Pharm of Multiple Sclerosis Flashcards
Name the two drugs in the IFN-beta-1a class.
Avonex and Rebif
Name the two drugs in the IFN-beta-1b class.
Betaseron and Extavia
What is the mechanism of action of the IFN-beta 1a and 1b drugs? (Avonex, rebif, betaseron and extavia)
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
What are the 4 disease subtypes of MS?
Monosyptomatic
Relapse Remitting
Primary Progressive
Secondary Progressive
What types of agents are used in the treatment of MS?
Anti-inflammatory immunomodulators-**most successful** Immunosuppressants Symptomatic Agents Experimental Therapies
What is used to treat and acute MS attack?
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
What are the Interferon drugs used to treat and which one is first line?
RRMS
Rebif is first line
Rebif, Betaseron and Extavia are used in high doses
What are the side effects of Avonex?
minor anemia elevation of liver enzymes (monitor) hypothyroidism Flu like symptoms minor irritation at injection site
What are the side effects of Rebif and the IFN-beta-1b drugs (betaseron and extavia)
- anemia
- leukopenia
- menstrual irregularities
- depression
- increase LFT
- hypothyroidism
- flu like symptoms
- irritation at injection site
Do the IFN drugs cross the BBB?
NO
Which of the Interferon drugs cause the least amount of neutralizing antibodies?
Avonex
Name 4 drugs, aside from the interferons, that are used to treat RRMS?
Glatiramer Acetate
Natalizumab
Fingolimod
Teriflunomide
What is the mechanism of action of Glatiramer Acetate (myelin basic protein analog) and what are the side effects?
- Mechanism: T-cell apoptosis, induces anti-inflammatory Th2 cells, induces Treg with induction of anergy
- Side effects: injection site reaction, anxiety attack-like reaction
What is the mechanism of action of Natalizumab (monoclonal antibody) and what are the side effects?
- mechanism: Binds VLA4 inhibiting leukocyte micgration across BBB
- side effects: PML, acute urticaria, systemic hypersensitivity infusion reaction, headache, dizziness, fatigue, arthralgia, rigors
What is the mechanism of action of Fingolimod (Sphingosine-1-phosphate analog)?
-mechanism: sequesters circulating lymphocytes in secondary lymphoid organs via induction of intracellular internalization of receptors on lymphocytes
What are the side effects of Fingolimod?
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
What is the mechanism of action of Teriflunomide and what are the side effects?
- 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
What is the mechanism of action of dimethyl fumarate and what are the side effects?
- mechanism: Enhances Nrf2 pathway; some Th1 -> Th2 shift
- side effects: N & V, diarrhea, stomach pain, flushing, itching, redness and rash
Which medication requires patients to be VZV immune before?
Fingolimod
Name the 5 drugs that work through immune suppression and what they are used to treat.
Mitoxantrone Azathioprine Methotrexate Cyclophosphamide Mycophenolate Mofetil _Used for SPMS
Which of the following decreases the frequency of clinical relapse, reduces disease progress, and reduces disability: Mitoxantrone Azathioprine Methotrexate Cyclophosphamide Mycophenolate Mofetil
Mitoxantrone
Which of the following drugs has side effects of dose dependent cardiac toxicity and induction of acute leukemia: Mitoxantrone Azathioprine Methotrexate Cyclophosphamide Mycophenolate Mofetil
Mitoxantron
What are the side effects of Azathioprine,
Methotrexate, Cyclophosphamide, and Mycophenolate Mofetil?
systemic toxicity-monitor the blood for changes
Which of the Interferon drugs has no effect on disease progression?
Betaseron and Extavia
Which medication works best when it is given as early as possible after diagnosis?
Glatiramer acetate-has no effect on disease progression
