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Phar 504 > Pharmcotherapy of Multiple Sclerosis > Flashcards

Pharmcotherapy of Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis

A

an immune mediated, progressive neurological disorder

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2
Q

What are characteristics of MS

A

inflammation, demyelination and axonal damage in the CNS

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3
Q

T/F: Women are more likely to MS

A

True

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4
Q

What vitamin may be protective against developing MS

A

Vitamin D

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5
Q

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

A

True

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6
Q

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

A

Environmental, Genetic predisposition, individual characteristics

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7
Q

What happens on a cellular level in MS

A

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

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8
Q

what is used to diagnose MS

A

McDonald Criteria

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9
Q

What are symptoms of MS

A

vision loss, weak spatiscity, tingling sensations

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10
Q

What is the first clinical episode of MS called

A

clinically isolated syndrome

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11
Q

What are characteristics of clinically isolated syndromes

A

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

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

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

A

Primary progressive MS, disease becomes worse from onset

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15
Q

What is the acute relapse treatment for MS, what happens

A

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

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16
Q

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

A

Interferon beta 1-a and 1-b

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17
Q

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

A

30%

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18
Q

What are adverse effects of interferon

A

flu-like syndromes, injection site reactions, maybe depression

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19
Q

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

A

Copaxone

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20
Q

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

A

30%

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21
Q

What are adverse effects of Copaxone

A

injection site reactions, immediate of transient post injection reactions

22
Q

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

A

Natalizumab

23
Q

What is the efficacy of Natalizumab

A

68% (best efficacy)

24
Q

What is the Black Box Warning of Natalizumab

A

increase risk of developing Progressive Multifocal Leukoencephalopathy (PML)

25
Q

What causes PML

A

JC virus

26
Q

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

A

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

27
Q

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

A

Fingolimod( Gilenya)

28
Q

What is the efficacy for Fingolimod

A

54%

29
Q

What is the formation for Fingolimod

A

.5mg capsule

30
Q

In What patients is fingolimod contraindicated

A

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

31
Q

What happens in patients who do not handle fingolimod correctly

A

Severe bradycardia

32
Q

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

A

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

33
Q

What must be monitored when taking Fingolimod

A

CBC, LFTs, and HR

34
Q

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

A

Teriflunomide

35
Q

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

A

Tecfidera (Dimethyl Fumarate)

36
Q

what is the efficacy of Tecfidera

A

53%

37
Q

What are significant side effects of Tecfidera

A

GI problems, PML with lymphocyte counts less than 500

38
Q

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

A

Ocrelizumab

39
Q

What is the efficacy of Ocrelizumab

A

47%

40
Q

What must be monitored for when a patient is taking Ocrelizumab

A

Hepatitis B reactivation

41
Q

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

A

Alemtuzumab

42
Q

What is the efficacy of Alemtuzumab

A

49 to 55%

43
Q

What is the Black Box warning of Alemtuzumab

A

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

44
Q

What medications have the lowest efficacy

A

interferons, copaxone, Teriflunomide

45
Q

What medications have moderate to good efficacy

A

Tecfidera, fingolimid, Ocrevus

46
Q

What medications have high efficacy but pose significant risks

A

Natalizumab, Alemtuzumab

47
Q

What medications are injectable

A

Interferons and Copxone

48
Q

Which medications are Oral

A

Tecifidera , Fingolimid, Teriflunomide

49
Q

Which medications are IV

A

Ocrevus, Natalizumab, and Alemtuzumab

50
Q

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

A

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

51
Q

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

A

Ocrelizumab (Ocrevus)

52
Q

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

A

teriflunomide, copaxone, fingolimod

Phar 504 (34 decks)

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