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Flashcards in 00 Multiple Sclerosis Deck (26)
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1
Q

What is MS?

A

A chronic inflammatory and degenerative disease of the CNS. Characterized by inflammation, demyelination, and axonal injury

2
Q

What are some common clinical presentations of MS?

A

Visual complaints/optic neuritis. Gait problems and falls. Paresthesias. Weakness. Fatigue. Bowel/bladder dysfunction. Sexual dysfunction. Depression (secondary)

3
Q

What is Relapsing-Remitting MS (RRMS)?

A

Periods of attacks and remissions followed by full or partial recovery with NO DISEASE PROGRESSION. Can last for years or decades

4
Q

What is Secondary-Progressive MS (SPMS)?

A

Slow and steady irreversible neurologic dysfunction that occurs with or without attacks. Disease course is steadily progressive and can manifest with or without relapses

5
Q

What is Primary-Progressive MS (PPMS)?

A

Continuous neurologic decline from disease onset without distinct attacks. Steady decline without relapse

6
Q

What is Progressive-Relapsing MS (PRMS)?

A

Neurologic decline is steady from disease onset. Occasional distinct attacks may occur. Steady disease progression continues during the relapses

7
Q

What are the first line agents for MS?

A

Interferon B-1a, Interferon B-1b, Glatiramer acetate

8
Q

What are the uses of Interferon B?

A

First-line disease-modifying therapy (DMT). Indicated for: treatment of RRMS to reduce the frequency of relapse and for treatment of CIS (except for interferon B-1a SC)

9
Q

What is the generic of Avonex?

A

Interferon B-1a IM

10
Q

What is the generic of Rebif?

A

Interferon B-1a SC

11
Q

What is the generic of Betaseron?

A

Interferon B-1b SC

12
Q

What is the generic of Extavia?

A

Interferon B-1b SC

13
Q

What are the ADRs associated with Interferon B?

A

Flulike symptoms (prophylaxis with APAP). Injection site reactions. Depression. LFT abnormalities

14
Q

What are the uses of Glatiramer acetate?

A

First-line for MS. Indicated for: RRMS to reduce the frequency of relapse and patients with CIS. Good choice for patients unable to tolerate flu-like sxs or have coexisting depression

15
Q

What are some common ADRs with Glatiramer?

A

Lipoatrophy at injection site (rare, permanent, no treatment). Injection site reactions

16
Q

What needs to be counseled about Glatiramer?

A

Rare self-limited postinjection reaction (flushing, palpitations, anxiety, throat constriction). Advise patient that this reaction is temporary and should remain calm, sit upright, and breathe slowly

17
Q

What is the generic of Gilenya?

A

Fingolimod (first oral DMT for RRMS)

18
Q

What needs to be monitored with Fingolimod?

A

Monitor for bradycardia for at least 6 hours after first dose. Bradycardia usually resolves within 1 month of treatment initiation. If treatment is interrupted for 2 weeks or more, monitoring for at least 6 hours is again required after the next dose

19
Q

When is Fingolimod contraindicated?

A

In patients w/ pre-existing or recent (within last 6 months) heart conditions or stroke, taking antiarrythmic meds

20
Q

What is the generic of Tysabri?

A

Natalizumab (second-line, d/t safety issues, to reduce relapse frequency and delay physical disability in patients with RRMS who have inadequate response to first line DMTs)

21
Q

What is a rare and serious ADR (FDA warning) of Natalizumab?

A

Progressive Multifocal Leukoencephalopathy (PML). Administered only through infusion centers registered with TOUCH

22
Q

What is usually the next step in patients with RRMS that’s refractory to initial treatment with IFN-B or Glatiramer?

A

Adding IV methylprednisolone 1000mg monthly bolus. Natalizumab 300mg by IV infusion Q4 weeks as monotherapy only

23
Q

What is usually the next step in patients with RRMS who are poor responders to IFN-B, Glatiramer, Natalizumab, and Methylprednisolone?

A

IV pulse cyclophosphamide combined with pulse methylprednisolone. IV mitoxantrone Q3 months up to a max lifetime cumulative dose of 140mg/m2

24
Q

What is the most commonly used treatment for MS relapse and can be given safely with MS DMTs?

A

Corticosteroids

25
Q

What is the generic of Ampyra?

A

Dalfampridine: the only pharmacologic therapy FDA approved for walking in MS patients

26
Q

What is the FDA warning with Ampyra (Dalfampridine)?

A

Do not use in patients with a history of seizures, moderate to severe renal impairment, already taking compounded 4-aminopyridine