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Neuro-Malloy > Optic Neuritis > Flashcards

Optic Neuritis Flashcards

1
Q

What are the 4 types of optic neuritis?

A
  1. Perioptic Neuritis
  2. Neuroretinitis
  3. Papillitis
  4. Retrobulbar
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2
Q

This type of ON is inflammation is around the nerve sheath and ON. What 2 things cause this?

A
  • Perioptic Neuritis

- Syphilis, Sarcoid

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3
Q

This type of ON is inflammation in ON and Retina.

A

Neuroretinitis

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4
Q

Is neuroretinitis related to MS?

A

No

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5
Q

What 2 workups are needed for a patient presenting with Neuroretinitis?

A
  1. Toxoplasmosis

2. Cat-Scratch Disease

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6
Q

What labs are used to rule out cat scratch disease?

A
  1. Bartonella Quintana

2. Bartonella Henselae

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7
Q

What is the tx for cat-scratch disease?

A
  1. Bactrim
  2. Gentamicin
  3. Ciprofloxacin
  4. Rifampin
  5. Azithromycin
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8
Q

This is ON inflammation at the optic disc only. What % of idiopathic ON cases is this?

A

Papillitis

- found in 35% of cases

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9
Q

This is ON inflammation behind the eye. What % of idiopathic ON cases is this?

A

Retrobulbar neuritis

- found in 65% of cases

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10
Q

Uhtoff’s phenomenon states what?

A

Tasks that raise the body temp worsen ON and cause transient blur

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11
Q

What area of the VF is mainly affected in ON?

A

Central 30 degrees 97.1%

Peripheral = 70%

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12
Q

NMO tends to affect what channels?

A

Aquaporin-4 channels

- causes demyelination

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13
Q

What does NMO affect in the body?

A
  1. Spinal Cord
  2. Optic Neuritis
    (not brain!!!)
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14
Q

What are the typical features of NMO?

A
  1. Muscle Weakness
  2. Sensory dysfunction
  3. Bladder dysfunction
  4. Optic Neuritis
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15
Q

What is the workup for NMO?

A

Order NMO-IgG antibody testing

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16
Q

What is the acute tx for NMO?

A
  1. IV Methylprednisolone

2. Plasma Exchange (PLEX)

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17
Q

What is the maintenance therapy for NMO?

A
  1. IvIgG

2. Immunosuppressants

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18
Q

What are the top 3 low risk features that prove that MS may not be the cause?

A
  1. Severe disc edema
  2. Hemorrhages
  3. Absence of Pain
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19
Q

CSF analysis looks for what that’s presence in almost all MS patients?

A
  1. Oligoclonal bands

- bands with elevated IgG

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20
Q

What type of MRI is used to evaluate white matter in MS patients?

A

FLAIR

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21
Q

An MRI should be performed within how many days of an idiopathic ON?

A
  • w/in 8 days
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22
Q

What tx should be started when an idiopathic optic neuritis is found?

A
  • IV Methylprednisolone x 3 days

- Oral prednisone x 10 days

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23
Q

What is the chance of a patient developing MS in 15 years with 0 lesions and one or more lesions?

A
  1. 0 lesions = 25% chance

2. 1+ lesions = 75% chance

24
Q

Via the ONTT study, treatment with prednisone alone is ?

A

Contraindicated

25
Q

What is the treatment for ON w/ an abnormal MRI?

A
  1. IV methylprednisolone
  2. Oral prednisone taper
  3. Immunomodulating therapy
26
Q

What is the most commonly used medications for MS?

A

Injectables

27
Q

What are the 2 types of injectables?

A
  1. Interferon Beta

2. Copaxone

28
Q

Extavia & Betaseron (IFN 1b) is administered how?

A

subcutaneous injection QOD

29
Q

Avonex (IFN-b 1a) is administered how?

A

Intramuscular Injection QW

30
Q

Rebif (1a) is administered how?

A

subcutaneous injection 3x a week

31
Q

Plegridy (1a) is adminstered how?

A

subcutaneous injection q 14 days

32
Q

Capaxone (Glatiramer Acetate) is administered how?

A

SC QD

33
Q

Are orals safer than injectables? Why?

A

No, orals are not

- They cause PML

34
Q

PML is caused by what virus?

A

JC virus - crosses the BBB

35
Q

What is the mortality rate of pts with PML?

A

30-50% in the first few months

36
Q

What was the first oral MS med? How is it adminstered?

A

Gilenya (fingolimod)

- PO QD

37
Q

What type of MS is associated with optic neuritis?

A

Relapsing/Remitting form

38
Q

What are the 5 type of injectable IFN-betas?

A
  1. Betaseron (SC QOD)
  2. Extavia (SC QOD)
  3. Avonex (IM QW)
  4. Rebif (SC 3x/w)
  5. Plegridy (SC q14days)
39
Q

Which oral med is associated with increased macular edema?

A

Gilenya (Fingolimod)

40
Q

If a pt needs steroids while on Gilenya, what will the doctor do to stop herpes virus reactivation?

A

Tx prophylactically w/ Valacyclovir

41
Q

What class of meds must a patient on Gilenya avoid?

A

Class 1a and III antiarrhythmics, Calcium Channel and beta blockers

42
Q

Tecfidera (Dimethyl fumarate) is an oral medication administered how many times a day?

A

PO BID

43
Q

What are the SEs of Tecfidera?

A
  1. GI upsent and flushing

2. PML

44
Q

What is the only oral med not associated with PML? What’s the pregnancy category?

A

Aubagio (Teriflunomide) (PO QD)

- Preg. Category X

45
Q

Aubagio’s (Teriflunomide) efficacy is equal to what?

A

= to injectables

46
Q

What oral med is indicated to tx motor dysfunction and gait impairment? This is taken how many times a day?

A

Fampyra (Fampridine)

- BID

47
Q

What oral med is useful in the tx of acquired pendular nystagmus?

A

Namenda (Memantine)

48
Q

What infusion has a definite association w/ PML having > 400 cases?

A

Tysabri (Natalizumab)

49
Q

How many times is Tysabri administered?

A

IV infusion q 28 days (once a month)

50
Q

Discontinuing Tysabri (natalizumab) abrudptly causes _____ and an aggressive recurrence of disease.

A

Immune reconstitution syndrome

51
Q

Zinbryta (Daclizumab) is a monoclonal antibody thats INJECTED how? and how often?

A

SC injection a 4 weeks (every month)

52
Q

How does Zinbryta (Daclizumab) compare to IFN-betas?

A

Superior efficacy w/ worse SEs (infection, rash, liver issues)

53
Q

Lemtrada (Alemtuzumab) is a monoclonal INFUSION that is administered how?

A

2 IV infusions total

  • 1st infusion (5 days total)
  • 2nd infusion, 1 year after 1st (3 days total)
54
Q

What are the 2 possible side effects of Lemtrada?

A
  1. Idiopathic Thrombocytopenic Purpura (ITP)

2. Hyperthyroidism

55
Q

What is the only approved drug for the relapsing and primary progressive forms of MS?

A

Ocrevus (ocrelizumab)

Neuro-Malloy (16 decks)

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