Drugs Used in the Treatment of Multiple Sclerosis

Every question here, with the answer

1. A client with relapsing MS starts interferon beta-1b and reports fever, chills and muscle aches on injection days. What should the nurse recommend?

   1. Take an analgesic-antipyretic on the days of treatment.
   2. Double the fluid intake and skip the next dose.
   3. Inject the drug into a different muscle group.
   4. Stop the drug until the symptoms go away.

   Answer: Take an analgesic-antipyretic on the days of treatment.

   Flu-like symptoms are common when interferons are started and are reduced by taking an analgesic-antipyretic on treatment days. Stopping or skipping doses is not the teaching, and interferon beta-1b is given subcutaneously, not into a muscle.

2. A client taking teriflunomide has an ALT three times the upper normal limit on two consecutive tests. What does the nurse anticipate?

   1. The drug will be continued with weekly ALT checks.
   2. Warfarin will be added to protect the liver.
   3. The dose will be reduced by half.
   4. The drug will be stopped and an accelerated elimination procedure begun.

   Answer: The drug will be stopped and an accelerated elimination procedure begun.

   Teriflunomide is very hepatotoxic; with ALT three times the upper limit on two consecutive tests, it must be stopped immediately and accelerated elimination (cholestyramine or activated charcoal) begins. Lowering the dose or continuing is not what the section describes, and warfarin does not protect the liver.

3. A nurse is preparing to start teriflunomide for a client of reproductive age. Which actions belong before therapy begins? Select all that apply.

   1. Stop the client's oral contraceptive.
   2. Perform a tuberculin skin test or IGRA.
   3. Obtain baseline ALT, AST and bilirubin.
   4. Give a live varicella vaccine on the first day of therapy.
   5. Obtain a pregnancy test.

   Answer: Perform a tuberculin skin test or IGRA., Obtain baseline ALT, AST and bilirubin., Obtain a pregnancy test.

   Teriflunomide is highly teratogenic, can activate latent TB, and is hepatotoxic, so a pregnancy test, TB screening and baseline liver tests come first. Live vaccines should be avoided during therapy, and because the drug can reduce oral contraceptive effectiveness, a backup barrier method is added rather than stopping contraception.

4. A client is receiving the first dose of siponimod in an outpatient clinic. What monitoring does the nurse carry out?

   1. Hourly heart rate and blood pressure for 6 hours.
   2. Pulse oximetry for 15 minutes only.
   3. Temperature once before discharge.
   4. Blood glucose every 30 minutes for 2 hours.

   Answer: Hourly heart rate and blood pressure for 6 hours.

   Starting an S1P receptor modulator lowers the heart rate, so all clients are monitored for 6 hours after the first dose with hourly heart rate and blood pressure. The other options do not watch for bradycardia over the required period.

5. A client with MS spasticity is taking oral baclofen. Which statements by the client show correct understanding? Select all that apply.

   1. "I will not drive until I know how the drug affects me."
   2. "I will not stop this drug suddenly."
   3. "I can drink alcohol because it relaxes my muscles too."
   4. "If I feel better, I can stop it on my own right away."
   5. "I will get up slowly from bed."

   Answer: "I will not drive until I know how the drug affects me.", "I will not stop this drug suddenly.", "I will get up slowly from bed."

   Baclofen must be tapered because abrupt withdrawal can cause psychoses, hallucinations and seizures; it can cause orthostatic hypotension and CNS depression, so the client rises slowly and avoids driving until effects are known. Alcohol adds CNS depression, and stopping abruptly is dangerous.

6. A client taking pregabalin develops swelling of the lips and tongue. What is the priority action?

   1. Taper the drug over one week.
   2. Give the next dose with an antihistamine.
   3. Document it as expected weight gain.
   4. Discontinue the drug immediately.

   Answer: Discontinue the drug immediately.

   Pregabalin must be stopped immediately at the first sign of angioedema, such as swelling of the face, tongue or lips. Tapering applies to planned discontinuation, and swelling of the lips and tongue is not weight gain.