Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHM 701 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What type of disease is MS

A

Chronic autoimmnune, inflammatory disease that destroys myelin sheath and impairs the ability to send electrical impulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is though to have an effect on MS

A

Higher Vitamin D levels reduce the disease activity in MS patients
The Epstein-Barr virus triggers MS in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is MS graded on a scale and how is severity determined?

A

On the Kurtzke scale and low is better

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some symptoms of MS?

A

muscle weakness, blurry vision, bladder problems, cognitive disturbances, sensitivity to heat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you diagnose MS?

A

2 documented clinical exacerbation separated by time and space
2 distinct MRI lesion separated by time and space (DIS - on areas known to be affected by MS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What MRI findings are consistent with MS?

A
  • 4 white matter lesions (>3mm)
  • 3 white matter lesions, 1 periventricular (>6mm)
  • Ovoid lesions perpendicular to ventricles
  • Open ring appearance gadolinium enhancements
  • Corpus callosum lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can you describe CIS

A

1st episode of neuro symptoms lasting 24 hours due to inflammation and demyelination.
Patient may or may not develop MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most common form of MS?

A

Relapsing Remitting Multiple Sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can you described RRMS?

A

Worsening or new onset of symptoms lasting >48 hours contrasted by symptoms free periods (remission)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can you describe SPMS?

A

Progression of RRMS and is steadily progressing with or without clear-cut relapses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can you describe PPMS?

A

Rare with a steady decline without clear cut relapses. Meds also aren’t generally effective at this point.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can you describe PRMS?

A

Rare with steady progression with clear-cut MS exacerbations. Can use steroids but disease will still progress.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment for MS?

A

No known cure. Can only treat symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How to treat symptoms of an acute severe attack?

A
  • Methylprednisolone
  • Corticotropin (Acthar gel)
  • H2 blocker/PPI (ulcer prophylaxis)
  • Monitor blood glucose
  • Watch for infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are your Original ABCR Injectables

A

Interferon Beta 1a
- Avonix
- Rebif
- Plegridy
Interferon Beta 1b
- Betaseron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What Interferon Beta used for?

A

Relapsing forms of MS: CIS, RRMS, active SPMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the interferon beta side effects?

A
  • Flu like symptoms!!!!!
  • Injection site reaction
  • Depression
  • Myalgia
  • Mayasteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Glatiramer Acetate?

A

may alter T cell activation/differentiation.
Available as Copaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Copaxone used for?

A

Relapsing forms: CIS, RRMS, actve SPMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the side effects of Copaxone?

A

Injection site reaction
Transient flushing
Chest tightness/pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the monoclonal antibodies used ins MS?

A
  • Natalizumab
  • Alemtuzumab
  • Daclizumab
  • Ocrelizumab
  • Ofatunumab
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does Natalizumab do?

A

Prevent transmigration of leukocytes across endothelium into inflamed parenchymal tissues

*crossing BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is Natalizumab also known as?

A

Tysabri

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is Natalizumab dosed?

A

300 mg IV every 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Natalizumab used for?

A

Relapsing forms: CIS, RRMS, active SPMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is fatal side effect of Natalizumab?

A

PML - rare, fatal viral infection that is activated by the latent JC virus and is demyelinating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What program is Natalizumab under and for what?

A

TOUCH prescribing program due to PML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Who must be registered under the TOUCH program?

A

Patients
Prescribers
Infusion centers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the side effects of Natalizumab?

A
  • Infusion site reaction
  • Resp Tract Infection
  • Urinary Tract Infection
  • Cholelithiasis
  • Depression
  • PML
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does Alemtuzumab do?

A

Decrease of T cell circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is Alemtuzumab indicated for?

A

Relapsing forms of MS and reserved for inadequate response to 2 or more medications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What should you do to initiate Alemtuzumab?

A

Premedicate with corticosteroids for the first 3 days and antiviral prophylaxis (herpes) on the first day till 2 months post alemtuzumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the side effect of Alemtuzumab?

A
  • Autoimmnue Thyroid Disorder (GRAVES)
  • Rash
  • Neuro problems
  • Musculoskeletal pain
  • Shortness of Breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is Alemtuzumab Black Box Warning?

A

autoimmnue condition: thrombocytopenia and antiglomerular basement membrane disease
Infusion Reaction
Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How should you monitor Alemtuzumab?

