RxPrep Systemic Steroids & Autoimmune Conditions

multiple sclerosis

What does MS stand for?

MS

chronic, progressive autoimmune disease in which the patient's immune system attacks the myelin sheath

blurred vision, fatigue, numbness

What are 3 early symptoms of MS?

cognitive function deterioration,

gait instability,

incontinence,

muscle spasms,

pain

What are 5 issues that can make life very challenging that develop as MS worsens?

MRI

What is a test that can be used to diagnose MS?

disease progression prevention

What is a primary goal of MS therapy?

true

True or False: What is lost in neuronal function cannot be regained in a patient with MS.

glatiramer acetate,

interferon beta formulations

What 2 drug classes have been the mainstay of treatment for patients with relapsing forms of MS?

Copaxone

What is the brand name for glatiramer acetate?

Plegridy

What is a brand name for pegylated interferon beta?

14 days

Pegylated interferon beta allows for more convenient subcutaneous dosing every ________.

albumin

Some interferon beta formulations used in MS contain ________.

SC

What route of administration is used for glatiramer acetate for MS?

3 times/week,

QD

What are 2 dosing options for glatiramer acetate for MS?

chest pain

What is a warning associated with glatiramer acetate?

diaphoresis, dyspnea, flushing, injection site reactions

What are 4 side effects associated with glatiramer acetate?

glatiramer acetate

What is the preferred agent if MS treatment is necessary during pregnancy?

IM, SC

What 2 routes of administration are used for interferon beta-1a for MS?

weekly

How often is IM interferon beta-1a administered for MS?

3 times/week

How often is SC interferon beta-1a administered for MS?

every other day

How often is interferon beta-1b administered for MS?

Q14D

How often is peginterferon beta-1a administered for MS?

increased LFTs,

injection site necrosis,

psychiatric disorders,

thyroid dysfunction

What are 4 warnings associated with interferon beta formulations?

flu-like symptoms

What is a side effect of interferon beta formulations?

false

(let stand at room temperature prior to injection)

True or False: Interferon beta formulations can be administered immediately after removing from the refrigerator.

true

True or False: You should not expel the small air bubble in prefilled interferon beta syringes due to loss of dose.

sphingosine 1-phosphate receptor modulators

Fingolimod, ozanimod, ponesimod, and siponimod are examples of ________ used in MS.

MAO inhibitor use

What is a contraindication for ozanimod?

CYP2C93/3 genotype

What is a contraindication for siponimod?

slow HR

Sphingosine 1-phosphate receptor modulators should be used with caution with other drugs that can ________.

6 hours

Patients starting fingolimod must be monitored for at least ________ after the first dose due to risk of bradycardia or other bradyarrhythmias.

ECG

A baseline ________ is required for patients starting fingolimod.

infection, macular edema

What are 2 warnings associated with sphingosine 1-phosphate receptor modulators?

varicella zoster virus

Patients should be screened for ________ before starting a sphingosine 1-phosphate receptor modulator.

CBC,

eye exam,

LFTs

What are 3 monitoring parameters for sphingosine 1-phosphate receptor modulators?

sphingosine 1-phosphate receptor modulator

MS can become much worse when treatment with a(n) ________ is stopped.

nuclear factor-like 2 activators

Dimethyl fumarate, diroximel fumarate, and monomethyl fumarate are examples of ________ used in MS.

false

True or False: Nuclear factor-like 2 activators can be crushed, chewed, or sprinkled on food for easier administration.

pregnancy

What is a contraindication for teriflunomide?

pyrimidine synthesis inhibitor

Teriflunomide is an example of a(n) ________ used in MS.

CD20-directed monoclonal antibodies

Ofatumumab, ublituximab-xiiy, and ocrelizumab are examples of ________ used in MS.

alemtuzumab, natalizumab

What 2 monoclonal antibodies used in MS are only available through a REMS program?

Tysabri

What is the brand name for natalizumab?

progressive multifocal leukoencephalopathy

What is the boxed warning associated with natalizumab?

potassium channel blocker

Dalfampridine is an example of a(n) ________ used in MS.

anticholinergics; laxatives; muscle relaxants; analgesics

Drugs commonly used for symptom control in MS include ________ for incontinence, ________ for constipation, ________ for muscle spasms/spasticity, or ________ for muscle spasms/pain.

propranolol

What drug can help with tremors in MS?

