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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
route of admin for lemtrada
IV for a few days
26
route of admin for ocrevus
IV Q6M
27
route of admin for biumvi
IV Q6M
28
route of admin for kesimpta
SQ QM
29
2 chemo agents used for MS
mitoxantrone mavenclad
30
mitoxantrone is reserved for
rapidly advancing refractory MS
31
major dosing/AE point for mitoxantrone
max cumulative lifetime dose due to cardiotoxicity
32
mitoxantrone AEs
cardiotoxicity, bone marrow suppression, esophagitis, alopecia, HA, NV
33
mavenclad key points for administration
PO NIOSH drug, wash hands, handle with dry hands, separate admin from other PO meds by 3 hours
34
BBW for mavenclad
malignancy, teratogenicity
35
AE of mavenclad
HA, nausea, infection, URTI
36
drugs that act on S1P receptors to inhibit T lymphocyte release
fingolimod siponimod ozonimod ponesimod
37
major AEs of S1P drugs for MS
BRADYCARDIA, macular edema, HTN, infection, PML, HA
38
Contraindication for S1P drugs
most cardiovascular issues
39
major warnings for S1P drugs
disease rebound when d/c, infection, CV disease, immunization, neurotoxicity, hepatic effects, respiratory effects, PML, bradycardia, QTc, malignancy, etc.
40
monitoring for S1P drugs
CBC, hepatic, ECG, eyes, BP, infection, skin exam
41
1st dose monitoring for fingolimod
REQUIRED at least 6 hours
42
dosing of siponimod is based on
CYP2C9 genotype statis
43
monitoring for 1st dose of siponimod
required for 6 hours IF PREEXISTING CV CONDITION
44
Contraindication of siponimod
CYP2C9*3/*3 genotype
45
siponimod DDI
2C9, 3A4, immunosuppressants, bradycardia causing agents, AV blocking agents, QT prolonging agents
46
contraindication/DDI for ozonimod
MAOI tyramine foods interact
47
monitoring for 1st dose of ponesimod
required for 4 hours IF CERTAIN CV CONDITIONS
48
agent that blocks pyrimidine synthesis and reduces B lymphocyte proliferation
teriflunomide (Aubagio)
49
AEs of teriflunomide
alopecia, diarrhea, increased LFTs, paresthesia, hypersensitivity, influenza
50
teriflunomide BBW
hepatotoxicity, teratogenicity
51
DDI of teriflunomide
max rosuvastatin 10 mg lowers INR on warfarin BCRP, 2C8, OATP1B1, OAT3
52
fumarates used for MS
dimethyl/diproximen/monomethyl fumarate tecfidera, vulmerity, bafiertam
53
AEs of dimethyl fumarate (tecfideria) and other fumarates how to manage?
GI symptoms- take w/ food flushing- premed w/ aspirin
54
med used for PBA (uncontrollable laugh/cry episodes) in MS
nuedexta
55
drug for walking in MS
dalfampridine (ampyra)
56
general MOA for interferon B
suppress T cell proliferation (among other immune system effects)
57
MOA of glatiramer acetate
alters T cell activation and differentiation
58
natalizumab MOA (Tysabri)
prevents adhesion to the BBB to prevent leukocytes from crossing
59
alemtuzumab MOA (lemtrada)
targets CD52 on T & B lymphocytes causing long-term reduction of T cells
60
mavenclad MOA
cytotoxic effects on B & T lymphocytes, depletes them from shutdown of DNA synthesis
61
teriflunomide MOA
cytostatic effect on proliferating T & B lymphocytes in the periphery
62
fumarates MOA
induces T-helper 2 cytokines to cause apoptosis in T cells and downregulate intracellular adhesion molecules

Therapeutics (34 decks)

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