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therapeutics 2 > Ott MS > Flashcards

Ott MS Flashcards

1
Q

What is DIT

A

Dissemination in time: time between evidence of new lesions in subsequent MRIs (30 days) –> damage that has happened more than once

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2
Q

what is DIS

A

dissemination in space: need for > 1 T2 lesion appearing in at least two of four MS-typical CNS regions (cortical, periventricular, infratentorial, spinal cord) –> damage that is in more than one place

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3
Q

What is Clinically Isolated Syndrome (CIS)

A

descriptor of a first demyelinating event involving the optic nerve, cerebrum, cerebellum, brainstem, or spinal cord

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4
Q

What is relapsing remitting MS (RRMS)

A

most common
consists of relapses with partial or complete remission between relapses
most will become progressive over time

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5
Q

what is secondary progressive MS (SPMS)

A

80% of RRMS patients will progress to this
consisting of fewer relapses with continuing disability

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6
Q

what is primary progressive MS (PPMS)

A

10-15% of patients
progressive form from onset with minor improvements or periods of stability
more common in patients diagnosed in later years (>50 years)

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7
Q

what is progressive relapsing MS (PRMS)

A

least common
steadily worsening disease from onset with later, clear, acute relapses
may be some recovery from attacks but no remission between relapses

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8
Q

what is the first choice of treatment for acute attacks

A

high dose corticosteroid
oral or IV

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9
Q

what is the dosing for acute ms attacks

A

methylprednisolone 500mg-1000mg IV daily for 3 to 7 days with or without an oral taper of 1-3 weeks

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10
Q

what is the outpatient dosing for acute attacks

A

oral prednisone 1250mg every other day x 5 doses without need for taper
(this is a lot of tabs. take with food and warn patient about side effects)

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11
Q

what are the oral medications for MS

A

dimethyl fumarate
diroximel fumarate
fingolimod
ozanimod
ponesimod
siponimod
teriflunomide

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12
Q

what are the injectable MS medications

A

interferon beta-1a
peginterferon beta-1a
interferon beta-1b
glatiramer acetate

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13
Q

what are the infusion MS medications

A

alemtuzumab
natalizumab
ocrelizumab

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14
Q

what must MS patients be tested for prior the getting drugs

A

JCV antibodies

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15
Q

what vaccines are preferred in MS

A

inactivated vaccines
live are not recommended because the ability to cause disease is weakened

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16
Q

what MS drug cannot be given with live virus vaccines

A

alemtuzumab

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17
Q

how should varicella vaccines be approached in MS patients

A

should be considered in patients who have never had chicken pox especially if started MS medications like fingolimod and alemtuzumab

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18
Q

administration counseling for dimethyl fumarate and diroximel fumarate and monomethyl fumarate

A

capsule should not be opened and sprinkled on food. do not crush or chew

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19
Q

what do you monitor with fumarate MS drugs

A

LFTs and CBC with differential

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20
Q

what are fumarate MS drugs associated with

A

PML
flushing (can take aspirin 30 min prior to help)

21
Q

what are the sphingosine 1-phosphate receptor modulators

A

fingolimod
ozanimod
ponesimod
siponimod

22
Q

what are sphingosine modulators contraindicated with

A

past arrhythmia diagnosis or MI, unstable angina, stroke/TIA, class 3/4 HF withing past 6 months

23
Q

what happens with discontinuing sphingosine modulators

A

significant worsening of MS symptoms

24
Q

what drug class must be avoided with ozanimod

A

MAO inhibitor

25
Q

what testing is required prior to starting siponimod

A

CYP2C9 genotype

26
Q

Injection side effects of glatiramer acetate

A

immediately post injection
flushing
sweating
dyspnea
chest pain
anxiety
itching

27
Q

what counseling point should you give for injection of glatiramer acetate

A

must rotate injection sites every time to avoid lipoatrophy

28
Q

when is glatiramer acetate preferred

A

pregnancy

29
Q

how can interferons be dosed

A

SC or IM every other day to every 2 weeks depending on the dosage form

30
Q

counseling for post injection of interferons

A

flu-like symptoms
may pre-treat with APAP or NSAID and inject at night

31
Q

what are the psychiatric effects of interferons

A

depression
suicidal thinking

32
Q

what must be monitored with interferons

A

LFTs and TSH

33
Q

what are the monoclonal antibody MS drugs

A

alemtuzumab
natalizumab
ocrelizumab

34
Q

alemtuzumab

A

REMS
fatal infusions reactions and autoimmune conditions
increased risk of malignancies
CI with HIV infection

35
Q

natalizumab

A

REMS program
associated with PML
third line

36
Q

ocrelizumab

A

only FDA drug for PPMS
CI in active hep b
increased risk of malignancies

37
Q

when do you vaccinate with monoclonal MS drugs

A

at least 6 weeks before starting treatment

38
Q

what MS drug is contraindicated in pregnancy

A

Teriflunomide
requires 2 methods of contraception

39
Q

how do you handle a pregnancy with a patient on teriflunomide

A

activated charcoal for 11 days until gone or repeat

40
Q

contraception for mitoxantrone

A

required for treatment
pregnancy test before each infusion

41
Q

contraception with fingolimod

A

contraception during treatment and at least 2 months after D/C

42
Q

contraception with ozanimod

A

during treatment and for at least 3 months after D/C

43
Q

contraception with ponesimod

A

during treatment and for at least 7 days after D/C

44
Q

contraception with siponimod

A

during treatment and at least 10 days after D/C

45
Q

contraception with ocrelizumab

A

during treatment and at least 6 months after D/C

46
Q

contraception with cladribine

A

required + barrier method for at least 6months after D/C
CI in breastfeeding

47
Q

Dalfampridine (Ampyra) moa

A

blocks potassium channels and prevents repolarization of cell
may improve walking speed

48
Q

what dosage form and doses should be avoided with dalfampridine

A

IR dosage forms and dose escalation
associated with seizures
CI with history of seizures

therapeutics 2 (24 decks)

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