MS

Question 1

definition of MS

Answer 1

–chronic, inflammatory autoimmune
–potentially disabling disease (brain and spinal cord)

Question 2

characteristics of MS

Answer 2

–inflammation
–demyelination
–scar development

Question 3

etiology of MS

Answer 3

–unknown
–autoimmune may be triggered by infection
–genetic predisposition

Question 4

risk factors for MS

Answer 4

–age: 20-40
–gender: women
–location: moderately cool climate (Northern US)
–race: Caucasian
—-genetics: family hx

Question 5

possible risk factors for MS

Answer 5

–smoking
–vitamin D deficiency
–obesity
–infection (Epstein Barr)

Question 6

patho of MS

Answer 6

–consists of autoimmune attack against the myelin sheath
–T lymphocytes migrate to CNS and cross the blood brain barrier
–antigen-antibody reaction in CNS initiates an inflammatory response
–axons are demyelinated and plaques/sclerosis forms
–axons are destroyed

Question 7

early disease effects of MS on nerves

Answer 7

–nerve fiber not affected
–impulses still transmitted
–may notice weakness

Question 8

later disease effects of MS on nerves

Answer 8

–axons are destroyed
–impulses are totally blocked
–permanent loss of function

Question 9

types of disease progression with MS

Answer 9

–benign
–relapsing-remitting
–primary-progressive
–secondary-progressive
–progressive-relapsing

Question 10

benign progression of MS

Answer 10

no disability with a return to normal between attacks

Question 11

relapsing-remitting progression of MS

Answer 11

unpredictable attacks which may leave permanent deficits followed by periods of remission

Question 12

primary-progressive progression of MS

Answer 12

steady increase in disability without attacks

Question 13

secondary-progressive progression of MS

Answer 13

initial relapsing-remitting MS that suddenly begins to decline without periods of remission

Question 14

progressive-relapsing progression of MS

Answer 14

steady decline since disease onset with superimposed attacks

Question 15

symptoms of MS

Answer 15

–numbness, tingling
–walking difficulty
–pain
–fatigue
–muscle spasms

Question 16

symptoms to monitor with MS

Answer 16

–cognitive problems (Cog Fog)
–vision problems
–depression
–fatigue
–pain
–bowel/bladder
–weakness
–sexual issues
–muscle stiffness/spasm
–walking/balance (vertigo; fall risk)

Question 17

goals of therapy for MS

Answer 17

–slow disability
–reduce frequency of relapses
–reduce new brain lesions

Question 18

what are drugs used for with MS?

Answer 18

–modify disease process
–treat acute relapse
–manage symptoms

Question 19

which MS drug is an injectable - interferon beta?

Answer 19

avonex

Question 20

which MS drug is an injectable - glatiramer acetate?

Answer 20

copaxone

Question 21

MOA of avonex

Answer 21

inhibit pro-inflammatory WBCs from crossing BBB

Question 22

adverse effects of avonex

Answer 22

–flu-like reactions
–liver toxicity
–bone marrow suppression
–depression
–drug interactions

Question 23

effectiveness of avonex

Answer 23

decreases relapse rate by up to 30%

Question 24

MOA of copaxone

Answer 24

increased production of anti-inflammatory T cells which cross the BBB and suppress inflammation

Question 25

adverse effects of copaxone

Answer 25

--injection site reactions --post-injection reactions (flushing, palpitations, chest pain, rash, laryngeal constriction)

Question 26

how long do side effects of copaxone last?

Answer 26

15-20 minutes

Question 27

oral MS meds

Answer 27

--fingolimod --dimethyl fumarate

Question 28

infusion MS meds

Answer 28

natalizumab

Question 29

MOA of fingolimod

Answer 29

retain lymphocytes in the lymph nodes, preventing them from crossing the BBB -- decreasing inflammation

Question 30

which progression stage does fingolimod target?

Answer 30

RRMS

Question 31

MOA for dimethyl fumarate

Answer 31

thought to inhibit immune cells and may have antioxidant properties

Question 32

MOA of natalizumab

Answer 32

prevents circulating T cells from leaving the vasculature and crossing the BBB

Question 33

therapeutic uses of natalizumab

Answer 33

MS and Crohn's

Question 34

specifics about natalizumab

Answer 34

--monotherapy only --relapsing form of MS

Question 35

adverse effects of natalizumab

Answer 35

--most common = HA, fatigue --progressive multifocal leukoencephalopathy (PML) --hepatotoxicity --hypersensitivity

Question 36

progressive multifocal leukoencephalopathy

Answer 36

--drug only available through TOUCH prescribing program --risk increases when combined with another immunosuppressant

Question 37

TOUCH prescribing program

Answer 37

only prescribers, infusion sites, and their associated pharmacies enrolled with the program are able to prescribe, distribute, or infuse

Question 38

alemtuzumab

Answer 38

--infusion --reserved for patients with poor response to 2 or more MS meds

Question 39

mitoxantrone

Answer 39

--secondary progressive --progressive-relapsing --worsening RRMS

Question 40

preferred treatment for acute relapses

Answer 40

--high dose IV glucocorticoid (frequent use or long-term use should be avoided) --IV gamma globulin (for patients intolerant to glucocorticoids)

Question 41

ACTH in treating acute relapse

Answer 41

--ACTH in gel form --prolonged release of ACTH after injection --unable to tolerate steroids or they have not been effective

Question 42

MS drug used to treat urinary frequency/retention

Answer 42

--anticholinergics --cholinergics

Question 43

MS drugs used to treat constipation

Answer 43

bulk-forming laxative

Question 44

MS drugs used to treat fatigue

Answer 44

amantadine

Question 45

MS drugs used to treat muscle spasms

Answer 45

muscle relaxants

Question 46

MS drugs used to treat cognitive dysfunction

Answer 46

donepezil