Day 3- Multiple Sclerosis Flashcards
What part of the nervous system does MS affect?
What are some risk factors for MS?
What is the pathophysiology of MS?
Chronic inflammatory disease of the central nervous system.
Northern geography, Age, Female Sex, Epstein-barr virus, vitamin D deficiency, cigarette smoking, obesity, sodium intake.
Perivenular infiltrate(immune cells get into CNS).
What are primary symptoms of MS?
What are secondary symptoms of MS?
What are tertiary symptoms of MS?
Optic Neuritis, other neurologic stuff.
Stuff caused from the CNS primary symptoms.
Quality of life problems.
What is clinically isolated syndrome?
What is RRMS?
What is benign RRMS?
first episode of neurologic symptoms, high risk of MS if lesions present, low risk of no lesions.
Most common MS, attacks separate by at least 30 days. Recovery between attacks.
Patients have full recovery. Best case scenario for MS.
What is SPMS?
What is PPMS?
What is PRMS?
Always begins as RRMS, steady deterioration unassociated with acute attacks.
Do not experience attacks, begins later in life, disability develops faster, steady functional decline.
Usually originally diagnosed as PPMS, steady deterioration with occasional attacks.
What is 1st line treatment for MS exacerbations?
What is 2nd line treatment for MS exacerbations and what to do if neither of these work?
When do you need to start treatment following diagnosis of MS?
IV corticosteroids(methylprednisolone 500-1000 mg IV daily for 3-5 days).
Corticotropin. If these aren’t effective do plasma exchnage or IVIG.
If you start in the 1st 2 years there are better outcomes. Efficacy seen 1-2 years after initiation of therapy.
What is your 1st line option for PPMS?
What special things to know about Interferons?
What are common A/E’s of interferons?
Ocrelizumab. Can also try Rituximab or experimental medications(those aren’t FDA approved though).
decreases production of interleukin gamma and activation of T cells. Considered a 1st line agent.
Flu like symptoms, take injection at night, NSAIDS or tylenol 24 hours before, start with 1/4-1/2 dose, increase to full dose over 1-2 months. Can use topical lidocaine, ice, appropriate technique and rotate injection site, auto injectors.
What are some of the severe interferon A/E’s?
What are some reasons to stop interferon?
What things to know about Glatiramer?
Bone marrow suppression, liver failure, hypo and hyper thyroid problems, HF, neutralizing antibodies, depression.
Lack/loss of clinical response, bone marrow suppression, liver failure, thyroid abnormality.
Pregnancy category B, 1st line, suppresses T-cell activation.
What are your Side effects for Glatiramer?
What things to know about Mitoxantrone?
What things to know about Fingolimod?
Injection site reactions, post-injection reaction(chest tightness, flushing, dyspnea) transient and NOT hypersensitive, infection, lipoatrophy, tissue necrosis(rare), hypersensitivity.
Don’t use it a ton. Use is limited due to toxicities. Black box warning for cardiotoxicity and bone marrow suppression. Secondary leukemia, chemo like side effects.
First oral disease modifying treatment. Common headache, increase in liver enzymes, nausea, diarrhea, infection(consider varicella zoster vaccine), increase in blood pressure.
What are the fingolimod’s REMS requirements?
What things to know about Teriflunomide?
What things to know about dimethyl fumarate?
Monitor for bradycardia, hourly pulse and BP(ECG at beginning and end of period), longer period for those with pre existing concern. Eye exams, VZV vaccination, liver function, pregnancy, education.
Category X pregnancy, Boxed warning of hepatotoxicity(DC if 3 x higher, can use cholestyramine to wash it out). and teratogenicity, watch for TB reactivation and steven johnsons syndrome.
120 mg PO BID.Unknown MOA.
What side effects do you see with dimethyl fumarate?
What things to know about natalizumab?
What can increase your risk for PML?
lymphocytopenia, increased LFT’s, lots of flushing(can prevent with aspirin goes away in a month or so), proteinuria, pruritius/rash.
Cheap, most effective disease modifying treatment for RRMS. Patients must be enrolled in TOUCH program due to PML.
History of JC virus infection, duration of treatment >24 months, prior use of immunosuppresive therapies.
What things to know about Alemtuzumab?
What is Alemtuzumab’s BBW?
What things to know about Daclizumab?
Expensive, mostly used in RRMS, reserved for patients who have failed 2 or more therapies. Infusion associated reaction but can premedicate, watch for respiratory and UTI, herpes infection(administer acyclovir prophyxlaxis)
Secondary autoimmune disease, bone marrow suppresion. Has a REMS program.
Hepatoxicity BBW. Immune mediated disorder BBW.
What things to know about Ocrelizumab?
Do you ever change therapies because of insurances?
How do you treat fatigue in MS?
Infusion related reactions, premedicate with steroids, antihistamine and tylenol, has RTI, skin infections, herpes virus, hep B reactivation. Watch infusion rate. Big role in PPMS.
NO.
1st step is to find cause, there are no FDA approved drugs but you can use Modafanil, Amantidine, Methylphenidate.
How do you treat bladder dysfunction in MS?
How do treat sexual dysfunction in MS?
How to treat bowel dysfunction in MS?
Anti muscarenic medications.
PDE-5, lubricants, etc.
adequate fluid intake, stool softeners(docusate), fiber.
How to treat spasticity in Ms?
How to treat heat and exercise intolerance in MS?
What are some complementary medicines to know for MS?
Baclofen or Tizanidine. benzos, dantriline, botox, etc.
Dalfampridine
Ginkgo biloba can be used for fatigue, magnetic therapy works for fatigue, spasicity and pain can be used for THC.
