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