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Pnt Exam 2 > MS > Flashcards

MS Flashcards

1
Q

define MS

A

chronic, autoimmune, inflammatory disease of the CNS variable in presentation and symptoms; characterized by multiple plaques or demylinated lesions

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2
Q

MS more common in

A

women

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3
Q

MS age at diagnosis

A

20-50

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4
Q

4 risk factors for MS

A

geography
15-45
environment
genetics

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5
Q

high risk geographic areas for MS

A

above 37th parallel

scandanavian whites

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6
Q

Environmental factors for development of MS

A

decreased sun exposure/vitamin D levels
Smoking
Viral/Bacterial infections (Ebstein barr, herpes zoster

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7
Q

Genetic factor connected with MS

A

HLA DRBI*1501

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8
Q

MRI findings in MS

A

black holes or tense lesions

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9
Q

age at onset of MS for favorable prognosis

A

< 40

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10
Q

gender for MS favorable prognosis

A

female

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11
Q

initial symptoms for favorable prognosis in MS

A

optic neuritis/sensory symptoms

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12
Q

of attacks early in disease for favorable MS prognosis

A

low

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13
Q

disease course for favorable MS prognosis

A

relapsing/remitting

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14
Q

5 prognostic indicators in MS

A 
age
gender
initial symptoms
# of attacks in early disease
disease course
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15
Q

What test must be done to diagnose MS

A

MRI

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16
Q

Primary signs of MS

A 
urinary incontinence/retention
spasticity 
optic neuritis
incontience/constipation
cognitive deficits
depression
weakness/fatigue
uhthoff's phenomenon
sexual dysfunction
tremor
pain
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17
Q

secondary signs of MS

A 
decubitis ulcers
UTI
falls
care difficulties
gait abnormalities
pain
suicide
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18
Q

tertiary signs of MS

A 
effect on activities of daily life
financial
personal
social
vocational
emotional
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19
Q

what is uhthoff’s phenomenon

A

high sensitivity to heat -> sweating, overheating, flushing

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20
Q

name 2 scales used to monitor MS

A

expanded disability status scale (EDSS)

multiple sclerosis functional composite (MSFC)

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21
Q

EDSS focuses on what

A

ambulation

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22
Q

MSFC focuses on what

A

ambulation, limb function, and cognitive function

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23
Q

Acute MS exacerbations are treated with what

A

methylprednisolone

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24
Q

methylprednisolone brand name

A

Medrol

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25
Q

methylprednisolone route and dosage for MS

A

500-1000mg IV qd

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26
Q

duration of methylprednisolone treatment

A

3-10 days

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27
Q

response seen with methylprednisolone treatment when

A

3-5 days

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28
Q

methylprednisolone action on acute MS

A

shortens duration and may delay repeat optic neuritis

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29
Q

AEs of methylprednisolone

A 
sleep disturbances
hyperglycemia
metallic taste
mood changes (depression, somnolence, elevated mood) 
long term risk of infections
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30
Q

What medication should be initiated ASAP after MS diagnosis

A

INF-beta or glatiramer

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31
Q

MOA of interferon beta

A

decrease in T cell activation, decreasing cytokine secretion and preserving myelin
prevention of upregulation of adhesion molecules

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32
Q

AEs with INF beta

A 
injection site reactions
poor tolerability 
hematologic abnormalities
neuropsychiatric conditions
flu like symptoms
fatigue
hair thinning
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33
Q

black box warning for interferons

A

risk of neuropsychiatric (Depression/suicide)
ischemia (MI)
infections

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34
Q

Interferon beta 1 beta brand name

A

betaseron

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35
Q

interferon beta 1 beta route

A

sub Q

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36
Q

interferon beta 1 beta dose and frequency

A

8 million units QOD

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37
Q

which interferon beta is associated with the most injection site reactions

A

betaseron

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38
Q

brand names of interferon beta 1 alpha

A

avonex, rebif

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39
Q

avonex route

A

IM

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40
Q

rebif route

A

SubQ

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41
Q

Avonex dose and frequency

A

30 mcg QW

42
Q

Rebif dose and frequency

A

22-33 mcg 3x weekly

43
Q

which interferon beta has least incidence of injection site reactiosn

A

avonex

44
Q

which interferon beta has least incidence of flu like symptoms

A

rebif

45
Q

how to treat injection site reactions with interferon beta

A

ice before and after
rotate injection site
administer at room temp
hydrocortisone cream if severe

46
Q

what hemotologic abnormalities require dose adjustments in interferon beta

A 
Hgb
WBC
ANC
Plts
Bilirubin
AST/ALT
Alk phos
47
Q

When do neutralizing antibodies develop when using interferon beta

A

18-24 months

48
Q

which interferon beta has the highest risk of developing antibodies

A

betaseron

49
Q

which interferon beta has the lowest risk of developing antibodies

A

avonex

50
Q

How do you treat flu like symptoms with interferon beta

A 
inject in evening
lower doses to start
ibuprofen 200 mg before an after (APAP or prednisone can also be given ) 
Maintain hydration
Temp 101+ go to ER
51
Q

