CASE STUDY CONDITIONS: MS Flashcards
(27 cards)
Multiple Sclerosis: Overview & Cause
- chronic inflammatory autoimmune disorder that damages the myelin sheath of neurons in the CNS
- cause: genetically vulnerable people following exposure to environmental or microbial factor that intiaties autoimmune activity
MS Subtypes
Four
- relapse remitting (most common)
- secondary progressive
- primary progressive
- progessive relapsing
MS: Drugs employed to:
- modify disease process
- treat acute relapse
- manage symptoms
no drugs to cure MS
Disease Modifying Drugs
- decrease the frequency and severity of relapse
- decrease the development of brain lesions
- decrease future disability
- help maintain QOL
- prevent damage to axons
MS: Classes of Disease Modifying Drugs
- immunomodulators
- immunosuppressants
MS Immune Modulators
names
- interferon beta
- dimethyl fimarate
- glatiramer acetate
- natalizumab
- finolimod
- terifulmonide
Routes of Admin: Immunomodulators
MS
IM or SubQ - interferon beta, glatiramer
PO - dimethyl fimarate, fingolimod, teriflumonide
IV - natalizumab
Side effects: dimethyl fumarate
MS
- facial flushing (most common)
- lymphopenia with inc. risk of infections (most serious)
Drug Interactions: dimethyl fumarate
MS
- can decrease the body’s response to live virus vaccines
- pts should not take live virus vaccines when taking drug
Glatiramer: overview
MS
- less well tolerated than inf. b
- requires more frequent injections
Glatiramer: Adverse Effects
MS
- injection site reactions - pain, erythema, pruritus, induration (most common)
- chest pain after injection (brief but severe)
does not cause flu-like effects like int. b
Adverse Effects: Interferon Beta
MS
- flu like symptoms
- liver injury
- myelosuppression
- injection site reactions
Fingolimod: Overview
Ms
binds with sphingosine 1-phosphate receptors to keep lymphocytes out of the brain , reducing axonal damage and inflammation
Fingolimod: Adverse Effects
MS
- bradycardia
- infection
- macular edema
- liver injury
- fetal harm
Natalizumab: Adverse Effects
MS
- progressive multifocal leukoencephalopathy, reactivation of JC virus
Natalizumab: Contraindications
MS
- do not combine with other immunosuppressant drugs
- do not give to pts with HIV or other conditions that compromise cell-mediated immunity
must be used in accord to TOUCH Prescribing Program
Teriflumonide: Adverse Effects
MS
- serious birth defects if taken by pregnant women
- birth defects may occur in women impregnated by man taking terifulmonide
Teriflumonide: Drug interactions
MS
- pts taking teriflumonide should not take leflumonide - fatal combination
- pateints taking teriflumonide should avoid live virus vaccines
Mitoxantrone: Overview
MS
- only immunosuppressant currently approved for MS
- suppresses immune function more than modulators, but is more toxic
- reserved for pateints who are unresponsive to, or intolerant of, immunomodulators
Mitoxantrone: Adverse Effects
MS
- myelosuppression
- cardiotoxicity
- fetal injury
Preferred treatment for acute MS relapse
MS
- short course of high dose IV glucocorticoids (methylprednisone)
OR
- intravenous gamma globulin
Interferon beta: baseline data
MS
- CBC
- LFT
Interferon beta: Identifying high risk patients
MS
- patients who use alcohol
- pts with active liver injury
- pts taking drugs that can cause liver injury or suppress bone marrow
Mitoxantrone: Baseline Data
MS
- pregnancy test
- LFT
- CBC
- LVEF determination
