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What factors determine the risk for developing MS (four)?
- 1.) Geography
- 2.) Age
- 3.) Environmental influences
- 4.) Genetics
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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
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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
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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
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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
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What are the three goals of MS therapy?
- 1.) Treat symptoms
- 2.) Treat acute attacks
- 3.) Utilize disease-modifying therapy
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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.
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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.
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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
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1.) Brand name for interferon beta-1B:
2.) Brand names for interferon beta-1A:
- 1.) Betaseron
- 2.) Avonex & Rebif
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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
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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
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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)
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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
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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.
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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).
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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
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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
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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
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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
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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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