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CPSP – Neuromodulation — SCE Neurology MCQ

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HardNeurorehabilitationCPSP – NeuromodulationSCE Neurology

A patient with relapsing multiple sclerosis is starting ponesimod. Baseline ECG shows sinus rhythm at 52 beats/min without higher-grade conduction disease. What first-dose plan is required?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Give the first dose with four-hour pulse and blood-pressure monitoring

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

E is correct: pre-treatment sinus bradycardia below 55 beats/min is one of the cardiac settings requiring four-hour observation after the first ponesimod dose, with at least hourly pulse and blood-pressure measurement. A uses an invented lower threshold. B converts a monitoring indication into an absolute contraindication. C is not routine prophylaxis. D bypasses the mandated titration and would increase first-dose cardiac risk. An end-of-observation ECG is added if abnormalities occur or symptoms develop.

Reference: Ponvory initiation-pack SmPC: https://www.medicines.org.uk/emc/product/100488/smpc