Múltiple Sclerosis Pharm Treatment

Question 1

MS is a disease of…?

Answer 1

The CNS

Question 2

Which cells does MS attack?

Answer 2

oligodendrocytes

Question 3

Is MS chronic?

Answer 3

Yes

Question 4

Secondary progressive MS is characterized by what?

Answer 4

The development of permanent neurological deficits and the progression of clinical disability

Question 5

Primary progressive MS is characterized by what?

Answer 5

When the disease is progressive from the onset

Question 6

What characterizes the initial stages of MS?

Answer 6

Reversible episodes of neurological deficits (relapses) that usually lasts for days or weeks

Question 7

What is clinical isolated syndrome?

Answer 7

What a patient presents with an initial attack of inflammatory demyelination (clinical symptoms and radiological evidence)

Question 8

What is primary progressive multiple sclerosis?

Answer 8

A patient with a disease course characterized by progression from onset , 1 year of disability progression independent of clinical relapse

Question 9

What is secondary progressive MS?

Answer 9

A patient who over time, develops a permanent neurological deficit and with the progression of clinical disability that becomes prominent

Question 10

What is radiologically isolated syndrome?

Answer 10

A patient with the presence of radiological signs of demyelination but no clinical evidence of disease

Question 11

What is relapsing remitting MS?

Answer 11

When a patient has short symptomatic periods followed by periods of full or partial remission

Question 12

What is rapid evolving aggressive disease?

Answer 12

A patient with early accumulation of disability along with high relapse frequency and highly active disease on MRI

Question 13

What is aggressive MS naive patient?

Answer 13

A patient who has 2 or more relapses with incomplete recovery in the past year

Question 14

do we have axonal injury and inefficient remyelination?

Answer 14

Yes

Question 15

Is there mitochondrial dysfunction is MS?

Answer 15

Yes

Question 16

What is the goal for MS treatment?

Answer 16

Ameliorate symptoms of disease, reduce the accumulation of disease, and improve quality of life of MS patients

Question 17

What are the NEDA features?

Answer 17

No new or enlarging T2-weighted lesions
No new gadolinium-enhancing lesions
No relapses
No confirmed worsening or expanded disability status scales scores

Question 18

The treatment of MS can be divided into what types of drugs?

Answer 18

Disease modifying and symptomatic treatments

Question 19

What is the treatment for acute relapses of MS?

Answer 19

3-5 days of IV methylprednisolone (500-1,000mg) or IVIG infusion. Also consider plasmapharesis

Question 20

What is the first line treatment for a clinically isolated syndrome?

Answer 20

Interferon beta and glatiramer acetate

Question 21

What is a second like treatment drug used to treat clinically isolated syndrome?

Answer 21

Teruflonamide

Question 22

If we have a patient with relapsing remitting MS who has a moderately active disease, what is a first line drug used?

Answer 22

Interferon beta, glatiramer acetate, teriflunamide,dimethyl fumarate

Question 23

If we have a patient with relapsing remitting MS who has a moderately active disease, what is a second line drug?

Answer 23

fingolimod and siponimod

Question 24

What drugs are used for a patient who has relapsing remitting MS who had an active disease?

Answer 24

Fingolimod, siponimod, natalizumab, cladribine, ocrelizumab

Question 25

What drugs are used for a patient with Relapsing remitting MS who also have a rapidly evolving aggressive disease?

Answer 25

Natalizumab, alentuzumab, ocrelizumab

Question 26

what does progressive MS mean?

Answer 26

It means that it has been a year since the patient has been in treatment and the patients condition continued to worsen

Question 27

What drugs are used to treat secondary progressive MS?

Answer 27

INF-beta 1a, and 1b subcutaneous

Question 28

What drugs are used to treat primary progressive MS?

Answer 28

Ocrelizumab IV, Biotin (vitamin B7), siponimod

Question 29

What is required in a patient with MS before pregnancy?

Answer 29

Washout period of at least 6 months

Question 30

When it comes to pregnancy, what therapies are indicated after the second trimester?

Answer 30

Immune reconstitution therapies

Question 31

What drugs can be given to a patient with MS while breastfeeding?

