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TIA – Cardioembolic Pattern — SCE Neurology MCQ

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HardCerebrovascular DiseaseTIA – Cardioembolic PatternSCE Neurology

A patient has taken fingolimod continuously for 18 months, then misses 16 consecutive days because of surgery. Cardiac status is unchanged. How should treatment be restarted?

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Correct answer: D — Repeat the full first-dose cardiac monitoring procedure when fingolimod is reintroduced

Explanation lettering: D = shown as A · A = shown as C · E = shown as D · C = shown as E

E is correct: after more than one month of treatment, an interruption longer than two weeks can restore the first-dose bradycardic and conduction effects, so first-dose monitoring must be repeated on reintroduction. A ignores the restart rule. B and C are not authorised mitigation strategies. D turns a monitoring requirement into a permanent contraindication. The timing threshold varies earlier in treatment, which is why duration on treatment is specified.

Reference: Gilenya 0.25 mg hard capsules SmPC: https://www.medicines.org.uk/emc/product/4545/smpc