MS Drugs

Question 1

Dimethyl fumarate MOA

Answer 1

Reduces toxic oxidative stress through activation of the nuclear 1 factor (erythroid-derived 2)-like 2 (Nrf2) antioxidant response pathway

Question 2

Side effects of dimethyl fumarate

Answer 2

Flushing (aspirin might help), leukopenia

Question 3

Diroximel fumarate is approved for ____ MS.

Answer 3

Relapsing-remitting
Same MOA as dimethyl fumarate, less GI side effects

Question 4

Fingolimod MOA

Answer 4

Sequesters lymphocytes in lymph nodes, thereby reducing the number of lymphocytes in peripheral circulation and the central nervous system
Downregulating sphingosine-1-phosphate receptors (S1PR)

Question 5

What medications down regulate sphingosine-1-phosphate receptors (S1PR)?

Answer 5

Fingolimod, siponimod, ozanimod, and ponesimod

Question 6

Side effects of fingolimod

Answer 6

First-dose bradycardia, atrioventricular block, and QT interval prolongation
Macular degeneration
Rebound of disease with abrupt sessation

due to activation of S1PRs on atrial myocytes

Question 7

What medications should be avoided when using fingolimod?

Answer 7

Beta-blockers and calcium channel blockers

Question 8

What are the fatal infections that can be seen with fingolimod use?

Answer 8

Cryptococcus meningitis, disseminated varicella-zoster, herpes simplex encephalitis, and PML

Question 9

Side effects of siponimod

Answer 9

Macular edema
Bradycardia

Question 10

What testing must be done before starting siponimod?

Answer 10

CYP2C9 genotyping and funduscopic testing

Certain CYP2C9 varients generally shouldn’t get this med

Question 11

Teriflunomide MOA

Answer 11

Reduces T- and B-cell activation, proliferation, and function

Question 12

How does teriflunomide inhibit pyrimidine synthesis for DNA replication?

Answer 12

Blocking dihydroorotate dehydrogenase

Question 13

Teriflunomide side effects

Answer 13

Leukopenia, alopecia, GI symptoms
Hepatotoxicity

Question 14

When should teriflunomide not be used and why?

Answer 14

Pregnancy, category X teratogenic

Question 15

Cladribine MOA

Answer 15

Purine antimetabolite

Question 16

Cladribine side effects

Answer 16

Leukopenia
Malignancy
Teratogenicity

Question 17

Ofatumumab MOA

Answer 17

Monoclonal antibody to CD20 B-cells

Question 18

What drug is proven to be more effective than teriflunomide in random drug trials?

Answer 18

Ofatumumab

Question 19

Ofatumumab side effects

Answer 19

Injection site irritation, upper respiratory tract infections, headache

Question 20

What must be done prior to starting ofatumumab?

Answer 20

Screening for hepatitis B and low immunoglobulins

Question 21

Mitoxantrone MOA

Answer 21

Type II topoisomerase inhibitor

Question 22

Mitoxantrone is approved for ___ MS.

Answer 22

Secondary progressive

Question 23

Mitoxantrone side effects

Answer 23

Dose-related cardiotoxicity
Alopecia, menstrual irregularity, amenorrhea, and leukopenia
Category D for pregnancy

Question 24

Alemtuzumab MOA

Answer 24

Monoclonal antibody targeting of the CD-52 receptor on activated T- and B-lymphocytes
Cytotoxic and complement meditated depletion

Question 25

Alemtuzumab side effects

Answer 25

Lymphopenia and autoimmune-related syndromes | Thyroid-40%, thrombocytopenia-1%,anti-glom basement membrane nephropathy

Question 26

Natalizumab MOA

Answer 26

Monoclonal antibody targeting of alpha 4-integrin which is expressed on activated T-lymphocytes | Blocks the transmigration of T-cells across the blood-brain barrier

Question 27

Most significant side effect of natalizumab

Answer 27

Progressive multifocal leukoencephalopathy

Question 28

What are the risks of developing natalizumab PML?

Answer 28

Positive anti-JC virus antibodies Prior use of immunosuppressive therapy More than 24 months of natalizumab therapy

Question 29

What can be used to accelerate drug clearance of natalizumab?

Answer 29

PLEX

Question 30

Ocrelizumab is approved for ____ MS.

Answer 30

Primary progressive

Question 31

Ocrelizumab MOA

Answer 31

Binds CD20 B-cells leading to cell-mediated cytotoxicity

Question 32

Side effect of ocrelizumab

Answer 32

Increased infection risk

Question 33

What is an alternative medication to DMARDs?

Answer 33

Dalfampridine

Question 34

Dalfampridine MOA

Answer 34

Inhibition of voltage-dependent potassium channels causes improved nerve conduction

Question 35

What patients should avoid dalfampridine?

Answer 35

End stage kidney disease and epilepsy