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Pharmacotherapeutics > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is the risk of developing MS, mean age of onset, women outnumber men by?

A

Risk is 1:1000, mean age 30, women outweigh men by 2:1

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2
Q

High risk of MS is lived in an area farther away from equator at what age?

A

before the age of 15

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3
Q

What produces myelin, the protective covering around neurons that allows for transmission?

A

Oligodendrocytes

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4
Q

What factors lead to MS lesions or plaques?

A

demyelination and inflammatory repsonse

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5
Q

What produces and releases antibodies against myelin resulting in inflammation?

A

b-lymphocytes

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6
Q

MS affects what areas of the body?

A

brain, optic nerve, spinal cord

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7
Q

What criteria is needed to diagnosis MS?

A

Dissemination in space and time

2 attacks, 2 lesions = MS

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8
Q

What enhances the MS diagnosis?

A

t2-weighted lesions, and gadolinium on MRI
Increased CSF immunogloblobulin G index and presence of oligoclonal bands
Measured electrical activity

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9
Q

What is the first attack of MS called?

A

Clinically isolated syndrome CIS

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10
Q

85% of patients present with what form of MS?

A

RRMS relapsing-remitting MS

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11
Q

Patients diagnosised with RRMS may progress to what form of MS?

A

SPMS secondary-progressive MS

worsening of symptoms

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12
Q

10% may never have relapse or remissions after initial presentation is this form of ms?

A

PPMS primary-progressive MS

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13
Q

Progressive worsening of disease without recovery period is what form of MS?

A

PRMS progressive relapsing MS

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14
Q

What are the indicators for unfavorable prognosis?

A

onset age >40, male, high attack frequency, progressive

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15
Q

What is the first treatment for RRMS?

A

interferon B or glatitamer acetate

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16
Q

When should therapy be accessed when first treating RRMS?

A

6-12 months before determining if yields suboptimal response

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17
Q

What are indicators of suboptimal response?

A

frequent relapses
progressive of disability
rising use of resources
imaging changes reflecting increased disease activity

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18
Q

Treatment with what drug is associated with the production of neutralizing antibodies?

A

interferon b

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19
Q

serum of NAb of what value of positive? Titer greater than what value will impact efficacy?

A

serum titer >= 20

>100-200 impact efficacy

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20
Q

How long should you wait to test for NAb after the last corticosteroid dose?

A

30 days

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21
Q

What are corticosteroids role in MS?

A

Manage relapses
methylprednisolone 500-1000mg IV q 3-5 days up to 10 days.
IV dexamethasone may be substituted.

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22
Q

insomnia, dysphoria, anxiety, hyperglycemia, headache, easy bruising, edema, palpitation, GI distress, myalgia are side effects of?

A

corticosteroids

23
Q

The administration of high dose steroids in an intermittent manner is called what?

A

Pulsed steroids for patients developing SPMS or failed other therapies

24
Q

These drugs reduce antigen presenatation and t-cell proliferation, alter cytokine and matrix metalloproteinase expression?

A

interferons

25
Q

When should high dose interferons be considered?

A

Patient on avonex who is responding poorly clinically or radiographically and antibody negative

26
Q

what are interferons ability to decrease relapse, MRI lesions, and disability progression?

A

relapse 33%
MRI lesions 80%
Disability progression moderate

27
Q

Depression, hepatotoxicity, flu-like symptoms, injection site reactions are side effects of?

A

interferons

28
Q

What are flu-like symptoms?

A

fever, chill, fatigue, sweating, headache, myalgia. occur for up to 24 hours.

29
Q

What things need to be monitored with interferons?

A

LFT, CBC, TFT, depression symptoms, aspetic technique

30
Q

What is the Brand name, route of interferon b-1b?

A

Betaseron
Subcutaneously every other day
Titrate over 6 weeks

31
Q

What is the Brand name, route interferon b-1a?

A

Avonex

intramuscularly once weekly

32
Q

What is the Brand name, route interferon b-1a (2)?

A

Rebif
subcutaneously three times a week
Titrate by 20% increase over 4 weeks

33
Q

What drug modifies the immune response that results in CNS inflammation, demyelination and axonal loss?

A

Glatiramer acetate(copaxone)

34
Q

What is the efficacy of Copaxone?

A

relapse 30-40%
MRI lesions 30-40%
no effect on disability progression

35
Q

What is the brand and route of glatiramer acetate?

A

Copaxone

20mg Subcutaneously once daily

36
Q

nausea, back pain, chest pain, vasodilation, rash, injection site reaction are side effects of?

A

Glatiramer acetate (copaxone)

37
Q

This inhibits alpha4-integrin mediated adhesion of lymphocytes to endothelium, preventing migration of leuocytes across the blood brain barrier.

A

Natalizumab (Tysabri)

38
Q

Efficacy of Tysabri is not known beyond how long?

A

2 years

39
Q

Tysabri evidence is?

A

relapse 66%
MRI lesions 90%
Disability progression 50%

40
Q

What is the brand and route of natalizumab?

A

Tysabri

300mg IV infusion over 1 hour every 4 weeks

41
Q

What drug is associated with PML progressive multifocal leukoencephalopathy?

A

Natalizumab (tysabri)

42
Q

What is PML, symptoms?

A

PML progressive multifocal leukoencephalopathy caused by JC virus, an opoortunistic viral infection of the brain in immunocompromised patients.
weakness on one side of body, vision, thinking, memory problems

43
Q

Headache, arthralgia, UTI, lower respiratory infection, gastroenteritis, vaginitis, depression are side effects of?

A

natalizumab (tysabri)

44
Q

What is the touch prescribing program?

A

Enrollment to receive/dispense natalizumab (tysabri). re-authorize treatment every 6 months

45
Q

This inhibits the proliferation of t-cells, b-cells, macrophages. impairs the secretion of molecules that promote inflammation.

A

Mitoxantrone (Novantrone)

46
Q

What is the brand name and route for mitoxantrone?

A

Novantrone

12mg/m2 IV infusion over 5-15 minutes every 3 months

47
Q

What is the maximum lifetime amount of mitoxantrone?

A

140mg/m2

48
Q

What are the contraindications with novantrone?

A

LVEF < 50%, neutrophil count <1500cells

49
Q

Which drug do you monitor for heart failure symptoms, myelosuppression, blue-green urine color, bluish sclera?

A

mitoxantrone (novantrone)

50
Q

This is a sphingosine 1-phosphate receptor modulator that blocks capacity of lymphocytes to egress from lymph nodes.

A

Fingolimod (Gilenya)

51
Q

What is the brand name and route for fingolimod?

A

Gilenya

0.5mg orally daily with or without food

52
Q

What monitoring should be done for Gilenya?

A 
Bradycardia - ECG
infections CBC with differential
macular edema - eye exam
respiratory effects - FEV1, DLCO
hepatic effects - LFT
53
Q

How are some symptoms of MS managed?

A

Fatigue - provigil(modafanil)
Interferon B - suicidal ideation
Urinary incontience - anticholinergic

Pharmacotherapeutics (12 decks)

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