MS

Question 1

exacerbations treatment

Answer 1

high dose corticosteroids
IV methylprednisone 1g daily 3 days
(w/in 2 wks onset symptoms)
3-5 days for improvement
taper w/ oral 3 weeks

Question 2

1st gen Disease Modifying Therapies

Answer 2

self injecting dec. inflammation 
dec. remission 30% takes 1-2 yrs to work 
IFN Betaseron
IFN Avonex
IFN Rebif
IFN Extavia 
IFN Pegylated Plegrid
GLATIRAMER ACETATE (non IFN)

Question 3

2nd gen Disease Modifying Therapies

Answer 3

monoclonal antibodies
Natilizumab
Alemtuzumab
Ocrelizumab

Fingolimod
Terifluonomide
Dimethylfumarate
IV Mitoxantrone

Question 4

Pregnancy category B

Answer 4

(no risk found)

glatriamer acetate

Question 5

Pregnancy category C

Answer 5

(not enough evidence)
IFNs 
-zumab (humanized antibodies)
fingolimod
dimethyl fumarate

Question 6

Pregnancy category D

Answer 6

(adverse human reactions)

mitoxantrone

Question 7

Pregnancy category X

Answer 7

Teriflunomide (men and women)

Question 8

IFN ade and contraindication

Answer 8

Depression

Question 9

Clinically Isolated Syndrome treatment

Answer 9

IFN or Glatiramer Acetate injection

Question 10

Relapsing Remitting treatment

Answer 10

safest- IFN or Glatiramer Acetate injection

convenient- dimethyl fumurate or teriflunomide or Natalizumab infusion (JVC screen 1st)

Question 11

high dose corticosteroids ADE

Answer 11

short term: sleep probs, metallic taste, inc blood sugar in diabetics
long term: acne, fungal infections, mood changes, GI hemorrhage

Question 12

Natalizumab

Answer 12

lymphocytes cant pass BBB
monitor: John Cunninghan virus, LFTs
ADE: PML, hepatotoxicity

Question 13

Alemtuzumab

Answer 13

dec. CD52
monitor: John Cunningham virus, LFTs
ADE: herpes, UTI, URI

Question 14

Ocrelizumab monitor/ADE

Answer 14

dec CD20
contraindicated: Hep B
ADE: herpes, UTI, URI

Question 15

Mitoxantrone

Answer 15

for: relapsing and progressive or worsening MS
inhibits DNA/RNA synthesis
ADE: secondary leukemia, cardiac toxicity, max lifetime dose

Question 16

Mitoxantrone contraindicated

Answer 16

in last 6 months:
MI, heart failure, unstable angina
AV block, sick sinus syndrome, prolonged QT
stroke/TIA
(before start do EKG CBC LFTs eye exam, varacella check/vaccine

Question 17

Fingolimod

Answer 17

observe 1st dose
ADE: AV block, macula retina edema
contraindicated: anti-A 1s and 3s
Ketoconazole increases concentration of Fingolimod

Question 18

Fingolimod moa

Answer 18

sequesters circulating lymphocytes

dec. T lymphocytes and macrophages into CNS

Question 19

Teriflunomide moa

Answer 19

immunomodulator
prevent B and T cell proliferation
dec. lymphocyte activation in CNS
dec. inflammation and demylination

Question 20

Teriflunomide ADE/contraindication

Answer 20

metabolizes Leftunomide (for RA)
ADE: Steven Johnson Syndrome (bad skin rxn)
liver failure HTN alopecia
TB activation Respiratory infection
neuropathy neutropenia

Question 21

dimethyl fumurate

Answer 21

unk moa, nicotinic receptor agonist
ADE: flushing rash itching
GI albuminuria lymphocytopenia

Question 22

Galatriamer Acectate moa/ADE

Answer 22

mix of 4 AA similar to myelin basic protein
mimics MBP and inhibts Tcell receptor complexes
dec. inflammation, demyelination, axonal damage
ADE: chest tightness, flushing

Question 23

Progressive multifocal leukoencephalopathy (PML) is

Answer 23

a rare fatal viral disease  
progressive damage (pathy) or inflammation of the white matter (leuko) of the brain (encephalo) at multiple locations (multifocal).  
caused by the JC virus (John Cunningham HPV type)

Question 24

Safest MS treatment/ CIS treatment

Answer 24

IV interferon or galatriamer acectate

Question 25

convenient MS treatment

Answer 25

oral Terifluonomide or Dimethylfumarate

Question 26

most effective MS treatment

Answer 26

Natalizumab