Multiple Sclerosis from Notes

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jdonaldson
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103658
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Multiple Sclerosis from Notes
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2011-09-23 11:25:29
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james James donaldson Donaldson usp USP
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"Let's go where no one can see us and find the difference between us." - the Dead Weather
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  1. What factors determine the risk for developing MS (four)?
    • 1.) Geography
    • 2.) Age
    • 3.) Environmental influences
    • 4.) Genetics
  2. 1.) If a pt has attacks (sxs lasting at least 24 hours) associated with MS, followed by remissions, this would be classified as _____ - _____ MS.
    2.) If a patient has no acute attacks or remissions; progressive disease occurs from the outset, with symptoms that worsen rapidly or slowly, but over time accrue increasing disability. This would be classified as _____ - _____ MS.
    • 1.) Relapsing-remitting MS
    • 2.) Primary-progressive MS
  3. Favorable prognosis if:
    1.) age at onset ____
    2.) gender ____
    3.) initial sxs are ____
    4.) # of attacks early in disease
    5.) disease type ____
    • 1.) < 40 yrs
    • 2.) female
    • 3.) optic neuritis or sensory symptoms
    • 4.) low
    • 5.) relapsing/remitting
  4. Unfavorable prognosis if:
    1.) age at onset ____
    2.) gender ____
    3.) initial sxs are ____
    4.) # of attacks early in disease
    5.) disease type ____
    • 1.) > 40 yrs
    • 2.) male
    • 3.) motor or cerebellar
    • 4.) high
    • 5.) progressive
  5. 1.) Expanded Disability Status Scale (EDSS) rates function systems using a numerical system (0-10) and places an emphasis on ______.
    2.) The Multiple Scelrosis Functional Composite (MSFC) scale includes _____, ______, and ______.
    3.) Which corresponds best with MRI data?
    • 1.) ambulation
    • 2.) ambulation, limb function, and cognitive function
    • 3.) MSFC
  6. What are the three goals of MS therapy?
    • 1.) Treat symptoms
    • 2.) Treat acute attacks
    • 3.) Utilize disease-modifying therapy
  7. 1.) T/F? Therapy for MS should be continued until MRI assessment shows a halting of disease progression.
    2.) T/F? Therapy should not be stopped during any evaluation period.
    • 1.) False. Therapy should be continued indefinitely unless intolerable side fx occur or a lack of benefit is shown.
    • 2.) True.
  8. Treatment algorithm for MS.
    1st line: IFN-Beta or glatiramer as soon as possible after definite diagnosis with MS.

    2nd line: natalizumab in pts with inadequate response or significant toxicities to 1st lines.

    *Mitoxantrone considered for pts with relapsing worsening disease or SPMS.
  9. What medication should be used to treat acute exacerbations of MS?
    • Methylprednisolone 500 - 1000 mg IV over 3-10 days
    • (response should be seen within 48 - 72 hours).

    *Or plasma exchange QOD for 7 treatments
  10. 1.) Brand name for interferon beta-1B:
    2.) Brand names for interferon beta-1A:
    • 1.) Betaseron
    • 2.) Avonex & Rebif
  11. Route, dose and frequency for:
    1.) Betaseron
    2.) Avonex
    3.) Rebif
    • 1.) 0.25 mg SubQ QOD
    • 2.) 30 mcg IM once weekly
    • 3.) 22 mcg or 44 mcg SubQ 3x/week
  12. What are some adverse effects of the interferons?
    • 1.) injection site reactions
    • 2.) poor tolerability
    • 3.) neuropsychiatric effects (suicidal ideation)
    • 4.) flu-like sxs
    • 5.) fatigue
    • 6.) hair-thinning
  13. Interferons should be avoided in any pt with MS who is also on medications for _____. (Or, at the very least, they should be monitored closely).
    Depression (due to neuropsychiatric side fx)
  14. Which medications are indicated after a first attack associated with MS following MRI results that are consistent with MS?
    • Betaseron
    • Copaxone (glatiramer)

    *Clinical definition of MS requires two or more episodes
  15. What is glatiramer's (Copaxone's) MOA?
    It is a random chain of four amino acids that are found on myelin basic protein, which works as a decoy to antigen-presenting cells/the immune system in general.
  16. 1.) What is Copaxone's (glatirmer's) dose, route, and frequency?
    2.) What adverse fx are associated with Copaxone?
    3.) How should it be stored?
    • 1.) 20 mg SubQ daily
    • 2.) Mild pain and itching at injection site, and a one time transient-rxn (including flushing, chest tightness, dyspnea, or palpitations)
    • 3.) Refrigerate (stable for one week at room temp).
  17. 1.) To what class of drugs does Tysabri belong?
    2.) What is Tysabri's MOA?
    3.) Aside from MS, what can Tysabri also treat?
    4.) Dose, route, and frequency -
    • 1.) Monoclonal antibody/selective adhesion molecule inhibitor
    • 2.) Binds to alpha-4-integrins on leukocytes, preventing the binding to adhesion cells on vascular epithelium and thus migration into CNS
    • 3.) Crohn's disease
    • 4.) 300 mg IV over 1 hour every 4 weeks
  18. Adverse reactions associated with Tysabri (natalizumab) -
    • 1.) Progressive Multifocal Leukoencephalopathy (rare but serious --> now only available through the TOUCH program to identify appropriate candidates
    • 2.) HA, chills, fever myaglias, nausea, hepatoxicity, serious infections
  19. 1.) To what class of drugs does fingolimod (Gilenya) belong?
    2.) fingolimod's MOA
    3.) Dose, route, and frequency
    4.) Adverse effects
    • 1.) Sphingosine 1-phosphate receptor modulator
    • 2.) Sequesters lymphocytes into secondary lymphoid orans, thus reducing numbers of T-lymphocytes and macrophages that migrate into CNS
    • 3.) 0.5 mg PO once daily (doses higher than this are not associated with increased efficacy, but are associated with increased toxicities).
    • 4.) HA, diarrhea, back pain, flu-like sxs, increased AST/ALT
  20. 1.) Brand name of mitoxantrone
    2.) Therapeutic classification
    3.) MOA
    • 1.) Novantrone
    • 2.) Antineoplastic agent
    • 3.) Inhibits cell division and impairs proliferation of T-cells, B-cells, and macrophages by inhibiting DNA replication. Causes apoptosis in APCs
  21. 1.) Dose, route, and frequency of mitoxantrone
    2.) FDA indications
    3.) Adverse rxns
    • 1.) 12 mg/m^2 IV every 3 months (max lifetime cumulative dose is 140 mg/m^2)(d/c if LVEF < 50% or marked reduction occurs)
    • 2.) SPMS, RRMS, hormone-refractory prostate cancer, non-lymphocytic leukemia
    • 3.) CHF, N&V, alopecia, amenorrhea, leukopenia, infections

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