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Pharm 3 Exam > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

2 characteristics of Multiple sclerosis

A

CNS demyelination and axonal damage

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2
Q

How does MS develop?

A

genetically susceptible individuals are exposed to random/environmental factors triggering immune mediated CNS damage

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3
Q

What are the 4 T helper cell subtypes and their clinical significance?

A

Th1 and Th17 = pathogenic pro-inflammatory
Th2 = anti-inflammatory
Treg = preventive of autoimmunity

  • mutual suppression b/t Th1 and Th2
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4
Q

Examples of favorable and unfavorable prognostic indicators for MS

A

Favorable –> relapsing/remitting, optic neuritis or sensory sxs, women

Unfavorable –> progressive course, motor or cerebellar sxs, polysymptomatic, men

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5
Q

What is MS?

A

immunologic disorder marked by chronic inflammation of the CNS

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6
Q

The key to the dx of MS is –>

A

the dissemination of these plaques in time and space

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7
Q

What are the 4 types of MS?

A
  1. RRMS – relapsing-remitting
  2. PPMS – primary-progressive
  3. SPMS – secondary-progressive
  4. PRMS – progressive-relapsing (or PR w/activity)
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8
Q

What are the 3 broad Tx categories for MS?

A
  • Tx of exacerbations = corticosteroids
  • DMT’s - disease modifying therapies
  • Symptomatic therapy for spasticity, bladder sxs, sensory sxs, & fatigue
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9
Q

Name 5 First-Generation DMT’s

A 
IFN = "BEAR" 
Betaseron
Extavia
Avonex
Rebif

non-IFN = Glatiramer acetate

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10
Q

What are First-Generation DMT’s?

A

self injected meds that decrease annualized relapse rates by 30%

decrease formation of new white matter lesion

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11
Q

How long is efficacy noted after starting therapy of First-Generation DMT’s?

A

1 to 2 years

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12
Q

Name some of the Second-Generation DMT’s for relapsing forms of MS.

A

“D-FANTOM”

Natalizumab
Alemtuzumab
Ocrelizumab
Fingolimod
Mitoxantrone
Teriflunomide
Dimethyl fumarate
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13
Q

2nd-Generation DMT w/an FDA indication for progressive or worsening MS?

A

Mitoxantrone

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14
Q

When is Mitoxantrone indicated?

A

SPMS, PRMS, and worsening RRMS

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15
Q

When is Fingolimod contraindicated?

A 
pt receive class I & III anti-arrhythmic drugs recent heart dz
2nd and 3rd degree AV block
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16
Q

Describe the limitations of Mitoxantrone

A

Lifetime limit of dose is 140
pregnancy category D
secondary leukemia

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17
Q

Which medications could be considered a possible Contraindicated if the pt has a PMHx of depression?

A

Interferons Beta 1a and 1b

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18
Q

What are the monitoring parameters for the interferon medications?

A

Electrolytes, CBC, LFT’s, thyroid, LVEF, depression

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19
Q

Chest tightness and flushing can occur w/ which medication?

A

Glatiramer acetate

20
Q

Which medication has an indication for CIS and RRMS?

A

Glatiramer acetate

21
Q

Which of the interferon medications is considered a LOW potency medication?

A

Interferon beta 1

22
Q

Describe the drug interaction of Fingolimod and Ketoconazole

A

Ketoconazole increases Fingolimod serum concentration (3A4 inhibitor)

23
Q

What is PML and the cause?

A

Progressive Multifocal leukoencephalopathy

  • viral infection that targets cells that make myelin
  • John Cunningham’s virus activated when a person’s immune system is compromised
24
Q

Which DMT is classified as pregnancy category X?

A

Teriflunomide

25
Which 2nd-generation DMT must you administer herpes viral prophylaxis on the first day of Tx?
Alemtuzumab
26
Adverse drug Rxn's of Interferon medications
depression | flu-like sxs
27
Adverse drug Rxn's of Mitoxantrone
cardiotoxicity | AML
28
Which DMT should you monitor JCV antibodies? why?
Natalizumab | Adverse drug rxn = PML
29
How can you reduce the incidence of flushing while taking Dimethyl fumarate?
taking it w/food
30
Adverse drug Rxn's of Teriflunomide
``` Steven-Johnson syndrome liver failure activation of TB Neutropenia lymphocytopenia ```
31
Which drug is contraindicated w/ HBV?
Ocrelizumab
32
What is the Tx for MS exacerbations and when can the pt expect to see improvement?
IV injection of high dose corticosteroids (Methylprednisolone) initiated w/in 2 weeks of onset improvement w/in 3-5 days
33
MOA for corticosteroids in MS
speculated to improve recovery by decreasing edema in the area of demyelination
34
Short-term use ADEs of Corticosteroids
sleep disturbance | metallic taste
35
Long duration of IV methylprednisolone can lead to -->
acne fungal infections mood alteration rarely GI hemorrhage
36
MOA of Teriflunomide (Aubagio)
inhibits dihyroorotate dehydrogenase --> prevents proliferation of peripheral lymphocytes (T & B cells) --> reduces activation of lymphocytes in the CNS --> reduces inflammation and demyelination
37
MOA of Dimethyl fumarate
unknown -- involved in cellular response to oxidative stress in vitro nicotinic acid receptor agonist in vivo activator of Nrf2 pathway
38
ADE's of Dimethyl fumarate
Flushing - give w/food Rash, pruritis GI discomfort Increased LFT's
39
Which medication has an active metabolite and the name of this substance?
Teriflunomide Leflunomide
40
If you prescribe Teriflunomide, which labs should you monitor for adverse effects?
``` pregnancy test TB (reactivation) LFT's CBC (lymphocytopenia, neutropenia) Blood pressure ```
41
If a pt declines oral therapy, what option might provide the pt w/ a safer alternative?
Interferons beta 1a or 1b | Glatiramer
42
In general, all IFNs do what 3 things?
- proposed MOA's in periphery and at the blood-brain barrier level - balances expression of pro- and anti-inflammatory agent in the brain - reduce number of inflammatory cells that cross blood brain barrier
43
MOA of Glatiramer acetate?
antigenically similar to myelin basic protein (MBP) --> inhibits MBP from binding to T-cell receptor complexes induces Th2 (anti-inflamm) --> reduction of inflammation, demyelination, and axonal damage Neuroprotective effect
44
What is the 1st line Tx for MS? and what additional therapies can be used if pt has inadequate response or intolerance?
1st line = 1st-generation DMT's 2nd generation DMTs
45
MOA of Mitoxantrone
inhibits RNA and DNA synthesis (use in oncology-leukemias)
46
MOA of Natalizumab
activated lymphocytes are denied entry past the blood-brain barrier
47
MOA of Fingolimod
exhibits immunosuppressant properties by sequestering circulating lymphocytes reduces the infiltration of T lymphocytes and macrophages into the CNS

Pharm 3 Exam (3 decks)

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