Raynaud's

common condition that's triggered by exposure to cold and/or stress, leading to vasospasm in the extremities (most commonly in the fingers and/or toes); skin turns white then blue

vasodilation

Prevention and treatment of Raynaud's involve ________ to improve blood flow to the affected areas.

nifedipine

What drug is commonly used for prevention of Raynaud's episodes?

amphetamines, beta blockers, bleomycin, cisplatin, illicit drugs, pseudoephedrine

bib cap

What are 6 drugs/classes that cause or worsen Raynaud's?

celiac disease

immune response to eating gluten

barley, rye, wheat

In what 3 things is gluten found?

avoid gluten

What is the primary and most effective treatment for celiac disease?

abdominal pain, bloating, diarrhea, weight loss

What are 4 common symptoms of celiac disease?

true

True or False: Pharmaceutical active ingredients are gluten-free, but some excipients may contain gluten.

starch;

corn, potato, tapioca, wheat

When going through a package insert to determine if an excipient contains gluten, look for the keyword "________," which will be either ________, ________, ________, or ________.

myasthenia gravis

autoimmune disease that attacks the connections between nerves and muscles, resulting in weakness in skeletal muscles

eyes/vision

Symptoms of myasthenia gravis often include changes to ________.

ptosis

drooping eyelid

ptosis

What is a common symptom of myasthenia gravis?

antiarrhythmics, antibiotics, antipsychotics, beta blockers, CCBs, local anesthetics, magnesium salts, muscle relaxants

What are 8 drug classes that can worsen or unmask myasthenia gravis?

aminoglycosides, quinolones

What 2 antibiotic classes most commonly worsen or unmask myasthenia gravis?

cholinesterase inhibitors; pyridostigmine

________, specifically ________, are the mainstay of treatment in myasthenia gravis.

cholinesterase inhibitor

drug class that blocks the breakdown of acetylcholine, which improves neuromuscular transmission and increases muscle strength

cholinergic effects

What is a warning associated with pyridostigmine?

diarrhea, excessive urination, lacrimation, salivation

What are 4 examples of cholinergic effects?

Sjogren's syndrome

autoimmune disease most often characterized by severe dry eyes and dry mouth

chronic oral infections,

corneal ulceration,

dental caries

What are 3 complications due to Sjogren's syndrome?

artificial teardrops

What is the primary treatment for dry eyes in Sjogren's syndrome?

Clear Eyes, Liquifilm, Refresh, Systane

What are 4 popular OTC artificial teardrops used in Sjogren's syndrome?

benzalkonium chloride

If the preservative ________ found in artificial teardrops is irritating, preservative-free formulations packaged in individual use containers are available.

cyclosporine

________ eye drops can be used for Sjogren's syndrome dry eye in patients who don't have satisfactory relief from other measures, including ductal occlusion.

Restasis

What is the brand name for cyclosporine emulsion eye drops?

infection

Patients using Restasis should be counseled to use it properly to avoid ________.

ocular burning

What is a side effect of Restasis?

unusual taste

What is a side effect of Xiidra (lifitegrast)?

antimicrobial mouthwash rinses,

sugar-free chewing gum w/ xylitol,

sugar-free lozenges

What are 3 non-drug treatments for Sjogren's syndrome dry mouth?

muscarinic agonists;

cevimeline, pilocarpine

If OTC treatments for Sjogren's syndrome dry mouth don't provide sufficient relief, prescription oral ________, such as ________ or ________, can be used.

narrow-angle glaucoma,

uncontrolled asthma

What are 2 contraindications for muscarinic agonists?

psoriasis

chronic, autoimmune disease that appears on the skin

plaque

The most common type of psoriasis is ________ psoriasis, which appears as raised, red patches covered with a silvery-white buildup of dead skin cells on any part of the body.

UV light

________ exposure causes activated T-cells in the skin to die.

UVB phototherapy

________, in controlled doses from an artificial source, can improve mild to moderate psoriasis symptoms.

anthralin, calcipotriene, coal tar, retinoids, salicylic acid, steroids, tapinarof

What are 7 topical drug options for the initial treatment of psoriasis?

topical calcineurin inhibitors

If initial topical therapies for psoriasis fail, ________ can be tried, and these are the preferred agents when applying to the face.

coal tar

What topical product used in psoriasis is also used for dandruff and dermatitis?

coal tar

What topical product used in psoriasis is messy, time-consuming, and can stain clothing and bedding?

retinoid

Acitretin is an example of a(n) ________ used in psoriasis.

retinoid

What drug class used in psoriasis is only used in severe cases when a patient is unresponsive to other therapies due to their numerous contraindications and side effects?

PDE-4 inhibitor

Apremilast is an example of a(n) ________ used in psoriasis.

weight loss

What is a warning associated with apremilast?

diarrhea

What is a common side effect of apremilast?

interleukin receptor antagonists

Brodalumab, guselkumab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab are examples of ________ used in psoriasis.

SC

What route of administration is used for interleukin receptor antagonists for psoriasis?

serious infections

What is a warning associated with interleukin receptor antagonists?

TB

Patients should be screened for ________ before starting an interleukin receptor antagonist for psoriasis.

diarrhea

What is a common side effect of interleukin receptor antagonists?

selective tyrosine kinase 2 inhibitor

Deucravacitinib is an example of a(n) ________ used in psoriasis.

adrenal insufficiency, inflammatory conditions

Steroids are commonly used in what 2 conditions?