Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PDAT4 > 32/33 - MS > Flashcards

32/33 - MS Flashcards

1
Q

Diagnosis of MS

A

McDonald Criteria
Clinical Attacts + MRI Results

Demonstration of
MS Lesions seperated in TIME & SPACE
Dissemination in Time & Space = DIT & DIS

Occurance of:
> 2 Seperate Neurological Events
representing:
Different sites of dmg in CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Definition of an

MS RELAPSE

A

New** or **Worsening
of previous symptoms lasting >24 hours

Has to be:
Seperated
from the previous relapse by >30 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is CIS?

A

Clinically Isolated Syndrome = CIS

First Clinical Episode
early neurological episode consistant w/ demyelinating process
must last >24 hours

does not completely fulfill diagnostic criteria

May or may NOT go on to develop MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is

RRMS

A

Relapsing / Remitting MS
85% of MS cases @ onset

Characterised by:
Acute Relapses
VVV
followed by periods of COMPLETE or PARTIAL remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is

SPMS

A

Secondary Progressive MS

ALWAYS BEGINS AS RRMS
most patients will progress to SPMS

Progressive Worsening of Neurological functioning over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is

PPMS?

A
  • *PRIMARY progressive MS**
  • typically do NOT experience RRMS*

15% of cases

Worsening of neurological symptroms
FROM ONSET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute Relapse Treatment for MS

Medication / Dose / Effect

A

METHYLPREDNISOLONE
500 - 1000 mg/d for 3-5 days
↓lymphocytes, ↓inflammation, ↓edema

no effect on disease progression
but better to start SOONER than later

Shortens Duration & Severity of attacks/relapses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

INF-Beta

ARR% - Indications - MoA

A

30%

RRMS & CIS

Reduces inflammation by:

  • inhibiting T-cell*
  • *​Activation / Proliferation / migration into CNS**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ADR’s & Monitoring

INF-Betas

Rebif / Plegridy / Avonex

Betaseron / Extavia

A

Flu-Like Symptoms** + **Injection Site Reactions
use NSAIDS / Tylenol prior to injection
Depression

ELEVATED LFTS
need to monitor 1/3/6months

decreased RBC
cbc 1/3/6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AVONEX

Drug Class / Admin

A

INF-beta
for MS - 30%
LFT / CBC

  • *Weekly IM injection**
  • Flu-like symptoms + inj site reactions + depression*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PLEGRIDY

Drug Class / Admin

A

INF-beta
for MS - 30%
LFT / CBC

  • *SUBQ** - q14days
  • Flu-like symptoms + inj site reactions + depression*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Beteseron / Extavia

Drug Class / Admin

A

Betaseron = Extavia
SAME DRUG - different maufacturer

INF-beta
for MS - 30%
LFT / CBC

  • *SUBQ -> QOD**
  • Flu-like symptoms + inj site reactions + depression*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rebif

Drug Class / Admin

A

INF-beta
for MS - 30%
LFT / CBC

  • *SUBQ** - TIW
  • *two titration schedules** due to ADRs
  • Flu-like symptoms + inj site reactions + depression*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which DMT for MS

is administered IM?

A

AVONEX

INF-beta
for MS - 30%
LFT / CBC

Weekly IM injection
Flu-like symptoms + inj site reactions + depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which MS drugs require
LFTs?

A

“LFT = LE F-I-T”

Fingolimod

INF-Betas
Rebif / Plegridy / Avonex / Betaseron = Extavia

Teriflunomide = Aubagio
BBW -> severe liver injury

Daclizumab
BBW for hepatic injury –> REMOVED from market

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Copaxone = Glatiramer Acetate

ARR% - Indications - MoA​

A

30%

CIS - RRMS

Synthetic Polypeptide mimicking myelin basic protein (MBP)
inhibits antigen presentation & T-cell Activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which MS drug is recommended for

WOMEN looking to get PREGNANT?

