Term
|
Definition
| chronic, debilitating autoimmune disorder of CNS that results in lesions called plaques/scars in the brain, spinal cord, or both |
|
|
Term
|
Definition
Nonspecific and are found in other disorders; Some come and go, others are longer lasting;
fatigue, numbness, weakness, paresthesias, pain; gait, balance & coordination problems; vision problems - double/blurred vision, eye pain; bladder/bowel dysfunction; sexual dysfunction; cognitive changes; speech difficulties; spasticity; depression; tremor |
|
|
Term
|
Definition
| occurs when new symptoms appear or old ones reappear or get markedly worse; can be mild or severe; lasts for a time period of days to weeks to longer; aka flare-up, attack, exacerbation, or acute episode |
|
|
Term
|
Definition
| unpredictable; nature of dx progression varies dramatically between individuals; |
|
|
Term
| Clinically Isolated Syndrome (CIS) |
|
Definition
|
|
Term
| Relapsing-Remitting MS (RRMS) |
|
Definition
| about 85% of pts present with this form of dx; involves RELAPSES followed by partial or COMPLETE recovery; relapses last at least 24 hrs & happen at least 30 days after any previous episode began; medications are very useful in treating this form |
|
|
Term
| Secondary-Progressive MS (SPMS) |
|
Definition
| most pt are initially diagnosed with most common form of dx, but then trasition into THIS phase; PROGRESSIVE phase characterized by worsening of symptoms; dx occurs with OR without relapses & minor recovery; |
|
|
Term
| Primary-Progressive MS (PPMS) |
|
Definition
| about 10% of individuals NEVER have clinical relapses or remissions after initial presentation; characterized by STEADY DECLINE in function & PROGRESSIVE disability from ONSET |
|
|
Term
| Progressive-Relapsing MS (PRMS) |
|
Definition
| about 5% of pts with dx have this form; characterized by STEADY WORSENING of dx and occasional attacks; PROGRESSIVE course without recovery period found in most common form of dx |
|
|
Term
| Secondary Complications of MS |
|
Definition
| pneumonia, UTIs, decubitis ulcers |
|
|
Term
| Indicators of Suboptimal Response to MS Therapy |
|
Definition
| frequent relapses; progression of disability; rising use of resources; imaging changes reflecting incresed dx activity |
|
|
Term
| interferon beta (Avonex, Betaseron, Rebif) OR glatiramer acetate (Copaxone) |
|
Definition
| early initiation of tx for RRMS |
|
|
Term
| Consider glatiramer acetate (Copaxone) vs others (IVIG, mitoxantrone, natalizumab, experimental therapy) |
|
Definition
| if taking an interferon beta (Rebif, Betaseron, Avonex), test with neutralizing antibodies (NAb) --> if POSITIVE for NAbs and SYMPTOMATIC consider this drug: |
|
|
Term
| Repeat NAb for 6 months & re-evaluate |
|
Definition
| If taking interferon beta (Avonex, Betaseron, Rebif) & test for NAb is POSITIVE and pt is ASYMPTOMATIC, do this: |
|
|
Term
| If on Betaseron (interferon beta-1b) or Rebif (interferon beta-1a), consider Copaxone (glatiramer acetate) vs others |
|
Definition
| if taking an interferon beta (Rebif, Betaseron, Avonex), test with neutralizing antibodies (NAb) --> if NEGATIVE for NAbs and SYMPTOMATIC consider this: |
|
|
Term
|
Definition
| if taking an interferon beta (Rebif, Betaseron, Avonex), test with neutralizing antibodies (NAb) --> if NEGATIVE for NAbs and ASYMPTOMATIC consider this: |
|
|
Term
| Consider change to ANY interferon (Avonex, Betaseron, Rebif) |
|
Definition
| If taking Copaxone (glatiramer acetate) and pt is SYMPTOMATIC, do this: |
|
|
Term
| Neutralizing Antibodies (NAbs) |
|
Definition
