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MS/HA/Stoke/Sleep > MS > Flashcards

MS Flashcards

(51 cards)

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1
Q

Charcots’ Neurologic Triad

A

-Dysarthria (difficult or unclear speech, plaques in brain stem interfere w/ conscious and unconscious movements)
-Nystagmus (involuntary rapid eye movements bc of plaques in the eye nerves)
-Intention tremor (plaques along motor pathways cause muscle weakness and spasms)

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2
Q

MS diagnosis

A

At least 2 documented exacerbations separated by time/space as well as 2 distinct MRI lesions separated by time and space

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3
Q

PPMS diagnosis

A

diagnosed after 1 year of disease progression and if the pt meets 2 criteria: DIS in brain, within spinal cord &/or positive CSF

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4
Q

CIS

A

diagnosed after 1 exacerbation and 1 lesion while clinician awaits second exacerbation and lesion to make MS diagnosis

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5
Q

CSF in MS

A

normal RBC and glucose, normal or mildly elevated protein, intrathecal IgG synthesis, inc IgG index, oligoclonal bands

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6
Q

RRMS

A

experience worsening of pre-existing sx or onset of new sx for greater than 48 hours w/o fever, known as relapses, flare ups or exacerbations of MS

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7
Q

SPMS

A

progression of RRMS, disease course is steadily progressing w/ or w/o clear cut relapses

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8
Q

PRMS

A

-steady disease progression, clear cut periods of exacerbations of MS
-use steroids to treat relapses, disease will progress regardless of therapy

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9
Q

Relapse treatment

A

-Corticosteroids or Corticotropin Acthar gel

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10
Q

Corticosteroids

A

-used in acute exacerbations to dec inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of inc. capillary permeability
-Methylprednisolone - may be followed by oral prednisone taper
-H2 blocker/PPI for ulcer prevention
-monitor blood glucose, watch for infection

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11
Q

Corticosteroids SE

A

insomnia, mood changes GI upset and inc irritability

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12
Q

Corticotropin acthar gel

A

stimulates adrenal cortex to secrete adrenal steroids (cortisol)
-IM or SQ (used when pt have poor venous access)

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13
Q

ABCR Injectables

A

-interferon beta may augment suppressor T-cell function, may dec interferon gamma secretion by activating lymphocytes; may dec macrophage activating effect; may down reg expression of major histocompatibility complex gene production on APC
-may also dec BBB permeability
-indication: relapsing forms including isolated syndrome, RRMS and active SPMS

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14
Q

Avonex

A

-beta 1a
-IM injection
-dec flu like sx
-preg C

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15
Q

Rebif

A

-beta 1a
-SQ injection given TIW
-Preg C

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16
Q

Plegridy

A

-beta 1a
-SQ injection given every 14 days
-Preg C
-Pegylated interferon = polyethylene glycol attached to interferon molecules to maintain effect longer

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17
Q

Betaseron

A

-beta 1a
-SQ injection given everyday
-Preg C
-SE: flu like sx (pre-medicate before injection with ibuprofen or Tylenol to dec sx), fever, chills, HA, chest pain, injection site rxn, depression, myalgia, arthralgia, malaise, abdominal pain

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18
Q

Glatiramer acetate

A

-may mimic antigenic properties of myelin basic protein
-SQ injection everyday
-Preg B
-Indication: CIS, RRMS, SPMS
-SE: ISR (masses/welts), transient flushing, vasodilation, chest tightness, N/V, arthralgia, anxiety, palpitation, throat congestion
-Patients may feel like they are having a heart attack (counseling point)
-does not cause depression or flu like sx, safest to use in women of child bearing age

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19
Q

ocrelizumab

A

-CD20
-humanized monoclonal antibody
-1st and only agent for PPMS
-binds to CD20 and depletes B-cells
-inc antibody dependent cell mediated cytotoxic effects, less immunogenic
-reduces relapse rates, disability progression and disease activity on MRI in RRMS and SPMS
-reduce disability progression, time required to walk 25 ft, volume of brain lesions in PPMS
-PML could occur

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20
Q

ocrelizumab AE

A

-infusion site rxn (pre-medicate with steroids, antipyretics and antihistamines)

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21
Q

ocrelizumab CI and warnings

Study These Flashcards
A

CI: active HBV
Warnings: herpes, active infection, infusion rxns, malignancy

22
Q

natalizumab

Study These Flashcards
A

-blocks leukocytes from getting to BBB
-humanized
-IV infusion given every 4 weeks
-Preg C
-CIS, RRMs, SPMS (active)
-PML (sometimes fatal viral opportunistic infection)

23
Q

PML

Study These Flashcards
A

-from latent John Cunningham polyomavirus in immunocompromised patients
-once myelin is lost in PML it cannot be regained
-TOUCH prescribing program to monitor for development of PML

24
Q

3 factors that inc risk for PML

Study These Flashcards
A

testing positive for antibodies to JCV, prior immunosuppression use, using natalizumab for 2+ years

