Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacotherapy III > MS - Ott > Flashcards

MS - Ott Flashcards

1
Q

What are the criteria for diagnosing MS?

A

Dissemination in time – 2 new lesion of 30 days, evidence that damage has happened more than once
Dissemination in space – >1 lesion in at least 2/4 typical regions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is NMOSD?

A

Disease similar to MS - more common in AA, Asian, Latin American, children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is CIS?

A

First demyelinating event involving optic nerve, cerebrum, cerebellum, or spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percentage of patients progress to SPMS?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who si more likely to have PPMS?

A

Patients diagnosed later in life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the least common MS?

A

Progressive Relapsing MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is PRMS?

A

Steadily worsening disease from onset with clear relapses, but no remission between relapses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What scale is used to assess MS treatment efficacy?

A

EDSS - expanded disability status scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How long does it take to progress to SPMS from RRMS?

A

20-25 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to treat acute attacks? Inpatient

A

Methylprednisolone 500-1000 mg IV daily for 3 to 7 days with taper over 1-3 weeks (oral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to treat acute attacks? outpatient

A

Prednisone 1250 mg every other day x 5 doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to treat acute attacks? w/ optic neuritis

A

IV methylprednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F: Most MS drugs have a noticable effect in patient

A

FALSE: Most drug effects cannot be seen by patient in short-term; counsel on importance of long-term benefits!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

First-line RRMS treatment?

A

InterferonB1a, InterferonB1b, Glatiramer acetate, fingolimod

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

First/second line RRMS treatment?

A

Teriflunomide

Dimethyl fumurate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Second line RRMS treatment?

A

natalizumab

mitoxantrone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment-resistant MS option?

A

alemtuzumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PPMS treatment?

A

Ocrelizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What types of MS is ocrelizumab used to treat?

A

PPMS and RRMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Ocrelizumab is contraindicated with ___

A

Active hepatitis B infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ocrelizumab has an increased risk of ___

A

malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What drug class can cause flu-like symptoms?

A

iNterferons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What patient population is most likely to experience flue-like symptoms as an ADE?

A

Females with low BMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can you reduce flu like symptoms?

