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Neurology Board Review > MS Drugs > Flashcards

MS Drugs Flashcards

1
Q

Dimethyl fumarate MOA

A

Reduces toxic oxidative stress through activation of the nuclear 1 factor (erythroid-derived 2)-like 2 (Nrf2) antioxidant response pathway

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2
Q

Side effects of dimethyl fumarate

A

Flushing (aspirin might help), leukopenia

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3
Q

Diroximel fumarate is approved for ____ MS.

A

Relapsing-remitting
Same MOA as dimethyl fumarate, less GI side effects

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4
Q

Fingolimod MOA

A

Sequesters lymphocytes in lymph nodes, thereby reducing the number of lymphocytes in peripheral circulation and the central nervous system
Downregulating sphingosine-1-phosphate receptors (S1PR)

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5
Q

What medications down regulate sphingosine-1-phosphate receptors (S1PR)?

A

Fingolimod, siponimod, ozanimod, and ponesimod

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6
Q

Side effects of fingolimod

A

First-dose bradycardia, atrioventricular block, and QT interval prolongation
Macular degeneration
Rebound of disease with abrupt sessation

due to activation of S1PRs on atrial myocytes

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7
Q

What medications should be avoided when using fingolimod?

A

Beta-blockers and calcium channel blockers

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8
Q

What are the fatal infections that can be seen with fingolimod use?

A

Cryptococcus meningitis, disseminated varicella-zoster, herpes simplex encephalitis, and PML

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9
Q

Side effects of siponimod

A

Macular edema
Bradycardia

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10
Q

What testing must be done before starting siponimod?

A

CYP2C9 genotyping and funduscopic testing

Certain CYP2C9 varients generally shouldn’t get this med

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11
Q

Teriflunomide MOA

A

Reduces T- and B-cell activation, proliferation, and function

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12
Q

How does teriflunomide inhibit pyrimidine synthesis for DNA replication?

A

Blocking dihydroorotate dehydrogenase

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13
Q

Teriflunomide side effects

A

Leukopenia, alopecia, GI symptoms
Hepatotoxicity

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14
Q

When should teriflunomide not be used and why?

A

Pregnancy, category X teratogenic

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15
Q

Cladribine MOA

A

Purine antimetabolite

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16
Q

Cladribine side effects

A

Leukopenia
Malignancy
Teratogenicity

17
Q

Ofatumumab MOA

A

Monoclonal antibody to CD20 B-cells

18
Q

What drug is proven to be more effective than teriflunomide in random drug trials?

A

Ofatumumab

19
Q

Ofatumumab side effects

A

Injection site irritation, upper respiratory tract infections, headache

20
Q

What must be done prior to starting ofatumumab?

A

Screening for hepatitis B and low immunoglobulins

21
Q

Mitoxantrone MOA

A

Type II topoisomerase inhibitor

22
Q

Mitoxantrone is approved for ___ MS.

A

Secondary progressive

23
Q

Mitoxantrone side effects

A

Dose-related cardiotoxicity
Alopecia, menstrual irregularity, amenorrhea, and leukopenia
Category D for pregnancy

24
Q

Alemtuzumab MOA

A

Monoclonal antibody targeting of the CD-52 receptor on activated T- and B-lymphocytes
Cytotoxic and complement meditated depletion

25
Q

Alemtuzumab side effects

A

Lymphopenia and autoimmune-related syndromes

Thyroid-40%, thrombocytopenia-1%,anti-glom basement membrane nephropathy

26
Q

Natalizumab MOA

A

Monoclonal antibody targeting of alpha 4-integrin which is expressed on activated T-lymphocytes

Blocks the transmigration of T-cells across the blood-brain barrier

27
Q

Most significant side effect of natalizumab

A

Progressive multifocal leukoencephalopathy

28
Q

What are the risks of developing natalizumab PML?

A

Positive anti-JC virus antibodies
Prior use of immunosuppressive therapy
More than 24 months of natalizumab therapy

29
Q

What can be used to accelerate drug clearance of natalizumab?

A

PLEX

30
Q

Ocrelizumab is approved for ____ MS.

A

Primary progressive

31
Q

Ocrelizumab MOA

A

Binds CD20 B-cells leading to cell-mediated cytotoxicity

32
Q

Side effect of ocrelizumab

A

Increased infection risk

33
Q

What is an alternative medication to DMARDs?

A

Dalfampridine

34
Q

Dalfampridine MOA

A

Inhibition of voltage-dependent potassium channels causes improved nerve conduction

35
Q

What patients should avoid dalfampridine?

A

End stage kidney disease and epilepsy

Neurology Board Review (16 decks)

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