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33 Cards in this Set
- Front
- Back
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Typical patient seen with MS |
Female (2:1) Age 20-50 Caucasian
*possibly related to autoimmune component? |
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How to obtain a definitive dx of MS |
MRI |
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Type of MS 85% of patients at dx |
Relapsing-remitting |
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Tx of acute relapses of MS |
Steroids! IV methyprednisolone -or- Oral prednisone (qod)
for about 5 days *taper not necessary |
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Interferon beta-1a IM brand name |
Avonex |
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Interferon beta-1a SC brand name |
Rebif |
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Single most common SE of Interferon beta-1's |
Flu-like symptoms (titrate drug up; give tylenol, aspirin, or NSAIDs for prophylaxis) |
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Important SEs of Interferon beta-1's |
-Psychiatric disorder/ depression -Bone marrow suppression -Hepatic effects |
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1st oral agent for MS |
Fingolimod (Gilenya)
-must obtain CBC prior to starting tx -drug interaction: KETOCONAZOLE |
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SEs of Glatiramer acetate (Copaxone®) |
-Flushing, non-cardiac related chest tightness, SOB, palpitations, anxiety -Injection site reactions (90%) |
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Patients must be monitored for 6 hours following their 1st dose of Fingolimod (Gilenya). Why? |
Bradycardia! |
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What two specific tests must you obtain prior to starting Fingolimod (Gilenya)? |
CBC (decreased lymphocytes) VZV (must be immune/vaccinated) |
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What drug can you NOT use with Fingolimod (Gilenya)? |
KETOCONAZOLE = increases Gilenya concentrations
+ vaccines (less effective) |
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Which drug causes menstrual disorders, UTI, greenish-blue urine, and CARDIOTOXICITY? |
Mitoxantrone |
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What drug can cause PML? and what is PML? |
Natalizumab (Tysabri) Progressive Multifocal Leukoencephalopathy Rapidly progressive viral CNS infection |
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Teriflunomide concern |
Pregnancy Cat X Accelerated elimination procedure required |
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Dimethyl fumarate/BG-12- you must monitor what? |
WBCs! |
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Only MS med that is a Pregnancy Cat B drug? |
Glatiramer acetate (Copaxone) |
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Tx for spasticity secondary to MS |
*must be active on CNS! 1st line: Baclofen & Tizanadine |
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75% of patients with myasthenia gravis have abnormalities in their _________. |
Thymus Hyperplasia vs tumors |
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When are females usually affected by MG? Males? |
Females 20s and 30s Males 50s and 60s |
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Myasthenia gravis is a problem involving the ____________________. |
Neuromuscular junction |
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Which electrolyte imbalances can precipitate MG? |
Hypermagnesmia Hypocalcemia Hypokalemia |
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First symptom of MG in most patients |
Ocular (ptosis, diplopia) *Function of pupillary muscles is usually intact |
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1st line drug for maintenance tx of MG |
Pyridostigmine |
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Tx of cholinergic crisis |
Atropine |
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Consider treating patients with antibody involvement in MG with what? |
Methylprednisolone 10-25 mg qod *higher doses may worsen MG temporarily |
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Etiology of Huntington's disease |
CAG trinucleotide repeats in gene that encodes huntington protein |
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Pathophysiology of Huntington's Disease |
Brain atrophy, loss of white matter **OVERactivity of dopamine pathways in nigrostriatal areas |
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Hallmark sx of Huntingtons Disease |
Huntington's Chorea sudden jerky movements of muscles in a wave across body |
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Only approved tx for Huntington's Disease chorea and how does it work? |
Tetrabenazene Depletes dopamine stores
(no meds stop progression of dx) |
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Metabolism of Tetrabenazene |
CYP 2D6 |
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Treatment for patients with Huntington's and depression/ psychosis/ aggression |
Avoid tetrabenazine Can try low dose antipsychotics (not FDA approved, but worth a shot) |
