MS

Question 1

What T helper cell is pro-inflammatory?

Answer 1

Th1 and 17

Question 2

What T helper cell is anti-inflammatory?

Answer 2

Th2

Question 3

Define MS

Answer 3

immunologic disorder marked by chronic inflammation of the CNS

Question 4

What is the key to the diagnosis of MS?

Answer 4

Dissemination of plaques in time and space

Question 5

What are the three broad treatment categories for MS?

Answer 5

1. Treatment of exacerbations-corticosteroids (anti-inflammatories)
2. Disease-modifying therapies
3. Symptomatic therapies for spasticity, bladder sx’s, sensory sx’s and fatigue

Question 6

How are first line disease-modifying therapies (DMTs) administered?

Answer 6

Self-injected

Question 7

Effects of DMTs

Answer 7

1. Decrease annual relapse rate

2. Decrease formation of new white matter lesion

Question 8

List the DMT agents

Answer 8

1. Interferon (IFN) formulations

2. Glatiramer acetate (non-IFN)

Question 9

List the 1st generation agents used for relapsing MS

Answer 9

1. Interferon-B1a (Avonex, Rebif)

2. Interferon-B1b

Question 10

List the 1st generation agents that are a Pregnancy Category C

Answer 10

1. Interferon-B1b

2. Pegylated Interferon-B1a

Question 11

List the 1st generation agents used for RRMS

Answer 11

1. Pegylated Interferon-B1a

2. Glatiramer acetate

Question 12

List the 1st generation agent that is administered as an IV infusion

Answer 12

Mitoxantrone

Question 13

Mitoxantrone indications

Answer 13

1. SPMS
2. PRMS
3. Worsening RRMS

Question 14

List the 1st generation agent that are a Pregnancy Category B

Answer 14

Glatiramer acetate

Question 15

List the 1st generation agents that are a Pregnancy Category D

Answer 15

Mitoxantrone

Question 16

Interferon-B1a ADEs

Answer 16

1. Depression

2. Flu like sx’s

Question 17

Interferon-B1b ADEs

Answer 17

Depression

Question 18

Glatiramer acetate ADEs

Answer 18

1. Chest tightness

2. Urticaria- @ any dose!

Question 19

Mitoxantrone ADEs

Answer 19

1. Cardiotoxicity

2. AML

Question 20

Natalizumab SEs

Answer 20

PML

Question 21

Natalizumab monitoring

Answer 21

JVC antibody

Question 22

Fingolimod ADEs

Answer 22

1. Macular retinal edema

2. AV block

Question 23

Teriflunomide ADEs

Answer 23

1. Steven-Johnson Syndrome
2. Liver failure
3. TB activation
4. Neutropenia
5. Alopecia

Question 24

Dimethyl fumarate ADEs

Answer 24

1. Flushing-Take with food
2. Rash/Pruritis
3. Increased LFTs
4. Albumineria
5. GI discomfort

Question 25

Alemtuzumab ADEs

Answer 25

Herpes Viral Infection

• Administer herpes viral prophylaxis starting on 1st day of Tx
• Continue for 2 months after completion of treatment OR
• until CD4 count @ 200

Question 26

List the disease modifying ORAL agents indicated for relapsing forms of MS

Answer 26

1. Natalizumab
2. Fingolimod
3. Teriflunomide
4. Dimethyl fumarate

Question 27

Alemtuzumab indications

Answer 27

RRMS

Question 28

Ocrelizumab indications

Answer 28

Relapsing or Progressive MS

Question 29

Define CIS

Answer 29

Clinically Isolated Syndrome

Frist episode of neurologic sx’s that lasts @ least 24 hrs

Question 30

what do we use to treat exacerbation sx’s?

Answer 30

Corticosteroids

Question 31

When should you initiate high dose corticosteroids (Methypredniolone, IV) with onset of sx’s? When do you start toe ee improvement of sx’s?

Answer 31

Within 2 weeks of sx onset

Improvement in 3-5 days

Question 32

Longer durations of IV methylprednisolone ADEs

Answer 32

1. Acne
2. Fungal infection
3. Mood alteration

Question 33

Short term ADEs of methylprednisolone

Answer 33

1. Metallic taste

2. Sleep disturbances

Question 34

Which medication carries a pregnancy category X rating?

Answer 34

Teriflunomide

Question 35

What labs would we monitor for adverse effects in Teriflunomide

Answer 35

1. Pregnancy test
2. LFTs
3. CBC
4. BP
5. TB tst

Question 36

IFN Beta 1a MOA

Answer 36

Alters expression and response to surface antigens enchanting immune cell activities

Question 37

IFN Beta 1b MOA

Answer 37

1. Balances the expression of pro and anti-inflammatory agents in the brain
2. Reduces number of inflammatory cells that cross the BBB

Question 38

Glatiramer acetate MOA

Answer 38

1. Mimics the antigenic properties of Myelin Basic Protein (MBP)
2. Inhibits binding of MBP t oTe-cell receptors
3. Reduces inflammation, demyelination, and axonal damage
4. Neuroprotective effect

Question 39

Which medication has an indication for CIS and RRMS?

Answer 39

Glatiramer acetate

Question 40

Three of the interferons are considered to be high potency medications. Which medication is consider a low potency medication?

Answer 40

Interferon beta 1a- brande name Avonex

Question 41

If our patient was a female, which agent is a Category B Pregnancy?

Answer 41

Glatiramer acetate

Question 42

Our patient reports a PMH of depression. Which medications would be considered a possible contraindication?

Answer 42

Interferons beta 1a and beta 1b

Question 43

What is appropriate monitoring parameters for the interferon medications?

Answer 43

1. Electrolytes
2. CBC
3. LFTs
4. Thyroid function
5. LVEF
6. Depression

Question 44

List the drugs that are used in cases of inadequate response or intolerance to first-line agents

Answer 44

1. Fingolimod
2. Natalizumab
3. Alemtuzumab
4. Mitoxantrone

Question 45

what is the life time list of dose for mitoxantrone?

Answer 45

140 mg/m

Question 46

Mitoxantrone ADEs

Answer 46

1. Cardiotoxicity
2. AML (acute myeloid leukemia)
3. Pregnancy D

Question 47

When is fingolimod contraindicated?

Answer 47

Patients receiving:

Class I and III antiarrythmic drugs

Question 48

When is Mitoxantrone indicated?

Answer 48

1. SPMS
2. PRMS
3. Worsening RRMS

Question 49

What medication increases Fingolimod serum concentration? Why?

Answer 49

Ketoconazole

3A4 inhibition