MS

Question 1

What are the 2 IFN-beta-1a meds used for RRMS and which one is used as the 1st line treatment?

Answer 1

Avonex

Rebif–1st line treatment –trails showed its more efficacious

Question 2

What are the 2 IFN-beta-1b meds used for RRMS

Answer 2

Betaseron and Extavia

Have no effect on disease progression

Question 3

What is the mechanism of action of the IFN-beta drugs used for RRMS?

Answer 3

Inhibit T cell activation
shift from Th1--> Th2
Inhibit lymphocyte movement into CNS
Anti-proliferative effect
Apoptosis of T-cells 
Anti-viral
IFN-g antagonism

Question 4

Myeline basic protein analog used for RRMS

Answer 4

Glatiramer acetate

Question 5

What is the mechanism of action of glatiramer acetate?

Answer 5

T-cell apoptosis

Th1–> Th2 switch

Question 6

Where is glatiramer acetate active

Answer 6

CNS

Question 7

What are the major complications with the use of glatiramer acetate?

Answer 7

Injection site reaction

Anxiety attack-like reaction

Question 8

Monoclonal antibody used for RRMS–and is 2nd line therapy due to adverse side effects

Answer 8

Natalizumab

Question 9

What is the mechanism of action of natalizumab

Answer 9

Binds VLA4–integrin subunit—> inhibiting leukocyte migration across BBB

Question 10

What are the side effects of natalizumab?

Answer 10

PML–caused by JC virus
Acute urticaria
Systemic hypersensitivity infusion reaction

Question 11

Sphingosine-1-phosphate analog used for the treatment of RRMS

Answer 11

Fingolimod

Question 12

What is the mechanism of action of fingolimod

Answer 12

Prodrug–sequesters circulating lymphocytes in secondary lymphoid organs via induction of intracellular internalization of receptors on lymphocytes

Question 13

What are the side effects of fingolimod?

Answer 13

Bradycardia and heart block

Macular edema

Question 14

What must be checked before putting a patient on fingolimod?

Answer 14

VZV immunity

Question 15

Immunosuppressant used for the treatment of RRMS that is a selective dihydro-orotate dehydrogenase inhibitor that blocks de novo pyrimidine synthesis

Answer 15

Teriflunomide

Question 16

Teriflunomide blocks de novo pyrimidine synthesis, what does this cause?

Answer 16

Reduction in T- and B- cell proliferation and functions against autoantigenes

Question 17

What are the side effects seen with teriflunomide

Answer 17

Hepatotoxicity

Teratogenicity

Question 18

MS treatment through enhancement of NRF2 pathway and cause of Th1–> Th2 shift

Answer 18

Dimethyl fumarate

Question 19

What are the side effects seen with dimethyl fumarate

Answer 19

N/V
Diarrhea
Stomach pain
Flushing—itching, redness, rash

Question 20

Broad immune suppression and modulation of B-cells, T-cells and macrophages used for SPMS and 2nd line for RRMS

Answer 20

Mitoxantrone–decreases frequency of clinical relapse, reduces disease progression, and reduces disability

Question 21

What are the side effects seen with mitoxantrone?

Answer 21

Dose-dependent cardiac toxicity
Induction of acute leukemia

N/V
Alopecia
Menstrual irregularities

Question 22

Name the 4 immunosuppresants used for the treatment of SPMS

Answer 22

Azathioprine
Methotrexate
Cyclophosphamide
Mycophenolate mofetil

Question 23

Corticosteroid used for acute MS attacks and SPMS—shortens acute attack duration and speeds recovery

Answer 23

Methylprednisone

Question 24

Used for acute MS attacks if pt allergic to corticosteroids or have poor IV access or if methylprednisone doesn’t work

Answer 24

ACTH

Question 25

Used for acute MS attacks when pts are not responsive to methylprednisone

Answer 25

Plasmapharesis