MS Flashcards
IN regards to gender, How is MS different?
Males= more severe
women= more common
What is the pathophysiology of MS?
Inflammation causing myelin breakdown, once myelin is gone axon starts to degenerate
What infection could cause MS?
Epstein Bar virus
Symptoms of MS?
Numbness, tingling, depression, vision issues, fatigue, walking difficulty, weak
What is relapse remitting MS?
periods of relapses but doesn’t get worse
most common
What is secondary progressive MS?
relapses then eventually progresses worse because body can only repair so much
What does relapse remitting eventually become?
secondary progressive
What is primary progressive MS?
more severe and always gets worse, no relapses
What is clinically isolated syndrome MS?
one relapse only
To diagnose, what must we know?
If an MS attack, always do an MRI
Why do drugs work less when in secondary progressive?
inflammation eventually goes down then our drugs do not work
ON the MS scale, what number do trials enrol?
<6= just walking issues not wheelchair
Non pharm for MS?
exercise, diet
alt medicine= not super helpful
What is considered a relapse?
new or worsening sx for >24 hrs, no fever or other causes separated by 30 days from another relapse
What is treatment for relapse?
Methylpred 500-000mg IV 3-5 days
prednisone 1250 mg for 3-5 days
Does relapse treatment need a taper?
not needed but can
Are all relapses treated?
No only if severe or if affecting necessary parts such as eyes
If people in relapse do not respond to CS, what can we do?
Plasma exchange
How can we help with fatigue?
OT/PT, sleep hygiene
amantadine
modafinil
methylphenidate
What are issues with the agents used for fatigue?
causes insomnia and not super helpful
What fatigue agent causes SJS?
modafinil
What can we do to help for gait?
fampridine, causes seizures and insomnia
What can we do for spasticity?
baclofen, gabapentin, botulinim
Is cannabis useful in MS?
lack of evidence and don’t know dosage/ ratio, and what type of cannabinoid to use
What is first DMT for MS?
IFNbeta-1b= betaseron
First oral DMT?
finoglimod
What is the only DMT that is immunomodulator?
interferon beta
What is PML and how can we monitor for it
progressive multifocal leukoencephalopathy
often fatal infection by JC virus that destroys myelin
Monitor with MRI
How do we treat PML?
Lower immunosuppression
What DMT has higher risks for PML?
Most is natalizumab after 2 years
also seen with dimethyl fumigate, fingolimod, ocrelizumab
Which drug causes lipoatrophy?
glatiramer
Which DMT options are injectables?
Interfereon, glatiramer, ofatumumab
General monitoring for ejectable DMT?
CBC and LFT
Which injectable does NOT need monitoring?
glatiramer
Which injectable is monthly?
ofatumumab
Oral DMT options?
teriflunomide, dimethyl fumarate, mods**, cladribine
Which Oral DMTs are teratogenic for both male and female?
teriflunomide, fingolimod, siponimod, ozanimod, cladribine
S/e of teriflunomide?
D,V, hair thin, neuropathy
Big s/e with dimethyl fumarate?
lymphopenia, gi, flushing
Which option MUST have cardiac monitoring?
fingolimod- esp after first dose for 6 hours
s/e of fingolimod?
HTN, slow Qt, bradycardia, block, macular edema
S/e of siponimod?
slow heart rate, d,n, pain/swelling in hands and feet
s/e of ozanimod?
infection risk
Which drug is only indicated for SPMS?
spinomid
How is cladribine dosed?
QD for 4-5 days each of the first 2 months on year 1 and 2
S/e of cladribine?
thinning hair, infection risk
Which drug must be avoided if Hep B
ocrelizumab
Which drug is indicated for PPMS?
ocrelizumab
Which options are transfusions?
natalizumab, ocrelizumab, alemtuzamab
What is special about frequency of ocrelizumab?
every 24 weeks
What is special about s/e of ocrelizumab?
premeditate with IVMP, antihistamine prior to infusion
S/e of alemtuzumab?
infusion run, thyroid issues, cancer risk
What happens when you d/c alemtuzumab?
still need to monitor ADR esp autoimmune for 4 years
Is rituximab worth it?
off label, works and is less s/e
Highest efficacy DMT?
natalizumab and alemtuzumab,
If MS does it affect fertility?
No
Does MS make pregnancy high risk?
Not necessarily
First line for pregnancy and breastfeeding?
Inject= Copaxone/IFN= good until conception
oral= teriflunomide???
Which ones are ok in breastfeeding?
IFN
Which drug has a high risk of relapse and rebound if stopped?
Natalizumab
What maps are good in breastfeed and pregnancy?
ocreluzumab and ofatumumab
What vaccines are a uno go for MS?
live
wait for 4-6 weeks AFTER relapse
