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?
2.) Two episodes of neurological disturbance that reflect distinct sites of damage in CNS that cannot be explained by other mechanisms
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
- 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
What are the FDA approved indications for mitoxantron (Novantrone)?
- Worsening RRMS
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