Multiple sclerosis

1

100

What is the basic pathophysiology of MS?

Autoimmune stripping of the myelin sheath around the CNS axons.

200

MS is most commonly found in what age groups?

15-45

300

Treatment goals of MS

•Improve overall quality-of-life and minimize long-term disability

•Altering MS exacerbations or relapses

•Decreasing the number of lesions on MRI

•Avert brain atrophy

400

First line drug class in treating MS? 

•Interferon Formulations

500

2nd line drug class in treating MS? 

•Monoclonal Antibodies – use when patient failed other therapies for later stage disease

2

100

3rd line drug classes in treating MS? 

•Teriflunomide – pyrimidine synthesis inhibitor

•Dimethyl Fumarate – alters cellular response to oxidative stress

•Fingolimod – alters lymphocyte migration

•Glatiramer – synthetic polypeptide that looks like myelin, acts as a decoy

200

Interferon should be avoided in patients with what? 

Untreated depression

300

Interferon B has what side effects? 

◦Depression, flu-like symptoms, injection site reaction

400

What labs should be monitored for Interferon B?

◦CBC, CMP, thyroid functions

◦(baseline, 1 month, q 3 months x 1 year, then q 6 months)

500

Side effects for Mitoxantrone

◦Bone marrow suppression, neutropenia, cardiotoxicity, AML, nausea, vomiting, diarrhea

3

100

Things to monitor with Mitoxantrone 

◦CBC, EKG, LVEF

200

What drug should be limited in maximum lifetime dose due to cardiotoxic properties? 

Mitoxantrone 

300

Natalizumab side effects

◦Depression, fatigue, respiratory infection, arthralgia

400

Monitor what with Natalizumab?

◦MRI, LFTs

500

Fingolimod side effects? 

◦Lymphocytopenia, macular retinal edema, AV block, infection

4

100

Fingolimod: things to monitor 

◦CBC, ECG, Varicella Zoster antibody, blood pressure, ophthalmic exam, LFTs

200

Teriflunomide side effects 

◦Steven-Johnson Syndrome, liver failure, neutropenia, respiratory infection, activation of TB, alopecia, neuropathy

300

Teriflunimide things to monitor 

◦CBC, LFTs, blood pressure, pregnancy, TB test

400

This drug is pregnancy catagory X

Teriflunomide

500

Dimethyl Fumarate side effects

◦Flushing, rash, pruritis, GI discomfort, lymphocytopenia, increased LFTs, albuminuria

5

100

For MS Exacerbations what drug can be given? 

Methylprednisolone

200

Baclofen, Dantrolene, Diazepam, Tizanidine, Tiagabine, Gabapentin, Pregabalin, Botulinum toxin type A. Can all treat what type of MS side effects? 

Spasticity

300

Propantheline, Oxybutynin, Dicyclomine, DDAVP, Self-catheterization, Imipramine or Amitriptyline, Prazosin, Botulinum toxin type A, Silfenacin. Are all ways to treat what type of MS symptoms? 

Bladder

400

Amantadine, Antidepressants, Modafinil, Methylphenidate, Dextroamphetamine, Armodafinil. Can all be used to treat what in MS? 

Fatigue 

500

Carbamazepine, Phenytoin, Amitriptyline or other TCAs, Gabapentin, Lamotrigine, Pregabalin. All treat what type of symptoms in MS? 

Sensory