Pharmcotherapy of Multiple Sclerosis Flashcards
What is multiple sclerosis
an immune mediated, progressive neurological disorder
What are characteristics of MS
inflammation, demyelination and axonal damage in the CNS
T/F: Women are more likely to MS
True
What vitamin may be protective against developing MS
Vitamin D
T/F: Migrating from high risk areas to low risk areas at ages less than 15 makes getting the disease less likely
True
What are the categories of factors that increase the risk of MS
Environmental, Genetic predisposition, individual characteristics
What happens on a cellular level in MS
T cells are activated and bypass the blood brain barrier where they cause inflammation allowing different cells to attack the CNS
what is used to diagnose MS
McDonald Criteria
What are symptoms of MS
vision loss, weak spatiscity, tingling sensations
What is the first clinical episode of MS called
clinically isolated syndrome
What are characteristics of clinically isolated syndromes
neurological episode must be for at least 24 hours, MRI shows old lesions
What is the most common form of MS, what characterizes this form of MS
Relapsing/Remitting MS (RRMS), acute relapses followed by periods of complete or partial remission
What is the second form of MS, what characterizes this form of MS
Secondary progressive MS, always begins with RRMS and disease progresses to the point where the patient never returns to baseline
What is the worst type of MS that a patient can acquire, what characterizes this form of MS
Primary progressive MS, disease becomes worse from onset
What is the acute relapse treatment for MS, what happens
Methylprednisolone for 3 to 5 days, the duration of the relapse is shortened
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
Interferon beta 1-a and 1-b
What is the efficacy (reduction in annualized relapse rate) of interferon in MS
30%
What are adverse effects of interferon
flu-like syndromes, injection site reactions, maybe depression
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
Copaxone
What is the efficacy (reduction in annualized relapse rate) Copaxone
30%
What are adverse effects of Copaxone
injection site reactions, immediate of transient post injection reactions
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
Natalizumab
What is the efficacy of Natalizumab
68% (best efficacy)
What is the Black Box Warning of Natalizumab
increase risk of developing Progressive Multifocal Leukoencephalopathy (PML)
What causes PML
JC virus
What are risk factors that increase the risk of PML in patients who use Natalizumab
duration of treatment is over 2 years, positive for JCV antibodies, prior immunosuppressant therapy
What medication for MS is a S1P inhibitor lowering the number of peripheral lymphocytes and migration into CNS and is for relapsing MS
Fingolimod( Gilenya)
What is the efficacy for Fingolimod
54%
What is the formation for Fingolimod
.5mg capsule
In What patients is fingolimod contraindicated
patients with MI, angina, stroke, heart failure in the past six months or are on cardio drugs
What happens in patients who do not handle fingolimod correctly
Severe bradycardia
T/F: Patients can be pregnant while also taking this medication
False: Pregnant Patients cannot concurrently take this medication and if pregnancy is considered they must wait 2 months after medication is stopped
What must be monitored when taking Fingolimod
CBC, LFTs, and HR
What oral medication is used for relapsing MS but has many contraindications with efficacy as low as interferon
Teriflunomide
What medication has anti-inflammatory properties and is used in relapsing MS
Tecfidera (Dimethyl Fumarate)
what is the efficacy of Tecfidera
53%
What are significant side effects of Tecfidera
GI problems, PML with lymphocyte counts less than 500
What medication is a humanized monoclonal antibody that binds B cells that works in relpasing MS AND Primary Progressive MS
Ocrelizumab
What is the efficacy of Ocrelizumab
47%
What must be monitored for when a patient is taking Ocrelizumab
Hepatitis B reactivation
What medication is a monoclonal antibody targeting CD52 on T and B cells, monocytes, and NK cells and is only used for Relapsing MS
Alemtuzumab
What is the efficacy of Alemtuzumab
49 to 55%
What is the Black Box warning of Alemtuzumab
serious infections, infusion reactions, serious and sometimes fatal autoimmune diseases, increased malignancies
What medications have the lowest efficacy
interferons, copaxone, Teriflunomide
What medications have moderate to good efficacy
Tecfidera, fingolimid, Ocrevus
What medications have high efficacy but pose significant risks
Natalizumab, Alemtuzumab
What medications are injectable
Interferons and Copxone
Which medications are Oral
Tecifidera , Fingolimid, Teriflunomide
Which medications are IV
Ocrevus, Natalizumab, and Alemtuzumab
What is the assesment of MS, what do the numbers mean
Epanded Disability Status Scale, 1 (early) to 10 (death)
What is the only medication that is approved for primary progressive MS
Ocrelizumab (Ocrevus)
What medications should be avoided if a patient could possibly become pregnant
teriflunomide, copaxone, fingolimod
