Da2017 Ms

Front 1

Only FDA-approved therapy for secondary progressive MS

Back 1

Mitoxantrone

Front 2

Mitoxantrone limited to 2-3 years because of what risk?

Back 2

Cardiomyopathy. (Need echo at baseline and prior to each dose)

Front 3

Natalizumab brand name and associated big risk

Back 3

Tysabri. PML

Front 4

First oral DMT in MS

Back 4

Fingolimod (Gilenya)

Front 5

Fingolimod (Gilenya) side effects

Back 5

AV block or bradycardia (monitor in office after first dose)

Some risk for PML. Much less risk than Natalizumab (Tysabri)

Lymphopenia (check VZV prior to starting)

Front 6

Next oral DMT for MS

Back 6

Teriflunomide (Aubagio)

Front 7

Last oral DMT

Back 7

Dimethyl fumerate (Tecfidera)

Front 8

Atomoxetine. Used for what? Mechanism of action is what?

Back 8

.

Front 9

Alemtuzumab mechanism?

Back 9

Alemtuzumab (Lemtrada) is an anti-CD52 monoclonal Ab. Infused over 5 days then for 3 days one year later.

Front 10

Glatiramir Acetate dosing route, mech of action, SE?

Back 10

Glatiramir acetate (Copaxone). IM. Polymer of 4 AA found in myelin basic protein, thought to be a decoy for immune system. Can get an immediate injection reaction with flushing, chest tightness, and SOB

Front 11

What screening should be done prior to starting teriflunomide?

Back 11

Quantiferon gold. Some cases reported of deactivation of TB.

Front 12

Alemtuzumab side effect

Back 12

Autoimmune diseases (can be hypo- or hyperthyroid)

Front 13

Fingolimod side effects

Back 13

Cardiac effects (slowed HR, AV block)

Macular edema (see ophthalmology before and 3 mo into treatment)

Infection risk (low lymphocytes)

Elevated LFTs

Few cases of PML

Front 14

Teriflunomide side effects

Back 14

Diarrhea, nausea, hair thinning

Hepatic

TB reactivation risk. Lowers WBC count.

May stay in the blood for two years (can clear more rapidly with cholecystiramine)

Front 15

Alemtuzimab side effects

Back 15

Autoimmune disease

ITP, anti-glomerular basement membrane Disease, thyroid disease

Infusion RXNs

Malignancies

Monthly labs for 48 months after last dose

Front 16

No live vaccines with which meds?

Back 16

Fingolimod and alemtuzumab

Front 17

Aquaporin-4 located where?

Back 17

A component of the dystroglycan complex located in astrocytic foot processes at the blood brain barrier

Most abundant water channel in CNS

Front 18

NMO clinical characteristics

Back 18

Longitudinally extensive myelitis

Optic neuropathy

Can have intractable N/V and hiccups (area postrema involvement)