20 - MS Flashcards Preview

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Flashcards in 20 - MS Deck (38):
1

What symptoms demyelination result in?

numbness, weakness, fatigue, cognitive difficulties, ataxia, optic neuritis, bowel/bladder abnormalities and neuropathic pain

2

What country has highest prevalence of MS? What regions?

Canada
-Atlantic and Prairies

3

Could be linked to low Vitamin ___

D

4

Treatment for relapsing remitting MS

DMT initiated at diagnosis

5

Treatment for secondary progressive MS

DMT has no effect, except in relapses

6

Treatment for primary progressive MS

ocrelizumab

7

What is the McDonald diagnostic criteria for MS?

At least 2 attacks, each attack lasting > 24 hours, at the attacks have to be separated by > 30 days

8

non-pharms for MS?

physiotherapy, stretching, fluid intake restriction & pelvic floor exercises, respiratory training, smoking cessation

9

What can we use for acute relapses?

IV methylprednisolone followed by oral prednisone

10

____ reduce rate of relapses in RRMS

DMTs

11

What does DMT stand for?

Disease Modifying Therapy

12

PML has been reported with most of DMTs, especially ______

natalizumab

13

What is PML?

Progressive multifocal leukencephalopathy

-opportunistic infection
-rare brain disease caused by infection or re-activation of JC virus

14

List the 1st line DMTs

-dimethyl fumarate
-glatiramer
-interferon beta
-ocrelizumab
-teriflunomide

15

List the 2nd line DMTs

-alemtuzumab
-cladribine
-daclizumab - not approved anymore
-fingolimod
-mitoxantrone - off-label
-natalizumab

16

What is the adjunctive treatment that improves walking?

fampiridine (blocks K+ channels, improves walking)

17

How does dimethyl fumarate work?

activates Nrf2 pathway which is involved in cellular response to oxidative stress

18

s/e of dimethyl fumarate

flushing, n/v/d, ab pain

can decrease lymphocytes, cause proteinuria, increase liver enzymes

19

MOA of glatiramer

immunomodulator, inhibits myelin reactive T cells, decreased T cell proliferation and decreases interferon-gamma secretion

20

s/e of glatiramer

rare, acute transient post injection reaction = flushing, chest tightness, palpitations and dyspnea

21

avoid what with dimethyl fumarate?

live vaccines

22

Interferon beta may cause ?

Nabs (neutralizing antibodies)

23

How does ocrelizumab work?

depletes CD20 B cells

24

ocrelizumab has slight risk of _____

neoplasm (abnormal growth of tissue)

25

How does teriflunomide work?

reduces T and B cell activity

26

_____ has no cases of PML reported

teriflunomide

27

How does Alemtuzumab work?

MAB that binds to CD52 on activated lymphocytes and targets their destruction

28

How does cladribine work?

temporarily depletes B and T lymphocytes, followed by lymphocyte reconstitution, thus not causing continuous immune suppression

29

Cladribine has s/e of high grade lymphopenia which is linked to ____

HSV

30

How does Fingolimod work?

blocks activated lymphocytes from circulating into blood stream from lymphoid tissues.

31

s/e of fingolimod?

-macular edema
-bradycardia
-VZV infection
-skin cancer
-reversible hepatic dysfunction
PML

32

Describe mitoxantrone

off-label
-suppresses immune cell activity

33

s/e of mitoxantrone

cardiotoxicity, leukemia

34

MOA of natalizumab

blocks attachment of T cells to the BBB

*highest risk of PML

35

_____ is a known teratogen

Teriflunomide

36

If someone's on teriflunomide and gets pregnant, you need to stop it and wash it out with ______

cholestyramine

37

Mainstay of care in pregnancy and breastfeeding for MS?

-These states decrease risk of relapses
-stop drugs for MS
-if need be, use corticosteroids in breastfeeding for acute relapses

38

All MS patients need how much of vitamin D/day?

1000 IU/day

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