DSA 36 Drugs for Multiple Sclerosis

Question 1

which drug is usually used to stop MS attacks in progress?

Answer 1

high dose corticosteroids

Question 2

what is the action of corticosteroids on phospholipase A2 (PLA2) and what is the result?

Answer 2

corticosteroids block PLA2 → decreased leukotriene and prostaglandin formation

Question 3

what is the treatment of choice for an acute MS attack?

Answer 3

3-5 day cource of high dose IV steroids

Question 4

fill in the blank: do not use _______ antagonists in MS.

Answer 4

TNF

Question 5

what are untoward effects of dimethyl fumarate?

Answer 5

some GI distress, some allergy phenomena, depression of circulating lymphocytes

Question 6

which disease-modifying drugs are orally active?

Answer 6

fingolimod, teriflunomide, and dimethyl fumarate

Question 7

which drugs have flu-like syndrome (fever, myalgias) as a side effect?

Answer 7

beta interferons, fingolimod, teriflunomide

Question 8

what might occur during treatment of MS with beta interferons?

Answer 8

development of neurtralizing antibodies to beta interferon (Nab), particular to interferon beta-1b drugs

Question 9

what is the effect of Nab with beta interferon treatment?

Answer 9

antibody production is associated with higher rates of MRI lesions

Question 10

which drug mimics myelin basic protein?

Answer 10

glatiramer

Question 11

what are some transient reactions seen with glatiramer treatment?

Answer 11

flushing, chest pain, dyspnea, urticaria

Question 12

identify: sphingosine-1-receptor modulator.

Answer 12

fingolimod

Question 13

what are common untoward effects of fingolimod?

Answer 13

influenza type syndrome, headache, diarrhea, elevated AST/ALT, cough

Question 14

what are concerning side effects of fingolimod?

Answer 14

shortness of breath and bradycardia, macular swelling with optic neuritis syndrome

Question 15

what is the mechanism of action of teriflunomide?

Answer 15

reversibly inhibits dihydroorotate dehydrogenase → reduces T cell and B cell proliferation/function

Question 16

identify: drug reported as having hemophagocytic syndrome as side effect.

Answer 16

fingolimod

Question 17

what is mechanism of action of natilizumab?

Answer 17

monoclonal antibody that reduces movement of immune cells into CNS, traps them in spleen and lymph nodes

Question 18

identify: drug treatment related to increased incidence of progressive multifocal leukoencephalopathy in patients with previous infection of JC virus.

Answer 18

natilizumab

Question 19

what is the mechanism of action of mitoxantrone?

Answer 19

intercalates with DNA and RNA → inhibits topoisomerase II → reduces activity of T cells, B cells, and macrophages

Question 20

what are the black box warnings for mitoxantrone?

Answer 20

cardiotoxicity (including heart failure) and acute myelogenous leukemia

Question 21

identify: this drug is prohibited from being given to patients with ejection fraciton less than 50% or with significant cardiac disease.

Answer 21

mitoxantrone

Question 22

what is the mechanism of action of natalizumab?

Answer 22

blocks entry of immune cells into the CNS. traps cells in the spleen

Question 23

what is a rare but deadly side effect of natalizumab?

Answer 23

progressive multifocal leukoencephalopathy

Question 24

what risk factor most determines the likelihood of developing PML when taking natalizumab?

Answer 24

antibody titer against JC virus.

another risk factor is recent history of immunosuppressant therapy.

Question 25

what should you monitor in patient taking dimethyl fumarate?

Answer 25

leukopenia

Question 26

interferon beta intereferes predominantly with?

Answer 26

virus replication

Question 27

what is expected outcome concerning relapses with infliximab?

Answer 27

increase number of attacks, increase severity of attacks

Question 28

patient presents with remitting MS. what is reasonable expectation of interferon beta 1a therapy?

Answer 28

reduced number of attacks per year

Question 29

with beta interferon therapy, shortly after every treatment patient is most likely to experience?

Answer 29

flu-like syndrome

Question 30

patient less likely to experience what side effect if taken interferon beta 1a instead of interferon beta 1b?

Answer 30

production of neutralizing antibodies

Question 31

patient on MS therapy experiences significant relapse including loss of vision in right eye. proper therapy is to add?

Answer 31

corticosteroid (e.g. methylprednisone)--all flares of MS have to be brought under control as quickly as possible

Question 32

patient switched to fingolimod. initial dose of this drug must be monitored carefully because it causes?

Answer 32

bradycardia

Question 33

what agent might be substituted over interferon beta 1a that has advantage of modifying disease without causing production of neutralizing antibodies?

Answer 33

glatiramer

Question 34

what are typical side effects of glatiramer?

Answer 34

injection site reaction, flush, tachycardia, dyspnea

Question 35

mitoxantrone is effective in multiple sclerosis because it?

Answer 35

intercalates with DNA → slows B cell and T cell formation

Question 36

what coexisting disease would contraindicate mitoxantrone treatment?

Answer 36

systolic heart failure