Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
129 Cards in this Set
- Front
- Back
|
MS is two times more common in ____ |
Females |
|
|
____ is a tool used as a liberal way to diagnose MS using MRIs, CSF assays and presenting symptoms and allows for earlier MS diagnosis and treatment |
Mcdonald criteria |
|
|
What are risk factors for MS |
living away from the equator or moving away from it before you are 15 White of scandinavian descent Genetics Being female Infections (epstein barr) Smoking Excess body weight |
|
|
____ accounts for 85% of MS cases and presents as acute exacerbations that last 24 hours to weeks and are seperated by at least 30 days with partial or full recovery occuring over weeks to months during which the patient is neurologically stable, but remission is less complete as the disease continues |
Relapsing Remitting MS |
|
|
____ begins as RRMS but steady deterioration is noted, and relapses may still occur during the progressive phase. |
SPMS |
|
|
____% of RRMS patients will develop SPMS within 15 years |
50 |
|
|
Treatment goal for SPMS is to___ |
Decrease relapses |
|
|
___ occurs for 10% of MS cases and presents as a steady functional decline with no relapses and typically occurs at older ages with no current treatment options |
PPMS |
|
|
____ accounts for only 5% of MS cases and is defined as a steady functional decline with occasional relapses. (Begins as PPMS) |
PRMS |
|
|
The goal of PRMS is to ____ |
Decrease the number of relapses |
|
|
Primary symptoms of MS are varied and are dictated based on ____ |
The area of damage in the brain |
|
|
Secondary symptoms of ms include |
UTI decubitus ulcers Poor nutrition Respiratory infection Depression |
|
|
Tertiary symptoms of ms include |
Job issues/disability Financial problems Emotional problems Relationship problems |
|
|
___ is the most widely used MS clinical rating scale that progressively measures decline but does not note cognitive or affect decline |
Expanded disability status scale |
|
|
____ uses 3 components (leg function/walking, arm and hand function, and cognitive function) to assess pt disability |
MS functional composite |
|
|
What are MRIs looking for in pts being evaluated for MS |
T2 lesions (lesions in non contiguous white matter tracts) |
|
|
What are treatment goals for MS |
Lessen relapse severity Decrease relapse # Decrease likelihood of a second attack Decrease demyelination progression Decrease disability Slow cognitive decline |
|
|
Acute exacerbations are more likely in patients with: |
Infection heat/warm climate Severe stress Hyperventilation Anemia Sleep deprivation Childbirth Organ dysfunction |
|
|
First line treatment for acute exacerbations of motor symptoms is _____ |
Glucocorticoids |
|
|
What glucocorticoid is used to treat acute motor symptoms |
Methylprednisolone 500-1000 mg/ day PO/IV x 3-10 days |
|
|
What are treatment options for acute exacerbations of MS |
Glucocorticoids Physical therapy Plasma exchange |
|
|
In severely impaired patients, ____ every other day for 14 days can help |
plasma exchange |
|
|
What are the goals of disease modifying therapy |
Decrease the number of exacerbations Slow disease progression |
|
|
____ is not curative and has no impact on symptoms |
Disease modifying therapy |
|
|
Betaseron |
Interferon B1b |
|
|
Extavia |
Interferon B1b |
|
|
Avonex |
Interferon B1a |
|
|
Rebif |
Interferon B1a |
|
|
Plegridy |
Interferon B1a |
|
|
All disease modification therapies are approved for ____ |
RRMS |
|
|
___ is indicated for relapsing forms of MS |
Interferon B1a/b |
|
|
Interferon B1a/b treatment is most likely effective because it: |
Decreases iNF gamma MHC expression on antigen presenting cells Inhibits pro inflammatory marker expression Inhibits t cell formation Decreases BBB permeability |
|
|
Betaseron and Extavia are ___ |
Interferon B1b |
|
|
Interferon B1b is available in a pen and pre filled syringe and is dosed _____ |
250 subQ every other day |
|
|
Avonex comes in a refrigerated pre filled syringe and is dosed ___ |
30 mcg IM weekly |
|
|
Refib comes in an autoinjector and is dosed ____ |
