MS Theraputics Flashcards
0
Q
Interferon B- 1a,1b: MOA, admin, efficacy, SE (common and rare for monitoring)
A
- MOA: unknown
- 1a: IM 1x/ week 1b: SQ 3x/week (check)
- efficacy: relapse rate and potentially disease progression
- SE: flulike symptoms,
~ uncommon: thyroid dysfunction (monitor TSH)
~ rare: hepatotoxicity/heme tox (monitor alt/ast and CBC)
1
Q
Acute MS treatment
A
- High-dose methylprednisalone; 500-1000 mg/d x 3 days
- IV or Oral: oral less well tolerated
- shortens attack, doesn’t interfere with progression of disease
- SE: sleep disturbances, BG elevation, GI upset,
2
Q
Glatiramer acetate: MOA, admin, efficacy, SE
A
- synthetic AA pp
- MOA: unknown
- QD subQ
- efficacy: decrease relapse and lesions; may decrease disease progression
- SE: mild injections site reaction; possible systemic rxn
3
Q
Natalizumab: MOA, admin, efficacy, SE
A
- MAb to a4 integrin (blocks interaction with endo vcams)
- MOA: inhibits lymphocyte diapedesis into CNS
- IV q 4 weeks
- efficacy: more decrease in lesions/relapse AND slow disease progression.
- SE: PML, infection
4
Q
Fingolimod: MOA, admin*, efficacy, SE (lots)
A
- MOA: sphingosine 1 receptor agonist -> inhibits lymphocyte homing
- ORAL admin
- efficacy: decrease in relapse (more than IFN) and lesions/ disease progression
- SE: bradyarrythmia, PML, macular edema, dyspnea, LFT elevation
5
Q
Mitoxantrone: MOA, admin, efficacy, SE
A
- MOA: similar to anthracyclines (DNA intercalation -> linkage breakage)
- IV q 3 mo
- efficacy: decrease relapse in RRMS and slow progression in SPMS
- SE: cardiotoxicity, secondary leukemias, infection, nausea, alopecia, amenorrhea
6
Q
Teriflunomide: MOA, admin, efficacy, SE
A
- active compound of leflunomide: MOA - antimetabolite that inhibits lymphocyte proliferation
- oral admin
- efficacy decrease relapse rate
- SE: acute renal failure, hepatotoxicity, peripheral neuropathy, infections
7
Q
Dimethyl Fumarate: MOA, efficacy, SE
A
- MOA: unknown
- protective against oxidative stress
- efficacy: reduce relapse by 50% (similar to fingolimod; slightly better than teriflunomide)
- SE: flushing, decreasing GI upset, lymphopenia (normalizing)
8
Q
MS trt escalation
A
- natalizumab, fingolimod and Mitoxantrone reserved for failure of initial trt.
9
Q
NM
A
NM = IV
- n: IV Q 3 weeks
- m: IV Q 4 mo
10
Q
PML risk
A
Natalizumab
Fingolimod
11
Q
Plaque formation
A
- Formation begins with lymphocytic infiltration via blood vessels, Thick bands of perivascular lymphocytes accumulate
- Large numbers of lipid laden macrophages and B cells accumulate in active plaques + for lipid in cells
12
Q
Oligocclonal Ab bands in CSF
A
- indicative of MS
