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Pharm Unit 3 > Pharm of Multiple Sclerosis > Flashcards

Pharm of Multiple Sclerosis Flashcards

1
Q

Name the two drugs in the IFN-beta-1a class.

A

Avonex and Rebif

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2
Q

Name the two drugs in the IFN-beta-1b class.

A

Betaseron and Extavia

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3
Q

What is the mechanism of action of the IFN-beta 1a and 1b drugs? (Avonex, rebif, betaseron and extavia)

A

Many, potentially:

1) inhibit T-cell activation
2) shift from Th1 to Th2
3) inhibit lymphocyte movement into CNS
4) anti-proliferative effect
5) apoptosis of T-cells
6) anti-viral
7) IFN-g antagonism

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4
Q

What are the 4 disease subtypes of MS?

A

Monosyptomatic
Relapse Remitting
Primary Progressive
Secondary Progressive

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5
Q

What types of agents are used in the treatment of MS?

A 
Anti-inflammatory
immunomodulators-**most successful**
Immunosuppressants
Symptomatic Agents
Experimental Therapies
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6
Q

What is used to treat and acute MS attack?

A

Corticosteroids- shorten acute attack and speed recovery
OR
Plasmapheresis-for pt allergic to methyprednisone or if methylprednisone doesnt work
ACTH-if not responsive to methylprednisone

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7
Q

What are the Interferon drugs used to treat and which one is first line?

A

RRMS
Rebif is first line
Rebif, Betaseron and Extavia are used in high doses

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8
Q

What are the side effects of Avonex?

A 
minor anemia
elevation of liver enzymes (monitor)
hypothyroidism
Flu like symptoms
minor irritation at injection site
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9
Q

What are the side effects of Rebif and the IFN-beta-1b drugs (betaseron and extavia)

A
  • anemia
  • leukopenia
  • menstrual irregularities
  • depression
  • increase LFT
  • hypothyroidism
  • flu like symptoms
  • irritation at injection site
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10
Q

Do the IFN drugs cross the BBB?

A

NO

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11
Q

Which of the Interferon drugs cause the least amount of neutralizing antibodies?

A

Avonex

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12
Q

Name 4 drugs, aside from the interferons, that are used to treat RRMS?

A

Glatiramer Acetate
Natalizumab
Fingolimod
Teriflunomide

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13
Q

What is the mechanism of action of Glatiramer Acetate (myelin basic protein analog) and what are the side effects?

A
  • Mechanism: T-cell apoptosis, induces anti-inflammatory Th2 cells, induces Treg with induction of anergy
  • Side effects: injection site reaction, anxiety attack-like reaction
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14
Q

What is the mechanism of action of Natalizumab (monoclonal antibody) and what are the side effects?

A
  • mechanism: Binds VLA4 inhibiting leukocyte micgration across BBB
  • side effects: PML, acute urticaria, systemic hypersensitivity infusion reaction, headache, dizziness, fatigue, arthralgia, rigors
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15
Q

What is the mechanism of action of Fingolimod (Sphingosine-1-phosphate analog)?

A

-mechanism: sequesters circulating lymphocytes in secondary lymphoid organs via induction of intracellular internalization of receptors on lymphocytes

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16
Q

What are the side effects of Fingolimod?

A

Bradycardia

  • Heartblock (EKG for first 6 hours)
  • Macular edema (need opthalmology exam before and after 3 months)
  • Reduced FEV1
  • Increased LFTs
  • Lymphopenia, leukopenia
  • Asthenia, back pain, blurred vision, headache dizziness, infections
17
Q

What is the mechanism of action of Teriflunomide and what are the side effects?

A
  • mechanism: elective dihydro-orotate dehydrogenase inhibitor; blocks de novo pyramidine synthesis, reducing T- and B-cell proliferation and function against autoantigens
  • side effects: Hepatotoxicity, teratogenicity
18
Q

What is the mechanism of action of dimethyl fumarate and what are the side effects?

A
  • mechanism: Enhances Nrf2 pathway; some Th1 -> Th2 shift

- side effects: N & V, diarrhea, stomach pain, flushing, itching, redness and rash

19
Q

Which medication requires patients to be VZV immune before?

A

Fingolimod

20
Q

Name the 5 drugs that work through immune suppression and what they are used to treat.

A 
Mitoxantrone
Azathioprine
Methotrexate
Cyclophosphamide
Mycophenolate Mofetil
_Used for SPMS
21
Q 
Which of the following decreases the frequency of clinical relapse, reduces disease progress, and reduces disability: 
Mitoxantrone
Azathioprine
Methotrexate
Cyclophosphamide
Mycophenolate Mofetil
A

Mitoxantrone

22
Q 
Which of the following drugs has side effects of dose dependent cardiac toxicity and induction of acute leukemia: 
Mitoxantrone
Azathioprine
Methotrexate
Cyclophosphamide
Mycophenolate Mofetil
A

Mitoxantron

23
Q

What are the side effects of Azathioprine,

Methotrexate, Cyclophosphamide, and Mycophenolate Mofetil?

A

systemic toxicity-monitor the blood for changes

24
Q

Which of the Interferon drugs has no effect on disease progression?

A

Betaseron and Extavia

25
Q

Which medication works best when it is given as early as possible after diagnosis?

A

Glatiramer acetate-has no effect on disease progression

Pharm Unit 3 (14 decks)

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