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701 > MS > Flashcards

MS Flashcards

1
Q

What vitamin plays a role in MS development?

A

Vitamin D

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1
Q

Diagnosing MS

A

Separated by time and space:
- At least 2 documented clinical exacerbations
- At least 2 MRI lesions

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2
Q

PPMS diagnosis

A

One year of disease progression plus 2 of the following:
- DIS in the brain
- DIS within the spinal cord
- Positive CSF

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3
Q

CIS diagnosis

A

1 exacerbation (24h+) and 1 lesion

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4
Q

RRMS

A
  • Most common (85%)
  • periodic worsening of symptoms followed by remissions
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5
Q

SPMS

A
  • Decreased incidence due to modern medicine
  • Relapsing/remitting becomes steady progression
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6
Q

PPMS

A
  • Rare (10%)
  • Steady decline without relapses
  • Medications generally not effective
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7
Q

PRMS

A
  • Rarest (5%)
  • Steady disease progression in addition to exacerbations (RR)
  • Exacerbations can be treated with steroids BUT disease still progresses
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8
Q

Acute MS exacerbation treatment

A

Corticosteroids*
- Solumedrol (methylp.) IV followed by prednisone taper
(maybe corticotropin acthar gel)

H2b/PPI for ulcer prophylaxis
Monitor BP, watch for infection

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9
Q

ABCR injectables

A

Indicated for for CIS, RRMS, SPMS

Interferon beta-1a (Avonex, Rebif, Plegridy)
Interferon beta-1b (Betaseron, Extavia)
Glatiramer acetate (Copaxone, Glatopa)

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10
Q

Interferon beta

A
  • Pregnancy category C
  • FLU LIKE SYMPTOMS!! -> premedicate with APAP/ibuprofen, titrate up slowly
  • Avonex given IM once weekly
  • Rebif given SC three times weekly
  • Plegridy given SC once weekly, peglyated
  • Betaseron/Extavia given SC every other day
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11
Q

Glatiramer acetate

A
  • Pregnancy category B*
  • INJECTION SITE REACTION!!
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12
Q

Natalizumab (Tysabri)

A

Indicated for for CIS, RRMS, SPMS
- a4-integrin antagonist, humanized moAb
- Stops leukocytes from crossing BBB
- IV q4w
- Pregnancy category C
- PML risk!!***
- UTI, RTI, depression, GI issues, headache, arthralgia

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13
Q

Alemtuzumab (Lemtrada)

A

Indicated for RRMS and SPMS
- Reserved for inadequate response to 2+ medications
- moAb targets CD52 on T and B cells, resets immune system
- Pregnancy category C
- Premedicate with corticosteroids
- Stay in hospital for 5 days for IV infusion, then for 3 days in a year
- DEVELOPMENT OF AUTOIMMUNE THYROID DISORDERS (1/3 of pts) -> monitor TSH
- rash, HA, GI, infections, fatigue, malignancy
- BBW immune thrombocytopenia and anti-glomerular basement membrane disease
-> monitor CBC, SCr
- very serious infusion reactions

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14
Q

Ocrelizumab (Ocrevus)

A

Indicated for CIS, RRMS, SPMS, and PPMS**
- CD20 cell lysis of B cells
- Infusion reactions
- Hepatitis B reactivation
- Herpes infection
- Malignancy
- PML

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15
Q

Ofatumumab (Kesimpta)

A

Indicated for for CIS, RRMS, SPMS
- CD20 cell lysis of B cells
- Similar to ocrelizumab
- Subcutaneous -> patients can take home, pt friendly!
- Separate vaccines
- Infections, injection reactions, PML

16
Q

Mitoxantrone

A

Indicated for SPMS, PRMS, or worsening of RRMS
- Breaks DNA, stops repair via topoisomerase II
- cardiotoxicity, bone marrow sup., GI, HA, alopecia
- max 100 mg/m^2 lifetime dose

17
Q

Mavenclad (cladribine)

A

Indicated for RRMS and SPMS for those intolerant to other therapies
- Purine analog, prodrug, depletes ATP, decrease lymphocytes
- Max 3.5 mg/kg over 2 years
- Missed dose -> extend treatment cycle
- Lymphocytes must be WNL
- Teratogenic, malignancies
- CI in pregnancy, infection, malignancy
- PML, cardiotox, hepatotox, HA

18
Q

Fingolimod (Gilenya)

A

Indicated for CIS, RRMS, SPMS >10 y/o
- S1P, depletes CD4, CD8 T cells
- oral therapy 0.5mg QD for RRMS and SPMS
- ECG needed for initiating
- Monitor CV
- HA, infection, macular edema, HTN, GI, pain

19
Q

Mayzent (Siponimod)

A

Indicated for CIS, RRMS, SPMS
- S1P
- Lower dose for CYP2C9 genotype 1/3 or 2/3
- CONTRAINDICATED for 3/3
- infections, PML, macular edema, CV, QT, malignancy, hepatotox, HTN
- CYP2C9 DDI
- Additional monitoring for pt with sinus bradycardia (<55 HR), AV blokc, MI, HF

20
Q

Ozonimod (Zeposia)

A

Indicated for CIS, RRMS, SPMS
- S1P
- Oral dosing
- CV contraindications
- CV ADEs, infection, hepatotox, macular edema, neurotox, PML
- tyramine -> hypertensive crisis

21
Q

Teriflunomide (Aubagio)

A

Indicated for CIS, RRMS, SPMS
- cytostatic effect on T and B cells
- food affects absorption
- HA, pain, infections, alopecia
- BBW hepatotox, teratogenicity (even in semen)
- decrease concentration with cholestyramine

22
Q

Dimethyl fumarate

A

Indicated for CIS, RRMS, SPMS
- Cytokine induction -> T cell apoptosis
- GI SYMPTOMS!! (with/without food)
- flushing (take with ASA), PML
- Vulmerity less GI effects than Tefidera
- Monomethyl fumarate (Bafiertam) also has less GI effects

23
Q

Drugs to treat spasticity in MS

A
  • Baclofen
  • Dantrolene
  • Diazepam, clonazepam
  • Tizanidine
  • Gabapentin, pregablin, tiagabine
  • Botox
  • Dalfampridine
24
Q

Which drug treats pseudobulbar affect (PBA) in MS?

A

Nuedexta

25
Q

Which drug helps with walking in MS?

A

Dalfampridine

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