MS Drugs Flashcards
interferons act where
periphery and BBB
interferon MOA
inhibit T cells, dendritic cells
inhibit BBB penetration by decreasing MMP
efficacy reduced by neutralizing antibodies
glatiramer acetate acts where
periphery
glatiramer acetate MOA
decreased T cell activation through dendritic cell modulation
fingolomod acts where
periphery and CNS
fingolomod MOA
S1P receptor agonist
stimulates oligodendrocyte survival / remyelination in CNS
blocks movement of T cells out of lymph nodes
what is PML
progressive multifocal leukoencephalopathy
potentially lethal brain infection
drugs with increased risk of PML
fingolomod
natalizumab
fumarates
natalizumab acts where
periphery and BBB
natalizumab MOA
MAB specific for alpha 4 integrin
inhibits VLA-4 binding and interferes with B and T cell movement into CNS
- effects could be limited by neutralizing antibodies
mitoxantrone acts where
periphery
mitoxantron MOA
cytotoxic effect
reduces the number of lymphocytes
teriflunomide acts where
periphery
teriflunomide MOA
cytotoxic effect
inhibits proliferation of lymphocytes (B and T cells)
dimethyl fumarate
diroximel fumarate
monomethyl fumarate
act where
periphery and CNS
fumarates MOA
metabolized by esterases
suppress activated T cells
promote remyelination
activate Nrf2 mediated antioxidant response and antiinflammatory pathways
siponimod, ozanimod, ponesimod location
periphery and CNS
siponimod, ozanimod, ponesimod MOA
S1P agonists
oligodendrocyte survival, remyelination
interfere with lymphocyte movement out of lymphoid organs
cladribine location
periphery
cladribine MOA
cytotoxic effect , results in lymphocyte depletion
rituximab (Ocrelizumab) location
periphery
rituximab MOA
targets CD20, a B cell marker
- limited by neutralizing antibodies
rituximab (Ocrelizumab) treats
decreased relapse rate in RRMS and PPMS some effectiveness in decreased disease progression
ATL1102 is an _____targeting ____
antisense oligonucleotide targeting VLA4
(same outcome natalizumab)
ATL1102 acts at
blood brain barrier
drugs that effectiveness could be limited by neutralizing antibodies
interferon B, natalizumab, rituximab (ocrelizumab)
drugs acting via cytotoxic
mitoxantrone
teriflunomide
cladribine
drugs acting at BBB
interferon
natalizumab
ATL1102
drugs acting in periphery and CNS
fingolamide, other mods
fumarates
treatment of acute attacks inpatient
methylprednisolone 500-1000 mg IV for 3-7 days +/- oral taper over 1-3 weeks
treatment of acute attacks outpatient
prednisone 1250 mg PO every other day x 5 doses with no taper
oral meds
fumarates, fingolomods, teriflunomide
injectible meds
interferons, glatiramer acetate
infusion meds
almetuzumab, natalizumab, ocrelizumab
patients must be tested for what to check for risk of PML?
JCV antibodies
which kind of vaccines are preferred in MS
inactivated
which drug can you not take with live vaccine
almetuzumab
____ vaccine should be considered in pts who have never had
varicella, chicken pox
fumarates pearls and monitoring
do not open capsule
monitor LFTs
PML risk
flushing, take with ASA 30 mins before
SP1 agonist are contraindicated in what
pts with arrythmia hx or heart condition
discontinuation of what agent can worsen sx
SP1 agonists , mods
which drug to avoid with MAO inhibitor
ozanimod
which drug requires CYP2C9 testing?
siponimod
glatiramer acetate pearls
rotate injection site - lipoatrophy
flu like symptoms or chest pain
maybe good for pregnancy
interferons dosing
subq or IM every other day to every 2 weeks
interferons side effects
flu like symptpms - take acetaminophen or NSAID before
depression / suicide
interferons monitoring
LFT and TSH
which drug contraindicated in HIV
almetuzumab
which drug contrainidcated in Hep B
ocrelizumab
drug approved for PPMS
ocrelizumab
which drug contraindicated in pregnancy
teriflunomide
what to give if pregnant on teriflunomide
charcoal for 11 days or cholestryamine
drugs with pregnancy concerns
mitroxantrone, cladribine, SP1s, ocrelizumabw
which drug can improve walking speed
dalfampridine
IR dosing of dalfampridine can cause what
seizures