A

Monitor TSH levels at baseline and every 3 months
Monitor CBC w/ differential, SCr, urinalysis periodically for 48 mos post alemtuzumab
Baseline and yearly skin exams
ECG prior each treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Protocol for initiating Alemtuzuamb

A

Admin in setting with appropriate equipment and personnel (anaphylaxis or infusion reaction) - life threatening
Observe for 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does Ocrelizumab work?

A

May play a role in immune system mediated damage to brain and spinal cord tissues

37
Q

Are there any medications that can help treat PPMS?

A

Yes. Ocrelizumab is the first to show results during the ORATORIO trial

37
Q

What does Ocrelizumab do?

A

It reduces relapse, disease progression and disease activity on MRI in RRMS, SPMS

38
Q

What is Ocrelizumab indicated for?

A

PPMS, relapsing forms: CIS, RRMS, active SPMS

39
Q

What are your side effects or precautions while on Ocrelizumab?

A
  • decrease in IgG levels (monitor levels for opportunistic infection)
  • Increase risk in URTI and UTI
  • Systemic and local injection reaction
  • PML
  • Use contraception in reproductive females during and 6 months post
40
Q

What are your immunomodulator drugs?

A
  • Mitoxantrone
  • Mavenclad
41
Q

How does Mitoxantrone work?

A

It causes DNA strand breaks and inhibits repair via topoisomerase II. It affects rapidly dividing cells.

42
Q

What is mitoxantrone indicated for?

A

SPMS, PRMS, worsening RRMS
- to reduce neuro disability and relapse frequency
- reserve for rapid advancing/refractory

43
Q

What are the side effects of Mitoxantrone?

A
  • Cardiotoxicity
  • Hepatic dysfunction
  • Alopecia
  • Bone marrow suppression (CBC)
  • Stoma/esophagitis, oral ulceration
44
Q

What is Mavenclad?

A

Immunomodulator that is a purine nuceloside analog. It is a prodrug and it helps deplete lymphocytes by DNA breakage and repair synthesis shutdown

45
Q

What is Mavenclad indicated for?

A

RRMS, active SPMS (when response is inadequate)

46
Q

How to dose Mavenclad?

A

3.5 mg/kg over a 2 year course
1.75 mg/kg/year
4 - 5 consecutive days
Available as 10 mg tablets
Max daily dose is 20 mg/day

47
Q

What should you do if you miss a dose?

A

Admin missed dose next day and extend treatment by number of missed doses

48
Q

What is the precaution with taking Mavenclad?

A

Lymphocyte must be within normal limits before initiating treatment

49
Q

What is the precaution with of Mavenclad administering Mavenclad?

A

NIOSH says its hazardous so wear gloves during handling, admin, disposal of Mavenclad

50
Q

What is the BBW associated with Mavenclad?

A
  • Malignancies
  • Teratogenicity
51
Q

What is Mavenclad Contraindicated with?

A
  • Hypersensitivity
  • Breastfeeding
52
Q

What MS drug requires first dose monitoring?

A

Fingolomod
Siponimod

53
Q

How long does Fingolomod first dose monitoring last?

A

6 hours
-ECG and monitor hourly for bradycardia

54
Q

What are the side effects of Fingolomod?

A
  • Lympho/Leukopenia
  • URTI
  • macular edema
  • Increased BP and Hypertension
  • Increased LFTs
55
Q

What are your precautions in Fingolomod usage?

A

Use contraceptives

56
Q

What is Mayzent/Siponomod?

A

It is an MS drug; S1P receptor modulator that decrease the amount of lymphocytes available to the CNS; blocks from leaving lymph nodes

57
Q

What is Mayzent/Siponomod indicated for?

A

CIS, RRMS, active SPMS

58
Q

What is the protocol for initiating Mayzent/Siponomod therapy?

A

CYP2C9 Gentotype testing

59
Q

What genotypes to test for Mayzent/Siponomod?

A

1/1, 1/2, 2/2; I: 0.25 - 1.25, M: 2
1/3, 2/3; I: 0.25 - 0.75, M: 1

60
Q

What genotype is contraindicated in Mayzent/Siponomod therapy?

A

CYP2C9 3/3

61
Q

What is the protocol for Mayzent/Siponomod therapy intitation?

A

First dose monitoring for pre-existing cardiac conditions (6 hours)

62
Q

What are the contraindications of Mayzent/Siponomod?

