Pharmcotherapy of Multiple Sclerosis

Question 1

What is multiple sclerosis

Answer 1

an immune mediated, progressive neurological disorder

Question 2

What are characteristics of MS

Answer 2

inflammation, demyelination and axonal damage in the CNS

Question 3

T/F: Women are more likely to MS

Answer 3

True

Question 4

What vitamin may be protective against developing MS

Answer 4

Vitamin D

Question 5

T/F: Migrating from high risk areas to low risk areas at ages less than 15 makes getting the disease less likely

Answer 5

True

Question 6

What are the categories of factors that increase the risk of MS

Answer 6

Environmental, Genetic predisposition, individual characteristics

Question 7

What happens on a cellular level in MS

Answer 7

T cells are activated and bypass the blood brain barrier where they cause inflammation allowing different cells to attack the CNS

Question 8

what is used to diagnose MS

Answer 8

McDonald Criteria

Question 9

What are symptoms of MS

Answer 9

vision loss, weak spatiscity, tingling sensations

Question 10

What is the first clinical episode of MS called

Answer 10

clinically isolated syndrome

Question 11

What are characteristics of clinically isolated syndromes

Answer 11

neurological episode must be for at least 24 hours, MRI shows old lesions

Question 12

What is the most common form of MS, what characterizes this form of MS

Answer 12

Relapsing/Remitting MS (RRMS), acute relapses followed by periods of complete or partial remission

Question 13

What is the second form of MS, what characterizes this form of MS

Answer 13

Secondary progressive MS, always begins with RRMS and disease progresses to the point where the patient never returns to baseline

Question 14

What is the worst type of MS that a patient can acquire, what characterizes this form of MS

Answer 14

Primary progressive MS, disease becomes worse from onset

Question 15

What is the acute relapse treatment for MS, what happens

Answer 15

Methylprednisolone for 3 to 5 days, the duration of the relapse is shortened

Question 16

What medication can be used to reduce inflammation, inhibit T cell activation/proliferation, and migration into the CNS while only being used for relapsing MS and CIS

Answer 16

Interferon beta 1-a and 1-b

Question 17

What is the efficacy (reduction in annualized relapse rate) of interferon in MS

Answer 17

30%

Question 18

What are adverse effects of interferon

Answer 18

flu-like syndromes, injection site reactions, maybe depression

Question 19

What medication can be used to mimic myelin basic protien, inhibit antigen presentation and the activation of T-cell while only being used in relapsing MS and CIS

Answer 19

Copaxone

Question 20

What is the efficacy (reduction in annualized relapse rate) Copaxone

Answer 20

30%

Question 21

What are adverse effects of Copaxone

Answer 21

injection site reactions, immediate of transient post injection reactions

Question 22

What medication is a humanized monoclonal antibody that bind to lymphocytes blocking entry into CNS while only being used in relapsing MS and patients who have failed alternative therapies

Answer 22

Natalizumab

Question 23

What is the efficacy of Natalizumab

Answer 23

68% (best efficacy)

Question 24

What is the Black Box Warning of Natalizumab

Answer 24

increase risk of developing Progressive Multifocal Leukoencephalopathy (PML)

Question 25

What causes PML

Answer 25

JC virus

Question 26

What are risk factors that increase the risk of PML in patients who use Natalizumab

Answer 26

duration of treatment is over 2 years, positive for JCV antibodies, prior immunosuppressant therapy

Question 27

What medication for MS is a S1P inhibitor lowering the number of peripheral lymphocytes and migration into CNS and is for relapsing MS

Answer 27

Fingolimod( Gilenya)

Question 28

What is the efficacy for Fingolimod

Answer 28

54%

Question 29

What is the formation for Fingolimod

Answer 29

.5mg capsule

Question 30

In What patients is fingolimod contraindicated

Answer 30

patients with MI, angina, stroke, heart failure in the past six months or are on cardio drugs

Question 31

What happens in patients who do not handle fingolimod correctly

Answer 31

Severe bradycardia

Question 32

T/F: Patients can be pregnant while also taking this medication

Answer 32

False: Pregnant Patients cannot concurrently take this medication and if pregnancy is considered they must wait 2 months after medication is stopped

Question 33

What must be monitored when taking Fingolimod

Answer 33

CBC, LFTs, and HR

Question 34

What oral medication is used for relapsing MS but has many contraindications with efficacy as low as interferon

Answer 34

Teriflunomide

Question 35

What medication has anti-inflammatory properties and is used in relapsing MS

Answer 35

Tecfidera (Dimethyl Fumarate)

Question 36

what is the efficacy of Tecfidera

Answer 36

53%

Question 37

What are significant side effects of Tecfidera

Answer 37

GI problems, PML with lymphocyte counts less than 500

Question 38

What medication is a humanized monoclonal antibody that binds B cells that works in relpasing MS AND Primary Progressive MS

Answer 38

Ocrelizumab

Question 39

What is the efficacy of Ocrelizumab

Answer 39

47%

Question 40

What must be monitored for when a patient is taking Ocrelizumab

Answer 40

Hepatitis B reactivation

Question 41

What medication is a monoclonal antibody targeting CD52 on T and B cells, monocytes, and NK cells and is only used for Relapsing MS

Answer 41

Alemtuzumab

Question 42

What is the efficacy of Alemtuzumab

Answer 42

49 to 55%

Question 43

What is the Black Box warning of Alemtuzumab

Answer 43

serious infections, infusion reactions, serious and sometimes fatal autoimmune diseases, increased malignancies

Question 44

What medications have the lowest efficacy

Answer 44

interferons, copaxone, Teriflunomide

Question 45

What medications have moderate to good efficacy

Answer 45

Tecfidera, fingolimid, Ocrevus

Question 46

What medications have high efficacy but pose significant risks

Answer 46

Natalizumab, Alemtuzumab

Question 47

What medications are injectable

Answer 47

Interferons and Copxone

Question 48

Which medications are Oral

Answer 48

Tecifidera , Fingolimid, Teriflunomide

Question 49

Which medications are IV

Answer 49

Ocrevus, Natalizumab, and Alemtuzumab

Question 50

What is the assesment of MS, what do the numbers mean

Answer 50

Epanded Disability Status Scale, 1 (early) to 10 (death)

Question 51

What is the only medication that is approved for primary progressive MS

Answer 51

Ocrelizumab (Ocrevus)

Question 52

What medications should be avoided if a patient could possibly become pregnant

Answer 52

teriflunomide, copaxone, fingolimod