diagnosis of exclusion
-a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or testing
activated immune cells cross the blood-brain barrier
Lesions occur when ______________.
McDonald Criteria
-is the gold standard criteria for MS diagnosis
numbness/tingling, walking difficulty, vision problems
What are 3 of the first symptoms to emerge in those diagnosed with MS?
genetics, viruses, gut microbiome triggers, environmental
What are potential causes of MS? (4)
2; HLA-DR
MHC class _________ variant haplotypes ________ may contribute up to 60% of genetic risk.
d
What kind of virus is Epstein-Barr?
a) single stranded RNA virus
b) double stranded RNA herpes virus
c) single stranded DNA virus
d) double stranded DNA herpes virus
low vitamin d, smoking
What environmental factors can contribute to MS? (2)
a
Is characterized by a first neurologic episode that lasts at least 24 hours.
a) Clinically Isolated Syndrome
b) Relapsing Remitting MS
c) Secondary Progressive MS
d) Primary Progressive MS
d
Is characterized by an onset of symptoms, WITHOUT early relapses or remissions.
a) Clinically Isolated Syndrome
b) Relapsing Remitting MS
c) Secondary Progressive MS
d) Primary Progressive MS
c
Follows an initial relapsing-remitting course but can be further characterized at different points in time as either active or not-active.
a) Clinically Isolated Syndrome
b) Relapsing Remitting MS
c) Secondary Progressive MS
d) Primary Progressive MS
b
The most common disease course, characterized by clearly defined attacks of new or increasing neurologic symptoms.
a) Clinically Isolated Syndrome
b) Relapsing Remitting MS
c) Secondary Progressive MS
d) Primary Progressive MS
determine whether neurologic episode is caused by damage in CNS; determine the likelihood they will develop MS
What are the 2 challenges a HC provider must determine in order to diagnose a patient with Clinically Isolated Syndrome(CIS)?
Th-17
-immune cells that open BBB and cause axonal damage and neuronal death
gray matter
Earliest pathology of MS may point to _______.
f; equally important
T- cell disease is more important than B-cell disease in the MS disease course. T/F?
dissemination in space
-suggestions of damage in more than one place in the nervous system
dissemination in time
-suggestions that damage has occurred more than once.
T1 weighted scans
-these brain scans are the most effective at revealing new lesions by using a chemical substance known as gadolinium which will reveal areas of active lesions by "lighting up".
T2-weighted scans
-these scans tell us the size and number of new lesions; can also tell us about older, inactive lesions.
1 or more lesions in 2/4 areas of CNS; T2
According to McDonald's criteria, what must be seen in the brain scan to officially diagnose a patient with MS? What kind of scan?
reduce: MRI activity, frequency & severity of relapses, the residual deficits from relapses
What are the short-term aims of disease therapy in RRMS? (3)
to delay or prevent disease from evolving to secondary progressive and development of permanent disability
What are the long-term goals of treatment in RRMS?
interferon beta
-increase anti‐inflammatory cytokines (IL-10) while downregulating pro-inflammatory cytokines
lysine, glutamic acid, tyrosine, alanine
What are the 4 naturally occurring amino acids found in Glatiramer acetate?
involves it hijacking & activating T-cells to enter the CNS and release anti-inflammatory cytokines & TGF-B
Glatiramer Acetate MOA?
Tumor growth factor beta (TGF-B)
-suppresses cytotoxic T cell response and the production of TNF as well as other factors that contribute to myelin damage.
b
Which DMARD- medication requires a CBC, as recent as 6 months, prior to initiating treatment?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
b
Which DMARD-medication can cause flushing and GI problems?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
b
Which DMARD-medication is a prodrug who's active metabolite induces nuclear accumulation of Nrf2?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
fumarate
_______ is essential for oxidation respiration in the Citric Acid cycle .
inhibits pyrimidine synthesis by blocking dihydroorotate dehydrogenase in active T- and B-lymphocytes
AUBAGIO MOA?
c
Which DMARD-medication has a BBW for liver injury?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
-imod
-sphingosine 1-phosphate receptor blockers
S1P receptor blocker that blocks lymphocytes from exiting lymph nodes and entering CNS
Imods MOA?
d,e
Which DMARD- medication(s) redistributes T-lymphocytes rather than depleting them?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
d,e
Which DMARD-medication(s) can cause Bradycardia & infection?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
d
Which DMARD-medication has dose reduction with CYP2C9* genotype?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
f) Natalizumab
f
Which DMARD-medication is a selective adhesion molecule (SAM) inhibitor that blocks integrin?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
f) Natalizumab
f
Which DMARD-medication has BBW for PML?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
f) Natalizumab
PML
-opportunistic viral infection of the brain that usually leads to death or severe disabiliy
JC virus
Progressive multifocal leukoencephalopathy (PML) is a result of activation of _______
a
Before a patient can be prescribed ______ they must undergo a Hepatitis B virus screening before their first dose.
a) OCREVUS
b) BRIUMVI
c) LEMTRADA
d) MAVENCLAD
a,b
Which IMR causes antibody-dependent cellular cytolysis in B cells?
a) OCREVUS
b) BRIUMVI
c) LEMTRADA
d) MAVENCLAD
b
Which IMR has been glycoengineered to enhance Natural Killer Cell Fc receptor binding?
a) OCREVUS
b) BRIUMVI
c) LEMTRADA
d) MAVENCLAD
c,d
Which IMR is not for patients who have Clinically Isolated Syndrome?
a) OCREVUS
b) BRIUMVI
c) LEMTRADA
d) MAVENCLAD
c
What is the treatment schedule for LEMTRADA?
a) 2 course treatment; 6 months apart
b) 1 course treatment
c) 2 course treatment; 12 months apart
d) none of the above
d
Which IMR is a prodrug who's active metabolite is a lymphocyte-adenosine chain terminator?
a) OCREVUS
b) BRIUMVI
c) LEMTRADA
d) MAVENCLAD
oral dose divided into 2 yearly treatment courses; after completing 2 courses do not administer
How does MAVENCLAD dosing schedule work?
d
Which IMR can increase the risk of malignancy and teratogenic effects in pregnant women?
a) OCREVUS
b) BRIUMVI
c) LEMTRADA
d) MAVENCLAD
d
Which IMR is a CD52-directed monoclonal antibody?
a) OCREVUS
b) BRIUMVI
c) LEMTRADA
d) MAVENCLAD
prodrug that becomes active upon phosphorylation to a triphosphate metabolite that serves as a chain terminator for lymphocyte-adenosine analogs
MAVENCLAD MOA?
e
Which DMARD blocks S1P R3 in cardiac tissue?
a) Glatiramer Acetate
b) Dimethyl fumarate
c) AUBAGIO
d) Siponimod
e) Fingolimod
f) Natalizumab
ocrevus, briumvi, lemtrada, mavenclad
What are our Immune Reconstitution medications? (4)
interferon beta, glatiramer acetate, DMF, aubagio
What are our anti-inflammatory medications? (4)
a,b,c
Which IMR targets CD-20 on B-cells?
a) OCREVUS
b) BRIUMVI
c) LEMTRADA
d) MAVENCLAD