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PHAR 358 - Therapeutics (Dr. K. Halpape) > MS Lectures > Flashcards

MS Lectures Flashcards

1
Q

Between what ages are most MS patients diagnosed?

A

20 - 40yrs

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2
Q

Women are affected by MS at higher frequencies (3:1) than males; which gender typically has a more severe disease course?

A

Males

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3
Q

What is the underlying pathophysiology of MS?

A

Immune trigger causes inflammation, leading to demyelination & axonal degeneration within the CNS.

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4
Q

Sx of MS?

A

-Numbness / Tingling
-Vision Problems
-Fatigue
-Brain Fog
-Trouble Walking
-Bladder / Bowel Issues
-Pains / Weakness
-Muscle Spasms

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5
Q

What is “Lhermitte’s Sign”?

A

Chin tilted downwards & shooting pains running down the spinal column.

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6
Q

Describe “Uhtohoff’s Phenomenon”.

A

Heat intolerance that worsens typical symptoms; heat avoidant behaviors also commonplace.

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7
Q

What is the “MS Hug”?

A

Numbness & tightness around the midsection.

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8
Q

Four types of MS?

A

1) Relapse-Remitting (85%)

2) Secondary Progressive (most with RR go on to develop this; 10-15yrs common timeframe of development)

3) Primary Progressive (10-15%; more commonly seen with men)

4) Clinically Isolated Syndrome (CIS)

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9
Q

T or F: Inflammation is typically lower in more advanced MS presentations.

A

True… High during relapses / remission episodes, then lower as disease worsens.

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10
Q

Why are drug studies related to MS medications limited in terms of applicability?

A

Only look at patients with EDSS scores < 6… More severe MS presentations lack data on effectiveness!

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11
Q

What defines a true MS relapse?

A

-Lasts >/= 24hrs.
-No fever / infection.
-Must be >/= 30d since previous episode.

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12
Q

What is the treatment for an MS relapse?

A

1) Methylprednisolone 500-1000mg IV x 3-5d

OR

2) Prednisone 1250mg po x 3-5d

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13
Q

If a relapsing MS patient is non-responsive to high dose corticosteroids, what can be done?

A

Plasma Exchange

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14
Q

Amantadine, Modafinil & Methylphenidate can all be used to treat MS-related fatigue; describe their side effect profiles.

A

Amantadine: Insomnia & sleep disturbances.

Modafinil: Headache, insomnia, SJS, fetal abnormalities.

Methylphenidate: Insomnia, anxiety, dizziness.

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15
Q

Name of the shitty drug that can be used (on occasion) for MS-related Gait?

A

Fampridine

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16
Q

Drugs for treating MS-related muscle spasms?

A

Baclofen
Gabapentin
Botox

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17
Q

How often is Botox dosed for treating MS spasticity?

A

q3-6mths

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18
Q

Sativex (1:1 THC to CBD) is a cannabinoid drug used to treat spasticity & pains related to MS; what dosage form does it come in?

A

Buccal Spray

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19
Q

Potential ADRs of Sativex?

A

-Fatigue
-LT Cognitive Effects
-Increased HR
-Dizzy
-Blurry Vision
-Falls

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20
Q

What was the very first DMT drug that came to market for treating MS?

A

Betaseron (IFN beta-1b)

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21
Q

Which DMT drug is the only commercially available option with an official indication for treating Primary Progressive MS?

A

Ocrevus (Ocrelizumab)

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22
Q

Which DMT drug is the only commercially available option with an official indication for treating Secondary Progressive MS?

A

Mayzent (Siponimod)

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23
Q

What is the newest DMT drug available for treating MS?

A

Ponvory (Ponesimod)

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24
Q

List all the injectable DMT drugs for treating MS.

A

“PIIGO”

P - Peginterferon beta-1a
I - Interferon beta-1a
I - Interferon beta-1b
G - Glatiramer Acetate
O - Ofatumumab

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25
Q

List all the oral DMT drugs for treating MS.

