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DMF – Lymphopenia Stop Rule — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationDMF – Lymphopenia Stop RuleSCE Neurology

Six hours after the first fingolimod dose, an adult is asymptomatic. Heart rate has fallen hourly from 72 to 68, 63, 59, 55, 52 and 49 bpm; ECG shows sinus rhythm and QTc 450 ms. What monitoring action is required?

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

Reveal the answer and explanation

Correct answer: B — Extend monitoring for at least 2 hours and until heart rate rises

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

D is correct. If the six-hour heart rate is the lowest since dosing, the maximum chronotropic effect may not yet have occurred, so monitoring extends for at least two hours and until it rises. A ignores the immediate trajectory criterion. B over-monitors solely for a rate of 49 bpm when no overnight criterion is present. C is unnecessary in an asymptomatic stable patient. E abandons an effective treatment rather than applying the specified observation rule.

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