Ott MS Flashcards
What is DIT
Dissemination in time: time between evidence of new lesions in subsequent MRIs (30 days) –> damage that has happened more than once
what is DIS
dissemination in space: need for > 1 T2 lesion appearing in at least two of four MS-typical CNS regions (cortical, periventricular, infratentorial, spinal cord) –> damage that is in more than one place
What is Clinically Isolated Syndrome (CIS)
descriptor of a first demyelinating event involving the optic nerve, cerebrum, cerebellum, brainstem, or spinal cord
What is relapsing remitting MS (RRMS)
most common
consists of relapses with partial or complete remission between relapses
most will become progressive over time
what is secondary progressive MS (SPMS)
80% of RRMS patients will progress to this
consisting of fewer relapses with continuing disability
what is primary progressive MS (PPMS)
10-15% of patients
progressive form from onset with minor improvements or periods of stability
more common in patients diagnosed in later years (>50 years)
what is progressive relapsing MS (PRMS)
least common
steadily worsening disease from onset with later, clear, acute relapses
may be some recovery from attacks but no remission between relapses
what is the first choice of treatment for acute attacks
high dose corticosteroid
oral or IV
what is the dosing for acute ms attacks
methylprednisolone 500mg-1000mg IV daily for 3 to 7 days with or without an oral taper of 1-3 weeks
what is the outpatient dosing for acute attacks
oral prednisone 1250mg every other day x 5 doses without need for taper
(this is a lot of tabs. take with food and warn patient about side effects)
what are the oral medications for MS
dimethyl fumarate
diroximel fumarate
fingolimod
ozanimod
ponesimod
siponimod
teriflunomide
what are the injectable MS medications
interferon beta-1a
peginterferon beta-1a
interferon beta-1b
glatiramer acetate
what are the infusion MS medications
alemtuzumab
natalizumab
ocrelizumab
what must MS patients be tested for prior the getting drugs
JCV antibodies
what vaccines are preferred in MS
inactivated vaccines
live are not recommended because the ability to cause disease is weakened
what MS drug cannot be given with live virus vaccines
alemtuzumab
how should varicella vaccines be approached in MS patients
should be considered in patients who have never had chicken pox especially if started MS medications like fingolimod and alemtuzumab
administration counseling for dimethyl fumarate and diroximel fumarate and monomethyl fumarate
capsule should not be opened and sprinkled on food. do not crush or chew
what do you monitor with fumarate MS drugs
LFTs and CBC with differential
what are fumarate MS drugs associated with
PML
flushing (can take aspirin 30 min prior to help)
what are the sphingosine 1-phosphate receptor modulators
fingolimod
ozanimod
ponesimod
siponimod
what are sphingosine modulators contraindicated with
past arrhythmia diagnosis or MI, unstable angina, stroke/TIA, class 3/4 HF withing past 6 months
what happens with discontinuing sphingosine modulators
significant worsening of MS symptoms
what drug class must be avoided with ozanimod
MAO inhibitor
what testing is required prior to starting siponimod
CYP2C9 genotype
Injection side effects of glatiramer acetate
immediately post injection
flushing
sweating
dyspnea
chest pain
anxiety
itching
what counseling point should you give for injection of glatiramer acetate
must rotate injection sites every time to avoid lipoatrophy
when is glatiramer acetate preferred
pregnancy
how can interferons be dosed
SC or IM every other day to every 2 weeks depending on the dosage form
counseling for post injection of interferons
flu-like symptoms
may pre-treat with APAP or NSAID and inject at night
what are the psychiatric effects of interferons
depression
suicidal thinking
what must be monitored with interferons
LFTs and TSH
what are the monoclonal antibody MS drugs
alemtuzumab
natalizumab
ocrelizumab
alemtuzumab
REMS
fatal infusions reactions and autoimmune conditions
increased risk of malignancies
CI with HIV infection
natalizumab
REMS program
associated with PML
third line
ocrelizumab
only FDA drug for PPMS
CI in active hep b
increased risk of malignancies
when do you vaccinate with monoclonal MS drugs
at least 6 weeks before starting treatment
what MS drug is contraindicated in pregnancy
Teriflunomide
requires 2 methods of contraception
how do you handle a pregnancy with a patient on teriflunomide
activated charcoal for 11 days until gone or repeat
contraception for mitoxantrone
required for treatment
pregnancy test before each infusion
contraception with fingolimod
contraception during treatment and at least 2 months after D/C
contraception with ozanimod
during treatment and for at least 3 months after D/C
contraception with ponesimod
during treatment and for at least 7 days after D/C
contraception with siponimod
during treatment and at least 10 days after D/C
contraception with ocrelizumab
during treatment and at least 6 months after D/C
contraception with cladribine
required + barrier method for at least 6months after D/C
CI in breastfeeding
Dalfampridine (Ampyra) moa
blocks potassium channels and prevents repolarization of cell
may improve walking speed
what dosage form and doses should be avoided with dalfampridine
IR dosage forms and dose escalation
associated with seizures
CI with history of seizures