A

COPAXONE
Glatiramer Acetate
30%

18
Q

ADRs & Monitoring

Copaxone
Glatiramer Acetate

A

LIPOATROPHY
@ injection site –> loss of SUBq fat

  • *Injection Site Reactions**
  • *SUBQ**
  • *Transient Post-Injection Reactions**
  • flushing / chest tightness / palpitation / anxiety*

ONLY PREGNANCY CLASS B DMT for MS

19
Q

Natalizuab
Tysabri

ARR% - Indications - MoA

A

68%
HIGHEST EFFICACY, typically last line

RRMS
Patients with poor response / failed alt therapies
IV Infusions Every Month

Humanized MAB
binds a4 subunit of integrin on surface of lymphocytes
prevents entry into CNS

20
Q

ADRs & Monitoring

Natalizumab
Tysabri

A

BBW - PML
demyelinating disease affecting CNS in IMS pts
TOUCH PROGRAM
3 Risk Factors
>2 years treatment + JCV ABs + Prior IMS therapy

Opportunistic Viral infection (by JC virus)
Death or Severe Disability

21
Q

What are RISK FACTORS for PML

when starting Natalizumab?

A
  • *Duration of Treatment**
  • *> 2 years**

+ JCV Antibodies

Prior IMS therapy
AZA - MTX

if any of these factors –> HUGE RISK for PML

22
Q

Which MS drugs have risk for

PML?

A

PML -> T-N-F
Tecfidera - Natalizumab - Fingolimod

Dimethyl Fumarate = Tecfidera

Natalizumab
BBW - Touch program

Fingolimod

23
Q

Fingolimod
Gilenya

ARR% - Indications - MoA​

A

54%

  • *RRMS**
  • *ORAL DAILY CAPSULE**
  • *S1P inhibitor**
  • *redues migration of peripheral lymphocyes –>CNS**
24
Q

Which MS drug is:

CONTRAINDICATED WITH CV ISSUES?