| when a pt with MS is treated with interferon beta, these may be produced; this MAY lead to loss of efficacy of interferon beta; Test for these at 12 months, check if breakthrough dx; DO NOT test for until 30 days after LAST corticosteroid dose |
|
|
Term
| methylprednisolone (IVMP) 500-1,000 mg IV for 3-5 days (up to 10 days) |
|
Definition
corticosteroid used for management of relapses;
Doses: administered as single daily dose of 500-1,000 mg IV for 3-5 days (up to 10 days);
may use with or without a subsequent steroid tapering schedule;
can substitute with dexamethasone instead; treat major relapses ASAP; take a "wait and see" approach for minor relapses; may be used with ALL disease modifying therapies |
|
|
Term
|
Definition
| this therapy is NOT recommended for MS; |
|
|
Term
| Pulse therapy with corticosteroids |
|
Definition
| single to multiple day treatment every few months; for pts who are developing SPMS (Secondary-Progressive MS), have failed other therapies & BEFORE using mitoxantrone (Novantrone) |
|
|
Term
| interferons (Avonex, Betaseron, Rebif) |
|
Definition
Uses: for pt as INITIAL therapy ASAP after receiving definite diagnosis of mS with a relapsing course; cosider high dose of drug for pt on Avonex who is responding poorly clinically/radiographically and Ab (-);
Evidence: decreases rate of relapse by 33%, decreases MRI lesions by 80%, moderate effect on disability progression;
Pregn. Cat. C;
ADRs: DEPRESSION and SUICIDAL IDEATION, elevated liver enzymes, injection site rxns (inflammation, swelling, pain), flu-like symptoms (fever, chills, fatigue, sweating, myalgia, HA) |
|
|
Term
| Monitoring Parameters for Interferons (Avonex, Betaseron, Rebif) |
|
Definition
CBC w/ platelets, LFTs at baseline, 1, 3, and 6 months & then periodically;
TFTs every 6 months if hx of thyroid dysfunction or as indicated;
Periodically reevaluate for depressive symptoms/suicidal ideatoin;
Periodically reevaluate understanding & use of aseptic self-injection techniques; |
|
|
Term
| interferon beta-1b (Betaseron) |
|
Definition
single-use vial: powder with diluent;
Storage: room temp., refrigerate & use within 3 hrs after reconstitution, do not freeze, do not expose to heat;
Dosing: SC every other day, titrate to target dose over 6 wks:
Week 1-2: 62.5 mcg
Week 3-4: 125 mcg
Week 5-6: 187.5 mcg
Week 7+: 250 mcg;
Injections should be about 48 hrs apart;
Injection sites: upper back portion of arm, abdomen, buttocks, thigh |
|
|
Term
| interferon beta-1a (Avonex) |
|
Definition
single use vial OR prefilled syringe;
Storage: refigerate, refrigerate and use within 6 hrs after following reconstitution, may be stored at room temp or less for 7 days (syringe) or 30 days (vial);
Dosing: give IM ONCE WEEKLY; injection on SAME DAY each week;
Injection sites: upper arm, thigh |
|
|
Term
| interferon beta-1a (Rebif) |
|
Definition
prefilled syringe;
Storage: refrigerate, may be stored at or less than room temp. for 30 days;
Dosing: SC three times a week; start at 20% of prescribed dose 3x per wk and increase over 4 wks to target dose; Administer at same time on same 3 days at least 48 hrs apart;
Take missed dose as soon as you remember then skip next day;
Injection sites: upper back portion of arm, abdomen, buttocks, thigh |
|
|
Term
| glatiramer acetate (Copaxone) |
|
Definition
Uses: initial therapy ASAP after receiving diagnosis of MS with a relapsing course; for pts on interferon beta who is responding poorly clinically & Ab (+);
Evidence: decrease rate of relapse 30-40%, decrease MRI lesions by 30-40%, NO EFFECT on disability progression;
Dosing:
20 mg SC once daily;
C/Is: hypersensitivity to drug or maannitol;
