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Spring 15 - Pharm Unit II > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

Multiple Sclerosis

A
  • inflammatory dz of CNS

- many areas of brain and spinal cord affected by plaques or sclerosed areas

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2
Q

MS Pathophys

A
  • demyelination and inflammation leads to
  • plaques in brain and spinal cord which leads to
  • neurologic sxs reflective of affected areas
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3
Q

What are the 4 MS classifications?

A
  • relapsing/remitting (discrete attacks then recovery)
  • primary progressive (steady decline)
  • secondary progressive (starts RRMS then decline)
  • progressive relapsing (overlaps PPMS and SPMS)
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4
Q

MS Treatment Goals

A
  • decrease severity, intensity and duration of exacerbations
  • enhance exacerbation recovery
  • prevent relapse and onset of progressive dz
  • stop or reverse progressive MS
  • provide symptomatic relief
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5
Q

How are moderate and severe acute exacerbations treated?

A

corticosteroid

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6
Q

Corticosteroids MOA in PD

A
  • unclear

- may help preserve myelin and maintain BBB integrity

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7
Q

Why should corticosteroid use be reserved for PD exacerbations?

A

-effects are transient and tend to diminish w/ repeated use

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8
Q

Plasma Exchange

A

-tx option for pts w/ very severe attacks that do not respond to aggressive corticosteroid treatment

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9
Q

Interferons MOA

A
  • alter expression and response to surface antigens
  • can augment suppressor cell function
  • can suppress T-cell proliferation
  • may decrease BBB permeability
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10
Q

Name a couple interferon meds for MS.

A
  • beta 1a: Avonex and Rebif

- beta 1b: Betaseron and Extavia

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11
Q

Efficacy of Interferons

A
  • decrease frequency of exacerbations and delay disability

- early tx with interferon assoc with significant reduction in risk of MS progression

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12
Q

What is a contraindication of all interferon meds?

A

pregnancy and lactation

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13
Q

What are the most common adverse effects of interferon meds?

A

-HA, flu-like sxs, myalgia, injection site rxn

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14
Q

Interferon Monitoring

A
  • EDSS: kurtzke expanded disability status scale 0-10

- baseline CBC, plt, LFTs at 1 month then q3 months x1 year, then q6 months

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15
Q

Glatiramer/Copaxone Indication

A

relapsing remitting

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16
Q

Glatiramer/Copaxone Efficacy

A

decreases relapses and postpones relapses

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17
Q

Glatiramer/Copaxone AEs

A
  • vasodilation
  • arthralgia
  • chest pain
  • injection site reaction
18
Q

Fingolimond/Gilenya Indication

A
  • relapsing remitting

- progressive relapsing

19
Q

Fingolimond/Gilenya Efficacy

A

modestly better than avonex (interferon) at preventing relapse

20
Q

Fingolimond/Gilenya AEs

A
  • HA, increased LFTs
  • decrease HR, heart block
  • macular edema, bronchitis, pneumonia

-avoid in pts w/ recent MI, angina, stroke, TIA, severe HF

21
Q

What is unique about Fingolimond/Gilenya?

A

first ORAL disease modifying therapy for MS

22
Q

Teriflunomide/Aubagio Indication

A

relapsing forms of MS

23
Q

Teriflunomide/Aubagio AEs

A
  • N/D
  • hair loss
  • black box warning for hepatotoxicity
  • increased infx risk
  • teratogenic
24
Q

Teriflunomide/Aubagio Monitoring

A

-LFTs baseline, qmonth x6 months, then periodically

25
Q

Dimethyl Fumarate/Tecfidera Indication

A

relapsing forms of MS

26
Q

Dimethyl Fumarate/Tecfidera AEs

A
  • flushing
  • N/D
  • decreased WBC
  • rare progressive multifocal leukoencephalopathy
27
Q

Dimethyl Fumarate/Tecfidera Monitoring

A

-WBC baseline, q 3-6 months, then periodically

28
Q

Mitoxantrone/Novantrone Indications

A

approved to decrease frequency of relapses and/or neurologic disability in adults w/ SPMS, PRMS or worsening RRMS

29
Q

Mitoxantrone/Novantrone AEs

A
  • decreased WBC and platelets, anemia
  • increased LFTs
  • decreased LVEF, HF
  • UTIs, N/V, mucositis
  • black box warning cardiotoxicity, acute myelogenous leukemia
30
Q

Which pts should use Mitoxantrone/Novantrone?

A

-reserved for pts with worsening dz because of cardiotoxicity AEs

31
Q

Natalizumab/Tysabri Indication

A

-monotherapy for relapsing forms of MS in pts who have documented inadequate response or intolerance to traditional MS therapies

32
Q

Why should Natalizumab/Tysabri only be used as monotherapy?

A

fatalities reported w/ combination therapy

33
Q

Natalizumab/Tysabri AEs

A
  • rare progressive multifocal leukoencephalopathy
  • pts followed in ongoing safety registry
  • hepatotoxicity
34
Q

Which pts should use Natalizumab/Tysabri?

A

reserved for pts who can’t tolerate or don’t respond to other therapies (due to risk of PML and hepatotoxicity)

35
Q

How long should therapy be continued?

A
  • continue indefinitely

- do not stop treatment during evaluation for continuing treatment

36
Q

What medication should be prescribed as soon as possible following a definite MS diagnosis?

A
  • interferon beta medication (Avonex, Rebif)

- or glatiramer acetate

37
Q

Who should not use any of the MS medications?

A

pregnant or nursing mothers

38
Q

Which drugs are considered first line disease modifying therapy for MS?

A
  • interferon beta

- glatiramer/copaxone

39
Q

Dalfampridine/Ampyra Efficacy

A
  • increased walking speed in 35-45% of MS pts

- improved walking speed = improved ambulation

40
Q

Dalfampridine/Ampyra AEs

A
  • back pain, dizziness, insomnia, fatigue
  • nausea, balance disorder, UTI, falls, HA
  • rare seizure
41
Q

Pt Education for MS

A
  • educate about MS
  • community support
  • tx: injection techniques, adverse effects, symptomatic management

Spring 15 - Pharm Unit II (9 decks)

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