A

FINGOLIMOD
Oral - 54%

MI - Unstable Angina - Stroke - HF
within 6 months

2nd / 3rd degree AV block

Class 1 / 3 Antiarrythmatic Drugs

Qtc interval > 500

25
**ADRs** **FINGOLIMOD**
* *_PML REPORTED_** * *Leukopenia + Lymphocytopenia** * *_First dose BRADYcardia_** * *Contraindicated for CV patients** * *_Bronchitis_** * mild reduction in* **Lung FXN** Risk of **_HERPES viral infection_** check VZ igG Ab **HT / Edema** **2 Month elimination --\> wait for pregnancy**
26
**Monitoring for** **FINGOLIMOD**
* *_Initial Monitoring Procedures_** * (_MUST BE REPEATED IF TREATMENT IS INTERRUPTED_**_)_*** * *CBC + LFT** * *Opthalmolgy Exam +** **VZ IgG Titer** ( Herpes ) * *EKG Baseline** **_First Dose Admin Monitoring_** **VS + Hourly BP/HR** for 6 hours **Post-Dose EKG** Opthalmic exam + CBC + LFT _Repeat 1 Initial Monitoring if... After Medication Initiation:_ * *_\>_ 1 day during the first 2 weeks** * *\> 7 days during weeks 3-4** * *\> 14 days after _\>_ 1 month**
27
**Teriflunomide** Aubagio ## Footnote **ARR% - Indications - MoA​**
**_30%_** * *RRMS** * *7 & 14 mg Tablet QD** **_ORAL_** * reduction is ONLY seen with 1**4mg/day*** *MoA is not well known*
28
**Which MS drugs have** **~30% ARR**? Reduction in Annualized Relapse Rate
**_INF-beta_** LFT / CBC / Depression **_Copaxone_** SC - Glatiramer Acetate - Pregnancy Cat B **_Teriflunomide = Aubagio_** Oral / BBW - LFT / Enterohepatic recycling
29
**Which MS drugs have** **intermediate (47-54%) ARR**? Reduction in Annualized Relapse Rate
* *_Tecfidera = Dimethyl Fumurate_** * *53%** - **ORAL - PML** **_Fingolimod = Gilenya_** **54% - ORAL - PML** contraindicated in CV patients & lot of monitoring **_Ocrelizumab = Ocrevus_** **47%** - only drug for **PPMS IV**+ needs**HEP B**
30
**Which MS drugs have** **HIGH EFFICACY** but pose **Significant Risks?**
**_Natalizumab = Tysabri_** **68% - HIGHEST ARR** But has **TOUCH - BBW for PML** **_Alemtuzumab_** **49-55% -** **BBW** - cause many issues Skin Exam / TSH / MALIGNANCIES Autoimmune disease / Infusion reaction
31
**ADRs** & **Monitoring** ## Footnote **Teriflunomide = Aubagio**
"**TERRIBLE = TERiflunomide"** * *_Severe Liver Injury = BBW_** * *LFTs** * *_Enterohepatic Recycling_** * *Pregnancy Category X --\> need to treat for pregnancy** **_TB INFECTION_** **Renal Fxn + CBC + BP** _Other ADRs:_ **ALOPECIA + GI ISSUES + Leukopenia & Lymphopenia**
32
**Which MS drug requires a** **TB TEST**
**_TERIFLUNOMIDE_** Aubagio **TB Test - CBC - Renal Fxn - BP** **BBW --\> LFT** **Pregnancy Cat X - Enterophpatic Recycling** Other ADR: **Alopecia / GI issues / Leukopenia**
33
**Dimethyl Fumarate = Tecfidera** **ARR% - Indications - MoA​**
**_53%_** * *RRMS** * *_Oral_ --\> 120 BID f7d --\> 240mg BID** *exact MoA is not known*
34
**ADR & Monitoring** **Dimethyl Fumarate = Tecfidera**
_has the *LEAST* ADR_ **Flushing - GI Problems -** ↓**Lymphocytes** **CBC** monitoring but has: **_PML_** patients with **prolong lymphopenia ( \<500 lymph count ) \> 6 months**
35
**Which MS drug is indicated for:** **_PRIMARY PROGRESSIVE MS_**
**_Ocrelizumab = Ocrevus_** **47%** **RRMS + PPMS _IV Administration_** MoA: **humanized MAB --\> binds CD20 on B-lymphocytes**
36
**Which DMT for MS requires** **_HEPATITIS B_** **Screening?**
**_OCRELIZUMAB_** CD20 - works on PPPMS **_HEPATITIS B_** need to screen for HBV b4 starting **_Significant Infusion RXNs_** premedicate with **MPD + APAP + Antihistamine** **IV administration**
37
**Alemtuzumab** = Lemtrada ## Footnote **ARR% - Indications - MoA​**
**_49-55%_** * *RRMS** * *2+ Inadequate Responses to OTHER DMTs** * *Only 2 IV infusions in lifetime** MoA: **MAB --\> CD52** on T + B lymphocytes + monocytes + nK cells
38
**Which DMT drug requires** **TSH Test?** **Thyroid Cancer / Malignancies**
**_ALEMTUZUMAB_** CD52 * *_BBW_** * *autoimmune disease** = immune thrombocytopenia * *infusion rxns** = serious & life threatening * *MALIGNANCIES** + **srs infections** _Monitoring_ **CBC + SCr + UA TSH / Skin Exam**
39
**What MS drugs are** **ORAL?**
**"Oral - DTF"** **_Dimethyl Fumarate = Tecfidera_** **_Teriflunomide = Aubagio_** **_Fingolimod = Gilenya_**
40
**What MS drugs are** **IV** intravenous
**_Ocrelizumab_** Ocrevus **_Natalizumab_** Tysabri **_Alemtuzumab_** lemtrada

PDAT4 (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions