MS Drugs

Question 1

interferons act where

Answer 1

periphery and BBB

Question 2

interferon MOA

Answer 2

inhibit T cells, dendritic cells
inhibit BBB penetration by decreasing MMP
efficacy reduced by neutralizing antibodies

Question 3

glatiramer acetate acts where

Answer 3

periphery

Question 4

glatiramer acetate MOA

Answer 4

decreased T cell activation through dendritic cell modulation

Question 5

fingolomod acts where

Answer 5

periphery and CNS

Question 6

fingolomod MOA

Answer 6

S1P receptor agonist
stimulates oligodendrocyte survival / remyelination in CNS
blocks movement of T cells out of lymph nodes

Question 7

what is PML

Answer 7

progressive multifocal leukoencephalopathy
potentially lethal brain infection

Question 8

drugs with increased risk of PML

Answer 8

fingolomod
natalizumab
fumarates

Question 9

natalizumab acts where

Answer 9

periphery and BBB

Question 10

natalizumab MOA

Answer 10

MAB specific for alpha 4 integrin
inhibits VLA-4 binding and interferes with B and T cell movement into CNS
- effects could be limited by neutralizing antibodies

Question 11

mitoxantrone acts where

Answer 11

periphery

Question 12

mitoxantron MOA

Answer 12

cytotoxic effect
reduces the number of lymphocytes

Question 13

teriflunomide acts where

Answer 13

periphery

Question 14

teriflunomide MOA

Answer 14

cytotoxic effect
inhibits proliferation of lymphocytes (B and T cells)

Question 15

dimethyl fumarate
diroximel fumarate
monomethyl fumarate
act where

Answer 15

periphery and CNS

Question 16

fumarates MOA

Answer 16

metabolized by esterases
suppress activated T cells
promote remyelination
activate Nrf2 mediated antioxidant response and antiinflammatory pathways

Question 17

siponimod, ozanimod, ponesimod location

Answer 17

periphery and CNS

Question 18

siponimod, ozanimod, ponesimod MOA

Answer 18

S1P agonists
oligodendrocyte survival, remyelination
interfere with lymphocyte movement out of lymphoid organs

Question 19

cladribine location

Answer 19

periphery

Question 20

cladribine MOA

Answer 20

cytotoxic effect , results in lymphocyte depletion

Question 21

rituximab (Ocrelizumab) location

Answer 21

periphery

Question 22

rituximab MOA

Answer 22

targets CD20, a B cell marker
- limited by neutralizing antibodies

Question 23

rituximab (Ocrelizumab) treats

Answer 23

decreased relapse rate in RRMS and PPMS some effectiveness in decreased disease progression

Question 24

ATL1102 is an _____targeting ____

Answer 24

antisense oligonucleotide targeting VLA4
(same outcome natalizumab)

Question 25

ATL1102 acts at

Answer 25

blood brain barrier

Question 26

drugs that effectiveness could be limited by neutralizing antibodies

Answer 26

interferon B, natalizumab, rituximab (ocrelizumab)

Question 27

drugs acting via cytotoxic

Answer 27

mitoxantrone teriflunomide cladribine

Question 28

drugs acting at BBB

Answer 28

interferon natalizumab ATL1102

Question 29

drugs acting in periphery and CNS

Answer 29

fingolamide, other mods fumarates

Question 30

treatment of acute attacks inpatient

Answer 30

methylprednisolone 500-1000 mg IV for 3-7 days +/- oral taper over 1-3 weeks

Question 31

treatment of acute attacks outpatient

Answer 31

prednisone 1250 mg PO every other day x 5 doses with no taper

Question 32

oral meds

Answer 32

fumarates, fingolomods, teriflunomide

Question 33

injectible meds

Answer 33

interferons, glatiramer acetate

Question 34

infusion meds

Answer 34

almetuzumab, natalizumab, ocrelizumab

Question 35

patients must be tested for what to check for risk of PML?

Answer 35

JCV antibodies

Question 36

which kind of vaccines are preferred in MS

Answer 36

inactivated

Question 37

which drug can you not take with live vaccine

Answer 37

almetuzumab

Question 38

____ vaccine should be considered in pts who have never had

Answer 38

varicella, chicken pox

Question 39

fumarates pearls and monitoring

Answer 39

do not open capsule monitor LFTs PML risk flushing, take with ASA 30 mins before

Question 40

SP1 agonist are contraindicated in what

Answer 40

pts with arrythmia hx or heart condition

Question 41

discontinuation of what agent can worsen sx

Answer 41

SP1 agonists , mods

Question 42

which drug to avoid with MAO inhibitor

Answer 42

ozanimod

Question 43

which drug requires CYP2C9 testing?

Answer 43

siponimod

Question 44

glatiramer acetate pearls

Answer 44

rotate injection site - lipoatrophy flu like symptoms or chest pain maybe good for pregnancy

Question 45

interferons dosing

Answer 45

subq or IM every other day to every 2 weeks

Question 46

interferons side effects

Answer 46

flu like symptpms - take acetaminophen or NSAID before depression / suicide

Question 47

interferons monitoring

Answer 47

LFT and TSH

Question 48

which drug contraindicated in HIV

Answer 48

almetuzumab

Question 49

which drug contrainidcated in Hep B

Answer 49

ocrelizumab

Question 50

drug approved for PPMS

Answer 50

ocrelizumab

Question 51

which drug contraindicated in pregnancy

Answer 51

teriflunomide

Question 52

what to give if pregnant on teriflunomide

Answer 52

charcoal for 11 days or cholestryamine

Question 53

drugs with pregnancy concerns

Answer 53

mitroxantrone, cladribine, SP1s, ocrelizumabw

Question 54

which drug can improve walking speed

Answer 54

dalfampridine

Question 55

IR dosing of dalfampridine can cause what

Answer 55

seizures