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Pharmacology Exam #3 > MS > Flashcards

Flashcards in MS Deck (49)
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1

What T helper cell is pro-inflammatory?

Th1 and 17

2

What T helper cell is anti-inflammatory?

Th2

3

Define MS

immunologic disorder marked by chronic inflammation of the CNS

4

What is the key to the diagnosis of MS?

Dissemination of plaques in time and space

5

What are the three broad treatment categories for MS?

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

6

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

Self-injected

7

Effects of DMTs

1. Decrease annual relapse rate
2. Decrease formation of new white matter lesion

8

List the DMT agents

1. Interferon (IFN) formulations
2. Glatiramer acetate (non-IFN)

9

List the 1st generation agents used for relapsing MS

1. Interferon-B1a (Avonex, Rebif)
2. Interferon-B1b

10

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

1. Interferon-B1b
2. Pegylated Interferon-B1a

11

List the 1st generation agents used for RRMS

1. Pegylated Interferon-B1a
2. Glatiramer acetate

12

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

Mitoxantrone

13

Mitoxantrone indications

1. SPMS
2. PRMS
3. Worsening RRMS

14

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

Glatiramer acetate

15

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

Mitoxantrone

16

Interferon-B1a ADEs

1. Depression
2. Flu like sx's

17

Interferon-B1b ADEs

Depression

18

Glatiramer acetate ADEs

1. Chest tightness
2. Urticaria- @ any dose!

19

Mitoxantrone ADEs

1. Cardiotoxicity
2. AML

20

Natalizumab SEs

PML

21

Natalizumab monitoring

JVC antibody

22

Fingolimod ADEs

1. Macular retinal edema
2. AV block

23

Teriflunomide ADEs

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

24

Dimethyl fumarate ADEs

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

25

Alemtuzumab ADEs

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

26

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

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

27

Alemtuzumab indications

RRMS

28

Ocrelizumab indications

Relapsing or Progressive MS

29

Define CIS

Clinically Isolated Syndrome
Frist episode of neurologic sx's that lasts @ least 24 hrs

30

what do we use to treat exacerbation sx's?

Corticosteroids

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?

Within 2 weeks of sx onset
Improvement in 3-5 days

32

Longer durations of IV methylprednisolone ADEs

1. Acne
2. Fungal infection
3. Mood alteration

33

Short term ADEs of methylprednisolone

1. Metallic taste
2. Sleep disturbances

34

Which medication carries a pregnancy category X rating?

Teriflunomide

35

What labs would we monitor for adverse effects in Teriflunomide

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

36

IFN Beta 1a MOA

Alters expression and response to surface antigens enchanting immune cell activities

37

IFN Beta 1b MOA

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

38

Glatiramer acetate MOA

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

39

Which medication has an indication for CIS and RRMS?

Glatiramer acetate

40

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

Interferon beta 1a- brande name Avonex

41

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

Glatiramer acetate

42

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

Interferons beta 1a and beta 1b

43

What is appropriate monitoring parameters for the interferon medications?

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

44

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

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

45

what is the life time list of dose for mitoxantrone?

140 mg/m

46

Mitoxantrone ADEs

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

47

When is fingolimod contraindicated?

Patients receiving:
Class I and III antiarrythmic drugs

48

When is Mitoxantrone indicated?

1. SPMS
2. PRMS
3. Worsening RRMS

49

What medication increases Fingolimod serum concentration? Why?

Ketoconazole
3A4 inhibition