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
2
Q
MS more common in
A
women
3
Q
MS age at diagnosis
A
20-50
4
Q
4 risk factors for MS
A
geography
15-45
environment
genetics
5
Q
high risk geographic areas for MS
A
above 37th parallel
scandanavian whites
6
Q
Environmental factors for development of MS
A
decreased sun exposure/vitamin D levels
Smoking
Viral/Bacterial infections (Ebstein barr, herpes zoster
7
Q
Genetic factor connected with MS
A
HLA DRBI*1501
8
Q
MRI findings in MS
A
black holes or tense lesions
9
Q
age at onset of MS for favorable prognosis
A
< 40
10
Q
gender for MS favorable prognosis
A
female
11
Q
initial symptoms for favorable prognosis in MS
A
optic neuritis/sensory symptoms
12
Q
of attacks early in disease for favorable MS prognosis
A
low
13
Q
disease course for favorable MS prognosis
A
relapsing/remitting
14
Q
5 prognostic indicators in MS
A
age gender initial symptoms # of attacks in early disease disease course
15
Q
What test must be done to diagnose MS
A
MRI
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
17
Q
secondary signs of MS
A
decubitis ulcers UTI falls care difficulties gait abnormalities pain suicide
18
Q
tertiary signs of MS
A
effect on activities of daily life financial personal social vocational emotional
19
Q
what is uhthoff’s phenomenon
A
high sensitivity to heat -> sweating, overheating, flushing
20
Q
name 2 scales used to monitor MS
A
expanded disability status scale (EDSS)
multiple sclerosis functional composite (MSFC)
21
Q
EDSS focuses on what
A
ambulation
22
Q
MSFC focuses on what
A
ambulation, limb function, and cognitive function
23
Q
Acute MS exacerbations are treated with what
A
methylprednisolone
24
Q
methylprednisolone brand name
A
Medrol
25
methylprednisolone route and dosage for MS
500-1000mg IV qd
26
duration of methylprednisolone treatment
3-10 days
27
response seen with methylprednisolone treatment when
3-5 days
28
methylprednisolone action on acute MS
shortens duration and may delay repeat optic neuritis
29
AEs of methylprednisolone
```
sleep disturbances
hyperglycemia
metallic taste
mood changes (depression, somnolence, elevated mood)
long term risk of infections
```
30
What medication should be initiated ASAP after MS diagnosis
INF-beta or glatiramer
31
MOA of interferon beta
decrease in T cell activation, decreasing cytokine secretion and preserving myelin
prevention of upregulation of adhesion molecules
32
AEs with INF beta
```
injection site reactions
poor tolerability
hematologic abnormalities
neuropsychiatric conditions
flu like symptoms
fatigue
hair thinning
```
33
black box warning for interferons
risk of neuropsychiatric (Depression/suicide)
ischemia (MI)
infections
34
Interferon beta 1 beta brand name
betaseron
35
interferon beta 1 beta route
sub Q
36
interferon beta 1 beta dose and frequency
8 million units QOD
37
which interferon beta is associated with the most injection site reactions
betaseron
38
brand names of interferon beta 1 alpha
avonex, rebif
39
avonex route
IM
40
rebif route
SubQ
41
Avonex dose and frequency
30 mcg QW
42
Rebif dose and frequency
22-33 mcg 3x weekly
43
which interferon beta has least incidence of injection site reactiosn
avonex
44
which interferon beta has least incidence of flu like symptoms
rebif
45
how to treat injection site reactions with interferon beta
ice before and after
rotate injection site
administer at room temp
hydrocortisone cream if severe
46
what hemotologic abnormalities require dose adjustments in interferon beta
```
Hgb
WBC
ANC
Plts
Bilirubin
AST/ALT
Alk phos
```
47
When do neutralizing antibodies develop when using interferon beta
18-24 months
48
which interferon beta has the highest risk of developing antibodies
