What are the two treatments for MS exacerbations
1. CCS
2. ACTH
What is the 1st line CCS
methylprednisolone
Sleep disturbances, metallic taste (PO), GI upset, and hyperglycemia are short term side effects of what class of drugs
CCS
What is the only FDA approved treatment for MS exacerbations
ACTH $
first generation disease modifying therapies for MS:
4 interferon produces
Glatiramer acetate
4 IFN products:
1. Avonex
2. Rebif
3. Betaseron/Extavia
4. Plegridy
What is the dosing for Avonex
6 million units IM weekly
What is the dosing for Rebif
22 mcg SQ three times weekly given at least 48 hours apart
What is the dosing for Betaseron/Extavia
8 million units SQ every other day
What is the dosing for Plegridy
6.3 mcg SQ every 14 days
Which two IFN products are high potency
Rebif
Betaseron/Extavia
Which IFN produce has more injection site reactions
Betaseron/Extavia
Pre-medication with antipyretics can be useful with which agent
Plegridy
4 ADRs of IFN therapy
1. Psychiatric issues
2. Flu-like symptoms
3. Injection site reactions
4. Increased LFTs
IFN therapies should be refrigerated up until administration?
False
Let sit at room temperature and do not expel air bubble in profiled syringes
Risk of Creutzfeldt-Jakob disease transmission is increased with IFN therapy with formulations containing albumin?
True
What is the preferred agent in pregnancy?
Copaxone/Glatopa
Copaxone/Glatopa dosing:
20 mg SQ three times a week
All 1st generation medications may not show efficacy until 1-2 years after starting?
True
ADRs of glatiramer acetate
Chest pain
Diaphoresis
Dyspnea
Flushing
Injection site reactions
All sphingosine-1-phosphate receptor modulators are CI in what conditions
1. MI
2. Unstable angine
3. Stroke/TIA
4. Class III/IV or hospitalization for HF in the last 6 months
4 sphingosine-1-phosphate receptor modulators
1. Gilenya
2. Zeposia
3. Ponvory
4. Mayzent
Relapsing forms of MS are treated with
sphingosine-1-phosphate receptor modulators
Gilenya
Fingolimod
Zeposia
Ozanimod
Ponvory
Ponesimod
Mayzent
Siponimod
All sphingosine-1-phosphate receptor modulators are given by what route`
Oral
what should be screened for for all sphingosine-1-phosphate receptor modulators
Latent infections
What sphingosine-1-phosphate receptor modulator is CI in severe untreated sleep apnea and concomitant use of MAOI
Zeposia
What sphingosine-1-phosphate receptor modulator is CI in CYP2C9*3/*3 genotype
Mayzent
What sphingosine-1-phosphate receptor modulator is CI with class Ia and III anti arrhythmic agents
Gilenya- QTc prolongation
Gilenya has what risk?
PML
Patients must be monitored for 6 hours post dose for what two sphingosine-1-phosphate receptor modulators
Gilenya
Mayzent
ADRs of sphingosine-1-phosphate receptor modulators
Bradycardia/bradyarrhythmias- ECGs
Macular edema- Eye exams
Fetal risk
Hepatotoxicity- LFTs
Nuclear factor-like-2-activators
Tecfidera (dimethyl fumigate)
Vumerity (Diroximel fumigate)
Bafiertam (monomethyl fumurate)
All nuclear factor-like-2-activators are given by what route
Oral
Nuclear factor-like-2-activators can be crushed, chewed, and sprinkled on food for patients who are not good at swallowing medications?
False
Main ADR of Nuclear factor-like-2-activators
Flushing
How to treat flushing associated with Nuclear factor-like-2-activators?
Take aspirin 30 minutes before and administer with food
Brand name of teriflunomide
Aubagio
CI of Aubagio
Pregnancy or not using adequate protection
Cholestyramine can be used for accelerated elimination of what medication?
Aubagio
ADRs of Aubagio
Alopecia
N/D
Lymphocytopenia
Infection risk
What are the two monoclonal antibodies
Tysabri (Natalizumab)
Kesimpta (Ofatumumab)
Which moAb binds to the alpha-4 subunit of intern on lymphocytes
Tysabri
Dosing of Tysabri
300 mg IV over 1 hr q 4 weeks
Which moAb is an anti-CD20
Kesimpta
Ocrevus
Briumvi
Dosing of Kesimpta
20 mg SQ once weekly for 3 doses then once monthly starting at week 4
Which drug is under the REMS program for PML?
Tysabri
Which agent can be initial first line therapy in severe RRMS
Tysabri
Which agent has a CI for active HepB infection
Kesimpta
What agent should be screened for John Cunningham virus?
Tysabri
Which agent is the only agent that has an indication for PPMS?
Ocrevus
Which moAbs are given IV
Tysabri
Lemtrada
Ocrevus
Briumvi
Which agent has a REMS program for autoimmunity, infusion reactions, and malignancies
Lemtrada
Pre-medications with steroids +/- antipyretics and ppx with acyclovir would be beneficial with which moAb?
Lemtrada
Pre-medication with methylprednisolone IV and antihistamine 30-60 minutes before infusion +/- APAP
Ocrevus
Pre-medication with methylprednisolone IV and antihistamine and considering an antipyretic would be beneficial with which moAb?
Briumvi
All vaccinations should be completed how long before treatment
6 weeks
ADRs of Alemtuzumab (Lemtrada)
Rash
Thyroid disease
Lymphocytopenia
Antibody development
What is only oral anti-neoplastic agent?
Mavenclad (cladribin)
Mavenclad can be used to treat
RRMS and SPMS
What agent has a boxed warning for malignancies and teratogenicity requiring 6 months of contraception?
Mavenclad
CI of Mavenclad
Malignancy, HIV, or active chronic infections