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