A

“DTF COPS”

D - Dimethyl Fumarate
T - Teriflunomide
F - Fingolimod
C - Cladribine
O - Ozanimod
P - Ponesimod
S - Siponimod

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26
Q

List all the infused DMT drugs for treating MS.

A

“ARON”

A - Alemtuzumab
R - Rituximab
O - Ocrelizumab
N - Natalizumab

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27
Q

Of all the MS drugs, which are considered to be the weakest agents?

A

Interferon beta-1a
Interferon beta-1b
Glatiramer Acetate

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28
Q

Which of the MS drugs are considered to be the strongest agents (due to suppression of both B + T Cells) & thus pose the greatest worry in cases of infection?

A

Alemtuzumab
Cladribine

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29
Q

Due to its unique MOA (preventing lymphocytes from crossing into CNS), which MS drug would be problematic in cases of meningitis?

A

Natalizumab

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30
Q

Which three MS drugs work by inhibiting CD20 lymphocytes?

A

Ocrelizumab
Ofatumumab
Rituximab

31
Q

Which MS drug works by decreasing CD40 B + T Cell activation?

A

Dimethyl Fumarate

32
Q

Describe what “Progressive Multifocal Leukoencephalopathy” (PML) is.

A

Condition whereby opportunistic JC virus infections lead to destruction of the cells that produce myelin.

33
Q

Is there a cure for PML?

A

Nope (& oftentimes fatal, making it very dangerous)… Only hope is plasma exchanges & stoppage of afflicting medication (pray that immune system jumpstarts itself).

34
Q

What four MS drugs can cause PML?

A

“FOND”

F - Fingolimod
O - Ocrelizumab
N - Natalizumab
D - Dimethyl Fumarate

35
Q

How often is Betaseron (Interferon beta-1b) injected? What delivery system does it come in?

A

EOD; SC injection

36
Q

How often is Avonex (Interferon beta-1a) injected? Rebif (Interferon beta-1a)? Describe each’s delivery system too…

A

Avonex: IM qwkly
Rebif: SC 3x / week

37
Q

How often is Plegridy (Peginterferon beta-1a) injected? What is its delivery system?

A

SC q2wks

38
Q

All three interferon type injectables have the same adverse effects; what are they?

A

Injection Site Rxn
Flu-Like Sx
Liver Toxicity
Lymphopenia

39
Q

Describe Copaxone 20, Copaxone 40, & Glatect’s (Glatiramer Acetate) dosing frequency, as well as their delivery systems.

A

Copaxone 20: SC QD
Copaxone 40: SC 3x / wk
Glatect: SC QD

40
Q

Prominent ADR that should be monitored for with Glatiramer Acetate drugs?

A

Lipoatrophy

41
Q

Describe Kesimpta’s (Ofatumumab) injection frequency, as well as its delivery system.

A

Week 1-3: SC qwkly
Thereafter: SC q4wks

42
Q

How often is Aubagio (Teriflunomide) dosed? Tecfidera (Dimethyl Fumarate)?

A

Teriflunomide: QD
Dimethyl Fumarate: BID

43
Q

Due to its dual-gender teratogenicity potential, how long should we tell Teriflunomide patients to use contraception?

A

2yrs post-drug usage

44
Q

Important Dimethyl Fumarate ADRs / monitoring parameters?

A

Facial Flushing
Lymphopenias (CBCs)

45
Q

How frequently is Gilenya (Fingolimod) dosed? Unique advantage of this drug?

A

QD; has a pediatric indication!

46
Q

Important ADRs to monitor for with Fingolimod usage?

A

Slowed HR
Prolonged QTc

47
Q

Given the cardiac side effects of Fingolimod, how long post-first dose do we need to conduct a cardiac observation?

A

6hrs post-first dose

48
Q

T or F: All oral DMT drugs are teratogenic in nature & thus require baseline pregnancy tests.

A

False… Tecfidera (Dimethyl Fumarate) is not highlighted as teratogenic.

49
Q

How frequently is Mayzent (Siponimod) dosed? What unique official indication does this drug have over others?

A

QD; Secondary Progressive MS.

50
Q

Most oral agents have a 2-3mth washout period… How long is Siponimod’s?

