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MS/HA/Stoke/Sleep > MS > Flashcards

MS Flashcards

1
Q

Charcots’ Neurologic Triad

A

-Dysarthria (difficult or unclear speech, plaques in brain stem interfere w/ conscious and unconscious movements)
-Nystagmus (involuntary rapid eye movements bc of plaques in the eye nerves)
-Intention tremor (plaques along motor pathways cause muscle weakness and spasms)

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2
Q

MS diagnosis

A

At least 2 documented exacerbations separated by time/space as well as 2 distinct MRI lesions separated by time and space

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3
Q

PPMS diagnosis

A

diagnosed after 1 year of disease progression and if the pt meets 2 criteria: DIS in brain, within spinal cord &/or positive CSF

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4
Q

CIS

A

diagnosed after 1 exacerbation and 1 lesion while clinician awaits second exacerbation and lesion to make MS diagnosis

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5
Q

CSF in MS

A

normal RBC and glucose, normal or mildly elevated protein, intrathecal IgG synthesis, inc IgG index, oligoclonal bands

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6
Q

RRMS

A

experience worsening of pre-existing sx or onset of new sx for greater than 48 hours w/o fever, known as relapses, flare ups or exacerbations of MS

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7
Q

SPMS

A

progression of RRMS, disease course is steadily progressing w/ or w/o clear cut relapses

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8
Q

PRMS

A

-steady disease progression, clear cut periods of exacerbations of MS
-use steroids to treat relapses, disease will progress regardless of therapy

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9
Q

Relapse treatment

A

-Corticosteroids or Corticotropin Acthar gel

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10
Q

Corticosteroids

A

-used in acute exacerbations to dec inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of inc. capillary permeability
-Methylprednisolone - may be followed by oral prednisone taper
-H2 blocker/PPI for ulcer prevention
-monitor blood glucose, watch for infection

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11
Q

Corticosteroids SE

A

insomnia, mood changes GI upset and inc irritability

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12
Q

Corticotropin acthar gel

A

stimulates adrenal cortex to secrete adrenal steroids (cortisol)
-IM or SQ (used when pt have poor venous access)

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13
Q

ABCR Injectables

A

-interferon beta may augment suppressor T-cell function, may dec interferon gamma secretion by activating lymphocytes; may dec macrophage activating effect; may down reg expression of major histocompatibility complex gene production on APC
-may also dec BBB permeability
-indication: relapsing forms including isolated syndrome, RRMS and active SPMS

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14
Q

Avonex

A

-beta 1a
-IM injection
-dec flu like sx
-preg C

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15
Q

Rebif

A

-beta 1a
-SQ injection given TIW
-Preg C

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16
Q

Plegridy

A

-beta 1a
-SQ injection given every 14 days
-Preg C
-Pegylated interferon = polyethylene glycol attached to interferon molecules to maintain effect longer

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17
Q

Betaseron

A

-beta 1a
-SQ injection given everyday
-Preg C
-SE: flu like sx (pre-medicate before injection with ibuprofen or Tylenol to dec sx), fever, chills, HA, chest pain, injection site rxn, depression, myalgia, arthralgia, malaise, abdominal pain

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18
Q

Glatiramer acetate

A

-may mimic antigenic properties of myelin basic protein
-SQ injection everyday
-Preg B
-Indication: CIS, RRMS, SPMS
-SE: ISR (masses/welts), transient flushing, vasodilation, chest tightness, N/V, arthralgia, anxiety, palpitation, throat congestion
-Patients may feel like they are having a heart attack (counseling point)
-does not cause depression or flu like sx, safest to use in women of child bearing age

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19
Q

ocrelizumab

A

-CD20
-humanized monoclonal antibody
-1st and only agent for PPMS
-binds to CD20 and depletes B-cells
-inc antibody dependent cell mediated cytotoxic effects, less immunogenic
-reduces relapse rates, disability progression and disease activity on MRI in RRMS and SPMS
-reduce disability progression, time required to walk 25 ft, volume of brain lesions in PPMS
-PML could occur

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20
Q

ocrelizumab AE

A

-infusion site rxn (pre-medicate with steroids, antipyretics and antihistamines)

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21
Q

ocrelizumab CI and warnings

A

CI: active HBV
Warnings: herpes, active infection, infusion rxns, malignancy

22
Q

natalizumab

A

-blocks leukocytes from getting to BBB
-humanized
-IV infusion given every 4 weeks
-Preg C
-CIS, RRMs, SPMS (active)
-PML (sometimes fatal viral opportunistic infection)

23
Q

PML

A

-from latent John Cunningham polyomavirus in immunocompromised patients
-once myelin is lost in PML it cannot be regained
-TOUCH prescribing program to monitor for development of PML

24
Q

3 factors that inc risk for PML

A

testing positive for antibodies to JCV, prior immunosuppression use, using natalizumab for 2+ years

25
Q

alemtuzumab

A

-reserved for refractory pts bc of SE (autoimmune thyroid disorders, pyrexia, pruritus, chest discomfort, UTI, flushing)
-IV infusion for RRMS and SPMS
-pre-medicate with corticosteroids (Methylpred)
-antiviral prophylaxis for herpes on first day and for 2 months after complete until lymphocytes >200
-Preg C

26
Q

alemtuzumab BBW

A

-fatal autoimmune conditions (monitor CBC counts, serum CR levels, and urinalysis)
-life threatening infusion rxns - monitor for 2 hours after infusion
-inc risk of malignancies

