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Pharmacology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is MS?

A

-autoimmune disorder marked by demyelination of neurons/axons

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2
Q

How do you diagnose MS?

A

dissemination of plaques in time and space

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3
Q

Name the four types of MS?

A
  1. RRMS-MCC
  2. PPMS
  3. SPMS
  4. PRMS
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4
Q

How do DMT’s work?

A
  • slow progression of disease
  • reduce severity of relapsing episodes
  • increase remitting episodes
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5
Q

What is MOA of 1st GEN DMT’s?

A
  • reduce relapse rate by 30%
  • reduces white matter lesions
  • IFN B1b immunomodulating properties
  • augment suppressor cell function
  • suppress T cell proliferation at blood brain barrier
  • decrease permeability of blood brain barrier
  • down regulate IFN-gamma by APC and MHC II
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6
Q

What are three broad tx categories of MS? (3)

A
  1. Tx of exacerbations-corticosteroids
  2. disease modifying therapies
  3. symptomatic tx for spasticity, bladder symptoms, fatigue
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7
Q

Name 3 IFN-B1a? What is MOA of INF-B1a?

A
  • Avonex
  • Plegridy
  • Rebif
  • alters expression and response to surface antigens enhancing immune cell activities
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8
Q

What are ADE of IFN-B1a (4)

A
  • Injection site rxn’s
  • Flu like symptoms
  • Leukopenia
  • depression
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9
Q

What should you monitor for patient’s taking 1st gen DMT’s? (5)

A

CBC, LFT’s, electrolytes, thyroid, depression

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10
Q

What is a contraindications for IFN-B1a?

A

depression

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11
Q

How long does it take for efficacy of IFN-B1a?What type of MS do they treat?

A
  • 1-2 years

- RRMS

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12
Q

What is administration route of iFN-B1a?

A

self injections

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13
Q

Name 1 IFN-B1b?

A

Betaseron

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14
Q

What is ADE of Betaseron?

A

increased injection site rxn’s

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15
Q

What are ADE of glatiramer acetate? (4)

A
  • chest tightness
  • urticaria
  • injection site rxn’s
  • infection
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16
Q

What is monitored for Glatiramer acetate?

A

post injection site rxn

  • MRI
  • tissue necrosis
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17
Q

What does Glatiramer acetate treat?

A

CIS

RRMS

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18
Q

Name 2 brand names of glatiramer acetate?

A

Glatopa

Copaxone

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19
Q

Name the 5 2nd gen DMT?

A

-Natalizumab
-Mitoxantrone
-Alemtuzumab
-Fingolimod
-Ocrelizumab
-Teriflunomide
-Acrelizumab
Dimethyl fumarate

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20
Q

What is MOA of mitoxantrone?

A

inhibits RNA and DNA synthesis

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21
Q

What is MOA of Natalizumab?

A
  • attaches to VL1 so it won’t attach to ligand on CNS

- blocks passage of active lymphocytes across blood brain barrier

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22
Q

What is MOA of alemtuzumab?

A

monoclonal ab that depletes expression of CD52 cells, T cells, B cells, monocytes, and NK killer cells

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23
Q

What is MOA of ocrelizumab?

A

monoclonal ab that binds to CD20 marker of plasma cells

-depletes B cells

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24
Q

T/F All IFN exert there actions at the blood brain barrier

A

True

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25
Q

What is MOA of glatiramer acetate? (3)

A
  • similar to myelin basic protein/MBP and stops MBP binding to T cell receptor complexes
  • L-alanine, tyrosine, lysine and glutamic acid
  • reduced inflammation, demyelination, and axonal damage
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26
Q

Which interferon is low potency?

A

Avonex IFN-BIa

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27
Q

Which pregnancy category is Glatiramer acetate?

A

Category B

28
Q

What are ADE of alemtuzumab? (7)

A
  • nasopharyngitis
  • thyroid disorders
  • Herpes infections
  • URI
  • UTI
  • Good pasture syndrome
  • IM thromobocytopenia
29
Q

What should you monitor on patients with alemtuzumab (2)?

A
  • skin infections

- infusion rxn’s

30
Q

What is type of MS is tx with alemtuzumab?

