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pharmacy 358 > MS > Flashcards

MS Flashcards

1
Q

IN regards to gender, How is MS different?

A

Males= more severe
women= more common

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2
Q

What is the pathophysiology of MS?

A

Inflammation causing myelin breakdown, once myelin is gone axon starts to degenerate

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3
Q

What infection could cause MS?

A

Epstein Bar virus

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4
Q

Symptoms of MS?

A

Numbness, tingling, depression, vision issues, fatigue, walking difficulty, weak

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5
Q

What is relapse remitting MS?

A

periods of relapses but doesn’t get worse
most common

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6
Q

What is secondary progressive MS?

A

relapses then eventually progresses worse because body can only repair so much

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7
Q

What does relapse remitting eventually become?

A

secondary progressive

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8
Q

What is primary progressive MS?

A

more severe and always gets worse, no relapses

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9
Q

What is clinically isolated syndrome MS?

A

one relapse only

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10
Q

To diagnose, what must we know?

A

If an MS attack, always do an MRI

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11
Q

Why do drugs work less when in secondary progressive?

A

inflammation eventually goes down then our drugs do not work

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12
Q

ON the MS scale, what number do trials enrol?

A

<6= just walking issues not wheelchair

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13
Q

Non pharm for MS?

A

exercise, diet
alt medicine= not super helpful

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14
Q

What is considered a relapse?

A

new or worsening sx for >24 hrs, no fever or other causes separated by 30 days from another relapse

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15
Q

What is treatment for relapse?

A

Methylpred 500-000mg IV 3-5 days
prednisone 1250 mg for 3-5 days

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16
Q

Does relapse treatment need a taper?

A

not needed but can

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17
Q

Are all relapses treated?

A

No only if severe or if affecting necessary parts such as eyes

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18
Q

If people in relapse do not respond to CS, what can we do?

A

Plasma exchange

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19
Q

How can we help with fatigue?

A

OT/PT, sleep hygiene
amantadine
modafinil
methylphenidate

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20
Q

What are issues with the agents used for fatigue?

A

causes insomnia and not super helpful

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21
Q

What fatigue agent causes SJS?

A

modafinil

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22
Q

What can we do to help for gait?

A

fampridine, causes seizures and insomnia

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23
Q

What can we do for spasticity?

A

baclofen, gabapentin, botulinim

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24
Q

Is cannabis useful in MS?

A

lack of evidence and don’t know dosage/ ratio, and what type of cannabinoid to use

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25
Q

What is first DMT for MS?

A

IFNbeta-1b= betaseron

26
Q

First oral DMT?

A

finoglimod

27
Q

What is the only DMT that is immunomodulator?

A

interferon beta

28
Q

What is PML and how can we monitor for it

A

progressive multifocal leukoencephalopathy
often fatal infection by JC virus that destroys myelin
Monitor with MRI

29
Q

How do we treat PML?

A

Lower immunosuppression

30
Q

What DMT has higher risks for PML?

A

Most is natalizumab after 2 years
also seen with dimethyl fumigate, fingolimod, ocrelizumab

31
Q

Which drug causes lipoatrophy?

A

glatiramer

32
Q

Which DMT options are injectables?

A

Interfereon, glatiramer, ofatumumab

33
Q

General monitoring for ejectable DMT?

A

CBC and LFT

34
Q

Which injectable does NOT need monitoring?

A

glatiramer

35
Q

Which injectable is monthly?

A

ofatumumab

36
Q

Oral DMT options?

A

teriflunomide, dimethyl fumarate, mods**, cladribine

37
Q

Which Oral DMTs are teratogenic for both male and female?

A

teriflunomide, fingolimod, siponimod, ozanimod, cladribine

38
Q

S/e of teriflunomide?

A

D,V, hair thin, neuropathy

39
Q

Big s/e with dimethyl fumarate?

A

lymphopenia, gi

40
Q

Which option MUST have cardiac monitoring?

A

fingolimod- esp after first dose for 6 hours

41
Q

s/e of fingolimod?

A

HTN, slow Qt, bradycardia, block, macular edema

42
Q

S/e of siponimod?

A

slow heart rate, d,n, pain/swelling in hands and feet

43
Q

s/e of ozanimod?

A

infection risk

44
Q

Which drug is only indicated for SPMS?

A

spinomid

45
Q

How is cladribine dosed?

A

QD for 4-5 days each of the first 2 months on year 1 and 2

46
Q

S/e of cladribine?

A

thinning hair, infection risk

47
Q

Which drug must be avoided if Hep B

A

ocrelizumab

48
Q

Which drug is indicated for PPMS?

A

ocrelizumab

49
Q

Which options are transfusions?

A

natalizumab, ocrelizumab, alemtuzamab

50
Q

What is special about frequency of ocrelizumab?

A

every 24 weeks

51
Q

What is special about s/e of ocrelizumab?

A

premeditate with IVMP, antihistamine prior to infusion

52
Q

S/e of alemtuzumab?

A

infusion run, thyroid issues, cancer risk

53
Q

What happens when you d/c alemtuzumab?

A

still need to monitor ADR esp autoimmune for 4 years

54
Q

Is rituximab worth it?

A

off label, works and is less s/e

55
Q

Highest efficacy DMT?

A

natalizumab and alemtuzumab,

56
Q

If MS does it affect fertility?

A

No

57
Q

Does MS make pregnancy high risk?

A

Not necessarily

58
Q

First line for pregnancy and breastfeeding?

A

Inject= Copaxone/IFN= good until conception
oral= teriflunomide???

59
Q

Which ones are ok in breastfeeding?

A

IFN

60
Q

Which drug has a high risk of relapse and rebound if stopped?

A

Natalizumab

61
Q

What maps are good in breastfeed and pregnancy?

A

ocreluzumab and ofatumumab

62
Q

What vaccines are a uno go for MS?

A

live
wait for 4-6 weeks AFTER relapse

pharmacy 358 (15 decks)

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