22-44 mcg SubQ TIW |
|
|
Copaxone dose |
20 mg SC daily |
|
|
____ occurs in ~15% of pts on copaxone and symptoms include chest tightness flushing dyspnea and anxiety |
Post injection effect |
|
|
Patients on copaxone should have _____ different injection sites to prevent tissue necrosis and injection reactions |
7 |
|
|
ADE with copaxone include ___ |
Injection site reactions, post injection effect, infection and GI upset |
|
|
Fingolimod |
Gilenya |
|
|
___ is a spingosine-1-phosphate modulator that traps lymphocytes in lymph nodes and decreades BBB permeability |
Fingolimod |
|
|
Fingolimod is taken ______ |
0.5 mg PO daily w or w/o food |
|
|
___ is contraindicated in pts with a qTC >500 ms, use with class 1a or 3 antiarrhythmics, 2nd or 3rd degree AV node block, sick sinus syndrome, mi, cva/tia, chf class 3/4 |
Fingolimod |
|
|
Patients on ____ should be monitored for AV node block and bradycardia |
Fingolimod |
|
|
Monitoring for fingolimod includes ____ at baseline |
EKG HR CBC LFTs Eye exam |
|
|
Plegridy comes in a pen injector and is dosed _____ |
Maintenance 125 mcg sQ q14days |
|
|
Patients taking Fingolimod need a ____ vaccine prior to initiation |
VZV |
|
|
After the first dose of ______, vitals are taken hourly for 6-24 hours and an EKG is repeated 6 hours after initiation |
Fingolimod |
|
|
ADE for ___ include av node block/ bradycardia, infection, elevated LFTs, macular edema and fetal toxicity |
Fingolimod |
|
|
Patients taking ____ need to use contraception for the duration of treatment and 2 months after |
Fingolimod |
|
|
A ___ must be taken at baseline and q6mths for pts on Fingolimod |
CBC |
|
|
An ___ must be done at baseline and q3months for pts on Fingolimod |
Eye exam |
|
|
AE for ___ includes injection site necrosis, flu like symptoms, hepatotoxicity, leukopenia/BMS, depression, and Aby formation |
interferon B1b/a |
|
|
LFTs are measured at 1,3,6 mth then qmonthly for treatment with ____ |
Interferon B |
|
|
To prevent flu like symptoms in pts on interferion b, ___ |
Premedicate with NSAIDs or APAP |
|
|
What monitoring needs to be done with Interferon B treatment |
LFT monthly after 6mtha monthly CBC Depression s/s |
|
|
Glatiramer acetate |
Copaxone |
|
|
What are possible MOAs for copaxone |
Induction of suppressor t cells Dec proinflamm cytokines Displace MBP from tcells |
|
|
Copaxone has ____ efficacy compared to INF |
Equivalent |
|
|
Copaxone comes in ____ which are stable at room temp for < 28 days |
prefilled syringes |
|
|
____ is a dihydro-orotate dehydrogenase inhibitor that stops pyrimidine synthesis and slows b and t lymphocytr DNS synthesis |
Teriflunomide |
|
|
Dimethyl fumarate |
Tecfidera |
|
|
___ is a monomethyl fumerate metabolite that activates nicotinic and nuclear factor like 2 pathway |
Dimethyl fumerate |
|
|
Dimethyl fumarate is indicated in ____ |
Relapsing forms of MS |
|
|
Dimethyl fumarate is dosed: |
120 mg PO BID x 7 d then 240 mg PO BID with food. |
|
|
What monitoring needs to be done for tecfidera |
CNC baseline and q6-12 mths |
|
|
____ ADE include angioedema, lymphopenia/ infection, rash, flushing , NVD, abdominal pain |
Tecfidera |
|
|
Daclizumab |
Zinbryta |
|
|
___ is an antiCD25 mAb and IL 2 inhibitor. |
Daclizumab |
|
|
daclizumab dose |
150 subQ q4w |
|
|
BBW for daclizumab include ____ |
Immune related disorders Hepatotoxicity |
|
|
Teriflunomide |
Aubagio |
|
|
Daclizumab is CI in patients LFTs are ____ |
> 2xULN |
|
|
daclizumab should be stopped if a patients LFTs ___ |
>5xULN |
|
|
ADE for ____ include rash, infection (nasopharyngitis/URTI) , LFT elevation, depression |
Daclizumab |
|
|
Lemtrada |
Alemtuzumab |
|
|
Campath |
Alemtuzumab |
|
|
___ is an antiCD25 mAb to inhibit b and t lymphocyte attachment to myelin |
Alemtuzumab |
|
|
Alemtuzumab is dosed |
12 mg IV over 4 hrs daily for 5 consecutive day the 1st year then 12 mg 3 consecutive days 12 months later |
|
|
Patients starting Alemtuzumab are pretreated with _____ for the first 3 days tx |
Steroids +/- antihistamines |
|
|
Alemtuzumab is reserved for patients who ___ |
Have inadequate response to 1-2 medications |
|
|
