Exam 3 - Ott (MS) Flashcards

1
Q
Route of Admin? 
Interferon B1a (Avonex)
A

IM once weekly

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2
Q
Route of Admin?
Interferon B1a (Rebif)
A

SQ 3 x week

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3
Q
Route of Admin?
Interferon B1b (Betaseron, Extavia)
A

SQ QOD

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4
Q
Route of Admin?
Peginterferon B1a (Plegridy)
A

SQ q 14 days

needs titration!!

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5
Q

Route of Admin?

Glatiramer (Copaxone)

A

SQ QD

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6
Q

Route of Admin?

Fingolimod (Gilenya)

A

PO QD

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7
Q

Route of Admin?

Teriflunomide

A

PO QD

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8
Q
Route of Admin?
Dimethyl Fumarate (Tecfidera)
A

PO BID

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9
Q

Route of Admin?

Natalizumab

A

IV q 4 weeks

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10
Q

Route of Admin?

Mitoxantrone

A

IV q 3 mos

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11
Q

Route of Admin?

Alemtuzumab

A

IV infusion over 4 hours
1st course x 5 days
2nd course x3 days (given 1 yr after first course)

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12
Q

Route of Admin?

Daclizumab

A

SQ once monthly

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13
Q

Route of Admin?

Ocrelizumab

A

IV at least 3.5 hours q 6 months

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14
Q

which MS drug should be premedicated with corticosteroids

A

alemtuzumab (lemtrada) done for 1st days of each course
also…
ocrelizumab

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15
Q

which MS drug is Pregnancy X/Contraindicated in pregnancy

A

Teriflunomide (Aubagio)

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16
Q

which MS drugs are given IM

A

interferon B1a (Avonex)

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17
Q

which MS drugs are given SQ

A
Interferon B1a (Rebif)
Interferon B1b (Betaseron, Extavia)
Peginterferon B1a (Plegridy)
Glatiramer Acetate (Copaxone)
Daclizumab (Zinbryta)
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18
Q

which MS drugs are given orally

A

Fingolimd (Gilenya)
Teriflunomide (Aubagio)
Dimethyl Fumarate (Tecfidera)

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19
Q

which MS drugs are given IV

A

Natalizumab (Tysabri)
Mitoxantrone (Novantrone)
Alemtuzumab (Lemtrada)
Ocrelizumab (Ocrevus)

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20
Q

which drug has AV block as a risk

A

Fingolimod (Gilenya)

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21
Q

what is measured in MS drug clinical trials to measure impact/efficacy

A

EDSS - expanded disability status scale

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22
Q

EDSS:

what would 0 mean? and what would 10 mean?

A
0  = normal neurological examiniation
10 = death from MS
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23
Q

in RRMS, progression ot SPMS is about _____ years

A

20 - 25

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24
Q

what type of MS typically starts in pts over 50 y.o

A

PPMS (primary progressive)

