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Pharmacology Exam #3 > MS > Flashcards

MS Flashcards

1
Q

What T helper cell is pro-inflammatory?

A

Th1 and 17

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2
Q

What T helper cell is anti-inflammatory?

A

Th2

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3
Q

Define MS

A

immunologic disorder marked by chronic inflammation of the CNS

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4
Q

What is the key to the diagnosis of MS?

A

Dissemination of plaques in time and space

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5
Q

What are the three broad treatment categories for MS?

A
  1. Treatment of exacerbations-corticosteroids (anti-inflammatories)
  2. Disease-modifying therapies
  3. Symptomatic therapies for spasticity, bladder sx’s, sensory sx’s and fatigue
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6
Q

How are first line disease-modifying therapies (DMTs) administered?

A

Self-injected

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7
Q

Effects of DMTs

A
  1. Decrease annual relapse rate

2. Decrease formation of new white matter lesion

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8
Q

List the DMT agents

A
  1. Interferon (IFN) formulations

2. Glatiramer acetate (non-IFN)

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9
Q

List the 1st generation agents used for relapsing MS

A
  1. Interferon-B1a (Avonex, Rebif)

2. Interferon-B1b

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10
Q

List the 1st generation agents that are a Pregnancy Category C

A
  1. Interferon-B1b

2. Pegylated Interferon-B1a

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11
Q

List the 1st generation agents used for RRMS

A
  1. Pegylated Interferon-B1a

2. Glatiramer acetate

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12
Q

List the 1st generation agent that is administered as an IV infusion

A

Mitoxantrone

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13
Q

Mitoxantrone indications

A
  1. SPMS
  2. PRMS
  3. Worsening RRMS
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14
Q

List the 1st generation agent that are a Pregnancy Category B

A

Glatiramer acetate

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15
Q

List the 1st generation agents that are a Pregnancy Category D

A

Mitoxantrone

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16
Q

Interferon-B1a ADEs

A
  1. Depression

2. Flu like sx’s

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17
Q

Interferon-B1b ADEs

A

Depression

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18
Q

Glatiramer acetate ADEs

A
  1. Chest tightness

2. Urticaria- @ any dose!

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19
Q

Mitoxantrone ADEs

A
  1. Cardiotoxicity

2. AML

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20
Q

Natalizumab SEs

A

PML

21
Q

Natalizumab monitoring

A

JVC antibody

22
Q

Fingolimod ADEs

A
  1. Macular retinal edema

2. AV block

23
Q

Teriflunomide ADEs

A
  1. Steven-Johnson Syndrome
  2. Liver failure
  3. TB activation
  4. Neutropenia
  5. Alopecia
24
Q

Dimethyl fumarate ADEs

A
  1. Flushing-Take with food
  2. Rash/Pruritis
  3. Increased LFTs
  4. Albumineria
  5. GI discomfort
25
Q

Alemtuzumab ADEs

A

Herpes Viral Infection

  • Administer herpes viral prophylaxis starting on 1st day of Tx
  • Continue for 2 months after completion of treatment OR
  • until CD4 count @ 200
26
Q

List the disease modifying ORAL agents indicated for relapsing forms of MS

A
  1. Natalizumab
  2. Fingolimod
  3. Teriflunomide
  4. Dimethyl fumarate
27
Q

Alemtuzumab indications

A

RRMS

28
Q

Ocrelizumab indications

A

Relapsing or Progressive MS

29
Q

Define CIS

A

Clinically Isolated Syndrome

Frist episode of neurologic sx’s that lasts @ least 24 hrs

30
Q

what do we use to treat exacerbation sx’s?

A

Corticosteroids

31
Q

When should you initiate high dose corticosteroids (Methypredniolone, IV) with onset of sx’s? When do you start toe ee improvement of sx’s?

A

Within 2 weeks of sx onset

Improvement in 3-5 days

32
Q

Longer durations of IV methylprednisolone ADEs

A
  1. Acne
  2. Fungal infection
  3. Mood alteration
33
Q

Short term ADEs of methylprednisolone

A
  1. Metallic taste

2. Sleep disturbances

34
Q

Which medication carries a pregnancy category X rating?

A

Teriflunomide

35
Q

What labs would we monitor for adverse effects in Teriflunomide

A
  1. Pregnancy test
  2. LFTs
  3. CBC
  4. BP
  5. TB tst
36
Q

IFN Beta 1a MOA

A

Alters expression and response to surface antigens enchanting immune cell activities

37
Q

IFN Beta 1b MOA

A
  1. Balances the expression of pro and anti-inflammatory agents in the brain
  2. Reduces number of inflammatory cells that cross the BBB
38
Q

Glatiramer acetate MOA

A
  1. Mimics the antigenic properties of Myelin Basic Protein (MBP)
  2. Inhibits binding of MBP t oTe-cell receptors
  3. Reduces inflammation, demyelination, and axonal damage
  4. Neuroprotective effect
39
Q

Which medication has an indication for CIS and RRMS?

A

Glatiramer acetate

40
Q

Three of the interferons are considered to be high potency medications. Which medication is consider a low potency medication?

A

Interferon beta 1a- brande name Avonex

41
Q

If our patient was a female, which agent is a Category B Pregnancy?

A

Glatiramer acetate

42
Q

Our patient reports a PMH of depression. Which medications would be considered a possible contraindication?

A

Interferons beta 1a and beta 1b

43
Q

What is appropriate monitoring parameters for the interferon medications?

A
  1. Electrolytes
  2. CBC
  3. LFTs
  4. Thyroid function
  5. LVEF
  6. Depression
44
Q

List the drugs that are used in cases of inadequate response or intolerance to first-line agents

A
  1. Fingolimod
  2. Natalizumab
  3. Alemtuzumab
  4. Mitoxantrone
45
Q

what is the life time list of dose for mitoxantrone?

A

140 mg/m

46
Q

Mitoxantrone ADEs

A
  1. Cardiotoxicity
  2. AML (acute myeloid leukemia)
  3. Pregnancy D
47
Q

When is fingolimod contraindicated?

A

Patients receiving:

Class I and III antiarrythmic drugs

48
Q

When is Mitoxantrone indicated?

A
  1. SPMS
  2. PRMS
  3. Worsening RRMS
49
Q

What medication increases Fingolimod serum concentration? Why?

A

Ketoconazole

3A4 inhibition

Pharmacology Exam #3 (6 decks)

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