What drugs have a REMS program? |
Alemtuzumab Fingolimod Natalizumab Dalfampridine |
|
|
Teriflunomide is dosed |
7-14 mg PO daily |
|
|
Alemtuzumab has bbw for___ |
Autoimmune disease, infusion reactions, malignancy |
|
|
Patients on ___ need to be monitored for thyroid cancer, melanoma, lymphoproliferative disorders, infusion reactions; CBC, sCr;UA at baseline and monthly for 48 months after last dose; TFT q3m until 48 m after completion of tx |
Alemtuzumab |
|
|
ADE of ____ include BMS/ infection, HA, insomnia, nausea! Local infusion reaction |
Alemtuzumab |
|
|
Tb, PCP and herpes tests are performed and antiviral prophylaxis is given on day 1 of treatment and for 2 m after or until CD4 >200 in patients who take ____ |
Alemtuzumab |
|
|
Alemtuzumab is contraindicated in patients with ___ |
HIV active malignancy |
|
|
Natalizumab |
Tysabri |
|
|
___ is a humanized mAb that binds integrin preventing lymphocytes from crossing BBB |
Natalizumab |
|
|
Natalizumab is used to treat___ |
Refractory or aggressive MS |
|
|
___ decreases attack rate and disease severity |
Natalizumab |
|
|
Natalizumab dosing |
300 mcg IV q4w for 12-18 months |
|
|
Terifunomide is indicated for ____ as a monotherapy and in combo with INF B |
Relapsing forms of MS |
|
|
____ has a REM program called TOUCH which requires that only an authorized pharmacy may dispense it |
Natalizumab |
|
|
____ has a BBW for PML which is more likely to occur after > 2 years of use. Pt must be tested for anti JCV antibodies |
Natalizumab |
|
|
ADE for natalizumab include |
Infections HA/fatigue Depression GI upset Aby production |
|
|
Mitoxantrone |
Novantrone |
|
|
___ is an anthracycline that causes DNA strand breaks and cross-links and causes immunosuppression |
Mitoxantrone |
|
|
Mitoxantrone can be used for ___ |
SPMS, PRMS, severe RRMS |
|
|
Mitoxantrone is dosed ___ and must be given by an experienced physician |
12 mg/m2 IV q3m |
|
|
The LIFETIME max dose for mitoxantrone |
140 mg/ m2 |
|
|
____ has a BBW for cardiotoxicity, BMS, and inc risk of acute myeloid leukemia |
Mitoxantrone |
|
|
ADE for ___ include blue green fluid discoloration for abt 24 hrs after use, alopecia, gi upset/ wt changes |
Mitoxantrone |
|
|
Teriflunomide is CI in ___ |
Women of childbearing age not on contraception |
|
|
IVIG is used in ____ patients |
Refractory |
|
|
Rituximab may be used in___ |
SPMS PPMS |
|
|
What are alternative therapies for MS |
IVIG Rituximab Methylprednisolone DMARDs |
|
|
First line therapies for MS are: |
INF B Glatiramet Fingolimod Dimethyl fumarate Teriflunomide |
|
|
Therapy should be ____ if antibodies develop, treatment is ineffective, or intolerable se |
rotated |
|
|
Remind patients that medications____ |
Do not cure ms |
|
|
Dalfampridine |
Ampyra |
|
|
____ is indicated to improve walking distance (spasticity) |
Dalfampridine |
|
|
____ is a k channel blocker that increases action potential conduction through demyelinated axons |
Dalfampridine |
|
|
Dalfampridine is dosed ___ |
10 mg PO BID |
|
|
Teriflunomide is pregnancy category ____ |
X |
|
|
__ is contraindicated in patients with CrCl <50 or ho seizure |
Dalfampridine |
|
|
ADE for ampyra include ___ |
Seizures NVD UTI |
|
|
What monitoring needs to be done in pts taking ampyra |
SCr baseline and annually |
|
|
What can be used to help with spasticity |
Baclofen Tizanidine Dalfampridine |
|
|
What can be used to help with neuropathic pain |
CBZ GBP TCA SNRI |
|
|
Bladder dysfunction can be helped with |
Tolterodine Oxybutynin Boltulinum injection |
|
|
Patients with depression can be treated with |
SSRI SNRI |
|
|
Patients with fatigue can be given a ___ |
Stimulant |
|
|
Teriflunomide has BBW for |
Teratogenicity and hepatotoxicity |
|
|
If a patient on ____ is found to be pregnant they must use activated charcoal or cholestyramine for 10-14 days |
Teriflunomide |
|
|
Elevated LFTs in patients on _____ required a minimum of 11 days of activated charcoal |
Teriflunomide |
|
|
What needs to be monitored with patients on teriflunomide |
LFTs q6 mths BP CBC baseline and signs of infection Neuropathy Alopecia Diarrhea SJS/ TEN |
