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PEBC > 20 - MS > Flashcards

20 - MS Flashcards

1
Q

What symptoms demyelination result in?

A

numbness, weakness, fatigue, cognitive difficulties, ataxia, optic neuritis, bowel/bladder abnormalities and neuropathic pain

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2
Q

What country has highest prevalence of MS? What regions?

A

Canada

-Atlantic and Prairies

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3
Q

Could be linked to low Vitamin ___

A

D

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4
Q

Treatment for relapsing remitting MS

A

DMT initiated at diagnosis

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5
Q

Treatment for secondary progressive MS

A

DMT has no effect, except in relapses

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6
Q

Treatment for primary progressive MS

A

ocrelizumab

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7
Q

What is the McDonald diagnostic criteria for MS?

A

At least 2 attacks, each attack lasting > 24 hours, at the attacks have to be separated by > 30 days

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8
Q

non-pharms for MS?

A

physiotherapy, stretching, fluid intake restriction & pelvic floor exercises, respiratory training, smoking cessation

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9
Q

What can we use for acute relapses?

A

IV methylprednisolone followed by oral prednisone

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10
Q

____ reduce rate of relapses in RRMS

A

DMTs

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11
Q

What does DMT stand for?

A

Disease Modifying Therapy

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12
Q

PML has been reported with most of DMTs, especially ______

A

natalizumab

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13
Q

What is PML?

A

Progressive multifocal leukencephalopathy

  • opportunistic infection
  • rare brain disease caused by infection or re-activation of JC virus
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14
Q

List the 1st line DMTs

A
  • dimethyl fumarate
  • glatiramer
  • interferon beta
  • ocrelizumab
  • teriflunomide
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15
Q

List the 2nd line DMTs

A
  • alemtuzumab
  • cladribine
  • daclizumab - not approved anymore
  • fingolimod
  • mitoxantrone - off-label
  • natalizumab
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16
Q

What is the adjunctive treatment that improves walking?

A

fampiridine (blocks K+ channels, improves walking)

17
Q

How does dimethyl fumarate work?

A

activates Nrf2 pathway which is involved in cellular response to oxidative stress

18
Q

s/e of dimethyl fumarate

A

flushing, n/v/d, ab pain

can decrease lymphocytes, cause proteinuria, increase liver enzymes

19
Q

MOA of glatiramer

A

immunomodulator, inhibits myelin reactive T cells, decreased T cell proliferation and decreases interferon-gamma secretion

20
Q

s/e of glatiramer

A

rare, acute transient post injection reaction = flushing, chest tightness, palpitations and dyspnea

21
Q

avoid what with dimethyl fumarate?

A

live vaccines

22
Q

Interferon beta may cause ?

A

Nabs (neutralizing antibodies)

23
Q

How does ocrelizumab work?

A

depletes CD20 B cells

24
Q

ocrelizumab has slight risk of _____

A

neoplasm (abnormal growth of tissue)

25
Q

How does teriflunomide work?

A

reduces T and B cell activity

26
Q

_____ has no cases of PML reported

A

teriflunomide

27
Q

How does Alemtuzumab work?

A

MAB that binds to CD52 on activated lymphocytes and targets their destruction

28
Q

How does cladribine work?

A

temporarily depletes B and T lymphocytes, followed by lymphocyte reconstitution, thus not causing continuous immune suppression

29
Q

Cladribine has s/e of high grade lymphopenia which is linked to ____

A

HSV

30
Q

How does Fingolimod work?

A

blocks activated lymphocytes from circulating into blood stream from lymphoid tissues.

31
Q

s/e of fingolimod?

A

-macular edema
-bradycardia
-VZV infection
-skin cancer
-reversible hepatic dysfunction
PML

32
Q

Describe mitoxantrone

A

off-label

-suppresses immune cell activity

33
Q

s/e of mitoxantrone

A

cardiotoxicity, leukemia

34
Q

MOA of natalizumab

A

blocks attachment of T cells to the BBB

*highest risk of PML

35
Q

_____ is a known teratogen

A

Teriflunomide

36
Q

If someone’s on teriflunomide and gets pregnant, you need to stop it and wash it out with ______

A

cholestyramine

37
Q

Mainstay of care in pregnancy and breastfeeding for MS?

A
  • These states decrease risk of relapses
  • stop drugs for MS
  • if need be, use corticosteroids in breastfeeding for acute relapses
38
Q

All MS patients need how much of vitamin D/day?

A

1000 IU/day

PEBC (130 decks)

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