Multiple Sclerosis (MS)

For exacerbation of MS, what drugs are commonly used?

Acute anti-inflammatory: Steroids --Usually methylprenisolone (SoluMedrol) 1000mg IVPB over 1 hr Q24hrs x 3-5 days --Then oral steroid taper (may also see oral steroids used initially) Usually with: --Calcium and vitamin D --H2RA --Glucose monitoring --HR and BP monitoring

Which MS drug has a long 1/2 life of 2 years and is contraindicatied for pregnancy (males/females) and the hepatically impaired?

Aubagio (Teriflunomide)

What are some examples of primary symptoms of MS?

--Numbness/tingling, weakness, neuropathic pain, muscle spasm/tremor, gait/balance issues, bowel and bladder problems, fatigue, cognitive changes

What are some major adverse effects when taking copaxone?

1) Anxiety 2) Chest tightness/dyspnea 3) Injection site rxn

What drugs are considered first-line in treatment of MS?

1) Avonex 2) Betaseron 3) Copaxone 4) Rebif

What are the ROA and dosing regimen for each of the interferon-beta drugs?

1) Avonex = IM q7days 2) Betaseron = SC q48hrs 3) Rebif = SC q3X/week

What labs should you monitor for at baseline when taking Copaxone?

1) BMP 2) CBC

What are the baseline labs required prior to starting Fingolimod (Gilenya)?

1) CBC 2) LFT 3) Eye exam 4) Baseline HR & BP 5) ECG if heart problems 6) Varicella serology and varicella zoster virus vaccination if antibody negative (Don't start med until 1 month after vaccination) 7) Skin screen for precancerous lesions 8) 1st dose: 6 hr monitoring

What are some options to accelerate the removal process of Teriflunomide?

1) Cholestyramine = 8g Q8h x 11 day or 4g dose if not tolerated 2) Activated charcoal powder = 50g Q12h x 11d

What are some symptoms of MS?

1) Fatigue 2) Spasticity 3) Bladder issues: incontinence, retention 4) Bowel: constipation 5) Depression 6) Cognitive impairment 7) Peripheral neuropathy 8) Sexual dysfunction

What are some major ADEs of the interferon-beta drugs?

1) Flu-like symptoms (development of neutralizing antibodies0 2) Depression 3) Injection site rxn

What are the oral disease-modifying treatments for MS?

1) Gilenya (Fingolimod) 2) Aubagio (Teriflunomide)

What drugs are considered the "bigger guns" in the treatment of MS?

1) Natiluzimab (Tysabri) 2) Mitoxantrone (Naovantrone)

What maintenance monitoring is required for Teriflunomide?

1) S/S of infection 2) LFT 3) BP 4) 2 year elimination period

A T1 type MRI ___(does/doesn't) use ____ to reveal ____ (new/old/ or new AND old) lesions . A T2 type MRI ___(does/doesn't) use ____ to reveal ____ (new/old/ or new AND old) lesions .

A T1 type MRI DOES use GADOLINIUM to reveal NEW lesions . A T2 type MRI DOESN'T use RADIOCONTRAST DYE to reveal NEW AND OLD lesions .

What drug can be used to treat walking difficulties in patients with MS?

Dalfampridine (Amprya)

True or False MS patients should prevent influenza by becoming vaccinated with the seasonal vaccine (activated or inactivated).

False = INACTIVATED only

True or False MS is most commonly diagnosed before the age of 20.

False = most commonly between 20-50 years

True or False Prevalence of MS increases in those who live closer to the equators.

False = there is a link to Vitamin D levels; prevalence increases in those who live FARTHER from the the equator

What drug is associated with macular edema and 1st dose bradycardia and should not be used in patients with heart issues?

Gilenya (Fingolimod)

What results from a lumbar puncture would indicate MS?

HPLC results on CSF: 1) IgG Oligoclonal bands 2) Myelin basic protein (MBP) 3) Immunoglobulins

How does Copaxone work in the treatment of MS?

It is a drug that becomes the target for the body's immune system instead because it looks like a mylein sheath.

which MS drug can make the urine blue and is associated with heart toxicity?

Mitoxantrone (Novantrone)

Outline the pathophysiology of MS.

Myelin sheath around CNS axons gets attacked by immune system and stripped as a result. --Inflammatory cascade response with infiltration of T cells, B cells, macropharges, antibodies, and complement --Forms a lesion around the damaged axon ("plaque") --Formation of plaques and then repair ==> ongoing and position of these plaques are related to the symptoms

Which drug is associated with the TOUCH prescribing program created to address the drugs risk of progressive multifocal leukoencephalopathy (PML), which can cause death or sever disability?

Natalizumab (Tysabri)

What is the dosing schedule for Copaxone?

SC every day

What criteria is used to diagnose MS and what tests are involved in this diagnosis?

The McDonald Criteria -- Medical History & Neurological exam a. MRI b. Evoked Potentials c. Lumbar puncture

True or False Primary signs and symptoms depends upon the sclerotic lesion location in the brain.

True

True or False Treatment for MS is to be continued indefinitely, unless there is clear lack or benefit, intolerable SE, new data that reveal other reasons for cessation, or better therapy becomes available.

True

True or False While the ratio of women developing MS is 2:1 to men, men are more likely to have a higher severity of disability

True

Which are treatment options for treating fatigue in MS patients? (Select all that apply) a) Amantadine (Symmetrel) b) Methylphenidate (Ritalin) c) Pemoline (Cylert) d) Dextroamphetamine (Dexedrine) e) Modafanil (Provigil) f) Baclofen (Lioresal) g) Tizanidine (Zanaflex) h) All of the above are options.

a) Amantadine (Symmetrel) b) Methylphenidate (Ritalin) c) Pemoline (Cylert) d) Dextroamphetamine (Dexedrine) e) Modafanil (Provigil)

Which are drug options to treat spasticity in MS patients? a) Baclofen (Lioresal) b) Tizanidine (Zanaflex) c) Amantadine (Symmetrel) d) Pemoline (Cylert) e) Dantrolene (Dantrium) f) Diazepam (Valium) g) Botulinum toxin h) All of the above are options

a) Baclofen (Lioresal) b) Tizanidine (Zanaflex) e) Dantrolene (Dantrium) f) Diazepam (Valium) g) Botulinum toxin

What lab monitoring is required before starting Aubagio (Teriflunomide)? (Select all that apply) a) CBC b) LFT c) Renal fxn d) BP e) Thyroid fxn f) Pregnancy test g) TB screen h) Chem 7 I) Eye exam

a) CBC b) LFT d) BP f) Pregnancy test g) TB screen h) Chem 7

Which of the following are treatment strategies to reduce fatigue in MS patients? (Select all that apply) a) Keep cool b) Amantadine c) Dantrolene d) Methylphenidate e) Baclofen f) Regular exercise

a) Keep cool b) Amantadine d) Methylphenidate f) Regular exercise

Which type of MS is diagnosed for the majority of patients? a) Relapsing remitting b) Progressive relapsing c) Primary progressive d) Secondary progressive

a) Relapsing remitting

Which type of MS is there an initial attack followed by a period of remission? a) Relapsing remitting b) Primary progressive c) Progressive relapsing d) Secondary progressive

a) Relapsing remitting

Which type of MS are there no remission periods and symptoms only get worse over time? a) Relapsing remitting b) Primary progressive c) Progressive relapsing d) Secondary progressive

b) Primary progressive

Which are tip(s) to help with injection reactions? (Select all that apply) a) Apply a heating pad to the site b) Room temperature medication c) Fast rate of administration d) Inject just before going to bed e) Pre-medicate with APAP, NSAIDS, steroids f) Apply EMLA or hydrocortisone cream

b) Room temperature medication d) Inject just before going to bed e) Pre-medicate with APAP, NSAIDS, steroids f) Apply EMLA or hydrocortisone cream Other viable options: --Apply ICE to numb the site --Post medicate --Keep track of injection sites

Which type of MS is a progressive disease with few relapses? a) Relapsing remitting b) Primary progressive c) Progressive relapsing d) Secondary progressive

c) Progressive relapsing

Which of the following agents is suitable initial therapy for a newly diagnosed MS patient? a) Mitoxantrone (Novantrone) b) Dalfampridine (Amprya) c) Natalizumab (Tysarbri) d) Glatiramer acetate (Copaxone)

d) Glatiramer acetate (Copaxone)

Which of the following agents may become inactive over time due to production of neutralizing antibodies? a) Dalfampridine (Ampyra) b) Glatiramer acetate (Copaxone) c) Fingolimod (Gilenya) d) Interferon beta-1a (Avonex)

d) Interferon beta-1a (Avonex)

Which type of MS describes when a pt enters a progressive phase where it is difficult to differentiate between attacks and remissions? a) Relapsing remitting b) Primary progressive c) Progressive relapsing d) Secondary progressive

d) Secondary progressive