Therapeutics - Multiple Sclerosis Flashcards
multiple sclerosis is a _______ disease of the CNS
demyelinating
true or false
women and men are affected equally by MS
false - women more than men
true or false
the age of onset for MS is old
FALSE - young
20-30ish
true or false
MS DOES affect life expectancy
true
cause of MS
not really known
potentially low levels of vitamin D – immune system stimulates MS (infection)
may be genetic, increased risk in smokers…
the first MS attack is called what
CIS — clinically isolated syndrome
most common clinical pattern of MS
RRMS
relapsing-remitting MS
in which stage of MS are drugs MOST EFFECTIVE
relapsing-remitting MS
20% of relapsing-remitting MS goes on to….
secondary progressive MS (SPMS)
disease progression with our without relapses
what is primary progressive MS
are drugs effective in this stage?
rare – the disease just keeps getting worse right from the beginning
only one drug has been shown to be effective in this stage
diagnosis criteria for MS
2 attacks + MRI
the 2 attacks must be separated by over a month, and also be in different areas of the CNS
the attacks must last at least 24 hours
there must be no other explanation for these attacks!! (ie - brain tumor, stroke, etc)
what is the most sensitive, non-invasive way of imaging the brain and spinal cord and is the preferred method to DIAGNOSE MS?
MRI
what to look for in an MRI to diagnose MS
look for plaques
initial MS symptoms
difficulty walking, fatigue, pain, abnormal sensations (pins and needles)
differentiate between primary, secondary, and tertiary MS symptoms
primary - direct result of dymyelination
secondary - complications BC OF the primary symptoms
tertiary - social/psychological complications
is depression a primary secondary or tertiary MS symptom
may be considered all 3
true or false
treatment for MS is not very effective
false - it is pretty effective, just very expensive
true or false
treatment options for MS are VERY individual-based
true
***she will not ask us to choose a med on the test!
dont really have to mem what is used when
the med options for MS are divided into:
highly effective
moderately effective
modestly effective
explain what should be used first, and when treatment should be switched
start with a highly effective agent
switch if there’s a suboptimal response, more than 1 relapse, OR toxicity/safety issue
how are the interferons administered
SUBQ or IM - patients can give to themselves
when are interferons contraindicated
in severe depression – bc an AE is depression
name some side effects of interferons
injection site reactions
flu-like symptoms
depression
high LFT
patient education for interferons
take ibuprofen or tylenol before injection and every 4 hours prn to lessen flu like symptoms
take at night to “sleep off” any symptoms
rotate injection site
bring syringe to body temp before injecting
use ice to minimize pain at the sight
*true or false
glatiramer acetate can be used in pregnancy
true
place in therapy for glatiramer acetate
RRMS
how often is glatiramer acetate dosed
either qd or 3 times a week
boxed warning glatiramer
anaphyalxis risk - even if you’ve been taking for a long time!! can happen any time
route administration dimethyl fumurate
PO
approved as first line for RRMS
dimethyl fumurate
side effects dimethyl fumarate
rash, flushing, liver injury
pretty well tolerated
____ has the same active metabolite as dimethyl fumurate
diroximel
the active metabolite is monomethyl fumarate
____ can cause flushing
what may be used to prevent?
diroximel
pretreat with 325mg aspirin (NOT EC) 30 mins prior
abbreviation for the sphingosine 1-phosphate receptor modulators
mods
how are the mods administered
orally
***mods concern
bradycardia!!!!!!!!!! monitor for 4-6 hours after the 1st dose in the office
which mod should not be used within 6 months of a heart attack or stroke
ponesimod
the mods are indicated for what
relapsing MS
which mod’s dose depends on the genotype
siponimod
**true or false
teriflunomide can be used in pregnancy
FALSE - cannot
hepatotoxic and teratogen
teriflunomide boxed warning
hepatotoxicity and teratogenicity
*only monoclonal (or really any MS drug) approved for PPMS (primary progressive MS)
ocrelizumab (ocrevus)
ADRs of the monoclonals used for MS
infusion reactions
infections
autoimmunity
malginancies
READ THE BOXED WARNINGS FOR EACH DRUG!
As mentioned, an ADR of the monoclonals for MS is infusion reactions
how can this be prevented
pre-treat with antihistamines and acetaminophen
which monoclonal is barely ever used due to PML and hepatotoxicity
natalizumab
however, we do have a test now to identify pts at risk of PML, but still not really ever used
which monoclonal for MS decreases new white matter lesions
ocrelizumab (ocrevus)
there is a new subq formulation of ocrelizumab combined with _____
hyaluronidase
this helps the drug go to the tissues better
__ is only given to pts who have not responded to or cant tolerate other therapies
cladibrine
BBW cladibrine
route of administration?
increased risk of malignancy and fetal death (no pregnancy)
given orally
the use of corticosteroids for MS is established in….
explain the regimen
RELAPSES
high dose methylprednisolone (0.5-1 g IV QD) for 3-5 days
PROPHYLACTIC USE IS NOT ESTABLISHED! (oral low dose, IV high dose_
name of the drug that is approved to improve walking in MS patients
is it disease modifying?
what is the class?
dalfampridine (ampyra)
potassium channel blocker, not disease modifying - just improves symptoms
ADR dalfampridine
what do you do if it occurs?
seizures
dose-dependent tho..if seizure occurs, discontine and dont reiniaate
true or false
is a patient is on dalfampridine, they are not on anything else for MS
FALSE
usually on another drug too
what other drugs may be used for MS
immunosuppressants like methotrexate, azathioprine, IV immunoglobulin, mycophenolate, cyclophosphamide, etc
MS patient has bladder frequency/urgency
what can they use
anticholinergics
botox
myrbetriq
MS patient has tremors
what can they use (2 options)
primidone
propranolol
MS patient has neuropathic pain
what can they use (3 options)
gabapentin
duloxetine
carbamazepine
3 things that can help with fatigue from MS
modafanil
armodafanil
amantadine
2 drugs that can be used for sleep disturbances caused by MS (RLS)
gabapentin
pramipexole
drug that can be used for uncontrollable laughter or crying caused by MS
dextromethorphan + quinidine
patients with MS tend to have ___ deficiency
vitamin D
supplement with vitamin D!
true or false
it is not important to find out the CAM therapies that MS patients are on
FALSE - it is
may interact with other meds
