
  • solifenacin/ vesicare
  • darifenacin/ enablex
  • trospium
  • hyoscyamine
  • fesoterodine / toviaz
  • mirabegron (Myrbetiq)
34
Q

Treatment for sensory symptoms of MS (Paresthesias, neuropathic pain)

A
  • carbamazepine, oxcarbazepine
  • phenytoin
  • TCAs
  • Gabapentin
  • lamotrigine
  • pregabalin
  • duloxetine
35
Q

Treatment for Fatigue/ Cognitive / Emotional issues in MS

A
  • Amantadine
  • SSRI / SNRI
  • Modafanil
  • Methylphenidate
  • Dextroamphetamine
36
Q

Pseudobulbar Affect

A
  • uncontrollable episodes of crying or laughing
  • treatment with Nuedexta (Dextromethorphan + Quinidine)
37
Q

Improved walking with MS:

A

Dalfampridine (Ampyra)
- broad spectrum CCB

38
Q

Use of Cannabinoids in MS treatment

A

effective for spasticity, pain, painful spasm, and bladder voiding

Therapeutics P3 Fall (21 decks)

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