A

10d

51
Q

Due to its dual-gender teratogenicity potential, how long should we tell Mavenclad (Cladribine) patients to use contraception post-drug stoppage?

A

6mths post-last dose

52
Q

Describe Cladribine’s weird dosing regimen.

A

Mth 1: 4-5d of 1 or 2 pills (depending upon weight)

Mth 2: 4-5d of 1 or 2 pills (depending upon weight)

Mths 3-12: No doses given (for a total of 8-10 doses over a year).

53
Q

How often are Zeposia (Ozanimod) & Ponvory (Ponesimod) dosed?

A

QD

54
Q

How often is Tysabri (Natalizumab) dosed? Ocrevus (Ocrelizumab)?

A

Natalizumab: q4wks

Ocrelizumab: Stat, wk 2, then q24wks thereafter

55
Q

Important Natalizumab monitoring tests?

A

JCV status q6-12mths
Brain MRI q6-12mths

56
Q

Ocrevus (Ocrelizumab) is commonly associated with infusion rxn’s… How many mins prior to infusions should we infuse with IV steroids & anti-histamines?

A

30-60mins

57
Q

What would be an automatic contraindication to using Ocrelizumab?

A

Hep B infection (because drug can reactivate).

58
Q

Ocrevus (Ocrelizumab) has a unique official indication compared to other DMTs… What is it?

A

Primary Progressive MS

59
Q

A woman on Ocrevus (Ocrelizumab) is wanting to become pregnant & is preparing to stop her medication… How long should she wait post-last infusion to try becoming pregnant?

A

6-12mths

60
Q

Lemtrada (Alemtuzumab) is associated with infusion rxn’s… Up to how many hours post-dosing can this appear?

A

2hrs post-dose

61
Q

Alemtuzumab use is also associated with increased risk of developing autoimmune disorders (e.g. Thyroid, Skin, Nephropathies)… How long from the last dose given should we monitor these for?

A

4yrs

62
Q

How many treatment courses of Alemtuzumab will the SK government cover?

A

Two; third treatment (if needed) is not covered.

63
Q

What labs should a patient on Alemtuzumab be ordered for four years after the last dose given?

A

CBCs qmthly

Urinalysis + Cell Ct qmthly

TSH q3mths

Annual skin exams

Annual HPV / Cervical Dysplasia screens

64
Q

What other MS drug (besides Fingolimod) has an official indication for use in pediatric patients?

A

Rituximab

65
Q

What other two conditions (besides off-label use in MS) is Rituximab indicated for?

A

Non-Hodkin’s Lymphoma

Rheumatoid Arthritis

66
Q

Rituximab is dosed stat & at 2wks, then q___mths thereafter.

A

6

67
Q

Does an MS diagnosis affect a woman’s fertility potential? Does pregnancy worsen potential long-term disability?

A

Nope; nope.

68
Q

Is it safe to give pregnant women IV Methylprednisolone in cases of symptomatic relapse?

A

Yep!

69
Q

Although washout periods for many DMT drugs are necessary prior to becoming pregnant, will they make oral contraceptives less effective?

A

Nope (do not interact with one another).

70
Q

Safest agents for use in pregnancy / breastfeeding?

A

Glatimer Acetate (Copaxone)

Interferon beta-1a & 1b preps (Betaseron, Avonex, Rebif, Plegridy)

Anti-CD20 MABs (Ocrelizumab, Ofatumumab, Rituximab; 2023 evidence goes against what was said in 2019)

71
Q

An MS patient wants to update their influenza & Covid vaccines… How long from the onset of their last relapse should we wait before administering?

A

4-6wks from onset of last relapse

72
Q

Can pharmacists in SK initiate EDS applications for MS patients?

A

Nope; has to be initiated by a physician, with cases reviewed by a panel of individuals.

73
Q

What subtype of MS did Jess mention having?

A

Relapse-Remitting

74
Q

What was the first symptom Jess described having?

A

Double vision driving to work

PHAR 358 - Therapeutics (Dr. K. Halpape) (7 decks)

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