Multiple Sclerosis

Question 1

What are first line treatment options for MS

Answer 1

1) Interferon Beta

2) Glatiramer

Question 2

What are 2nd line treatment?

Answer 2

1) Mitoxantrone
2) Natalizumab
3) Fingolimod

Question 3

Interferon Beta Side effects

Answer 3

1) Injection site tenderness
2) Flu-like symptoms such as chills, athralgias; can be prevented with Ibuprofen or Tylenol 30 minutes before injection.
3) Increased liver enzymes
4) Depression

Question 4

Interferon Beta CI

Answer 4

• Active, severe depression

- Live vaccine

Question 5

Glatiramer SE

Answer 5

1) lipoatrophy
2) rare, post injection reaction of dyspnea, palpitations, flushing
2) No contraindications

Question 6

Natalizumab SE

Answer 6

1) depression
2) increased liver enzymes
3) Rarely, PML and increased risk if have JC virus and have been taking immunosuppressants in past. Symptoms are rapidly worsening cognitive functions and nerve pain.
4) athralgias, nausea, headache.

Question 7

Mitoxantrone SE

Answer 7

1) Cardiotoxic and could cause HF esp. if above cumulative life time max dose
2) Blue-green urine
3) Alopecia, menstrual disturbances

Question 8

Mitoxantrone CI

Answer 8

1) HF
2) Leukopenia
3) leukemia
4) Pregnancy
5) liver dysfunction.

Question 9

Special advantage of Fingolimod

Answer 9

1) only drug that is oral

Question 10

Fingolimod SE

Answer 10

1) first dose hypotension and hypertension long term
2) QT prolongation
3) Increased liver enzymes
4) Infection.