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Flashcards in MS Deck (32):
1

MS is caused my degradation of _____

myelin

2

How many MS patients are there in the US?

400k

3

What latitude is at high risk of MS?

northern/ cool climates (possible vitamin D link)

4

Genetic risk assc with MS

20-40x risk if 1st degree relative has MS

5

Acute treatment of optic neuritis

1 gram IV prednisone 3-5 days
(for quicker improvement but no clear impact on longterm improvement)

6

What is needed to diagnose MS in the absence of symptoms?

-positive brain MRI
-positive spinal cord MRI
-positive CSF
(2/3 needed)

7

CSF findings in MS

1) oligoclonal banding
2) high IgG/ albumin ratio
3) high IgG synthesis

8

What are traditional (platform) agents for treating MS?

1) interferons
2) glatiramer (copaxone)

**No evidence to combine the two
**Medicaid prefers copaxone first

9

Disadvantages to traditional agents for MS?

1) injections
2) incomplete efficacy
3) neutralizing Abs
4)ADRs/ adherence

10

What are three new MS oral therapies?

1) fingolimod (gilenya)
2)teriflunomide (augbagio)
3) dimethyl fumarate (tecfidera)

11

Gilenya/Fingolimod:
-MC ADR
-Most dangerous ADR

1) MC headache
2) dangerous: bradycardia, hypotension- first dose must be monitored

12

Teriflunomide:
compatible with pregnancy?

- must be removed from system with cholestyramine if woman becomes pregnant

13

Common ADRs assc with Teriflunomide (auba-by-gio)

-diarrhea
-alopecia
-hepatotoxic

14

Dimethyl fumarate (tecfidera) common side effects

flushing
diarrhea
nausea

15

Natalizumab is the most effective drug for MS but is second line why?

1/1000 risk of PML
*can test patients for PML Ab to predict risk before starting drug (2% risk conversion)

16

Transverse myelitis: define

demyelination of the spinal cord

17

Variant of MS that fails to respond to DMARDs

Primary Progressive MS

18

Neuromyelitis Optica:
aka

Devics Disease

19

NMO: location of lesions

spinal cord+ optic nerves
(loss of vision, loss of sensation, bladder dysfunction)

20

NMO Ab

IgG against aquaporin 4 (chloride channel)

21

Tx NMO

Rituximab (CD20 Ab)

22

Which is more severe: NMO or MS

NMO

23

Classic MRI finding in NMO

very long central necrotic region in cord MRI

24

NMO CSF findings

no bands

25

Is co-existing autoimmune disease more common in NMO or MS?

NMO

26

Treatment for spasticity

-baclofen
-benzos
-tizanidine
(all= fatigue)

27

Treatment for neuropathic pain

1) amitryptiline (Elavil)
2) gabapentin (Neurontin)
3) pregabalin (lyrica)
4) carbamazepine (tegretol)
6) duloxetine (Cymbalta)

28

Cognitive domain usually spared in MS

language and verbal skills

29

What causes ^^ risk of cognitive dysfunction in MS

-large T2 lesion area
-large T1/2 lesion load
-greater number of juxtacortical lesions

30

What improves cognitive symptoms in MS?

stimulants, not alzheimers drugs

31

How is urinary retention treated in MS?

alpha blockers
catheterization (intermittent)

32

How is failure of bladder to store treated in MS?

1) scheduled voiding, limit fluids/diuretics
2) anticholinergics
3) botox in bladder