00 Multiple Sclerosis Flashcards
What is MS?
A chronic inflammatory and degenerative disease of the CNS. Characterized by inflammation, demyelination, and axonal injury
What are some common clinical presentations of MS?
Visual complaints/optic neuritis. Gait problems and falls. Paresthesias. Weakness. Fatigue. Bowel/bladder dysfunction. Sexual dysfunction. Depression (secondary)
What is Relapsing-Remitting MS (RRMS)?
Periods of attacks and remissions followed by full or partial recovery with NO DISEASE PROGRESSION. Can last for years or decades
What is Secondary-Progressive MS (SPMS)?
Slow and steady irreversible neurologic dysfunction that occurs with or without attacks. Disease course is steadily progressive and can manifest with or without relapses
What is Primary-Progressive MS (PPMS)?
Continuous neurologic decline from disease onset without distinct attacks. Steady decline without relapse
What is Progressive-Relapsing MS (PRMS)?
Neurologic decline is steady from disease onset. Occasional distinct attacks may occur. Steady disease progression continues during the relapses
What are the first line agents for MS?
Interferon B-1a, Interferon B-1b, Glatiramer acetate
What are the uses of Interferon B?
First-line disease-modifying therapy (DMT). Indicated for: treatment of RRMS to reduce the frequency of relapse and for treatment of CIS (except for interferon B-1a SC)
What is the generic of Avonex?
Interferon B-1a IM
What is the generic of Rebif?
Interferon B-1a SC
What is the generic of Betaseron?
Interferon B-1b SC
What is the generic of Extavia?
Interferon B-1b SC
What are the ADRs associated with Interferon B?
Flulike symptoms (prophylaxis with APAP). Injection site reactions. Depression. LFT abnormalities
What are the uses of Glatiramer acetate?
First-line for MS. Indicated for: RRMS to reduce the frequency of relapse and patients with CIS. Good choice for patients unable to tolerate flu-like sxs or have coexisting depression
What are some common ADRs with Glatiramer?
Lipoatrophy at injection site (rare, permanent, no treatment). Injection site reactions
What needs to be counseled about Glatiramer?
Rare self-limited postinjection reaction (flushing, palpitations, anxiety, throat constriction). Advise patient that this reaction is temporary and should remain calm, sit upright, and breathe slowly
What is the generic of Gilenya?
Fingolimod (first oral DMT for RRMS)
What needs to be monitored with Fingolimod?
Monitor for bradycardia for at least 6 hours after first dose. Bradycardia usually resolves within 1 month of treatment initiation. If treatment is interrupted for 2 weeks or more, monitoring for at least 6 hours is again required after the next dose
When is Fingolimod contraindicated?
In patients w/ pre-existing or recent (within last 6 months) heart conditions or stroke, taking antiarrythmic meds
What is the generic of Tysabri?
Natalizumab (second-line, d/t safety issues, to reduce relapse frequency and delay physical disability in patients with RRMS who have inadequate response to first line DMTs)
What is a rare and serious ADR (FDA warning) of Natalizumab?
Progressive Multifocal Leukoencephalopathy (PML). Administered only through infusion centers registered with TOUCH
What is usually the next step in patients with RRMS that’s refractory to initial treatment with IFN-B or Glatiramer?
Adding IV methylprednisolone 1000mg monthly bolus. Natalizumab 300mg by IV infusion Q4 weeks as monotherapy only
What is usually the next step in patients with RRMS who are poor responders to IFN-B, Glatiramer, Natalizumab, and Methylprednisolone?
IV pulse cyclophosphamide combined with pulse methylprednisolone. IV mitoxantrone Q3 months up to a max lifetime cumulative dose of 140mg/m2
What is the most commonly used treatment for MS relapse and can be given safely with MS DMTs?
Corticosteroids
