MS

Question 1

IN regards to gender, How is MS different?

Answer 1

Males= more severe
women= more common

Question 2

What is the pathophysiology of MS?

Answer 2

Inflammation causing myelin breakdown, once myelin is gone axon starts to degenerate

Question 3

What infection could cause MS?

Answer 3

Epstein Bar virus

Question 4

Symptoms of MS?

Answer 4

Numbness, tingling, depression, vision issues, fatigue, walking difficulty, weak

Question 5

What is relapse remitting MS?

Answer 5

periods of relapses but doesn’t get worse
most common

Question 6

What is secondary progressive MS?

Answer 6

relapses then eventually progresses worse because body can only repair so much

Question 7

What does relapse remitting eventually become?

Answer 7

secondary progressive

Question 8

What is primary progressive MS?

Answer 8

more severe and always gets worse, no relapses

Question 9

What is clinically isolated syndrome MS?

Answer 9

one relapse only

Question 10

To diagnose, what must we know?

Answer 10

If an MS attack, always do an MRI

Question 11

Why do drugs work less when in secondary progressive?

Answer 11

inflammation eventually goes down then our drugs do not work

Question 12

ON the MS scale, what number do trials enrol?

Answer 12

<6= just walking issues not wheelchair

Question 13

Non pharm for MS?

Answer 13

exercise, diet
alt medicine= not super helpful

Question 14

What is considered a relapse?

Answer 14

new or worsening sx for >24 hrs, no fever or other causes separated by 30 days from another relapse

Question 15

What is treatment for relapse?

Answer 15

Methylpred 500-000mg IV 3-5 days
prednisone 1250 mg for 3-5 days

Question 16

Does relapse treatment need a taper?

Answer 16

not needed but can

Question 17

Are all relapses treated?

Answer 17

No only if severe or if affecting necessary parts such as eyes

Question 18

If people in relapse do not respond to CS, what can we do?

Answer 18

Plasma exchange

Question 19

How can we help with fatigue?

Answer 19

OT/PT, sleep hygiene
amantadine
modafinil
methylphenidate

Question 20

What are issues with the agents used for fatigue?

Answer 20

causes insomnia and not super helpful

Question 21

What fatigue agent causes SJS?

Answer 21

modafinil

Question 22

What can we do to help for gait?

Answer 22

fampridine, causes seizures and insomnia

Question 23

What can we do for spasticity?

Answer 23

baclofen, gabapentin, botulinim

Question 24

Is cannabis useful in MS?

Answer 24

lack of evidence and don’t know dosage/ ratio, and what type of cannabinoid to use

Question 25

What is first DMT for MS?

Answer 25

IFNbeta-1b= betaseron

Question 26

First oral DMT?

Answer 26

finoglimod

Question 27

What is the only DMT that is immunomodulator?

Answer 27

interferon beta

Question 28

What is PML and how can we monitor for it

Answer 28

progressive multifocal leukoencephalopathy often fatal infection by JC virus that destroys myelin Monitor with MRI

Question 29

How do we treat PML?

Answer 29

Lower immunosuppression

Question 30

What DMT has higher risks for PML?

Answer 30

Most is natalizumab after 2 years also seen with dimethyl fumigate, fingolimod, ocrelizumab

Question 31

Which drug causes lipoatrophy?

Answer 31

glatiramer

Question 32

Which DMT options are injectables?

Answer 32

Interfereon, glatiramer, ofatumumab

Question 33

General monitoring for ejectable DMT?

Answer 33

CBC and LFT

Question 34

Which injectable does NOT need monitoring?

Answer 34

glatiramer

Question 35

Which injectable is monthly?

Answer 35

ofatumumab

Question 36

Oral DMT options?

Answer 36

teriflunomide, dimethyl fumarate, mods**, cladribine

Question 37

Which Oral DMTs are teratogenic for both male and female?

Answer 37

teriflunomide, fingolimod, siponimod, ozanimod, cladribine

Question 38

S/e of teriflunomide?

Answer 38

D,V, hair thin, neuropathy

Question 39

Big s/e with dimethyl fumarate?

Answer 39

lymphopenia, gi, flushing

Question 40

Which option MUST have cardiac monitoring?

Answer 40

fingolimod- esp after first dose for 6 hours

Question 41

s/e of fingolimod?

Answer 41

HTN, slow Qt, bradycardia, block, macular edema

Question 42

S/e of siponimod?

Answer 42

slow heart rate, d,n, pain/swelling in hands and feet

Question 43

s/e of ozanimod?

Answer 43

infection risk

Question 44

Which drug is only indicated for SPMS?

Answer 44

spinomid

Question 45

How is cladribine dosed?

Answer 45

QD for 4-5 days each of the first 2 months on year 1 and 2

Question 46

S/e of cladribine?

Answer 46

thinning hair, infection risk

Question 47

Which drug must be avoided if Hep B

Answer 47

ocrelizumab

Question 48

Which drug is indicated for PPMS?

Answer 48

ocrelizumab

Question 49

Which options are transfusions?

Answer 49

natalizumab, ocrelizumab, alemtuzamab

Question 50

What is special about frequency of ocrelizumab?

Answer 50

every 24 weeks

Question 51

What is special about s/e of ocrelizumab?

Answer 51

premeditate with IVMP, antihistamine prior to infusion

Question 52

S/e of alemtuzumab?

Answer 52

infusion run, thyroid issues, cancer risk

Question 53

What happens when you d/c alemtuzumab?

Answer 53

still need to monitor ADR esp autoimmune for 4 years

Question 54

Is rituximab worth it?

Answer 54

off label, works and is less s/e

Question 55

Highest efficacy DMT?

Answer 55

natalizumab and alemtuzumab,

Question 56

If MS does it affect fertility?

Answer 56

No

Question 57

Does MS make pregnancy high risk?

Answer 57

Not necessarily

Question 58

First line for pregnancy and breastfeeding?

Answer 58

Inject= Copaxone/IFN= good until conception oral= teriflunomide???

Question 59

Which ones are ok in breastfeeding?

Answer 59

IFN

Question 60

Which drug has a high risk of relapse and rebound if stopped?

Answer 60

Natalizumab

Question 61

What maps are good in breastfeed and pregnancy?

Answer 61

ocreluzumab and ofatumumab

Question 62

What vaccines are a uno go for MS?

Answer 62

live wait for 4-6 weeks AFTER relapse