Multiple Sclerosis

Question 1

MS is an autoimmune disease in which the body’s immune system attacks the CNS. It affects the ability of nerve cells in the brain and spinal cord to communicate with each other by attacks myelin sheath

• Manage acute attack

Answer 1

Acute attack
- Corticosteroid to reduce inflammation
IV methylprednisone with catheter insert in the arm and left it there for 3-5 days. Then pt will be taper with prednisone.

Question 2

Ampyra

• Indication
• Dose
• SEs
• Available through specialty pharmacy.

Answer 2

Dalfampridine

• Indication: relapsing MS
• Dose: 10mg PO BID
• SEs: SZ
• Available through specialty phram

Question 3

Gilenya

• Indication
• MOA
• Dose
• SE/Serious SEs

Answer 3

Fingolmod

• Indication: relapsing MS
• MOA: a sphingosine 1-phosphate receptor modulator
• Dose: 0.5mg PO QD
  Should observe x 6H of 1st dose for s/s of bradycardia

SEs
- HA, flu, diarrhea, back pain, abn LTF, cough

Serious SEs

• Bradycardia
• Infection
• Vision/Breathing/Liver problem

Question 4

Capaxone

• Indication
• Dose

Answer 4

Glatiramer

• Indication: MS
• Dose: 20mg SC QD

Question 5

Avonex

• Indication
• Dose
  Avonex
• Interferon monitoring
• Interferon SEs

Answer 5

Interferone Beta 1A

• Indication: MS
• Dose: Avonex: 30mg IM QW
• Prefilled syringe. Refrigerate. RT x 7d. Protect from light
• Vials: refrigerate. RM x 30d. Protect from light

Interferone monitoring

• CBC w/ diff
• Depression/suicidal
• Thyroid
• S/S of CV
• LFTs (Rebif)
• Seizures

Interferon SEs
- Flu like sx: fever, night sweats, muscle ache

Question 6

Betaseron
Extavia

• Dose
• Storage

Answer 6

Interferone Beta 1B

• Dose: SC QOD
• RT until reconstitute, then refrigerate and use w/in 3Hs

Question 7

Tysabri

• Indication
• MOA
• SE
• Special program

Answer 7

Natalizumab

• Indication: MS and Crohn’s Disease
• MOA: monoclonal antibody
• SEs: serious brain infection
• Program: Pts, prescribers and pharmacies must be enrolled in the Tysabri Outreach Unified Commitment to Health (TOUCH).

Question 8

Rebif

Answer 8

Interferone beta 1A

• F: SC 3x/W
• Refrigerate. RT x 30d. Protect from light

Question 9

Techfidera

• Form
• Indication

Answer 9

Dimethyl fumarate

• F: PO
• I: Relapse MS

Question 10

Lemtrada

• Form
• Indication

Answer 10

Alemtuzumab

• F: IV
• I: Relapse MS