Drugs for Multiple Sclerosis EAQ
Which medication can be used to manage fatigue associated with multiple sclerosis? Select all that apply. A. Modafinil [Provigil] B. Clonazepam [Klonopin] C. Dalfampridine [Ampyra] D. Amantadine [Symmetrel] E. Carbamazepine [Tegretol]
A, D Fatigue develops in about 90% of patients with multiple sclerosis, and the drugs most commonly used to manage this symptom include modafinil and amantadine. Clonazepam may be useful for alleviating tremor and ataxia associated with the disease. Carbamazepine, an antiepileptic drug, may be helpful for alleviating neuropathic pain. Dalfampridine may be given to improve walking.
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? A. "I enjoy walking and outdoor activities in the sun." B. "I volunteer at a local day care center once a week." C. "I drink grapefruit juice with breakfast each morning." D. "I understand this drug may cause my urine to turn blue."
B. "I volunteer at a local day care center once a week." Mitoxantrone can cause myelosuppression. Patients taking this drug should be advised to avoid contact with people who have infections, such as children in day care centers. The other statements are appropriate for patients taking this drug.
Which medication used for the management of multiple sclerosis cannot be self-administered? A. Fingolimod [Gilenya] B. Natalizumab [Tysabri] C. Interferon beta-1b [Betaseron] D. Glatiramer acetate [Copaxone]
B. Natalizumab [Tysabri] Natalizumab [Tysabri] is administered by intravenous infusion over 1 hour. The patient must be observed during the infusion and also must be monitored for 1 hour after the infusion is complete. Before this medication can be prescribed and administered, everyone involved with the drug—patients, physicians, pharmacists, infusion nurses, and infusion centers—must be registered with the TOUCH Prescribing Program. The other medications can be self-administered: fingolimod (oral), glatiramer acetate, and interferon beta-1b (subcutaneous injection).
Which assessment is essential before a patient receives a second dose of mitoxantrone [Novantrone]? Select all that apply. A. Pregnancy test B. Echocardiogram C. Complete blood count D. T 3, T 4, and TSH levels E. Ophthalmic examination F. Magnetic resonance imaging (MRI)
A, B, C Mitoxantrone [Novantrone] can cause a variety of adverse effects. Myelosuppression, cardiotoxicity, and fetal injury are the greatest concerns. Consequently, a pregnancy test and a complete blood count should be done, as well as an echocardiogram to determine the left ventricular ejection fraction. Thyroid function studies and MRI are not necessary. Ophthalmic examinations are necessary when the patient is experiencing macular edema, an adverse effect of fingolimod.
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? A. Inflammation and myelin destruction in the central nervous system B. An imbalance of dopamine and acetylcholine in the central nervous system C. A high-frequency discharge of neurons from a specific focus area of the brain D. An inability of serotonin to bind to its receptors in the chemoreceptor trigger zone
A. Inflammation and myelin destruction in the central nervous system The underlying pathophysiology of MS is related to myelin destruction and slowing of axonal conduction related to inflammation within the central nervous system. The demyelination leads to the characteristic neurologic symptoms associated with MS.
The nurse is caring for a patient with multiple sclerosis 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. A. Hemoglobin A 1c B. Blood urea nitrogen C. Alkaline phosphatase D. Complete blood count E. Immunoglobulin G levels
C, D When monitoring a patient receiving interferon, the nurse should watch for potential adverse reactions of hepatotoxicity (alkaline phosphatase) and myelosuppression (complete blood counts). The blood urea nitrogen value is an indicator of renal function, which is not affected by interferon beta-1a. The hemoglobin A1c test is a weighted average of the glucose level over the past several months. Glucose levels are not affected by interferon beta-1a. Immunoglobulin G levels might be assessed when making the diagnosis, but they are not used to monitor for adverse effects of interferon.
Which complaint by a patient taking fingolimod [Gilenya] requires prompt evaluation by the prescriber? A. Hair loss B. Backache C. Dizziness and fatigue D. Blue-green tint to the skin
C. Dizziness and fatigue Fingolimod slows the heart rate and can cause bradycardia. Dizziness and fatigue may be consequences of bradycardia. Backache is an adverse effect that occurs in 12% of patients taking the medication, but it does not require prompt attention. Reversible hair loss and a blue-green tint to the skin are adverse effects of mitoxantrone [Novantrone].
The nurse is caring for a patient hospitalized with an acute episode (relapse) of multiple sclerosis (MS). Which agent is the preferred treatment during relapse? A. Interferon beta-1a [Avonex] IM B. Natalizumab [Tysabri] IV infusion C. Methylprednisolone [Solu-Medrol] IV D. Glatiramer acetate [Copaxone] subQ
C. Methylprednisolone [Solu-Medrol] IV During an acute relapse episode of MS, the treatment of choice is a high-dose IV glucocorticoid, such as methylprednisolone, to reduce the inflammation and diminish symptoms. The other agents are disease-modifying drugs that are used in the long-term management of MS.
