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Multiple Sclerosis > MS treatment > Flashcards

MS treatment Flashcards

1
Q

Brand name of daclizumab

A

Zinbryra

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2
Q

Brand name of Glatiramer Acetate

A

Copaxone

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3
Q

Brand name of Inf b-1a

A

Avenox and Rebif

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4
Q

Brand name of Inf b-1b

A

Betaseron and Extavia

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5
Q

Brand name of pegylated Inf b-1a

A

Plegridy

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6
Q

Brand name of Dimethyl fumarate

A

Tecfidera

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7
Q

Brand name of Fingolimod

A

Gilenya

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8
Q

Brand name of Teriflunomide

A

Aubagio

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9
Q

Brand name of Alemtuzumab

A

Lemtrada

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10
Q

Brand name of Mitoxantrone

A

Novantrone

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11
Q

Brand name of Natalixumab?

A

Tysabri

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12
Q

Brand name of Ocrelizumab

A

Ocrevus

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13
Q

What are Tier 1 medications?

A

Interferon beta 1-b, interferion beta-1a, pegylated Inf b-1a, and Copaxone

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14
Q

Indications for Tier 1 medications?

A

typically considered 1st line therapy for new diagnosis of MS. If patient has severe disease burden, contraindications to the injectables, severe recurrent relapses in a short period, then can start with Tier 2

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15
Q

Mechanism of action of daclizumab/Zinbrya?

A

modulation of IL-2 mediated activation of lymphocytes

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16
Q

Common Adverse effects of Zinbrya?

A

URI, pharyngitis, increased ALT, UTI

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17
Q

Labs to follow for Zinbrya and how often?

A

get baseline ALT/AST/Tbili and check Q mo up to 6 mo after last dose

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18
Q

Mechanism of action of the Inf b-1b and 1a?

A

anti-inflam: down regulates cytokines, MHC Ags, decrease transmigration of T lymphocytes across the BBB

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19
Q

Side effects of Inf b-1b and 1a?

A

flu-like sx, leukopenia, elevated liver enzymes, thyroid dysfunction, injection site reaction, depression

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20
Q

Labs to follow for Inf b-1b and 1a?

A

CBC, LFT q 3 mos during frst yr and then q6mos thereafter; TSH q3-6 mos during 1st year and yearly thereafter, monitor mood changes, site rotation

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21
Q

Mechanism of action of Demethyl fumarate/Tecfidera?

A

unknown; activates Nrf2 pathway (involved in cellular response to oxidative stress)

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22
Q

Common side effects of Tecfidera?

A

flushing, abdominal pain, nausea, diarrhea

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23
Q

Warnings of Tecfidera?

A

lymphopenia

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24
Q

Labs to monitor for Tecfidera?

A

CBC < 6 mo before starting txt and annually

25
Q

Mechanism of action of Fingolimod/Gilenya?

A

binds to immune cells and sequesters them in lymph nodes, reducing availability for cell mediated immune response

-fingolimod crosses BBB –> phosphorylated to form fingolimod-phosphate –> binds to S1P receptors and down regulation of S1P receptors –> reduces release of lymphocytes

26
Q

Major possible side effects of Gilenya?

A

bradycardia after 1st dose, infxn, macular edema, decreased PFTs, liver injury, HTN and increase risk of herpes zoster

27
Q

What do you need to monitor with Gilenya?

A

screen: WBC, AST/ALT,bili, serum varicella zoster ab testing (in pts withno hx of chicken pox), baseline EKG, ophthalmologic evaluation. Observe brady x 6hrs after 1st dose, ophtho eval after 3-4 mo of txt, PFT if indicated, use contraception during txt and for 2 mo after stopping txt

28
Q

Efficacy of Gilenya?

A

it is more effective than injectables; less effective than Tysabri. A good alternative to Tysabri. Per Dr. Eicher, 54% efficacy.

29
Q

Contraindications to starting Gilenya? (5)

A

preexisting or recent heart conditions, baseline QTc > 500ms, txt with class Ia or class III antiarrhythmic drugs, TIA, stroke

30
Q

Efficacy of Tecfidera?

A

per Dr. Eicher, it has a high fail rate in patients with strong MS

31
Q

Mechanism of Aubagio

A

inhibits DNA synthesis in rapidly dividing cells such as lymphocytes. Alternate salvage pathway allows pyrimidine synthesis to continue at reduced rate in resting cells

32
Q

common side effects of Aubagio?

