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CU Child Neurology Neuroimmunology > 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 Dimethyl fumarate

A

Tecfidera

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4
Q

Brand name of Fingolimod

A

Gilenya

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5
Q

Brand name of Teriflunomide

A

Aubagio

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6
Q

Brand name of Alemtuzumab

A

Lemtrada

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7
Q

Brand name of Mitoxantrone

A

Novantrone

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8
Q

Brand name of Natalizumab?

A

Tysabri

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9
Q

Brand name of Ocrelizumab

A

Ocrevus

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10
Q

Mechanism of action of daclizumab?

A

modulation of IL-2 mediated activation of lymphocytes

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11
Q

Common Adverse effects of daclizumab?

A

URI, pharyngitis, increased ALT, UTI

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12
Q

Labs to follow for daclizumab and how often?

A

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

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13
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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14
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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15
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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16
Q

Mechanism of action of dimethyl fumarate?

A

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

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17
Q

Common side effects of dimethyl fumarate?

A

flushing, abdominal pain, nausea, diarrhea

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18
Q

Warnings of dimethyl fumarate?

A

lymphopenia

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19
Q

Labs to monitor for dimethyl fumarate?

A

CBC < 6 mo before starting txt and annually

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20
Q

Mechanism of action of fingolimod?

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

21
Q

Major possible side effects of fingolomod?

A

Bradycardia after 1st dose, infection, macular edema, decreased PFTs, liver injury, HTN and increased risk of herpes zoster

22
Q

What do you need to monitor with fingolomod?

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

23
Q

Efficacy of fingolomod?

A

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

24
Q

Contraindications to starting fingolomod? (5)

A

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

25
Mechanism of teriflunomide
inhibits DNA synthesis in rapidly dividing cells such as lymphocytes. Alternate salvage pathway allows pyrimidine synthesis to continue at reduced rate in resting cells
26
Common side effects of teriflunomide?
abnormal liver function, alopecia, diarrhea, influenza, nausea, paresthesias
27
Black box warnings of teriflunomide?
black box: elevated LFTs and fetal death/malformations; skin rxn, BP increase, respiratory effects
28
Pre-treatment evaluation for teriflunomide? What do you monitor during treatment?
pre-txt: eval for infxn, pregnancy, RF, peripheral neuropathy, interstitual pulm disease, HTN, WBC, AST/ALT/tbili. During txt: BP monitoring and AST/ALT
29
Indications for alemtuzumab?
Only approved for patients who have had inadequate response to 2+ therapies due to high side effect profile.
30
Mechanism of alemtuzumab?
binds CD52 (cell surface Ag on T and B lymphocytes, nKC, macrophages) --\> ab-dependent cytolysis and complement mediated lysis
31
Possible side effects of alemtuzumab?
infusion rxn in 92% of pts during infusion and up to 24 hours after (3% are severe such as anaphylactic shock, angioedema, bronchospasm, hypotension). Serious autoimmune conditions such as thrombocytopenia and increase risk of malignancy
32
What to monitor before and during treatment with alemtuzumab?
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
33
Mechanism of action of mitoxantrone?
inhibits DNA synthesis, reduces lymphocytes, reduces Th1 cytokines
34
Common side effects of Novantrone?
blue-green urine 24 hours after administration, infections, bone marrow suppression, nausea, hair thinning, bladder infections, mouth sores
35
Major side effect of mitoxantrone?
dose dependent cardiac toxicity, AML (esp with cumulative doses \> 60mg/m2)
36
What to monitor while on mitoxantrone?
baseline LVEF prior to each dose and after txt completed
37
Mechanism of natalizumab?
binds to alpha4/beta 1 integrin on activated lymphocytes and monocytes; inhibits leukocyte migration across the BBB
38
Major side effects of natalizumab?
PML, hepatotoxicity including acute liver failure, encephalitis/meningitis with HSV and VZV
39
What is the general risk of PML when on natalizumab?
1 in 1000
40
What are risk factors that increase risk of PML in natalizumab recipients to 11 in 1000?
JC ab+, prior txt with immunosuppressant, \> 2 years on Tysabri
41
What to monitor while on natalizumab?
JC virus titers
42
Mechanism of ocrelizumab?
binds CD20, cell surface antigen on pre-B and mature B lymphocytes, causing antibody-dependent and complement-mediated cytolysis
43
Potential side effects of ocrelizumab?
Respiratory tract infxns, herpes, potentially PML, hepatitis B reactivation, possible increased immunosuppressive effect, increase risk of malignancy
44
What to do prior to treatment with ocrelizumab?
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
45
What drugs can be used to treat MS-related fatigue?
Modafinil, SSRI, amantadine
46
What drugs can be used to treat MS-related spasticity?
baclofen, tizanidine
47
What drugs can be used to treat MS-related paroxysmal symptoms and pain?
carbamazepine, phenytoin, gabapentin, TCAs, Botox
48
What drugs can be used to treat MS-related cerebellar tremor?
Clonazepam, Valproic acid, Isoniazid, thalamic stimulator

CU Child Neurology Neuroimmunology (6 decks)

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