betaseron
49
which interferon beta has the lowest risk of developing antibodies
avonex
50
How do you treat flu like symptoms with interferon beta
```
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
Monitoring for interferon beta
CBC, plts, LFTs
| baseline, 1 month, Q 3 months for one year, then Q 6 months
52
glatiramer brand name
copaxone
53
glatiramer dosage form
SubQ
54
glatiramer dose and frequency
20 mg QD or 40 mg 3x weekly
55
AEs of glatiramer
```
pain and itching at injection site
transient reaction (chest tightness, flushing, dyspnea)
```
56
Caution with glatiramer in what pts
history or presence of CAD
57
Natalizumab brand name
Tysabri
58
Natalizumab MOA
brings to alpha 4 integrins preventing leukocytes from entering CNS
59
Natalizumab route
IV
60
natalizumab dose and frequency
300 mg over 1 hour Q 4 week s
61
AEs of natalizumab
```
progressive multifocal leukoencephalopathy
headache
chills
fever
myalgias
nausea
hepatotoxicity
hematologic effects
infections
```
62
Caution with fingolimod in which pts
heart failure, angina, MI, stoke, TIA
63
fingolimod brand name
gilenya
64
fingolimod route
PO
65
fingolimod dose and frequency
0.5 mg QD
66
AEs of fingolimod
```
headache
diarrhea
increased ALT/AST
back pain
flu like syndrome
bradyarrthymia
AV block
increased BP
Macular edema
1st dose bradycardia
lymphopenia
```
67
fingolimod MOA
pulls lymphocytes into lymphoid organs to reduce number going to CNS
68
Teriflunomide brand name
Aubagio
69
teriflunomide MOA
inhibits pyrimidine synthesis
70
teriflunomide route
PO
71
teriflunomide dose and frequency
7-14 mg QD
72
Teriflunomide drug interactions
CYP 2C8, echinacea, warfarin, immunosuppressants, repaglinide, vacciens
73
Teriflunomide black box warning
severe liver injury/liver failure
| teratogenicity
74
AEs of teriflunomide
```
myelosuppression
alopecia
diarrhea
flu
nausea
liver dysfunction
paraesthesia
```
75
Dimethyl fumarate brand name
Tecfidera
76
Dimethyl fumarate MOA
activates antioxidant response pathway
77
dimethyl fumarate dosage form
PO
78
dimethyl fumarate dose and frequency
120 mg BID x 7 days, 20 mg BID
79
dimethyl fumarate drug interactions
live vaccines(adenovirus, flumist, shingles, MMR, rotavirus, typhoid, varicella, small pox, yellow fever)
80
dimethyl fumarate black box warning
lymphopenia/flushing
81
AEs of dimethyl fumarate
flushing
abdominal pain
nausea
lymphopenia
82
Mitoxantrone brand name
novantrone
83
mitoxantrone MOA
inhibits DNA synthesis
84
mitoxantrone route
IV
85
mitoxantrone dose and frequency
12mg/m2 Q 3 months
86
mitoxantrone max cumulative dose
140mg/m2
87
AEs of mitoxantrone
```
CHF
N/V
alopecia
amenorrhea/mestrual disorder
leukopenia
infections
```
88
possible treatments for MS associated gait difficulties and spasticity
baclofen
| tizanidine
89
baclofen brand name
lioreseal
90
tizanidine brand name
zanaflex
91
possible treatment for MS associated bowel and bladder symptoms
anticholinergics
| oxybutynin
92
oxybutynin brand name
ditropan
93
possible treatment for MS associated tremors
propranolol
94
possible treatment for MS associated depression
```
treat accordingly (sertraline/desipramine)
Avoid interferon or natalizumab
```
95
possible treatment for MS associated sensory symptoms
carbamazepine preferred for trigeminal neuralgias
96
possible treatment for MS associated sexual dysfunction
sildenafil, tadalafil, vardenafil
97
possible treatment for MS associated fatigue
amantidine
methylphenidate
modafinil
98
modafinil brand name
provigil
99
possible treatment for MS associated cognitive symptoms
stimulants or cholinesterase inhibitors
100
CAM therapies used for MS
vitamin D
accupuncture
exercise