A

RRMS

31
Q

Which drugs are used to treat relapsing MS? (5)

A
  • Natalizumab
  • Ocrelizumab
  • Fingolimide
  • Terifluonimide
  • Dimethyl fumarate
32
Q

What are ADE of natalizumab? (6)

A
  • arthralgias
  • liver toxicity
  • PML!!
  • depression
  • fatigue
  • respiratory infections
33
Q

What should you monitor for Natalizumab? (2)

A

JCV antibodies

LFTS

34
Q

What are ADE of Fingolimod? (4)

A
  • lymphocytopenia
  • macular retinal edema
  • Av block
  • headache
  • infection
35
Q

What does mitoxantrone tx? (3)

A

SPMS, PRMS, worsening RRMS

36
Q

What are ADE of mitoxantrone? (7)

A 
Bone marrow suppression
AML
Neutropenia 
Cardiotoxocity
Nausea
Diarrhea
Alopecia
37
Q

What should you monitor for pt taking Mitoxantrone? (4)

A

CBC, ECG, LFTs, LVEF

38
Q

What is MOA of Fingolimide?

A
  • sequesters circulating lymphocytes

- reduces infiltration of lymph and macrophages into the CNS

39
Q

What is MOA of Teflurionimide?

A
  • prevents the proliferation of peripheral lymphocytes

- reduces activation of lymphocytes in the CNS and decreases inflammation and demyelination

40
Q

What is MOA of Dimethyl fumarate?

A

involved in cellular response to oxidative stress

41
Q

What are ADE of Tefluronimide? (4)

A
  • Steven Johnson Syndrome
  • reactivation of TB
  • Alopecia
  • pregnancy x rating
42
Q

What do you monitor for Tefluronimide? (4)

A
  • CBC
  • LFT’s
  • pregnancy
  • TB test
43
Q

What are ADE of Dimethyl fumarate (5)

A 
Lymphocytopenia
Albuminuria
Flushing
Rash
Pruritus
44
Q

What should you monitor for DM? (2)

A

CBC

LFTS

45
Q

T/F taking food with DM will reduce flush

A

True

46
Q

What is MOA of corticosteroids?

A

decrease edema at site of demyelination

47
Q

T/F Corticosteroids has been shown to affect disease progression

A

False-does not affect disease progression

48
Q

When is high dose IV corticosteroid tx initiated? what is high dose corticosteroid tx?

A
  • within 2 weeks of symptom onset

- 500-1000 mgIV/day

49
Q

When does improvement occur?

A

3-5 days

50
Q

What are ADE of corticosteroids? (2)

A

metallic taste

-sleep issues

51
Q

Which pt may experience elevated levels of high sugar in their blood with use of corticosteroids?

A

DM

52
Q

What are long term ADE of corticosteroid use? (4)

A
  • acne
  • GI hemorrhage
  • fungal infections
  • mood changes
53
Q

Which med carries a pregnancy X rating?

A

Tefluronimide

54
Q

Which medication has an active metabolite? Name the metabolite?

A

Tefluronimide; Leflunomide

55
Q

How do you minimize the flushing seen with Dimethyl F?

A

take with food

56
Q

What labs should be appropriate to monitor if taking Tefluronimide?

A

CBC, LFT, pregnancy, TB test

57
Q

What therapy option might offer the patient a safer alternative?

A

Interferon IFN-B1a or IFN-B1b

Glatiramer

58
Q

Which medication has an indication for CIS and RMMS?

A

Glatiramer

59
Q

If our patient was a female which agent is a Category B Pregnancy?

A

Glatiramer

60
Q

Our patient reports a past medical hx of depression. Which medication would be considered a possible contraindication?

A

INF_B1a and IFN-B1b

61
Q

What are appropriate monitoring parameters for the interferon medications?

A

CBC, LFT’s, electrolytes, thyroid, depression

62
Q

Chest tightness can occur with flushing with which medication?

A

Glatiramer acetate

63
Q

What are limitations to mitoxantrone? (3)

A
  • lifetime dose of 140mg/nm2
  • pregnancy category D
  • secondary leukemia
64
Q

When is Fingolimod contraindicated?

A
  • class I and III anti arrhythmic drugs
  • cardiac disease
  • 2nd and 3rd AV block
65
Q

What is PML and the cause?

A
  • Progressive multi focal leukoencephalopathy
  • virus attacks cells that make mylein
  • John Cunningham virus activated when body becomes immunosuppressed
66
Q

What is mitoxantrone used?

A

worsening RRMS, SPMS, and PRMS

67
Q

Describe the drug interaction with ketaconazole and fingolimod?

A

Ketaconazole increases fingolimod serum concentration

Pharmacology (47 decks)

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