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Therapeutics > MS > Flashcards

MS Flashcards

1
Q

first episode of neurologic symptoms lasting at least 24 hours caused by inflammation & demyelination in 1 or more sites in the CNS
(1 attack & 1 lesion)

A

clinically isolated syndrome

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2
Q

most common MS, worsening of preexisting symptoms or onset of new symptoms for >48 hours without fever, contrasted by remission with no symptoms

A

relapsing-remitting

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3
Q

progression of RRMS steadily progressing with or without clear cut relapses

A

secondary-progressive

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4
Q

MS with steady decline without relapse, meds not effective

A

primary-progressive

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5
Q

steady progressing MS with periods of exacerbations

A

progressive relapsing

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6
Q

two options for MS relapse treatment

A

corticosteroids, corticotropin acthar gel

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7
Q

indication for ALL disease modifying MS treatments

A

RELAPSING FORMS
including CIS, RRMS, active SPMS

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8
Q

interferon beta-1a products
route of admin?

A

avonex IM
rebif SQ
plegridy SQ

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9
Q

interferon beta-1b products
route of admin?

A

betaseron, extavia SQ

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10
Q

major AE of interferon beta?
how to manage?

A

flu-like symptoms
premedicate with APAP or ibuprofen

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11
Q

non-interferon ABCR agent?
route of admin?

A

glatiramer acetate (copaxone, glatopa)
SQ

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12
Q

major AEs of glatiramer acetate

A

injection site rxn (masses, welts), vasodilation, chest pain, throat constriction.

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13
Q

sometimes fatal opportunistic infection from activation of latent JCV
demyelinating disease

A

progressive multifocal leukoencephalopathy (PML)

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14
Q

common AEs for MoAbs for MS

A

infusion rxn, infection (URTI, UTI), HA, fatigue, diarrhea, dizziness, chills, nausea, insomnia, PML.

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15
Q

MoAbs for MS?

A

Natalizumab (Tysabri)
Alemtuzumab (Lemtrada)

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16
Q

anti CD20 MoAbs for MS?

A

Ocrelizumab (ocrevus)
ublituximab (biumvi)
ofatunumab (kesimpta)

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17
Q

route of admin for tysabri

A

IV Q4W

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18
Q

alemtuzumab (lemtrada) is reserved for….

A

inadequate response to 2 or more other meds

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19
Q

which MoAbs recommend premedicating? with what?

A

lemtrada, ocrevus, biumvi
treat w/ antihistamine, steroid, antipyretics

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20
Q

major AEs of lemtrada

A

development of autoimmune thyroid disorders, rash

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21
Q

BBW for lemtrada

A

autoimmune condition, infusion reactions, malignancy

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22
Q

Contraindication for anti CD20 MoAbs?
Warnings?

A

CI- active HBV
Warn- HBV, herpes, infection, PML, malignancy, infusion rxn, immunizations

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23
Q

which MS therapy is the ONLY ONE APPROVED FOR PPMS

A

ocrelizumab (ocrevus)

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24
Q

special warning for ublituximab (biumvi) for hypersensitivity due to

A

polysorbate 80 in the formulation

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25
Q

route of admin for lemtrada

A

IV for a few days

26
Q

route of admin for ocrevus

A

IV Q6M

27
Q

route of admin for biumvi

A

IV Q6M

28
Q

route of admin for kesimpta

A

SQ QM

29
Q

2 chemo agents used for MS

A

mitoxantrone
mavenclad

30
Q

mitoxantrone is reserved for

A

rapidly advancing refractory MS

31
Q

major dosing/AE point for mitoxantrone

A

max cumulative lifetime dose due to cardiotoxicity

32
Q

mitoxantrone AEs

A

cardiotoxicity, bone marrow suppression, esophagitis, alopecia, HA, NV

33
Q

mavenclad key points for administration

A

PO NIOSH drug, wash hands, handle with dry hands, separate admin from other PO meds by 3 hours

34
Q

BBW for mavenclad

A

malignancy, teratogenicity

35
Q

AE of mavenclad

A

HA, nausea, infection, URTI

36
Q

drugs that act on S1P receptors to inhibit T lymphocyte release

A

fingolimod
siponimod
ozonimod
ponesimod

37
Q

major AEs of S1P drugs for MS

A

BRADYCARDIA, macular edema, HTN, infection, PML, HA

38
Q

Contraindication for S1P drugs

A

most cardiovascular issues

39
Q

major warnings for S1P drugs

A

disease rebound when d/c, infection, CV disease, immunization, neurotoxicity, hepatic effects, respiratory effects, PML, bradycardia, QTc, malignancy, etc.

40
Q

monitoring for S1P drugs

A

CBC, hepatic, ECG, eyes, BP, infection, skin exam

41
Q

1st dose monitoring for fingolimod

A

REQUIRED at least 6 hours

42
Q

dosing of siponimod is based on

A

CYP2C9 genotype statis

43
Q

monitoring for 1st dose of siponimod

A

required for 6 hours IF PREEXISTING CV CONDITION

44
Q

Contraindication of siponimod

A

CYP2C93/3 genotype

45
Q

siponimod DDI

A

2C9, 3A4, immunosuppressants, bradycardia causing agents, AV blocking agents, QT prolonging agents

46
Q

contraindication/DDI for ozonimod

A

MAOI
tyramine foods interact

47
Q

monitoring for 1st dose of ponesimod

A

required for 4 hours IF CERTAIN CV CONDITIONS

48
Q

agent that blocks pyrimidine synthesis and reduces B lymphocyte proliferation

A

teriflunomide (Aubagio)

49
Q

AEs of teriflunomide

A

alopecia, diarrhea, increased LFTs, paresthesia, hypersensitivity, influenza

50
Q

teriflunomide BBW

A

hepatotoxicity, teratogenicity

51
Q

DDI of teriflunomide

A

max rosuvastatin 10 mg
lowers INR on warfarin
BCRP, 2C8, OATP1B1, OAT3

52
Q

fumarates used for MS

A

dimethyl/diproximen/monomethyl fumarate
tecfidera, vulmerity, bafiertam

53
Q

AEs of dimethyl fumarate (tecfideria) and other fumarates
how to manage?

A

GI symptoms- take w/ food
flushing- premed w/ aspirin

54
Q

med used for PBA (uncontrollable laugh/cry episodes) in MS

A

nuedexta

55
Q

drug for walking in MS

A

dalfampridine (ampyra)

56
Q

general MOA for interferon B

A

suppress T cell proliferation (among other immune system effects)

57
Q

MOA of glatiramer acetate

A

alters T cell activation and differentiation

58
Q

natalizumab MOA (Tysabri)

A

prevents adhesion to the BBB to prevent leukocytes from crossing

59
Q

alemtuzumab MOA (lemtrada)

A

targets CD52 on T & B lymphocytes causing long-term reduction of T cells

60
Q

mavenclad MOA

A

cytotoxic effects on B & T lymphocytes, depletes them from shutdown of DNA synthesis

61
Q

teriflunomide MOA

A

cytostatic effect on proliferating T & B lymphocytes in the periphery

62
Q

fumarates MOA

A

induces T-helper 2 cytokines to cause apoptosis in T cells and downregulate intracellular adhesion molecules

Therapeutics (20 decks)

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