3- MS Flashcards
(43 cards)
What is Multiple Sclerosis
CNS demyelination and axial damage
What is the key to MS diagnosis
dissemination of plaques
What is the pathophys of MS
PMN infiltrate space between A&V and pia mater and demyelinate axons. Immune reactions form plaques in multiple areas of CNS
What gets MS
genetically susceptible people exposed to random environmental effects that trigger immune mediated CNS damage
What are th most common MS triggers
Vitamin D deficiency CMV EBV HHV6 Smoking High dietary sodium Circadian Disruption
What is the “theory” behind MS
T helper cells stick to vessels and create openings allowing them to cross BBB
In the CNS, T helper cells produce cytokines
Cytokines call other inflammatory cells and they all form an immune attack causing plaques
What are the cytokines involved in MS
Th1 and Th2: pro-inflammatory
Th17 anti-inflammatory
Treg regulatory
Name the most favorable prognosis patient with MS
<40 female presenting Sx of option neuritis or sensory Sx RRMS Low T1/T2 single lesions
What is unique about Th17 and Treg
They can change and become Th1 and Th2
What are indications for Treatment of MS exacerbation
Relapses localize to optic nerve, spinal cord, or brainstem
Sx affect daily living
Sx worsen over 2 weeks
What is your med tx of choice for exacerbations of MS
Corticosteroids; high dose IV Methylprednisone w/in 2 days of Sx
(improvement w/in 3-5 days)
How does Methylprednisone work
Improves recovery by decreasing edema around demyelination
BUT doesn’t affect disease progression
What are S/E of Methylprednisone
Sleep disturbance
Metallic taste
Increase BG in Diabetics
Long term: acne, fungal infections, mood changes
What should your RRMS treatment regimen be (steps)
Interferon Glatarimir acetate Fingolimode Teriflunomide Dimethyl fumarate
What is Terifluronimide
Oral DMT that (inhibits dihydroorotate dehydrogenase) prevents proliferation of peripheral T/B lymphocytes= lower inflammation and demyelination
Pregnancy X**
S/E of Teriflunomide include
Steven-Johnson syndrome (flu sx, then painful red and purple rash and blisters, then top layer of skin dies and sheds)
What is Leflunomide
active metabolite of Teriflunomide
What is Dimethyl Fumarate
Nicotinic receptor agonist
Nuclear factor pathway activator
-Involved in response to oxidative stress
What are S/E of Dimethyl fumarate
Flushing (give w/ food)
Lymphocyopenia
rash, pruritus, GI discomfort
What do you need to monitor if patient is taking Teriflunomide or Dimethyl fumarate
Pregnancy TB test LFT CBC BP (may increase)
When would you add Teriflunomide or Dimethyl fumarate
If Symptoms continue to worsen when already on corticosteroids
What are your First Line DMT
Interferons (IFN Beta 1a/1b) and Glatiramir acetate
What are the IFN Beta 1a
Avonex (low potency)
Rebif (high potency)
What are the IFN Beta 1b
Betaseron (high potency)
Extavia (high potency)