27
Q

mitoxantrone

A

-chemotherapy drug
-IV infusion given every 3 months
-Preg D
-not indicated for PPMS, used for rapidly advancing, refractory MS
-SE: cardiotoxicity, bone marrow suppression, stomatitis esophagitis, oral ulceration, N?V, alopecia, hepatic dysfunction

28
Q

Mavenclad

A

-chemotherapy drug
-not recommended in CIS
-missed dose: admin on following day and extend # of days in the treatment cycle. If 2 missed, extend cycle by 2 days
-lymphocytes must be within normal limits before start & >/= 800 before second treatment. 2nd course can be delayed up to 6 months to get to >/= 800. If they do not get to >/= 800 do not continue drug
-swallow whole, use dry hands and avoid prolonged contact with skin, wash hands and surface after and don’t take anything else for 3 hours

29
Q

Mavenclad BBW

A

malignancies and teratogenicity

30
Q

Mavenclad CI

A

pregnancy, HIV, chronic infections, breastfeeding

31
Q

Mavenclad warnings

A

bone marrow suppression, infection, PML, vaccines, graft-vs-host disease, hepatotoxicity, cardiotoxicity

32
Q

Fingolimod

A

-S1P - depletes CD4 and CD8 lymphocyte release
-oral for RRMS and SPMS, CIS >/= 1- years old
-CYP met; no DDI; no toxic metabolites
-HR dec on day 1 (monitor for 4-6 hrs in clinic)
-dec in FEV1 at high doses
-Repeat 1st dose monitoring if patient misses 1 day in first 2 weeks, 7 days in 3rd and 4 weeks, or 14 days after 1 month
-wait 30 days after VZV
-use contraception

33
Q

Fingolimod CI

A

heart problems

34
Q

Siponimod

A

-S1P
-CIS, RRMS, SPMS in adults
-Refrigerate
-only high risk pt need 1st dose observation
-missed dose >24 hrs = reinitiate w/ day 1 of titration reg
-not to be used in preg and use risk/benefit for lactation

35
Q

Siponimod CYP2D6 1/1, 1/2, 2/2

A

-0.25 (day 1 and 2), 0.5 (day 3), 0.75 (day 4), 1.25 (day 5)
-2 mg on day 6 (maintenance)

36
Q

Siponimod CYP2D6 1/3 or 2/3

A

-0.25 (day 1 and 2), 0.5 (day 3), 0.75 (day 4)
-1 mg on day 5 (maintenance)

37
Q

Siponimod CYP2D6 3/3

A

contraindicated

38
Q

Siponimod CI

A

3/3 CYP2D6 genotype, MI, unstable angina, stoke, TIA, HF

39
Q

Ozonimod

A

-S1P
-admin 1 month following live vaccines
-CI: MI, unstable angina, stroke, ischemic attack, HF, MAOIs
-warnings: AV block, bradycardia, hepatotoxicity, HTN, infections, macular edema, PML, VZ infection, pregnancy
-avoid foods high in tyramine (HTN crisis)

40
Q

Teriflunomide

A

-blocks pyrimidine synthesis, inhibits protein tyrosine-kinase and cyclo-oxygenase-2 and dec APC ability to activate T-cells
-for relapsing forms of MS
-food delays absorption
-rosuvastatin should not be > 10 mg
-May dec INR in pts taking warfarin

41
Q

Teriflunomide BBW

A

hepatotoxicity, teratogenicity (X), no breastfeeding, accelerated elimination w/ cholestyramine activated charcoal (dec conc)

42
Q

Dimethyl fumarate (Tecfidera)

A

-induces T-helper 2-like cytokines causing apoptosis in activated T-cells and down reg of intracellular adhesion molecules = reduced lymphocytes migration
-SE: GI sx (give with high fat/protein foods); flushing (give aspirin 30 min before)

43
Q

Diroximel fumerate (Vulmerity)

A

-causes less GI effects than dimethyl fumarate bc it converts to monomethyl fumarate
-admin aspirin 30 min before to reduce flushing
-limit fat and calories to </= 30g and </= 700 cal if taking with food
-avoid alc at same time as dose is taken

44
Q

Monomethyl fumerate (Bafiertam)

A

-less GI SE than dimethyl fumerate
-not evaluated in relapsing MS
-admin non-EC aspirin up to 325 mg 30 min prior to dose to reduce flushing

45
Q

What treats spasticity in MS

A

Baclofen, dantrolene, diazepam, clonazepam, tizanidine, gabapentin, tiagabine, pregabalin, botox, dalfampridine

46
Q

What treats bladder problems in MS

A

propantheline, oxybutynin, dicyclomine, DDAVP, cathetherization, imipramine/amitriptyline, prazosin, botox, solifenacin, darifenacin, trospium, hyoscyamine, myrbetiq

47
Q

What treats sensory problems in MS

A

CBZ, O-CBZ, Phenytoin, TCAs, Gabapentin, lamotrigine, pregabalin, duloxetine

48
Q

What treats fatigue/emotions in MS

A

Amantadine, SSRI/SNRI, modafanil, methylphenidate, dextroamphetamine

49
Q

Pseudobulbar affect (PBA)

A

-uncontrolled crying and laughing (occurs in pts with ALS, AD, PD, MS, stoke, TBI)
-treatable with Nuedexta (DXM HBr and quinidine sulfate)

50
Q

Walking

A

-Dalfampridine (Ampyra)
-Cl in severe renal impairment, hx of seizures
-AE: asthenia, balance disorder, HA, insomnia, UTI

51
Q

Cannabinoids

A

used with spasticity, central pain, bladder voiding, and cognitive impairment

MS/HA/Stoke/Sleep (4 decks)

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