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Multiple Sclerosis
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what is a clinically isolated syndrome
the first attack or onset of Sx
Sx of CIS
optic neuritis
spinal transverse myelitis
brainstem and cerebellar lesions
what is uthoffs phenomenon
overlap in the nerve terminal
reversible exacerbation
unfavorable prognostic factors of MS
> 40 yrs
male
motor or cerebellar sx
progressive
high attack frequency
most common subtype of MS
relapse-remitting
what are pts with RRMS initially responsive to
immunosuppression
what is RRMS
last at least 24 hrs
separated from new sx by at least 30 days
followed by remissions
secondary progressive MS
progressive phases with or without relapses
how does SPMS respond to immunosuppression
less responsive than RRMS
what is Progressive-relapsing MS (PRMS)
slow onset of progressive phase with superimposed attacks/relapses
what is primary progressive MS (PPMS)
the onset of progressive neurological dysfunction without attacks/relapses or remission
PPMS response to immunotherapy
little to no response
which disease state is the least likely to have new MRI inflammatory lesions
PPMS
what does the diagnosis of MS require
1. clinical signs and sx
2. elimination of more likely dx (differential)
3.s demonstration of dissemination of lesions in space and time
what are the white areas on an MRI scan
lesions
agents used to manage balance
meclizine
prochlorperazine
promethazine
agents used for spasticity
baclofen
tizanidine
dantrolene
diazepam
clonazepam
gabapentin
agents used to manage fatigue
amantadine
modafanil
stimulants
SSRIs
agents used to treat incontinence (bladder)
desmopressin
oxybutynin
tolterodine
TCAs
agents to manage incontinence (bowel)
dicyclomine
laxatives
j
agents used to treat pain
carbamazepine
gabapentin
pregabalin
duloxetine
agents used to manage depression
SSRI/SNRI
TCA
target of current treatments for RRMS
inflammation
early tx of CIS w immunotherapy may delay conversion to MS
which types of acute exacerbations need to be treated
severe exacerbations
mild exacerbations do not significantly impact a persons activities
DOC for acute exacerbations
methylprednisolone (Medrol)
high doses of Medrol have been shown to shorten duration and repeat attacks of
optic neuritis
low doses of Medrol have been used for
milder MS attacks
pulse doses of Medrol given once a month have been helpful in treating
active MS
main ADRs for corticosteroids
Insomnia
hyperglycemia
hypertension
fluid retention
wt gain
acute monitoring for corticosteroids
blood glucose
INR
glaucoma
epilepsy
drug regimen for pts with acute exacerbations
drug therapy for a pt with +
IV Medrol 500mg - 1g for 3-7 days
PO prednisone 500 - 1.25g for 3-7 days or 1 to 2 weeks
DMT is not effective in
highly active inflm and progressive MS
1st line DMT
betaseron
avonex
rebif
glatiramer acetate (copaxone)
betaseron IND and dosing
RRMS and SPMS relapses
62.5 mcg SC qod; increase q 2 wks to 250 mcg
avonex IND and dosing
RRMS or CIS with active MRI lesion
30 mcg IM q 1 wk
rebif IND and dosing
RRMS only
22-44 mcg SC 3 x per wk (separate by at least 48 hr)
glatiramer acetate IND and dosing
RRMS + CIS
20mg SC qd
ADRs of INF agents
injection site rxn
flu-like sx
depression
myelosuppression
hepatotoxicity
SOB
tachycardia
seizures
HA
INF ADR mgmt
rotate inj site
prednisone PO 10 - 30mg
HA- triptans, NSAIDS
INF monitoring
CBC/platelets
LFTs
how often do you monitor ptĀ on INF therapy
baseline
q 3mths for 1 yr
q 6mths
INF-B injection sites
thighs or buttocks
copaxone injection site
back of upper arm
within 2 inches of naval
area on side above hip
front of leg at least 2 inches above knee
2 inches below groin
INF/glatiramer counseling
improve disease progression but not symptoms
rotate inj site
use aseptic technique
warm med to body temp before administration
place ice on site of inj before and after
administer topical corticosteroids HC cream
take APAP or NSAID before and at reg interv for the next 24 hrs
educate pt that these symptoms will lessen with use after 3-6 mths of therapy
INF-B SC vs IM efficacy
increased efficacy seen with increased dosing frequency
oral DMTs
teriflunomide (aubagio)
dimethyl fumarate (Tecfidera)
fingolimod (gilenya)
indication for oral DMTs
RRMS
teriflunomide black box warning
hepatotoxicity (increase LFT)
fetal death/malformations
when should fingolimod first be administered
in the MD office with monitoring up to 6 hrs
signs and sx to educate pt on fingolimod
hepatic failure
macular edema
infection
how long till full effect of fingolimod
can be months due to t1/2
2nd line DMTs
mitoxantrone (novantrone)
natalizumab (tysabri)
how are 2nd line DMTs given
IV
max lifetime dose of mitoxantrone
140mg/m2
AE of tysabri
PML- stop natalizumab
JC viral infection-- demylelination increased risk after 2 yrs
natalizumab counseling
educate on signs and sx of PML
-stop therapy immediately if sx arise
educate pt about touch program
-prescriber and pt must be enrolled along with pharmacies and infusion centers
Author
alvo2234
ID
214746
Card Set
Multiple Sclerosis
Description
PT I exam III
Updated
2013-04-21T19:10:11Z
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