A

Give at night to sleep through symptoms; take OTC pain reliever 4-6 hours before injection; titrate dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Injection site reactions occur with what medications?
Interferons, glatiramer
26
Lipatrophy occurs with what drug?
Glatiramer
27
How do you reduce injection site reactions?
Warm compresses or ice before injection; warm med to room temperature; ensure needle completely penetrates skin
28
What are post-injection reactions?
Facial flushing, chest tightness, dyspnea, palpitations, anxiety
29
How do you treat post-injection reactions?
you don't
30
Which medication has a life-threatening infusion reaction? What do you do about it?
alemtuzumab | Monitor pt for 2 hours post-infusion
31
What medications have infusion reactions?
alemtuzumab | ocrelizumab
32
How can you decrease ocrelizumab's infusion reaction?
Premedicate with corticosteroid/antihistamine/antipyretic
33
What is PML?
Reactivation of JCV that causes neurobehavioral, motor, language, and cognitive changes, seizures, tremor - can look like MS relapse
34
What drugs cause PML?
Natalizumab (black box warning) Fingolimod Dimethyl fumarate
35
How can you avoid PML?
Test for JCV antibodies before injection
36
What are contraindications to natalizumab?
Viral hepatitis Malignancy Inability to have MRI immunocompromised
37
Alemtuzumab has what side effects?
thrombocytopenia, basement membrane disease, increased risk of malignancies
38
Alemtuzumab is contraindicated with what?
HIV infection
39
You should avoid dosing alemtuzumab when?
In patient with active infection - until infection is fully controlled
40
Ocrelizumab has what warning?
Increased malignancy
41
Why is alemtuzumab not first line?
It has LOTS of ADEs - only use if other MS drugs fail
42
Daclizumab is contraindicated with what/
Hepatitis or hepatic impairment
43
What medications need to avoid live vaccination?
Alemtuzumab, daclizumab, fingolimod, ocrelizumab, teriflunomide
44
Before initiating daclizumab, evaluate for ___
TB
45
What drugs are associated with cardiac adverse effects?
Fingolimod | Mitoxantrone
46
Fingolimod can cause _____. How do you monitor?
reduction in HR, heart block In clinic for 6 hours after initial dose w/BP monitoring If CV risk factors - keep for 24-hour EKG
47
Who should not receive fingolimod b/c of heart effects?
Patients with sinus bradycardia or heart block and no pacemaker
48
What does mitoxantrone cause (cardiotoxicity)?
reduced LVEF, CHF; monitor EF
49
What is pseudobulbar affect?
Inappropriate responses to situation
50
What is used to treat pseudobulbar affect?
Neudextra
51
What is in Neudextra?
DM | Quinidine
52
How does Neudextra work?
Dextromethorpahan agonist suppresses release of excitatory NTs and agonizes sigma-1 receptors DM is metabolized to dextrorphan by P450 Quinidine inhibits P450 --> more DM
53
How do you treat gait abnormalities?
PT | Dalfampridine
54
Dalfampridine MOA?
Blocks K channels --> prolonged AP
55
Side effects of dalfampridine? ER
``` UTI Insomnia HA Dizziness Nausea ```
56
Side effects of dalfampridine? IR
Seizures
57
Which drugs are category X?
Teriflunomide - avoid for 2 years after stopping drug
58
Which drugs are category D?
Mitoxantrone - pregnancy test before each infusion
59
Which drugs are category B?
Glatiramer
60
Which drugs are category C?
All others
61
If I'm taking fingolimod and want to get pregnant, what do I do?
D/C fingolimod for 2 months before pregnancy (long half life)
62
Can I keep taking MS therapy while pregnant?
No - D/C before conception
63
What is considered treatment failure?
1. No decrase in relapse rates 2. Acquired disabilities (EDSS score changed by 1 point in one year) 3. MRI activity (new lesions)
64
What can medical marijuana be used for w/MS?
Spasticity (OCE/THC) | Central pain/painful spasms (OCE/THC)
65
How do you treat bladder dysfunction w/MS? What is the downside?
anticholinergics (oxybutynin, tolteridone) | May worsen cognitive dysfunction
66
What is the most common side effects with MS?
Bladder dysfunction
67
How do you treat bowel dysfunction (constipation) with MS?
Bulk-forming agents (methylcellulose, psyllium), stool-softeners Adequate fluid/fiber in diet
68
How do you treat cognitive dysfunction?
NOT memantine or cholinesterase inhibitors | DMDs may slow decline
69
How to treat pseudobulbar affect?
DM/quinidine
70
What percentage of patients develops pseudobulbar affect?
10%
71
What symptom do 50-60% of patients report as the WORST of their disease?
Fatigue!
72
How do you treat fatigue?
Rule out drug effects/side effects, other problems (depression, sleep, metabolic disorders) Amantadine
73
How do you treat gait impairment?
Dalfampridine (improves walking speed by 35%)
74
How do you treat neurogenic pain?
Anticonvulsants (gabapentin, pregabalin, lamotrigine, levetiracetam, carbamazepine, ocxarbazepine) Duloxetine TCAs Oral cannabis extract
75
What can worsen spasticity?
``` Sudden movement Change in position Extreme temperature Humidity Infections Tight clothing ```
76
Where does spasticity occur?
Legs
77
How to treat spasticity?
Regular stretching/exercise Baclofen, tizanidine, diazepam, clonazepam, dantrolene Oral cannabis extract Tetrahydrocannabinol (THC) - for painful spasms
78
What percentage of patients have sexual dysfunction?
60-70%
79
Avonex dose (B1a)
30 mcg IM once weekly
80
Rebif dose (B1a)
22 or 44 mcg SC three times weekly
81
Betaseron/Extavia dose (B1b)
250 mcg sc every other day
82
Peginterferon dose
Titration to 125 mcg SC every 14 days
83
Glatiramer acetate dose
20 mg sc qd
84
fingolimod dose
0.5 mg po daily
85
Teriflunomide dose
7 mg or 14 mg orally once daily
86
Dimethyl fumarate dose
240 mg DR BID
87
Natalizumab dose
300 mg IV every 4 weeks
88
Mitoxantrone dose
12 mg/m2 IV every 3 months
89
Alemtuzumab dose
IV over 4 hours 1st course: 12 mg/day x 5 2nd: 12 mg/day x 3 days (12 months after 1st)
90
What meds are given with alemtuzumab?
Corticosteroid (prior to infusion x 3 days) | Antiviral agent on 1st day of dosing x 2 months OR until CD4 >200 cells/mL
91
Daclizumab dose
150 mg SC once monthly
92
Ocrelizumab
600 mg in 500 mL IV over at least 3.5 hours every 6 months
93
What meds are given with ocrelizumab?
Methylprednisolone 100 mg + Antihistamine 30-60 minutes before first infusion
94
Side effects of interferons?
``` Depression Flu like symptoms Injection site reactions psychosis Hepatotoxicity Worsening CHF thryoid dysfunction Seizures Thrombotic microangiopathy ```
95
Side effects of glatiramer acetate?
``` Infection Hypersensitivity Chest tightness Flushing Urticaria Rash ```
96
Which medication is monotherapy only?
Natalizumab
97
Lifetime dose of mitoxantrone should not exceed what?
140 mg/m2
98
When is fingolimod contraindicated?
Stroke/heart attack 2nd or 3rd degree AV block QT interval prolongation decompensated CHF

Pharmacotherapy III (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions