Ch. 23 Drugs for MS

Which statement made by a patient indicates a need for further teaching by the nurse about reducing injection site reactions from interferon beta? "I need to rotate my injection sites, so I'll need to keep a record of them." "I will apply hydrocortisone ointment to the injection site if it is itchy." "Applying a warm compress before giving the injection will reduce the risk of pain at the site." "I can take over-the-counter Benadryl if the injection site itches and is red."

Applying a warm compress before giving the injection will reduce the risk of pain at the site

The nurse is teaching a patient about a new prescription for mitoxantrone [Novantrone]. Which statement made by the patient indicates a need for further teaching? "I volunteer at a local day care center once a week." "I drink grapefruit juice with breakfast each morning." "I enjoy walking and outdoor activities in the sun." "I understand this drug may cause my urine to turn blue."

I volunteer at a local day care center once a week

Teriflunomide

Immunomodulator Approved for relapsing forms of MS. Reduces relapse rates and disability progression when used alone, and augments clinical benefits when combined with interferon beta or glatiramer Adverse effects: headache, nausea, diarrhea, neutropenia, alopecia,

Interferon Beta

Immunomodulator Therapeutic use: relapsing forms of MS. Decreases the frequency and severity of attacks, reduce the number and size of MRI-detectable lesions, and delay progression of disability. Adverse effects: generally well tolerated. Flu-like reactions, hepatotoxicity, myelosuppression, injection-site reactions, depression, neutralizing antibodies.

Natalizumab

Immunomodulator approved for MS and Crohn's disease Was on the market for a short time and withdrawn because of reports of progressive multifocal leukoencephalopathy (PML), a severe infection of the brain. Should not be combined with other disease-modifying drugs due to risk of PML. Reduces annualized rate of relapse by 68% and number of new or enlarging brain lesions by 83%; these benefits are superior to other immunomodulators. approved only for monotherapy of relapsing forms of MS. Adverse effects: Generally well tolerated. Headache and fatigue, abdominal discomfort, depression, diarrhea, UTI. Most serious effects of PML and liver injury

Dimethyl Fumarate

Immunomodulator management of relapsing MS. Reduces relapse rates and slow disease progression. Adverse effects: Flushing, lymphopenia, GI discomfort, decrease in lymphocytes increasing infections, rash. Patients should not receive live virus vaccines while taking this

Fingolimod

Immunomodulator reduces frequency of MS exacerbations and delays disability in patients with relapsing forms of disease. Can cause significant adverse effects and is reserved for patients who cannot tolerate injections or have not responded well to other immunomodulators. Adverse effects: headache, cough, diarrhea, back pain, influenza, elevation of liver enzymes. Bradycardia, macular edema, infection, fetal harm, and liver injury

Mitoxantrone

Immunosuppressant. Originally developed for cancer and later approved for MS. Poses a significant risk of toxicity and reserved for pts who cannot be treated with safer agents. Approved for pts with worsening relapsing-remitting MS, secondary progressive MS, and progressive-relapsing MS. May delay time to relapse and time to disability progression. Not effective against primary progressive MS. Adverse effects: myelosuppression, cardiotoxicity, and fetal injury. Especially toxic to dividing cells. Can cause reversible hair loss, injury to GI mucosa, nausea, vomiting, menstrual irregularities, blue-green tint to skin, sclera, and urine.

All pts with relapsing-remitting MS should receive an immunomodulator as soon after diagnosis and continuing indefinitely

Interferon beta dimethyl fumarate glatiramer acetate natalizumab fingolimod teriflunomide

The nurse is caring for a patient hospitalized with an acute episode (relapse) of MS. Which agent is the preferred treatment during relapse? Interferon beta-1a [Avonex] IM Methylprednisolone [Solu-Medrol] IV Glatiramer acetate [Copaxone] subQ Natalizumab [Tysabri] IV infusion

Methylprednisolone IM

Which medication can be used to manage fatigue associated with multiple sclerosis? (Select all that apply.) Modafinil [Provigil] Clonazepam [Klonopin] Amantadine [Symmetrel] Carbamazepine [Tegretol] Dalfampridine [Ampyra]

Modafinil Amantadine

Which medication used for the management of multiple sclerosis cannot be self-administered? Fingolimod [Gilenya] Natalizumab [Tysabri] Glatiramer acetate [Copaxone] Interferon beta-1b [Betaseron]

Natalizumab

Immunosuppressants for MS

Only one. Mitoxantrone

A patient newly diagnosed with MS asks the nurse how a person gets this disease. Which response by the nurse is most accurate and appropriate? "Multiple sclerosis is a congenital condition that typically manifests itself in late adulthood." "Multiple sclerosis is a disease believed to be caused by exposure to drugs during a mother's pregnancy." "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system."

This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor

Multiple sclerosis

chronic, inflammatory, autoimmune disorder that damages the myelin sheath of neurons in the CNS

The nurse is caring for a patient with MS who is receiving interferon beta-1a [Rebif] by subcutaneous injection. Which laboratory tests should be performed regularly in this patient to monitor for a potential adverse effect? (Select all that apply.) Blood urea nitrogen Complete blood count Hemoglobin A1c Alkaline phosphatase Immunoglobulin G levels

complete blood count alkaline phosphatase

Immunomodulators

dimethyl fumarate, glatiramer acetate, natalizumab, fingolimod, teriflunomide, and interferon beta. Safer than immunosuppressants

Which complaint by a patient taking fingolimod [Gilenya] requires prompt evaluation by the prescriber? Hair loss Backache Dizziness and fatigue Blue-green tint to the skin

dizziness and fatigue

Glatiramer Acetate

immunomodulator Used for long term therapy of relapsing-remitting MS. Requires more frequent injections than interferon beta and is less well tolerated. Adverse effects: injection site reactions (rash, pain, erythema, pruritus, induration

Two main groups of disease-modifying drugs

immunomodulators and immunosuppressants

A patient with a history of numbness, weakness, and blurred vision recently was diagnosed with multiple sclerosis (MS). What does the nurse understand to be the underlying pathophysiology for these symptoms? An imbalance of dopamine and acetylcholine in the central nervous system Inflammation and myelin destruction in the central nervous system An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone High-frequency discharge of neurons from a specific focus area of the brain

inflammation and myelin sheath destruction in the CNS

The nurse is caring for a patient receiving glatiramer acetate [Copaxone] for MS. Which finding, if present in this patient, could be considered a potential adverse effect of this drug? Flulike symptoms with fever Decreased neutrophil count Jaundice and elevated bilirubin Injection site pain and redness

injection site pain and redness

Which assessment is essential before a patient receives a second dose of mitoxantrone [Novantrone]? (Select all that apply.) Pregnancy test Echocardiogram Complete blood count T3, T4, and TSH levels Ophthalmic examination Magnetic resonance imaging (MRI)

pregnancy test echocardiogram complete blood count

Natalizumab [Tysabri] is a very effective agent for treating MS. Which problem is associated with the administration of this drug, making it a second-line agent? Increased risk of sudden cardiac death Documented reports of necrotizing colitis Increased risk of Stevens-Johnson syndrome Rare cases of dangerous brain infections

rare cases of dangerous brain infections

Four subtypes of MS:

relapsing-remitting (the most common secondary progressive primary progressive progressive-relapsing

The nurse is caring for a patient with MS who is having worsening recurrent episodes of neurologic dysfunction followed by periods of partial recovery. How would this subtype be classified? Relapsing-remitting Secondary progressive Primary progressive Progressive-relapsing

secondary progressive