Learning objectives Flashcards
what is a definition for MS?
An immune mediated process in genetically susceptible people. There is inflammation of the myelin sheath which causes demyelination
what are the causes of MS?
An interplay between environment and genes
- extreme climates
- HLA DR2
what is the pathogenesis of MS?
factors cause a disruption of the BBB–> movement of t lymphocytes and demyelinating antibodies in to the CNS–> T lymphocytes adhere to the lining of cerebral blood vessels and cross the layer –> plaques form around medium sized vessels –> the inflammation attracts macrophages
what are the four types of MS?
- benign MS
- relapsing/ remitting
- primary progressive
- Secondary progressive
what are the most clinical signs of MS?
Visual changes bells palsy trigeminal neuralgia vertigo sensory changes
what is the diagnosis definition for primary progressive MS?
- progressive signs lasting over 6 months with other causes excluded
what is the diagnosis definition for relapsing MS?
- clinicaly definite when lesions are disseminated in time and space. evidence of 2 lesions in different pats at 2 different times.
what investigations can be done for MS?
- evoked potentials
- MRI
- lumbar puncture
what is an evoked potential?
Times the time for an electrical potential to be generated by a brief sensory stimulus
what is the common patient type for presenting with MS?
- 20-40 years
- more likely in women
what is the management of MS?
- steroids for acute attacks
- disease modifying drugs
- vitamin D and omega 3
what is the main medication given for an acute relapse of MS?
methylprednisolone
what is an injectable disease modifying drug for MS?
Beta interferon
what are oral disease modifying drugs that can be given for MS?
- fingolimod which prevents T cells leaving lymph nodes
- teriflunomide blocks proliferating lymphocytes
what can be given for urine incontinence due to MS?
Anti muscarinics such as oxybutinin
what is the MOA of trimethoprim?
- uncomplicated UTI
2. prevention of pneumocystitis pneumonia in immunosuppressed
what are adverse effects of trimethoprim?
GI upset
rash
megaloblastic anaemia
thrombocytopenia
what is an absolute contraindication for trimethoprim?
1st trimester of pregnancy
what is the MOA of oxybutynin?
competitive inhibitors of AcH especially M3 preventing bladder contraction and increasing capacity.
what are adverse effects of oxybutynin?
dry mouth
tachycardia
constipation
blurred vision
whats an absolute contraindication of oxybutynin?
UTI’s
what are oligoclonal bands in the blood and CSF a key sign of?
MS
