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
