00 Multiple Sclerosis

Question 1

What is MS?

Answer 1

A chronic inflammatory and degenerative disease of the CNS. Characterized by inflammation, demyelination, and axonal injury

Question 2

What are some common clinical presentations of MS?

Answer 2

Visual complaints/optic neuritis. Gait problems and falls. Paresthesias. Weakness. Fatigue. Bowel/bladder dysfunction. Sexual dysfunction. Depression (secondary)

Question 3

What is Relapsing-Remitting MS (RRMS)?

Answer 3

Periods of attacks and remissions followed by full or partial recovery with NO DISEASE PROGRESSION. Can last for years or decades

Question 4

What is Secondary-Progressive MS (SPMS)?

Answer 4

Slow and steady irreversible neurologic dysfunction that occurs with or without attacks. Disease course is steadily progressive and can manifest with or without relapses

Question 5

What is Primary-Progressive MS (PPMS)?

Answer 5

Continuous neurologic decline from disease onset without distinct attacks. Steady decline without relapse

Question 6

What is Progressive-Relapsing MS (PRMS)?

Answer 6

Neurologic decline is steady from disease onset. Occasional distinct attacks may occur. Steady disease progression continues during the relapses

Question 7

What are the first line agents for MS?

Answer 7

Interferon B-1a, Interferon B-1b, Glatiramer acetate

Question 8

What are the uses of Interferon B?

Answer 8

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)

Question 9

What is the generic of Avonex?

Answer 9

Interferon B-1a IM

Question 10

What is the generic of Rebif?

Answer 10

Interferon B-1a SC

Question 11

What is the generic of Betaseron?

Answer 11

Interferon B-1b SC

Question 12

What is the generic of Extavia?

Answer 12

Interferon B-1b SC

Question 13

What are the ADRs associated with Interferon B?

Answer 13

Flulike symptoms (prophylaxis with APAP). Injection site reactions. Depression. LFT abnormalities

Question 14

What are the uses of Glatiramer acetate?

Answer 14

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

Question 15

What are some common ADRs with Glatiramer?

Answer 15

Lipoatrophy at injection site (rare, permanent, no treatment). Injection site reactions

Question 16

What needs to be counseled about Glatiramer?

Answer 16

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

Question 17

What is the generic of Gilenya?

Answer 17

Fingolimod (first oral DMT for RRMS)

Question 18

What needs to be monitored with Fingolimod?

Answer 18

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

Question 19

When is Fingolimod contraindicated?

Answer 19

In patients w/ pre-existing or recent (within last 6 months) heart conditions or stroke, taking antiarrythmic meds

Question 20

What is the generic of Tysabri?

Answer 20

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)

Question 21

What is a rare and serious ADR (FDA warning) of Natalizumab?

Answer 21

Progressive Multifocal Leukoencephalopathy (PML). Administered only through infusion centers registered with TOUCH

Question 22

What is usually the next step in patients with RRMS that’s refractory to initial treatment with IFN-B or Glatiramer?

Answer 22

Adding IV methylprednisolone 1000mg monthly bolus. Natalizumab 300mg by IV infusion Q4 weeks as monotherapy only

Question 23

What is usually the next step in patients with RRMS who are poor responders to IFN-B, Glatiramer, Natalizumab, and Methylprednisolone?

Answer 23

IV pulse cyclophosphamide combined with pulse methylprednisolone. IV mitoxantrone Q3 months up to a max lifetime cumulative dose of 140mg/m2

Question 24

What is the most commonly used treatment for MS relapse and can be given safely with MS DMTs?

Answer 24

Corticosteroids

Question 25

What is the generic of Ampyra?

Answer 25

Dalfampridine: the only pharmacologic therapy FDA approved for walking in MS patients

Question 26

What is the FDA warning with Ampyra (Dalfampridine)?

Answer 26

Do not use in patients with a history of seizures, moderate to severe renal impairment, already taking compounded 4-aminopyridine