A

CYP2C9 3/3
MI/TIA/stroke/ADHF (hospitalized)/3rd degree heart block/Class III/IV HF

63
Q

What are the warnings/precautions of Mayzent/Siponomod?

A

Infections
Immunization (test VZV antibodies)
PML
Macular edema
Bradycardia (transient decrease in HR)
Atrioventricular conduction delays
QT prolongation
Cardio disease
Respiratory effects
Hepatic effects
HTN
Neurotoxicity
Malignancy
D/C of therapy (rebound syndrome)

64
Q

What are Mayzent/Siponomod DDIs

A

Immunosuppresants
Bradycardia causing agents
AV blocking agents
QT prolonging agents
2C/3A4 inducers may decrease conc
2C/3A4 inhibitors may increase concM

65
Q

What are the monitoring parameters for Mayzent/Siponomod?

A

ECG
CBC
Hepatic (baseline bilirubin/transaminase)
Ophthalmogic exam
Respiratory function
VZV antibodies
Sinus bradycardia
1st/2nd degree AV block
h/o MI or HF

66
Q

How does Zeposia/Ozonimod work?

A

Binds to S1P 1&5 receptors and blocks lymphocytes from emerging from lymph nodes

67
Q

What is contraindicated in Zeposia/Ozonimod therapy?

A

MI/unstable angina/TIA/ADHF (hospitaliztion), Class III/IV, 2nd or 3rd degree AV block, use of MAOBi

68
Q

What is your diet precaution with Zeposia/Ozonimod?

A

High tyramine food may cause hypertensive crisis

69
Q

What is Teriflunomide?

A

It blocks pyrimidine synthesis and decreases the ability of APC’s to activate T cells

70
Q

How does Teriflunomide work?

A

selectively produces a cytostatic effect on proliferating T and B cell lymphocytes in periphery and reduces B cell proliferation

71
Q

What is Teriflunomide indicated for?

A

For relapsing forms of MS

72
Q

What are the side effects of Teriflunomide?

A

Nasopharyngitis
URTI/UTI
Alopecia
Sensory disturbances
Nasopharyngitis
Increased LFTs

73
Q

What are the fumerates used in MS?

A

Dimethyl Fumerate (Tecfidera)
Diroximel Fumerate (Vulmerity)
Monomethyl fumerate (Bafiertam)

74
Q

How do the fumerates work?

A

reduce migration of lymphocytes

75
Q

What are the side effects of a fumerate?

A

GI side effects (food; due to MMF)
Flushing (admin aspirin)

76
Q

What is the difference between the fumerates?

A

Vulmerity rapidly converts MMF - less GI effects
Bafiertam lower dose needed - lower GI effects

77
Q

What are the treatable symptoms of MS?

A

Spasticity
Bladder problems
Sensory issues
Fatigue/cognitive issue/emotional issues
Walking
Pseuldobulbar Affect

78
Q

How can you treat spasticity in MS?

A

Baclofen
Dantrolene
Benzo (diazepam, clonazepam)
Tizanaidine
Gabentin, pregabalin, tiagabine
Botox
Dalfampridine

79
Q

How to treat bladder problems in MS?

A

Propantheline
Oxybutinin
Dicyclomine
Desmopressin
Mirabegron (Mybetriq)

**Antimuscarininc
**Anticholinergic

80
Q

How to treat sensory issues in MS?

A

Gabapentin
Pregabalin
Carba/Oxcarbazepine
TCAs
Lamotrigine
Duloxetine

81
Q

How to treat Fatigue/Cognitive/Emotional issue in MS?

A

Amantadine
SSRI/SNRI
Modafanil
Methylphenidate
Dexamphetamine

82
Q

What is pseudobulbar affect?

A

uncontrollable laughing or crying in MS, AD, ALS patients

83
Q

How can we treat pseudobulbar affect?

A

Nuedexta

84
Q

What are the contents of Nuedexta?

A

Dextromethorphan and Quinidine

85
Q

What does Dextromethorphan in PBA in MS?

A

Inhibit glutamate at NMDA receptor

86
Q

What does Quinidine do in PBA in MS?

A

Boosts Dextromethorphan (blocks its metabolism)

87
Q

What helps with walking in MS?

A

Dalfampridine

88
Q

What is Dalfampridine contraindicated in?

A

It is contraindicared in moderate or severe renal impairment

PHM 701 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions