Autoimmune Conditions: MS

Question 1

MS is a chronic progressive autoimmune disease in which the patient’s immune system attacks the:

Answer 1

myelin sheath – the fatty substance that surrounds and insulates nerve fibers of the brain and spinal cord axons

*electrical impulses will dwindle

Question 2

How do MS patients present in the early stages?

Answer 2

fatigue

weakness

tingling

numbness

burred vision

Question 3

Clinical presentation as MS progresses?

Answer 3

deterioration of cognitive function, visual disturbances

muscle spasms

pain

incontinence

gait instability

*worse in males :)

Question 4

What test is performed to make a diagnosis?

Answer 4

MRI, spinal fluid analysis, evoked proteins

Question 5

What is the primary goal of therapy?

Answer 5

prevention of disease progression - medications are used to modify disease, treat relapses and manage symptoms

what is lost in neuronal function cannot be regained

Question 6

a chemotherapeutic agent approved for MS

Answer 6

mitoxantrone

Question 7

What meds are used to help with relapses?

Answer 7

steroids

corticotropin - SC, IM x 2-3 weeks

Question 8

What parenteral drugs are the mainstay of treatment for patients with relapsing forms of MS

Answer 8

interferon beta formulations –> Betaseron, Avonex, Rebif, Extavia, Plegridy

glatiramer acetate –> Copaxone, Glatopa

Question 9

What is the name of the PEGYLATED interferon beta? how is it dosed?

Answer 9

Plegridy

every 14 days

Question 10

How is medication supplied/dispensed

Answer 10

single-dose profiled syringe & needles are provided

Question 11

Some of the powders reconstituted contain what?

Answer 11

albumin

Question 12

Brand: Copaxone

Answer 12

generic: glatiramer acetate

Question 13

an immune modulator thought to induce and activate t lymphocyte suppressor cells in relapsing forms of MS // MOA not really defined

Answer 13

glatiamer acetate

Question 14

This drug is dosed: SC daily, or SC 3x per week (48 hours between)

Warnings: chest pain

side effects: flushing, diaphoresis, dyspnea

Answer 14

glatiamer acetate

Question 15

What is the drug of choice in pregnancy for MS?

Answer 15

glatiamer acetate

Question 16

this drug alters the expression and response to surface antigens, enhancing immune cell function /// MOA not really defined

Answer 16

interferon beta products

Question 17

generic: interferon beta-1a

Answer 17

Brand: Avonex, Rebif

Question 18

How is Avonex dosed?

Answer 18

IM weekly

Question 19

How is Rebif dosed?

Answer 19

SC three times per week/ 48 hours apart

Question 20

generic: interferon beta-1b

Answer 20

Brand: Betaseron, Extavia

Question 21

How is Betaseron dosed?

Answer 21

every other day

Question 22

Which drug is dosed every 14 days?

Answer 22

Plegridy

Question 23

This drug class has warnings for psychiatric disorders, injection site necrosis, increased LFTs, thyroid dysfunction (hypo and hyper)

side effects: flu like symptoms

Answer 23

Interferon beta products

Question 24

Do yu want to expel the air bubble in profiled syringes?

Answer 24

no!!!!!!!

Question 25

teriflunomide fingolimod dimethyl fumarate diroximal fumarate siponimod What drug class?

Answer 25

Oral immunomodulators

Question 26

Brand: Aubagio

Answer 26

teriflunomide

Question 27

Brand: Gilenya

Answer 27

fingolimod

Question 28

Which of the oral immunomodulators are contraindicated in pregnancy?

Answer 28

teiflunomide

Question 29

Which of the oral immunomodulators cause bradycardia and needs to be monitored for at least 6 hours; contraindicated in those with CVD/stroke use caution with drugs that cause slow HR MS can become much worse when stopped

Answer 29

fingolimod

Question 30

What drug can cause macular edema and needs to be monitored with eye exams. Also need to monitor LFTs and CBC

Answer 30

fingolimod & siponimod

Question 31

Which oral immunomodulator should not be crushed, but chewed and sprinkled on food

Answer 31

dimethyl fumarate diroximal fumarate

Question 32

Which oral immunomodulator is contraindicated with CYP2c9*3/*3 genotype?

Answer 32

siponimod

Question 33

What is the name of the drug that is a potassium channel blocker and works by increasing nerve signal conduction; indicated to improve WALKING

Answer 33

dalfampridine/ Amprya

Question 34

Brand: natalizumab

Answer 34

generic: Tysabri

Question 35

This MAb has a boxed warning for PML and has REMS

Answer 35

natalizumab

Question 36

Alemtuzumab Ocrelizumab drug class?

Answer 36

recombinant humanized MAb *REMS

Question 37

The oral anti-neoplastic

Answer 37

cladribine/ Mavenclad

Question 38

What drugs are used for MS symptom control?

Answer 38

anticholinergics for incontinence, laxatives for constipation, muscle relaxants, analgesics propranolol can help with hand tremor

Question 39

Drugs used for symptom control can...

Answer 39

worsen other symptoms :(