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45 Cards in this Set
- Front
- Back
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MOA of Interferon B-1b/a (5)
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1)unknown, antiviral and immunoregulatory fxns
2)augment suppressor cell fxn 3)incr production of anti-inflammatory TH2 4)decr pro-inflam cytokines and TH1 5)decr BBB permeability |
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Interferon B-1b/a ADR's (6)
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1)flu-like symptoms (dose w/ APAP to prevent)
2)injection site rxns 3)incr LFT's 4)thrombocytopenia 5)neutralizing Ig's to any interon-B can occur (can decr effectiveness of therapy, do NOT change therapy if pt is stable and doing well) 6)DEPRESSION |
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Interferon B
a)CI (2) b)monitoring parameters (2) |
a1)hypersensitivity to interferonB or albumin
a2)hypersensitivity to E.coli derived products (BETASERON ONLY) b1)LFT/CBC month 1,3,6 then yearly b2)thyroid fxn every 6months |
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Copaxone (Glatiramer)
a)indication b)use (2) |
a)first line for RRMS, and those who can NOT tolerate InterferonB
b1)decr relapse rate b2)slow progression of disability |
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Copaxone MOA (3)
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1)synthetic mixture of proteins (L-alanine, glutamate, lysine, tyrosine) which are found in myelin
2)causes immature CD4 T-cells to be less inflamatory 3)neuroprotective b/c stimulates CD4 T-cells to produce a neuroprotection factor that helps prevent axonal loss |
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Copaxone ADR's (8)
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1)injection site rxns
2)post injexn rxn (WITHIN 30MIN OF INJEXN) a)chest pain b)palpitations c)flushing d)SOB e)generally occurs once f)symptoms mimic an MI so if these happen after 30min might be MI |
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Copaxone
a)CI b)monitoring |
a)hypersensitivity to glatiramer or mannitol
b)none |
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Interferon B counseling (5)
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1)get drug to room temp b4 injexn
2)ice injexn site b4/after injecting 3)do NOT shake 4)rotate injexn sites 5)do NOT inject into lump/know |
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Tysabri (Natalizumab)
a)indication b)special things about it (2) c)MOA (3) |
a)pts who do NOT respond/tolerate other DMDs
b1)available thru TOUCH prescribing only b2)MUST BE USED AS MONOTHERAPY DUE TO PML***** c1)humanized MAb that binds alpha-4 subunit of integrin molecules on lymphocytes c2)blocks T-cell migration into the CNS c3)reduces specific inflammatory cell populations in target tissues |
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Tysabri (Natalizumab) ADR's (6)
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1)black box warning of PML
a)aphasia b)ataxia c)visual field defects 2)infusion rxns (rash, fever, chills) occur within 2hrs from start of infusion 3)neutrailzing Ig's (decr efficacy of drug) |
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Tysabri (Natalizumab)
a)CI (3) b)monitoring (4) |
a1)hypersensitivity to drug or murine proteins
a2)history of PML a3)pregnancy b1)hypersensitivity during and 1h after infusion b2)PML b3)MRI @ baseline, 3,6mon after first infusion then every 6mon b4)CBC |
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Novatrone (mitroxantrone)
a)indication b)use (3) |
a)SPMS (chronic), PRMS, worsening RRMS
b1)in CONJUNCTION w/ 1st line DMDs (NO MONOTHERAPY) b2)reduces # of clinical relapses b3)decr T-cell migration into the CNS |
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Novatrone (mitroxantrone)
a)MOA (4) b)dose |
a1)synthetic anthracenedione
a2)intercalates into DNA and causes strand breaks and interstrand cross-links a3)interferes w/ RNA syn a4)decr T-cell migration into CNS b)max lifetime dose of 140mg/m^2 |
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Novatrone (mitroxantrone)
a)ADR's (5) b)CI (3) |
a1)cardiotoxicity/HF (BLACK BOX WARNING)
a2)blood dyscrasias/AML (BLACK BOX WARNING) a3)arrhythmia a4)menstrual irregularities a5)urine blue-green (eyes too) b1)hypersensitivity b2)LV EF less than 50% or 5% decline from baseline b3)pregnancy |
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Novatrone (mitroxantrone) Monitoring parameters (6)
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1)LV EF @ baseline and prior to each dose
2)s/sx of HF 3)CBC 4)serum uric acid 5)LFT 6)pregnancy test prior to all doses |
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Combo therapy guidelines w/ DMDs (2)
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1)Novatrone (mitroxantrone) can be added to 1st line DMDs
2)Natalizumab should NEVER be used in combo w/ others****** |
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Spasticity
a)what happens (3) |
a1)incr muscle tone from hyperexcitability of stretch reflex
a2)primarily effect lower limbs a3)causes pain, tremor, stiff, spasm |
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Spasticity
a)pharma tx (2) b)nonpharma tx (4) |
a1)Baclofen
a2)Tizanidine b1)PT b2)regular exercise b3)stretch b4)avoid triggers (infexn, constipation, bed sores) |
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Bladder Dysfxn presentations (3 w/ 4,2,0)
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1)Hyperreflexic (failure to store)
