Quiz 4

Question 1

What is the autoimmune theory?

Answer 1

Attach on the CNS leading to a disruption of the BBB
Migration of T lymphocytes into the CNS
T-lymphocytes attack myelin
Results in demyelination

Question 2

What is RRMS?

Answer 2

Relapsing-Remitting MS

Question 3

What is the most common form of MS at diagnosis?

Answer 3

RRMS

Question 4

What are RRMS exacerbations?

Answer 4

Clearly defined

Question 5

What happens to neurologic function in RRMS?

Answer 5

Acute worsening

Question 6

Is there remission from RRMS?

Answer 6

Periods of partial/complete

Question 7

If a patient has RRMS, what other form may it develop into w.in 10 years?

Answer 7

SPMS

Question 8

What is SPMS?

Answer 8

Secondary progressive MS

Question 9

What happens to SPMS QOL during progression?

Answer 9

Steadily worsening +/- flare ups

Question 10

Does SPMS have remission?

Answer 10

Minor recoveries

Question 11

What is PPMS?

Answer 11

Primary progressive MS

Question 12

How does disease progress in PPMS?

Answer 12

Slow but continuous worsening of their disease from the onset

Question 13

Are there any relapses in PPMS?

Answer 13

No

Question 14

What is the rate of progression in PPMS?

Answer 14

Varies over time

Question 15

What is the least common MS?

Answer 15

PRMS

Question 16

What is PRMS?

Answer 16

Progressive relapsing MS

Question 17

How does PRMS progress?

Answer 17

Steadily worsening disease from the onset

Question 18

Are there any relapses in PRMS?

Answer 18

Clear acute relapses +/- recovery

Question 19

How does PRMS contrast to RRMS?

Answer 19

Periods between relapses are characterized by continuing disease progression

Question 20

How do we treat acute exacerbations of MS?

Answer 20

HD methylprednisolone (500-1000mg/d) x 3-10 days

Question 21

What are the 1a treatments for MS?

Answer 21

Interferon beta
Glatiramer
Dimethyl fumarate

Question 22

What are the 1b treatments for MS?

Answer 22

Fingolimod

Teriflunomide

Question 23

What are the 1c treatments for MS?

Answer 23

Natalizumab

Ocrelizumab

Question 24

What are the 2nd line treatments for MS?

Answer 24

Mitoxantrone
Alemtuzumab
Daclizumab

Question 25

What are the treatments of MS spasticity?

Answer 25

Baclofen Tizanidine Dalfampridine

Question 26

What are the treatments of MS bladder sx?

Answer 26

Oxybutynin Tolterodine Dicyclomine

Question 27

What are the treatments of MS sensory sx?

Answer 27

CBZ Gaba VPA TCAs

Question 28

What are the treatments of MS fatigue?

Answer 28

Amantadine Modafinil Methylphenidate

Question 29

What is the pathophysiology of PD?

Answer 29

Loss/degeneration of dopamine neurons -> relative increase of cholinergic interneuron activity (tremors) Development of Lewy Bodies

Question 30

What are the cardinal features of PD?

Answer 30

Bradykinesia Resting tremor Muscle rigidity Gait dysfunction, postural instability

Question 31

What are SEs of levodopa therapy?

Answer 31

Abnormal involuntary movements (motor complications) - Dyskinesia treatment - Peak too high, must dose adjust

Question 32

How do we treat dyskinesia d/t levodopa?

Answer 32

Smaller, more frequent doses of levodopa Use sustained-release products Amantadine 200-400mg QD

Question 33

What is the "off" effect d/t in levodopa therapy?

Answer 33

End of dose deterioration Motor sx of PD breakthrough Trough

Question 34

What is the management of the "off" effect?

Answer 34

Increase frequency of doses | Change to CR/ER formulation

Question 35

When is CR/ER levodopa formula more effective?

Answer 35

For HS dose

Question 36

What agents can be added to levodopa to get more steady dopamine effects?

Answer 36

DA, MAOI, COMT-i, or amantadine

Question 37

If a PD patient is having a severe "off" effect, what can be given?

Answer 37

SQ apomorphine

Question 38

What may cause drug resistant off periods

Answer 38

May be a result of delayed gastric emptying or absorption

Question 39

What are ways we can manage drug resistant off periods?

Answer 39

``` Give on an empty stomach Crush/chew and take with a full glass of water Avoid CR formulation Switch to ODT Increase dose and/or frequency ```

Question 40

How do we treat rapid on-off fluctuations?

Answer 40

Addition of DA, MAOI, COMT-i | Drug free period or drug holiday (rare)

Question 41

How do we have nocturnal off state?

Answer 41

HS dose of DA | ER formulation of levodopa/dopamine agonist

Question 42

What is the MOA of dimethyl fumarate?

Answer 42

Unknown Thought to prevent damage of the brain and spinal cord through its antioxidant properties brought about by activation of the nuclear factor-like 2 pathway

Question 43

What is the dose of dimethyl fumarate?

Answer 43

120mg twice daily for 7 days then increase to MD of 240mg twice daily

Question 44

What is the BBW for dimethyl fumarate?

Answer 44

Increase risk of Progressive Multifocal Leukoencephalopathy (PML)

Question 45

What are common AEs of dimethyl fumarate?

Answer 45

``` Flushing GI upset (ab pain, nausea, diarrhea), pruritus, rash, leukopenia ```

Question 46

What do we monitor in dimethyl fumarate?

Answer 46

CBC at baseline then every 6-12 months