Multiple Sclerosis

Question 1

What is MS gen char

Answer 1

Def: plaques or sclerosed areas in numerous areas of brain and spinal cord
Cause:
demyelination + inflammatory response ->
plaques brain, spinal cord, optic nerves ->
neurologic symptoms reflective of affected area

Question 2

What is MS clin

Answer 2

SS:
spasticity
bladder symptoms
sensory symptoms
fatigue
ED
depression
constipation
gait
pain
tremor
numbness
cognitive dysfunction

Txt goals:
decrease severity, intensity, and duration exacerbations
enhance exacerbation recovery
prevent relapse and onset of dx
stop or reverse progressive MS
provide symptomatic relief from MS complications

Txt:
Acute Exacerbations
Disease Modifying Therapy
Symptomatic management

Question 3

Acute Exacerbations Types

Answer 3

Mild
Moderate (Corticosteroid)
Severe (Corticosteroid/maybe plasma exchange

Question 4

Corticosteroids in MS

Answer 4

MOA: unclear
Drugs: 
methylprednisolone IV 500-1000 mg/day x 3-5 days
prednisone PO 1250 mg qoday x 5
AE:
GI upset
insomnia
mood swings
effects diminish with repeated use

Question 5

Plasma Exchange in MS

Answer 5

For hemiplegia, paraplegia, quadriplegia not respond to corticosteroids

Dose: qod x 7

Question 6

Interferons in MS gen char

Answer 6

Use: decrease frequency of exacerbations and delay disability

MOA: interferon that alter expression and response to surface antigens

Drugs:
Avonex
Rebif
Betaseron
Extavia

Question 7

Interferons in MS clin

Answer 7

AE:
HA
flu-like sx
myalgia
Injection Site rxns
depression

Monitoring:
EDSS
CBC
platelet
LFT 1 mth, q3 mth (1 yr), q6

Reactions:
antibodies form to interferons

Question 8

Dx modifying therapy types in MS

Answer 8

1st line:
Interferons
Glatiramer

Same efficacy as 1st line:
Fingolimod
Teriflunomide
Dimethyl fumarate

Special pts only:
Mitoxantrone
Natalizumab

Question 9

Glatiramer summary

Answer 9

MOA: suppress T-lympocytes
Indication: RR
AE:
vasodilation
arthralgia
Chest pain
injection site reaction

Question 10

MS classifications

Answer 10

Relapsing/Remitting (RR)
Primary Progressive (PP)
Secondary Progressive (SP)
Progressive Relapsing (PR)

Question 11

Fingolimod summary

Answer 11

MOA: prevent WBC migration to CNS

Indication: RR, PR

AE:
HA
increase LFT
decrease HR
Heart block
macular edema
bronchitis
pneumonia

CI: MI, angina, stroke, TIA, HF

Question 12

Teriflunomide summary

Answer 12

MOA: reduce activated lymphocytes in CNS

Indication: relapsing forms of MS

AE:
N/D
hair loss
hepatotoxicity
increase infection risk

CI:
No preg

Question 13

Mitoxantrone summary

Answer 13

MOA: suppress immune cells that attack body

Indication: RR, SP, PR

AE:
decrease WBC & platelets
anemia
increase LFT
Decrease LVEF
HF
UTI
N/V
mucositis

Monitor: LVEF baseline

Question 14

Dimethyl fumarate summary

Answer 14

MOA: protect neurons and myelin

Indication: relpasing forms of MS

AE:
flushing
N/D
decreased WBC
PML

Question 15

natalizumab summary

Answer 15

MOA: prevent lymphocytes from passing across BBB

Indication: monotherapy for relapsing forms of MS

AE:
progressive multifocal leukoencephalopathy

Monitor: safety registry

Question 16

Dalfampridine symmary

Answer 16

MOA: block K+ channels on nerve fiber surface

Indication: developed to help with MS walking speed

AE:
back pain
dizziness
insomnia
fatigue
N
balance disorder
UTI
falls
HA
seizures

CI:
seizures
Renal impairment