A

abnormal liver function, alopecia, diarrhea, influenza, nausea, paresthesias

33
Q

Black box warnings of aubagio?

A

black box: elevated LFTs and fetal death/malformations; skin rxn, BP increase, respiratory effects

34
Q

Pre-txt evaluation for Aubagio? What do you monitor during txt?

A

pre-txt: eval for infxn, pregnancy, RF, peripheral neuropathy, interstitual pulm disease, HTN, WBC, AST/ALT/tbili. During txt: BP monitoring and AST/ALT

35
Q

What are Tier 3 medications?

A

Lemtrada, Novantrone, Tysabri, Ocrevus

36
Q

Indications for Lemtrada?

A

pts who have had inadequate response to 2+ therapies

37
Q

Mechanism of Lemtrada?

A

binds CD52 (cell surface Ag on T and B lymphocytes, nKC, macrophages) –> ab-dependent cytolysis and complement mediated lysis

38
Q

Possible side effects of Lemtrada?

A

infusion rxn in 92% of pts during infusion and up to 24 hours after (3% are severe such as analhylactic shock, angioedema, bronchospasm, hypotension). serious autoimmune condition such as thrombocytopenia and increase risk of malignancy

39
Q

What to monitor before and during treatment with Lemtrada?

A

premedicate with corticosteroids prior to 1st three infusions, antiviral agents for herpetic ppx for 2 months or until CD4 count is > 200, check TSH Q3mo and CBC Q month, until 48 mo after last infusion, avoid during active infxn, avoid live viral vaccines

40
Q

Indications for Novantrone?

A

SPMS, PRMS, worsening RRMS

41
Q

Mechanism of action of Novantrone?

A

inhibits DNA synthesis, reduces lymphocytes, reduces Th1 cytokines

42
Q

Common side effects of Novantrone?

A

blue-green urine 24 hours after administration, infections, bone marrow suppression, nausea, hair thinning, bladder infections, mouth sores

43
Q

Major side effect of Novantrone?

A

dose dependent cardiac toxicity, AML (esp with cumulative doses > 60mg/m2)

44
Q

What to monitor while on Novantrone?

A

baseline LVEF prior to each dose and after txt completed

45
Q

Mechanism of Tysabri?

A

binds to alpha4/beta 1 integrin on activated lymphocytes and monocytes; inhibits leukocyte migration across the BBB

46
Q

Major side effects of Tysabri?

A

PML, hepatotoxicity including acute liver failure, encephalitis/meningitis with HSV and VZV

47
Q

What is the general risk of PML when on Tysabri?

A

1 in 1000

48
Q

What are risk factors that increase risk of PML in Tysabri recipients to 11 in 1000?

A

JC ab+, prior txt with immunosuppressant, > 2 years on Tysabri

49
Q

What to monitor while on Tysabri?

A

ab testing should be repeated Q6mo with monitoring 6 mo after end of txt

50
Q

Indications for Ocrevus?

A

RRMS, PPMS

51
Q

Mechanism of Ocrevus?

A

binds CD20, cell surface antigen on pre-B and mature B lymphocytes, causing antibody-dependent and complement-mediated cytolysis

52
Q

Potential side effects of Ocrevus?

A

Respiratory tract infxns, herpes, potentially PML, hepatitis B reactivation, possible increased immunosuppressive effect, increase risk of malignancy

53
Q

What to do prior to treatment with Ocrevus?

A

premedicate with corticosteroids and antihistamine and observe 1hr after infusion, administer all vaccines 6 weeks prior to Ocrevus, no live attenuated or live vaccines during txt until B cell repletion, breast cancer screening protocol

54
Q

txt of fatigue?

A

Modafinil, SSRI

55
Q

txt of spasticity?

A

OT/PT, baclofen, tizanidine

56
Q

txt of paroxysmal symptoms and pain

A

carbamazepine, phenytoin, gabapentin, TCAs, Botox

57
Q

txt of depression?

A

SSRI, TCAs,

58
Q

txt of cerebellar tremor?

A

Clonazepam, Valproic acid, Isoniazid, thalamic stimulator

Multiple Sclerosis (2 decks)

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