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Optic Neuritis Flashcards

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1
Q

What are the 4 types of optic neuritis?

A
  1. Perioptic Neuritis
  2. Neuroretinitis
  3. Papillitis
  4. Retrobulbar
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2
Q

This type of ON is inflammation is around the nerve sheath and ON. What 2 things cause this?

A
  • Perioptic Neuritis

- Syphilis, Sarcoid

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3
Q

This type of ON is inflammation in ON and Retina.

A

Neuroretinitis

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4
Q

Is neuroretinitis related to MS?

A

No

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5
Q

What 2 workups are needed for a patient presenting with Neuroretinitis?

A
  1. Toxoplasmosis

2. Cat-Scratch Disease

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6
Q

What labs are used to rule out cat scratch disease?

A
  1. Bartonella Quintana

2. Bartonella Henselae

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7
Q

What is the tx for cat-scratch disease?

A
  1. Bactrim
  2. Gentamicin
  3. Ciprofloxacin
  4. Rifampin
  5. Azithromycin
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8
Q

This is ON inflammation at the optic disc only. What % of idiopathic ON cases is this?

A

Papillitis

- found in 35% of cases

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9
Q

This is ON inflammation behind the eye. What % of idiopathic ON cases is this?

A

Retrobulbar neuritis

- found in 65% of cases

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10
Q

Uhtoff’s phenomenon states what?

A

Tasks that raise the body temp worsen ON and cause transient blur

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11
Q

What area of the VF is mainly affected in ON?

A

Central 30 degrees 97.1%

Peripheral = 70%

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12
Q

NMO tends to affect what channels?

A

Aquaporin-4 channels

- causes demyelination

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13
Q

What does NMO affect in the body?

A
  1. Spinal Cord
  2. Optic Neuritis
    (not brain!!!)
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14
Q

What are the typical features of NMO?

A
  1. Muscle Weakness
  2. Sensory dysfunction
  3. Bladder dysfunction
  4. Optic Neuritis
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15
Q

What is the workup for NMO?

A

Order NMO-IgG antibody testing

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16
Q

What is the acute tx for NMO?

A
  1. IV Methylprednisolone

2. Plasma Exchange (PLEX)

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17
Q

What is the maintenance therapy for NMO?

A
  1. IvIgG

2. Immunosuppressants

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18
Q

What are the top 3 low risk features that prove that MS may not be the cause?

A
  1. Severe disc edema
  2. Hemorrhages
  3. Absence of Pain
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19
Q

CSF analysis looks for what that’s presence in almost all MS patients?

A
  1. Oligoclonal bands

- bands with elevated IgG

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20
Q

What type of MRI is used to evaluate white matter in MS patients?

A

FLAIR

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21
Q

An MRI should be performed within how many days of an idiopathic ON?

A
  • w/in 8 days
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22
Q

What tx should be started when an idiopathic optic neuritis is found?

A
  • IV Methylprednisolone x 3 days

- Oral prednisone x 10 days

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23
Q

What is the chance of a patient developing MS in 15 years with 0 lesions and one or more lesions?

Study These Flashcards
A
  1. 0 lesions = 25% chance

2. 1+ lesions = 75% chance

24
Q

Via the ONTT study, treatment with prednisone alone is ?

Study These Flashcards
A

Contraindicated

25
What is the treatment for ON w/ an abnormal MRI?
1. IV methylprednisolone 2. Oral prednisone taper 3. Immunomodulating therapy
26
What is the most commonly used medications for MS?
Injectables
27
What are the 2 types of injectables?
1. Interferon Beta | 2. Copaxone
28
Extavia & Betaseron (IFN 1b) is administered how?
subcutaneous injection QOD
29
Avonex (IFN-b 1a) is administered how?
Intramuscular Injection QW
30
Rebif (1a) is administered how?
subcutaneous injection 3x a week
31
Plegridy (1a) is adminstered how?
subcutaneous injection q 14 days
32
Capaxone (Glatiramer Acetate) is administered how?
SC QD
33
Are orals safer than injectables? Why?
No, orals are not | - They cause PML
34
PML is caused by what virus?
JC virus - crosses the BBB
35
What is the mortality rate of pts with PML?
30-50% in the first few months
36
What was the first oral MS med? How is it adminstered?
Gilenya (fingolimod) | - PO QD
37
What type of MS is associated with optic neuritis?
Relapsing/Remitting form
38
What are the 5 type of injectable IFN-betas?
1. Betaseron (SC QOD) 2. Extavia (SC QOD) 3. Avonex (IM QW) 4. Rebif (SC 3x/w) 5. Plegridy (SC q14days)
39
Which oral med is associated with increased macular edema?
Gilenya (Fingolimod)
40
If a pt needs steroids while on Gilenya, what will the doctor do to stop herpes virus reactivation?
Tx prophylactically w/ Valacyclovir
41
What class of meds must a patient on Gilenya avoid?
Class 1a and III antiarrhythmics, Calcium Channel and beta blockers
42
Tecfidera (Dimethyl fumarate) is an oral medication administered how many times a day?
PO BID
43
What are the SEs of Tecfidera?
1. GI upsent and flushing | 2. PML
44
What is the only oral med not associated with PML? What's the pregnancy category?
Aubagio (Teriflunomide) (PO QD) | - Preg. Category X
45
Aubagio's (Teriflunomide) efficacy is equal to what?
= to injectables
46
What oral med is indicated to tx motor dysfunction and gait impairment? This is taken how many times a day?
Fampyra (Fampridine) | - BID
47
What oral med is useful in the tx of acquired pendular nystagmus?
Namenda (Memantine)
48
What infusion has a definite association w/ PML having > 400 cases?
Tysabri (Natalizumab)
49
How many times is Tysabri administered?
IV infusion q 28 days (once a month)
50
Discontinuing Tysabri (natalizumab) abrudptly causes _____ and an aggressive recurrence of disease.
Immune reconstitution syndrome
51
Zinbryta (Daclizumab) is a monoclonal antibody thats INJECTED how? and how often?
SC injection a 4 weeks (every month)
52
How does Zinbryta (Daclizumab) compare to IFN-betas?
Superior efficacy w/ worse SEs (infection, rash, liver issues)
53
Lemtrada (Alemtuzumab) is a monoclonal INFUSION that is administered how?
2 IV infusions total - 1st infusion (5 days total) - 2nd infusion, 1 year after 1st (3 days total)
54
What are the 2 possible side effects of Lemtrada?
1. Idiopathic Thrombocytopenic Purpura (ITP) | 2. Hyperthyroidism
55
What is the only approved drug for the relapsing and primary progressive forms of MS?
Ocrevus (ocrelizumab)

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