MS- Kutzer

Understand the categories of multiple sclerosis and the MS patient population that are affected by each category

1. relapsing-remitting MS (RRMS)

   • temporary periods called “relapses”

   • attacks followed by period of remission

   • ~85% of pts.

2. primary progressive MS (PPMS)

   • symptoms get worse with no remission period

   • ~10% of pts.

3. secondary progressive MS (SPMS)

   • slowly worsening of symptoms and fxn

   • 50% of pts. with RRMS convert to SPMS within 10-20

4. progression-relapsing (PRMS)

   • rare (~5% of pts.)

   • worsens from onset of 1st symptom

What are some lab tests for MS?

• CSF analysis

• MRI

• optic neuritis

• gadolinium

What does the Gadolinium test identify?

contrast agent to identify new lesions and disruption of the BBB

Answer the following about Interferon-B 1b drugs:

	Betaseron	Avonex	Plegridy
Dose			XXXXXXXXXX
Frequency
ROA

	Betaseron	Avonex	Plegridy
Dose	250 mcg	30 mcg	XXXXXXXXX
Frequency	every other day	once weekly	every 2 weeks
ROA	SQ	IM	SQ

Which medication was the first oral DMT and its contraindications?

• Fingolimod (sphingosine-1-phosphate receptor agonist)

• C/I:

  • Class Ia and III anti antiarrhythmic agents

What medication needs genetic testing for CYP2C9 polymorphisms?

Siponimod

Which medication has a black box warning for hepatotoxicity and teratogenicity?

Teriflunomide

What medications have a lifetime cumulative dose?

• Cladribine

• Mitoxantrone

What is the treatment of Pseudobulbar Palsy (aka emotional outbursts, dysphonia, dysphagia)?

Nuedexta (dextromethorphan and quinidine)

What medication should be used cautiously if a patient is depressed?

IFN and natalizumab

Negative TB skin test should be given before starting what medication?

• fyi!!! not LO

Teriflunomide

What are the drugs used for treatment of MS?

• fyi!!! not LO

• methylprednisolone

• interferon-B 1b (Betaseron, Extavia, Avonex, Rebif)

• Pegylated IFN-B1a (Plegridy)

• Glatiramer acetate (Copaxone)

• Natalizumab (Tysabri)

• Sphingosine-1-phosphate receptor agonists

  • Fingolimod, Siponimod, Ozanimod, Ponesimod

• Teriflunomide

• Fumarates

• Cladribine (Mavenclad)

• Alemtuzumab

• Ofatumumab

• Mitoxantrone

• Rituximab

MS is more common in men or women?

women

Describe the pathology of MS?

• lesions

• inflammation

• demyelination

• neurodegeneration

• T cell involvement (T cells cross BBB, blood vessels become leaky, T cells can attack myelin)

What type of symptoms are seen in MS?

• primary—> caused by damage to CNS (weakness, sensory loss, ataxia)

• secondary (caused by primary, ex: UTI)

• tertiary (psychological, depression, job loss)

What drugs can be used for the MS symptom of gait difficulty/spasticity?

baclofen, zanaflex, botox, ampyra

What drugs can be used for the MS symptom of tremor?

propranolol, primidone, isoniazid

What drugs can be used for the MS symptom of bowel/bladder symptoms?

anticholinergics

What drugs can be used for the MS symptom of fatigue?

methylphenidate, dexedrine, adderall

What drugs can be used for the MS symptom of cognition?

stimulants