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25
what is the most common MS type
RRMS
26
treating acute MS attacks: | __________ treatment is first choice
high dose corticosteroid
27
treating acute MS attacks: | Methylprednisolone dosing?
500 mg - 1000 mg IV daily x 3 - 7 days | w/ or w/out oral taper over 1 - 3 weeks
28
treating acute MS attacks: | if pt is output -- use what drug and how to dose it?
use oral prednisone! 1250 mg every OTHER day x 5 days (No need to taper!)
29
what drug is used for treatment resistant MS?
Alemtuzumab (Lemtrada)
30
Disease Modifying Therapies for MS: | what drugs are second line
Natalizumab (Tysabri) and Mitoxantrone (Novantrone)
31
Disease Modifying Therapies for MS: | what drugs are first line
the interferon drugs (B1a and B1b) Glatiramer Fingolimod
32
Disease Modifying Therapies for MS: | what drugs are first line (but newer drugs too)
teriflunomide Dimethyl fumurate Daclizumab
33
what drug is the only drug approved for PPMS
Ocrelizumab | can be used in RRMS tho*
34
which drug has to have 2 hour monitoring post administration? and why?
alemtuzumab - b/c life threatening allergic rxn possible/anaphylaxis
35
what are ways to decrease injection site reactions from MS drugs
apply warm compress or ice (before/after injection) warm medication to room temp ensure needle completely penetrates the skin during injection
36
how to reduce flu-like symptoms that come from interferon injections?
do right before bed | take OTC med to alleviate symptoms (tylenol and benadryl)
37
what are possible post- injection site reactions
facial flushing chest tightness/dyspnea palpitations/tachycardia anxiety
38
what is PML/ why does it happen?
a serious adverse event --- caused by reactivation of dormant JCV
39
what drugs are associated with PML
Natalizumab - black box warning) | recent report w/ fingolimod and dimethyl fumurate
40
Sxs of PML
``` neurobehavioral, motor, language, and cognitive changes seizures vision changes tremor hemiparesis ```
41
what is pseduobulbar effect
frequent/inappropriate episodes of crying/laughin
42
what drug is used for pseduobulbar effect
Neudexta (dextromethorphan and quinidine)
43
explain the mechanism of Neudexta (how do the two drugs in it related to each other..)
DM -- is an agonist for sigma-I receptors --- will suppress excitatory neruotransmitters DM --> Dextrophan in the periphery (not good bc DM needs to get through blood brain barrier --- cant do that as dextrophan) Quinidine used as P450 2D6 inhibitor to block conversion of DM --> Dextrophan (lets DM get to CNS!!!)
44
what MS drug has to have the first done at a clinic due to decreased HR or AV block
fingolimod
45
which MS drug is assoc. with cardiomyopathy, reduced LVEF, and irreversible CHF
Mitoxantrone
46
which MS drug is contraindicated if Hx of autoimmune hepatitis/hepatic impairment
Daclizumab
47
what MS drugs have increased risk of malignancies
Alemtuzumab (why for tx resistant MS) and Ocrelizumab
48
which drug is contraindicated in HIV infection and why?
Alemtuzumab (will decrease CD4 counts)
49
what drug can be used to help with gait abnormalities
Dalfampridine (Ampyra)
50
Side Effects of Dalfampridine --- depend on if ______
if its ER vs IR.... (they have diff ADE profiles)
51
Dalfampridine ADEs: ER ---- vs IR -----
ER: UTIs, Insomnia, Dizziness, HA, nausea IR: Seizures (CONTRAINDICATED in pts w/ hx of seizures)
52
Pregnancy and MS: | What drug is Category X
Teriflunomide
53
Pregnancy and MS: | which drug is category D
Mitoxantrone
54
Pregnancy and MS: | what drug has to be stopped 2 years before pregnancy
Teriflunomide | use activated charcoal to get out of system faster
55
Pregnancy and MS: | what drug has to be stopped at least 2 months before conception
Fingolimid | b/c half life is ~ 10 days
56
Ott Chart: | Interferon ADEs?
``` Flu Like Reactions Injection Site Reactions Depression Worsening of CHF (preexisting) Hepatotoxicty Thyroid Dysfunction Psychosis Seizures Thrombotic Microangiopathy ```
57
Ott Chart: | Interferon monitoring?
``` CBC LFTs LVEF Thyroid Depression/Mental State Cirrhosis Monitoring.. AVOID IN SEVERE DEPRESSION ```
58
Ott Chart: | Glatiramer ADEs?
``` Infection hypersensitvity chest tightness Flushing uticaria rash ```
59
Ott Chart: | Glatiramer Monitoring?
MRI Tissue Necrosis Post injection reaction (is Pregnancy Category B!)
60
Ott Chart: | Fingolimod ADEs?
``` Macular Retinal Edema AV BLOCK/BRADYCARDIA Decrease lung function HTN infections (maybe PML...test for JCV) ```
61
Ott Chart: | Fingolimod Monitoring?
Stays in system for 2 mos after stopping (Pregnancy Caution) CONTRAINDICATIONS - multiple (on diff.note card...) Must stay in clinic for 6 hours post dose Do not start in pts with active infection Avoid live attenuated vaccins during tx and 2 mos after REMS - bradycardia/AV block
62
Contraindications of Fingolimod
Recent MI/Stroke 2nd or 3rd degree AV block QT prolongation decompensated CHF
63
which drug do people have to stay in clinic for 6 hours post dose
Fingolimod
64
what is the REMS for fingolimod
Bradycardia | AV Block
65
Ott Chart: | Teriflunomide ADEs?
``` SJS liver failure neutropenia Respiratory infection Activation of TB Alopecia Neuropathy ```
66
Ott Chart: | Teriflunomide Monitoring?
Pregnancy -- CONTRAINDICATED (2 years after stopping too) do not start in pts with active infection screen for TB avoid live vaccines (TB Test, Pregnancy Test)
67
Ott Chart: | Dimethyl Fumurate ADEs
``` Flushing rash pruritis diarrhea increase LFTs Lymphocytopenia infections ```
68
Ott Chart: | Dimethyl Fumurate Monitoring?
if serious infection --- hold drug take with food decrease incidence of flushing monitor CBC and LFTs
69
what drug should be taken with food to decrease incidence of flushing
dimethyl fumurate
70
Ott Chart: | Natalizumab ADEs?
PML | Depression
71
Ott Chart: | Natalizumab Monitoring?
``` MONOTHERAPY ONLY Test for JCV Abs Washout period: 14 days for Interferon or Glatiramer and 6 mos for Mitoxantrone Risk of IRIS due to d/cing due to PML REMS --- limited availability ```
72
what drug has risk of IRIS (Immune reconstitution inflammatory syndrome) and why?
Natalizumab --- risk happens with you discontinue the drug because PML happened
73
Ott Chart: | Mitoxantrone ADEs?
Bone marrow suppression neutrophenia cardiotoxicity (decrease LVEF/irrever. CHF/cardiomyopathy) Acute Leukemia
74
Ott Chart: | Mitoxantrone Monitoring?
Pregnancy Test before each infusion for lifetime dose: do NOT exceed 140 mg/m^2 (Monitor: LVEF, CBC, EKG, LFTs)
75
what drug can not exceed 140 mg/m^2 in a lifetime
Mitoxantrone
76
Mitoxantrone can't surpass _______ as a lifetime dose
140 mg/m^2
77
which drug has PML monitoring but no need for JCV testing
Ocrelizumab
78
which drug needs Heb B screen before the first dose
ocrelizumab
79
what drug needs an antiviral agent for herpetic prophylaxis starting on day 1 of dosing then do for at least 2 mos once treatment is done?
Alemtuzumab
80
which drug causes bone marrow suppression
mitoxantrone
81
which drugs should have LVEF monitored
mitoxantrone | Interferons
82
which drugs need thyroid monitoring
interferons; Alemtuzumab
83
which drugs have REMS?
fingolimod Natalizumab Alemtuzumab Daclizumab
84
which drugs should you avoid live vaccines with
``` Alemtuzumab daclizumab ocrelizumab fingolimod teriflunomide ```
85
which drug needs a washout period between certain drugs
natalizumab
86
For Natalizumab: | Wash-Out Period for what drugs and how long?
14 days for GLATIRAMER or INTERFERON | 6mos for Mitoxantrone
87
Ott Chart: | what are the ADEs of Daclizumab
``` diaphoresis shivering/flu like symptoms skin reactions mouth ulcers seizures loss of appetite/mood changes N/V ```
88
what drug has a CI of AST/ALTs 2x normal limit
daclizumab