25
alemtuzumab
-reserved for refractory pts bc of SE (autoimmune thyroid disorders, pyrexia, pruritus, chest discomfort, UTI, flushing) -IV infusion for RRMS and SPMS -pre-medicate with corticosteroids (Methylpred) -antiviral prophylaxis for herpes on first day and for 2 months after complete until lymphocytes >200 -Preg C
26
alemtuzumab BBW
-fatal autoimmune conditions (monitor CBC counts, serum CR levels, and urinalysis) -life threatening infusion rxns - monitor for 2 hours after infusion -inc risk of malignancies
27
mitoxantrone
-chemotherapy drug -IV infusion given every 3 months -Preg D -not indicated for PPMS, used for rapidly advancing, refractory MS -SE: cardiotoxicity, bone marrow suppression, stomatitis esophagitis, oral ulceration, N?V, alopecia, hepatic dysfunction
28
Mavenclad
-chemotherapy drug -not recommended in CIS -missed dose: admin on following day and extend # of days in the treatment cycle. If 2 missed, extend cycle by 2 days -lymphocytes must be within normal limits before start & >/= 800 before second treatment. 2nd course can be delayed up to 6 months to get to >/= 800. If they do not get to >/= 800 do not continue drug -swallow whole, use dry hands and avoid prolonged contact with skin, wash hands and surface after and don't take anything else for 3 hours
29
Mavenclad BBW
malignancies and teratogenicity
30
Mavenclad CI
pregnancy, HIV, chronic infections, breastfeeding
31
Mavenclad warnings
bone marrow suppression, infection, PML, vaccines, graft-vs-host disease, hepatotoxicity, cardiotoxicity
32
Fingolimod
-S1P - depletes CD4 and CD8 lymphocyte release -oral for RRMS and SPMS, CIS >/= 1- years old -CYP met; no DDI; no toxic metabolites -HR dec on day 1 (monitor for 4-6 hrs in clinic) -dec in FEV1 at high doses -Repeat 1st dose monitoring if patient misses 1 day in first 2 weeks, 7 days in 3rd and 4 weeks, or 14 days after 1 month -wait 30 days after VZV -use contraception
33
Fingolimod CI
heart problems
34
Siponimod
-S1P -CIS, RRMS, SPMS in adults -Refrigerate -only high risk pt need 1st dose observation -missed dose >24 hrs = reinitiate w/ day 1 of titration reg -not to be used in preg and use risk/benefit for lactation
35
Siponimod CYP2D6 *1/*1, *1/*2, *2/*2
-0.25 (day 1 and 2), 0.5 (day 3), 0.75 (day 4), 1.25 (day 5) -2 mg on day 6 (maintenance)
36
Siponimod CYP2D6 *1/*3 or *2/*3
-0.25 (day 1 and 2), 0.5 (day 3), 0.75 (day 4) -1 mg on day 5 (maintenance)
37
Siponimod CYP2D6 *3/*3
contraindicated
38
Siponimod CI
*3/*3 CYP2D6 genotype, MI, unstable angina, stoke, TIA, HF
39
Ozonimod
-S1P -admin 1 month following live vaccines -CI: MI, unstable angina, stroke, ischemic attack, HF, MAOIs -warnings: AV block, bradycardia, hepatotoxicity, HTN, infections, macular edema, PML, VZ infection, pregnancy -avoid foods high in tyramine (HTN crisis)
40
Teriflunomide
-blocks pyrimidine synthesis, inhibits protein tyrosine-kinase and cyclo-oxygenase-2 and dec APC ability to activate T-cells -for relapsing forms of MS -food delays absorption -rosuvastatin should not be > 10 mg -May dec INR in pts taking warfarin
41
Teriflunomide BBW
hepatotoxicity, teratogenicity (X), no breastfeeding, accelerated elimination w/ cholestyramine activated charcoal (dec conc)
42
Dimethyl fumarate (Tecfidera)
-induces T-helper 2-like cytokines causing apoptosis in activated T-cells and down reg of intracellular adhesion molecules = reduced lymphocytes migration -SE: GI sx (give with high fat/protein foods); flushing (give aspirin 30 min before)
43
Diroximel fumerate (Vulmerity)
-causes less GI effects than dimethyl fumarate bc it converts to monomethyl fumarate -admin aspirin 30 min before to reduce flushing -limit fat and calories to
44
Monomethyl fumerate (Bafiertam)
-less GI SE than dimethyl fumerate -not evaluated in relapsing MS -admin non-EC aspirin up to 325 mg 30 min prior to dose to reduce flushing
45
What treats spasticity in MS
Baclofen, dantrolene, diazepam, clonazepam, tizanidine, gabapentin, tiagabine, pregabalin, botox, dalfampridine
46
What treats bladder problems in MS
propantheline, oxybutynin, dicyclomine, DDAVP, cathetherization, imipramine/amitriptyline, prazosin, botox, solifenacin, darifenacin, trospium, hyoscyamine, myrbetiq
47
What treats sensory problems in MS
CBZ, O-CBZ, Phenytoin, TCAs, Gabapentin, lamotrigine, pregabalin, duloxetine
48
What treats fatigue/emotions in MS
Amantadine, SSRI/SNRI, modafanil, methylphenidate, dextroamphetamine
49
Pseudobulbar affect (PBA)
-uncontrolled crying and laughing (occurs in pts with ALS, AD, PD, MS, stoke, TBI) -treatable with Nuedexta (DXM HBr and quinidine sulfate)
50
Walking
-Dalfampridine (Ampyra) -Cl in severe renal impairment, hx of seizures -AE: asthenia, balance disorder, HA, insomnia, UTI
51
Cannabinoids
used with spasticity, central pain, bladder voiding, and cognitive impairment

MS/HA/Stoke/Sleep (4 decks)

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