Pharm - Multiple Sclerosis

Question 1

What is the typical demographics for MS patients?

Answer 1

20-30 year old
Caucasian
Women
North America

Question 2

What are the motor signs of a patient with MS?

Answer 2

Lesions will be of the CNS and Spinal cord. Patient will have weakness, spasticity, hyperreflexia and babinski sign

Question 3

What are the sensory findings on a patient with MS?

Answer 3

Vibratory, touch, pain , temperature loss

Lhermitte’s sign = not specific for MS but will present as a sharp pain that shoots down the back when the head is flexed

Question 4

What is Lhermitte’s sign?

Answer 4

When the head is flexed sharp pain will shoot down the back indicating demyelination of posterior column of the cervical cord

Question 5

What cranial nerve signs will a patient with MS have?

Answer 5

Diplopia (MLF tract)
Optic neuritits (painful loss of vision)
Pain with movement of eyes
Intranuclear opthalmoplegia

Question 6

What cerebellar signs will a patient with MS have?

Answer 6

Ataxia

Unstable gait

Question 7

What are some other signs and symptoms of MS besides motor and sensory?

Answer 7

Autonomic: urinary incontinence, decrease sexual function, constipation
Fatigue: from medications, UTI, depression

Question 8

What psychiatric problems to patients with MS have?

Answer 8

Depression
Bipolar
Cognitive disorders

Question 9

What is Uthoff’s phenomenom?

Answer 9

Heat from a shower or exercise will worsen the symptoms of MS

Question 10

What radiographic signs will help diagnose MS?

Answer 10

MRI (T1, T2, FLAIR, Gadolinium) with show Dawson finger projections that are periventricular lesions in the white matter.

They will not have neovascularization
They will not have angiogeneis
They will not have necrosis`

Question 11

What other tests could be done for MS?

Answer 11

CSF to fing protein oligoclonal bands

Also evoked potentials

Question 12

What are the different forms of MS

Answer 12

Relapsing Remitting MS (85%)
Secondary Progressive (after 7-11 years of RRMS)
Primary Progressive MS (15% usually elderly men)
Progressive-Relapsing MS

Question 13

What are some treatments for MS?

Answer 13

Disease Modifying Therapies

Symptomatic Therapies

Question 14

What is used for acute MS relapse?

Answer 14

Corticosteroids

Question 15

Describe interferons

Answer 15

Make BBB less permeable
decrease cell movement to CNS
Decrease activation of T-cells
Activate T cell suppressors

AE: flu-like syndromes
depression
CBC, liver or thyroid abnormalities

Question 16

Describe Glatiramer acetate (Copaxone)

Answer 16

activate T2 suppressor cells

AE: Chest pressure

Question 17

Describe Natalizumab (Tysabri)

Answer 17

Monoclonal antibody that prevents migration of lymphocytes and monocytes
AE: Increase change of Progressive Multifocal Leukoencephalopathy
JC virus reactivation

Question 18

Fingolimod (Gilenya)

Answer 18

Blocks lymphocytes from leaving lymph nodes
AE: immunosupression
First dose Bradycardia

Question 19

Mitoxantrone (Novantrone)

Answer 19

broad immunosuppression of T cells, B cells and macrophages

AE: Cardiotoxicity, leukopenia, immunosuppressive, leukemia

Question 20

Teriflunomide (Aubagio)

Answer 20

Inhibits pyrimadine synthesis reducing activated lymphocytes

AE: Pregnancy category X, hair loss, hepatotoxicity

Question 21

Dimethyl fumarate

Answer 21

Activates Nrf2 pathway involved with cellular stress response
AE: GI flushing, lymphopenia