a)urgency/frequency b)incontinency c)noctura 2)Hyporeflexic (failure to empty) a)hesitancy b)retention 3)Combo of both |
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Tx of
a)failure to store (2) b)failure to empty (2) |
STORE
a)oxybutynin b)tolerodine EMPTY a)terazosin b)tamsulosin |
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Bowel dysfxn
a)presents as...(3) b)tx (2) |
a1)consitpation
a2)fecal impaction a3)diarrhea b1)high fiber diet b2)incr hydration |
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Fatigue
a)presents as...(4) b)tx (2) |
a1)subjective lack of physical and/or mental energy
a2)most common in late to middle afternoon a3)can worsen w/ heat, exertion, depression a4)limits ADLs, QoL b1)modafinil (Provigil) b2)methylphenidate |
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Sensory Symptoms
a)symptoms (4) b)tx (2) |
a1)numbness
a2)tingling a3)trigeminal neuralgia a4)dysasthesias b1)TCAs b2)gabapentin |
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Tremors
a)what is it b)tx (2) |
a)involuntary movements of the legs/arms
b1)propranolol b2)clonazepam |
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Cognitive dysfxn
a)symptoms (4) b)tx (1) |
a1)probs learning/retaining new info
a2)probs handling complex tasks a3)reasoning/language a4)behavior b1)donepezil |
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Depression
a)due to... (3) b)tx (3) |
a1)chronic diseases
a2)AE of interferon products a3)neuropathology of MS b1)psychotherapy b2)SSRI's b3)TCA's |
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Sexual dysfxn
a)men probs (3) b)women probs (3) c)tx |
a1)ED
a2)ejaculatory disorders a3)difficulty achieving orgasm b1)abnormal sensation b2)decr lubrication b3)difficulty achieving orgasm c)-denafils for men; not much for women |
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Plaque formation occurs in the following, EXCEPT
a)optic nerves b)brain c)stem cells d)spinal cord |
STEM CELLS
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Which of the following is a tertiary symptom
a)unemployment b)spasticity c)decubitus ulcer d)constipation |
unemployment
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JM is a 42 yo female that has been dx w/ MS for 11years. She reports that initially she had a total of about 10 acute attacks in the 8years after dx in which she would lose feeling in her legs. She generally returned to near baseline, but each time slightly more debilitated than before. However, since then (in the last 3years) she reports no acute attacks but a progressive decline in her fxning ability doing her routine activities. She is now wheelchair bound. What stage of MS is she?
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Secondary-Progressive (SPMS)
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Drug of choice for tx of an acute attack is:
a)dexamethasone b)prednisone c)methylprednisolone d)IVIG |
methylprednisolone
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Which of the following is NOT a potential ADR of the tx of choice for acute attacks:
a)hypoglycemia b)fluid retention c)cognitive dysfxn d)infexn |
hypoglycemia
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Get case copied out of hand out for next 4 Q's
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n/a
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Her physician thinks it is time to begin tx w/ a DMD. Which DMD would you recommend based on her PMH
a)avonex b)betaseron c)copaxone d)tysabri |
copaxone b/c of depression
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What is an ADR that you want to make sure and warn JA about based on your choice of DMD in the previous question
a)depression b)chest pain c)edema d)incr risk of infexn |
chest pain
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Which primary sx are JA currently experiencing
a)bladder dysfxn b)bowel dysfxn c)spasticity d)tremors |
bladder dysfxn
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JA's fatigue worsens over the next 6months and she would like something to treat it, what would you recommend?
a)baclofen b)zofran c)methylphenidate d)venlafaxine |
methylphenidate
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Which trial showed benefit of Plavix over ASA
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CAPRIE
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Which trial showed a benefit of Plavix PLUS ASA compared to aspirin alone
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CURE
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Which two trials showed no benefit of Plavix PLUS ASA compared to either Plavix or ASA alone
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Plavix alone- MATCH
ASA alone- CHARISMA |
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CAPRIE
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Plavix better than ASA
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CURE
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Plavix and ASA is good
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MATCH
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Plavix and ASA has no benefit over Plavix alone
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CHARISMA
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Plavix and ASA has no benefit over ASA alone
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WARSS
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warfarin no better than ASA @ preventing non-cardioembolic stroke
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