American Board of Internal Medicine (ABIM) Certification Practice Exam

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Which of the following is a significant side effect associated with fingolimod?

Hypoglycemia
Bradycardia
Weight gain
Psychosis

The correct answer is: Bradycardia

Fingolimod, used primarily for the treatment of multiple sclerosis, can lead to bradycardia as a significant side effect. This occurs particularly upon the initiation of therapy because fingolimod has an effect on heart rate by acting on sphingosine-1-phosphate (S1P) receptors, which modulate heart function. Patients may experience a decrease in heart rate that typically stabilizes after the first dose, hence monitoring heart rate for several hours after the first dose is recommended to manage this risk effectively. The other options do not reflect significant side effects associated with fingolimod. Hypoglycemia is more commonly associated with certain antidiabetic medications, weight gain is not a prominent side effect tied to fingolimod as seen with other medications like corticosteroids, and while psychosis can occur with some neurologic medications, it is not a common or significant side effect of fingolimod.