Multiple Sclerosis

Question 1

Fampridine (Fampyra)

Answer 1

A) Potassium Channel Blocker

B)
1. Improvement of walking speed in MS patients with walking disability

C)
10 mg TWICE daily

D)
1. Clinical response (stop in 8 weeks if no effect)
2. Seizure risk
3. RENAL (caution)
NO hepatic

E)
Labels: 7b (7 days), 12, A
#Swallow tablet whole; do not crush
S/E:
*CNS (insomnia, anxiety, dizziness, headache)
*MOTOR (balance disorder, paresthesia, weakness, tremor, back pain)
*GIT (constipation)

Question 2

Fingolimod (Gilenya)

Answer 2

A) Sphingosine-1-phosphate receptor modulator

B)

1. Relapsing-remitting MS
2. Secondary progressive MS with relapses

C)
0.5 mg ONCE daily

D)
1. EYES/VISION (risk of macular oedema)
2. Signs of INFECTIONS (herpes, influenza, LRTI - immunosuppression)
3. COMPLETE BLOOD COUNT (lymphocyte)
4. VACCINATION STATUS
5. Signs of PML (progressive multifocal leucoencephalopathy)
6. LUNGS (dyspnoea + reduced lung function tests)
7. BLOOD PRESSURE (increased)
8. ECG/HR/CARDIAC monitoring (bradycardia and av block)
9. CONTRACEPTION (women - during and for 2 months after)
10. Clinical effect
11. Treatment Interruption
12. HEPATIC (increased liver enzymes)
NO renal (no evidence)

E)
Labels: 12, A
#Check with your doctor before receiving any VACCINES
#Contact your doctor if you MISS A DOSE for 1 day or more during 1st month of treatment, or 2 weeks or more after the 1st month of treatment
**DR - (immunosuppression) signs of fever and INFECTION
**DR - (macular oedema) changes in your VISION
**DR - (hepatic) n+v, loss of appetite, unusual tiredness, JAUNDICE or dark urine
S/E:
Headaches, diarrhoea, back-pain and cough

Question 3

Teriflunomide (Aubagio)

Answer 3

A) Immunosuppresant

B)
1. Relapsing form of MS

C)
14 mg ONCE daily

D)
1. INFECTION (immunosuppression - may reactivate latent TB)
2. COMPLETE BLOOD COUNT (leucopenia, neutropenia)
3. VACCINATION status
4. BLOOD PRESSURE (hypertension)
5. Steven-johnsons syndrome
6. Contraception (women - teratogenic)
7. HEPATIC (contraindicated - increased aminotransferase)
NO renal

E)
Labels: A (swallow whole)
#Check with your doctor before receiving any vaccines
**DR - persistent fever or signs of INFECTION
**DR - (peripheral neuropathy) NUMBNESS or tingling in fingers or toes
**DR - (steven-johnsons) RASH
S/E:
GIT (nausea, diarrhoea)
SKIN (alopecia, rash)
EYE (blurred vision)
CNS (anxiety, depression)