Monitoring for interferon beta

A

CBC, plts, LFTs

baseline, 1 month, Q 3 months for one year, then Q 6 months

52
Q

glatiramer brand name

A

copaxone

53
Q

glatiramer dosage form

A

SubQ

54
Q

glatiramer dose and frequency

A

20 mg QD or 40 mg 3x weekly

55
Q

AEs of glatiramer

A 
pain and itching at injection site
transient reaction (chest tightness, flushing, dyspnea)
56
Q

Caution with glatiramer in what pts

A

history or presence of CAD

57
Q

Natalizumab brand name

A

Tysabri

58
Q

Natalizumab MOA

A

brings to alpha 4 integrins preventing leukocytes from entering CNS

59
Q

Natalizumab route

A

IV

60
Q

natalizumab dose and frequency

A

300 mg over 1 hour Q 4 week s

61
Q

AEs of natalizumab

A 
progressive multifocal leukoencephalopathy
headache
chills
fever
myalgias
nausea
hepatotoxicity 
hematologic effects
infections
62
Q

Caution with fingolimod in which pts

A

heart failure, angina, MI, stoke, TIA

63
Q

fingolimod brand name

A

gilenya

64
Q

fingolimod route

A

PO

65
Q

fingolimod dose and frequency

A

0.5 mg QD

66
Q

AEs of fingolimod

A 
headache
diarrhea
increased ALT/AST
back pain
flu like syndrome
bradyarrthymia
AV block
increased BP 
Macular edema
1st dose bradycardia
lymphopenia
67
Q

fingolimod MOA

A

pulls lymphocytes into lymphoid organs to reduce number going to CNS

68
Q

Teriflunomide brand name

A

Aubagio

69
Q

teriflunomide MOA

A

inhibits pyrimidine synthesis

70
Q

teriflunomide route

A

PO

71
Q

teriflunomide dose and frequency

A

7-14 mg QD

72
Q

Teriflunomide drug interactions

A

CYP 2C8, echinacea, warfarin, immunosuppressants, repaglinide, vacciens

73
Q

Teriflunomide black box warning

A

severe liver injury/liver failure

teratogenicity

74
Q

AEs of teriflunomide

A 
myelosuppression
alopecia
diarrhea
flu
nausea
liver dysfunction
paraesthesia
75
Q

Dimethyl fumarate brand name

A

Tecfidera

76
Q

Dimethyl fumarate MOA

A

activates antioxidant response pathway

77
Q

dimethyl fumarate dosage form

A

PO

78
Q

dimethyl fumarate dose and frequency

A

120 mg BID x 7 days, 20 mg BID

79
Q

dimethyl fumarate drug interactions

A

live vaccines(adenovirus, flumist, shingles, MMR, rotavirus, typhoid, varicella, small pox, yellow fever)

80
Q

dimethyl fumarate black box warning

A

lymphopenia/flushing

81
Q

AEs of dimethyl fumarate

A

flushing
abdominal pain
nausea
lymphopenia

82
Q

Mitoxantrone brand name

A

novantrone

83
Q

mitoxantrone MOA

A

inhibits DNA synthesis

84
Q

mitoxantrone route

A

IV

85
Q

mitoxantrone dose and frequency

A

12mg/m2 Q 3 months

86
Q

mitoxantrone max cumulative dose

A

140mg/m2

87
Q

AEs of mitoxantrone

A 
CHF
N/V
alopecia
amenorrhea/mestrual disorder
leukopenia
infections
88
Q

possible treatments for MS associated gait difficulties and spasticity

A

baclofen

tizanidine

89
Q

baclofen brand name

A

lioreseal

90
Q

tizanidine brand name

A

zanaflex

91
Q

possible treatment for MS associated bowel and bladder symptoms

A

anticholinergics

oxybutynin

92
Q

oxybutynin brand name

A

ditropan

93
Q

possible treatment for MS associated tremors

A

propranolol

94
Q

possible treatment for MS associated depression

A 
treat accordingly (sertraline/desipramine) 
Avoid interferon or natalizumab
95
Q

possible treatment for MS associated sensory symptoms

A

carbamazepine preferred for trigeminal neuralgias

96
Q

possible treatment for MS associated sexual dysfunction

A

sildenafil, tadalafil, vardenafil

97
Q

possible treatment for MS associated fatigue

A

amantidine
methylphenidate
modafinil

98
Q

modafinil brand name

A

provigil

99
Q

possible treatment for MS associated cognitive symptoms

A

stimulants or cholinesterase inhibitors

100
Q

CAM therapies used for MS

A

vitamin D
accupuncture
exercise

Pnt Exam 2 (11 decks)

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