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1.) What tests are useful in making a diagnosis of MS?
2.) (Men/Women) are more commonly diagnosed with MS, and most of between _____ - _____ yrs of age.
3.) Some symptoms of MS-
- 1.) MRI, lumbar puncture.
- 2.) Women, 20-50 yrs of age
- 3.) (variable and nonspecific): visual complaints/optic neuritis, gait problems, paresthesias, pain, spasticity, weakness, speech difficulty, cognitive changes, fatigue
1.) T/F. Diagnosis of MS is based on exclusion of other diseases.
2.) What criteria must be met to have a definitive diagnosis of MS?
3.) What is the preferred tool used for diagnosis?
4.) How will IgG antibodies manifest in the body?
- 1.) True
- 2.) Two episodes of neurological disturbance that reflect distinct sites of damage in CNS that cannot be explained by other mechanisms
- 3.) MRI
- 4.) Serum IgG will be normal, CSF IgG will be elevated
What are some side effects of IV methylprednisolone in the treatment of acute MS exacerbations?
- - Sleep disturbances
- - Hyperglycemia
- - Metallic taste
- - Mood changes and infections with longer therapy
*pts who fail steroids will undergo plasma exchange QOD for 7 treatments
Which MS medication has a generic form available?
Interferon beta-1B: Extavia
What is the black box warning for interferons?
- 1.) May aggravate fatal autoimmune disorders
- 2.) May aggravate neuropsychiatric disorders (depression, suicidal ideation)
- 3.) May aggravate ischemic and infectious disorders
1.) Which interferons need to be refrigerated?
2.) Monitoring for interferons
- 1.) Avonex and Rebif
- 2.) Monitor CBCs, platelets, and LFTs at baseline, 1 month, then every 3 months for one year, then every 6 months.
What can be done to decrease injection site reactions with the interferons?
- 1.) Rotate injection site (thighs and buttocks)
- 2.) Apply ice to area before and after admin.
- 3.) Bring medication to room temperature
- 4.) May apply hydrocortisone if severe
*Injection site reactions are less common with IM Avonex
What can be done to decrease the flu-like sxs associated with interferons?
- 1.) Inject the dose in the evening
- 2.) Use lower dose for 2 weeks and then increase
- 3.) Use ibuprofen 200 mg before and 6 and 12 hours after admin (or APAP or prednisone taper)
- 4.) Maintain hydration
*Flu-like sxs less common with Rebif
What MS medication should be refrigerated but is stable at room temperature for one week?
What are the adverse effects associated with fingolimod (Gilenya)?
- ** Pronounced first-dose bradycardia
- - bradyarrhythmia or AV block
- - increased BP
- - macular edema
- - increased liver enzymes
- - lymphopenia
What are the FDA approved indications for mitoxantron (Novantrone)?
- - Worsening RRMS
- - SPMS
- - PRMS
What medications should be used for symptomatic MS relief of gait difficulties (spasticity, weakness, ataxia, defective proprioception?
- - Baclofen (Lioreseal)
- - Tizanidine (Zanaflex)
What medications should be used for symptomatic MS relief of bowel and bladder disorders?
- - Spasticity: baclofen (Lioreseal) 10 mg TID titrated up to 40 - 80 mg/day
- - Hyperactive bladder: anticholinergics --> oxybutinin (Ditropan) 10 - 20 mg/day
- - Constipation:
- - Tremors: propanolol
- - Sensory symptoms (numbness and parasthesias): carbamazepine
- - Depression: desipramine (Norpramine) or sertraline (Zoloft)
- - Sexual dysfunction:
- - Fatigue: amantadine 100 mg BID, methylphenidate (Ritalin)