Answer 31

IVIG, methylprednisolone All disease modifying drugs are contraindicated

Question 32

What is a first line drug for pediatric patient with MS?

Answer 32

Fingolimod

Question 33

What are second in line drugs used to treat MS?

Answer 33

INF-beta 1a, teriflunomide, dimethyl fumarate

Question 34

What type of interferon beta has the highest success when it comes to reducing the annualized relapses rate?

Answer 34

Pegylated INF-Beta 1a subcutaneously

Question 35

What is the mechanism of action of Interferon beta?

Answer 35

Induces a series of beneficial transcriptional JAK/STAT pathway changes. Decreases antigen presentation as well as proliferation of inflammatory T cells. Changes the expression of cytokines and matrix metalloproteinase (MMP)

Question 36

How is interferon beta eliminated in the body?

Answer 36

Via the liver and the kidneys

Question 37

Interferon beta can cause a rise in what?

Answer 37

Body temperature

Question 38

What are some adverse effects of interferon beta?

Answer 38

Flu-like symptoms, depressed bone marrow functions, formation of specific neutralizing antibodies that appear 6-18 months of treatment and depressive symptoms

Question 39

What is glatiramer acetate?

Answer 39

Immunomodulator that consists of the acetate salts of synthetic polypeptides, containing four naturally occurring amino acids: L-glutamic acid, L-alanine, L-tyrosine, and L-lysine

Question 40

What is the mechanism of action of glatiramer acetate?

Answer 40

Exhibits strong and promiscuous binding to MHC molecules and consequent competition with various myelin antigens for their presentation to T cells

Question 41

Glatiramer acetate also work by...

Answer 41

Inducing specific suppressor cells of the T helper 2 cell type

Question 42

Glatiramer acetate inhibits which types of cells?

Answer 42

Dendritic cells and monocytes

Question 43

Which MHC molecules variants does glatiramer acetate bind to?

Answer 43

HLA DRB1 variants

Question 44

What is teriflunomide?

Answer 44

An active metabolite of lefunomide and it acts as an immunomodulatory agent by inhibiting pyramidine synthesis

Question 45

What is the mechanism of action of teriflunomide?

Answer 45

Inhibits pyramidine synthesis by inhibiting the mitochondrial enzyme dihydroorotate dehydrogenase

Question 46

Teriflunomide is contraindicated in what?

Answer 46

Pregnant women and in women in childbearing age due to the risk of teratogenicity. Also contraindicated in severe hepatic impairment due to hepatotoxicity, hepatic failure and death

Question 47

What is dimethyl fumarate?

Answer 47

Non steroidal anti-inflammatory drug

Question 48

what is the mechanism of action of dimethyl fumarate?

Answer 48

Degraded to it’s active metabolite nonmethyl fumarate (MMF) MMF up regulates the nuclear factor (erythroid-derived 2)- like 2 (Nrf2) pathway that is activated in response to oxidative stress

Question 49

Dimethyl fumarate is rapidly hydrolyzed by what type of enzymes?

Answer 49

Esterases

Question 50

What are the main metabolites of the metabolism of dimethyl fumarate?

Answer 50

MMF, glucose, citric acid, Fumaric

Question 51

What is an important adverse effect of dimethyl fumarate?

Answer 51

Liver damage and allergic reactions

Question 52

What is the mechanism of action of fingolimod and siponimod?

Answer 52

It is a sphingosine 1-phosphate receptor modulator that exerts its mechanism of action in MS by binding to various sphingosine 1-phosphate receptors. It suppresses the release of lymphocytes from the lymph nodes leading to a lower level of circulation lymphocytes in the peripheral circulation

Question 53

Fingolimod metabolism occurs via 3 major metabolic pathways which are?

Answer 53

Phosphorylation, oxidation, and fatty acid like metabolism

Question 54

Siponimod is metabolized mainly by which enzyme?

Answer 54

CYP2C9 enzyme and subsequently by the CYP3A4 enzyme

Question 55

What are some adverse effects of fingolimod?

Answer 55

Hypotension, bradycardia, cardio toxicity, heart block, skin cancer

Question 56

What are some adverse effects of siponimod?

Answer 56

Carcinogenesis, mutagenesis, infertility, feral harm