Preg. Cat. B;
ADRs: nausea, back pain, vasodilation, chest pain, dyspnea, rash, injection site rxns, LOCALIZED LIPOATROPHY, IMMEDIATE POST-INJECTION RXN (flushing, chest tightness, palpitations, anxiety, shortness of breath)
NO LAB PARAMETERS TO MONITOR!!! |
|
|
Term
|
Definition
Evidence: decreased rate of relapse 66%, decreased MRI lesions 90%, decreased disability progression by 50%;
Uses: for pts w/ relapsing forms of MS who have had inadequate response to or are unable to tolerate other MS therapies - efficacy beyond 2 yrs unknown; SHOULD NOT be used in combo with other immunomodulatory agents;
Dosing:
300 mg IV infusion over 1 hr every 4 wks;
C/Is: progressive multifocal leukoencephelopathy (PML) & hypersensitivity;
Preg. Cat. C;
ADRs: HA, arthralgia, UTIs, LRTIs, gastroenteritis, vaginitis, depression, pain in extremity, abdominal discomfort, diarrhea, rash;
# of txs received --> INCREASED likelihood of PML; |
|
|
Term
| progressive multifocal leukoencephalopathy (PML) |
|
Definition
| opportunistic infection of brain that typically occurs in immunocompromised pts (JC virus); increased risk with long term use of natalizumab (Tysabri); Symptoms: progressive weakness on 1 side of body, disturbance of vision, changes in thinking, memory, & orientation leading to confusion & personality changes |
|
|
Term
| mitoxantrone (Novantrone) |
|
Definition
Evidence: decreased rate of relapse 67%, decreased MRI lesions 85%, decreased disability progression 59%;
Indication: reducing neurologic disability and/or frequency of clinical relapses in pts w/ SPMS, PRMS, or worsening RRMS;
Place in Therapy: for pts w/ rapidly advancing dx who have failed other therapies;
Dosing:
12 mg/m^2 administered at IV infusion over 5-15 min every 3 months, MAX lifetime dose = 140 mg/m^2;
C/Is: DO NOT GIVE if LVEF < 50%, neutrophil counts <1500 cells/mm^3 or hypersensitivity;
Preg. Cat. D;
ADRs: nausea, alopecia, amenorrhea, URTIs, UTIs, stomatitis, leukopenia, arrhythmias, diarrhea, constipation, back pain, HA, anemia |
|
|
Term
| Patient Education for mitoxantrone (Novantrone) |
|
Definition
have pt monitor for heart failure symptoms (shortness of breath, coughing, fluid build-up);
Have pt monitor for myelosuppression (fatigue, infections, bruising);
BLUE-GREEN URINE 24 hrs after administration;
Bluish discoloration of sclera;
Lifetime cumulative dose: 8-12 doses over 2-3 yrs; |
|
|
Term
| Monitoring for mitoxantrone (Novantrone) |
|
Definition
at baseline/prior to each infusion:
weight, left ventricular ejection fraction (LVEF) by EKG or MUGA, CBC w/ platelets, LFTs, pregnancy test (if indicated) |
|
|
Term
|
Definition
| tends to affect legs more than arms; potential risk for increased falls |
|
|
Term
|
Definition
| typically presents in late to middle afternoon; Off-label use for modafanil (Provigil) |
|
|
Term
|
Definition
| use interferon beta agents cautiously; Monitor for suicidal ideation |
|
|
Term
| Gait/Balance Problems with MS |
|
Definition
2/3rds of pts with MS remain able to walk; assistive devices may be used to conserve energy;
dalfampine (Ampyra) approved to improve walking distance |
|
|
Term
| Bladder Dysfunction in MS |
|
Definition
| complaints of urinary incontinence, frequency, urgency, & nocturia; Tx with anticholinergic meds to alleviate |
|
|
Term
| Lifestyle & Psychosocial Issues that cause Positive Benefits in pts with MS |
|
Definition
very low saturated fat & vitamin D supplementation;
minimal, regular sunlight exposure of most of body surface 2-3x per wk;
positive mental & social health & coping strategies;
exercise |
|
|