Natalizumab [Tysabri] is a very effective agent for treating multiple sclerosis. Which problem is associated with the administration of this drug that makes it a second-line agent? A. Increased risk of sudden cardiac death B. Documented reports of necrotizing colitis C. Rare cases of dangerous brain infections D. Increased risk of Stevens-Johnson syndrome
C. Rare cases of dangerous brain infections Soon after natalizumab was released on the market, there were three reports of progressive, multifocal leukoencephalopathy. All patients who developed this problem were taking natalizumab in combination with another immunosuppressant. The drug now is available only through a specialized, carefully controlled prescribing program.
Which statement made by a patient indicates a need for further teaching by the nurse about reducing injection site reactions from interferon beta? A. "I will apply hydrocortisone ointment to the injection site if it is itchy." B. "I need to rotate my injection sites, so I'll need to keep a record of them." C. "I can take over-the-counter Benadryl if the injection site itches and is red." D. "Applying a warm compress before giving the injection will reduce the risk of pain at the site."
D. "Applying a warm compress before giving the injection will reduce the risk of pain at the site." A brief application of ice rather than a warm compress application is indicated prior to injection. Warm compresses may be helpful following the injection. Injections sites should be rotated to decrease discomfort. Itching and erythema can be reduced by topical application of hydrocortisone or oral diphenhydramine.
A patient newly diagnosed with multiple sclerosis asks the nurse how a person gets this disease. Which response by the nurse is most accurate and appropriate? A. "Multiple sclerosis is a congenital condition that typically manifests itself in late adulthood." B. "Multiple sclerosis is a disease believed to be caused by exposure to drugs during a mother's pregnancy." C. "This disease is most often caused by an increase of rapidly dividing cells in the central nervous system." D. "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor."
D. "This is an autoimmune disease that occurs in people with certain genetic traits when they are exposed to some environmental trigger factor." Although the exact cause is unknown, multiple sclerosis (MS) is believed to have a genetic link. Susceptible individuals have an autoimmune response when exposed to environmental or microbial factors. It is more common among first-degree relatives of individuals who have the disease and is more prevalent among Caucasians. It also is more common in cooler climates, with increased incidence moving away from the equator. MS may also be associated with the Epstein-Barr virus, human herpes virus 6, and Chlamydia pneumonia.
The nurse is caring for a patient receiving glatiramer acetate [Copaxone] for multiple sclerosis. Which finding, if present in this patient, could be considered a potential adverse effect of this drug? A. Decreased neutrophil count B. Flu-like symptoms with fever C. Jaundice and elevated bilirubin D. Injection site pain and redness
D. Injection site pain and redness Injection site reactions, such as pain, erythema, pruritus, and induration, are the most common adverse effects of glatiramer. Unlike interferon, glatiramer does not cause flu-like symptoms, myelosuppression, or hepatotoxicity, which would be indicated in the other responses.
The primary healthcare provider has prescribed dimethyl fumarate [Tecfidera] to a patient. Which condition can be treated with this medication? A. Myasthenic crisis B. Myasthenia gravis C. Chronic progressive phase of multiple sclerosis D. Remission-exacerbation phase of multiple sclerosis
D. Remission-exacerbation phase of multiple sclerosis Dimethyl fumarate [Tecfidera] possesses immunomodulatory properties and is used to treat symptoms such as spasticity, which occur during the remission-exacerbation phase of multiple sclerosis. Oral administration of 120-240 mg of dimethyl fumarate [Tecfidera] twice daily is recommended for relieving symptoms. Neostigmine [Prostigmin] is used in the treatment of myasthenic crisis and also for controlling myasthenia gravis. Cyclophosphamide [Cytoxan] is an immunosuppressant that is used to treat the chronic progressive phase of multiple sclerosis.
The nurse is caring for a patient with multiple sclerosis (MS) who is having worsening recurrent episodes of neurologic dysfunction followed by periods of partial recovery. How would this subtype be classified? A. Relapsing-remitting B. Primary progressive C. Progressive-relapsing D. Secondary progressive
D. Secondary progressive In secondary progressive MS, the patient with the relapsing-remitting subtype experiences declining function with or without occasional recovery of function. Relapsing-remitting MS is marked by defined episodes of neurologic dysfunction separated by periods of partial or full recovery. Primary progressive MS presents with progressive decline of function from the onset. Progressive-relapsing MS is rare and is similar to primary progressive but has acute episodes in addition to the progressively worsening dysfunction.