Flashcards in MS Deck (49)
What T helper cell is pro-inflammatory?
Th1 and 17
What T helper cell is anti-inflammatory?
immunologic disorder marked by chronic inflammation of the CNS
What is the key to the diagnosis of MS?
Dissemination of plaques in time and space
What are the three broad treatment categories for MS?
1. Treatment of exacerbations-corticosteroids (anti-inflammatories)
2. Disease-modifying therapies
3. Symptomatic therapies for spasticity, bladder sx's, sensory sx's and fatigue
How are first line disease-modifying therapies (DMTs) administered?
Effects of DMTs
1. Decrease annual relapse rate
2. Decrease formation of new white matter lesion
List the DMT agents
1. Interferon (IFN) formulations
2. Glatiramer acetate (non-IFN)
List the 1st generation agents used for relapsing MS
1. Interferon-B1a (Avonex, Rebif)
List the 1st generation agents that are a Pregnancy Category C
2. Pegylated Interferon-B1a
List the 1st generation agents used for RRMS
1. Pegylated Interferon-B1a
2. Glatiramer acetate
List the 1st generation agent that is administered as an IV infusion
3. Worsening RRMS
List the 1st generation agent that are a Pregnancy Category B
List the 1st generation agents that are a Pregnancy Category D
2. Flu like sx's
Glatiramer acetate ADEs
1. Chest tightness
2. Urticaria- @ any dose!
1. Macular retinal edema
2. AV block
1. Steven-Johnson Syndrome
2. Liver failure
3. TB activation
Dimethyl fumarate ADEs
1. Flushing-Take with food
3. Increased LFTs
5. GI discomfort
Herpes Viral Infection
-Administer herpes viral prophylaxis starting on 1st day of Tx
-Continue for 2 months after completion of treatment OR
-until CD4 count @ 200
List the disease modifying ORAL agents indicated for relapsing forms of MS
4. Dimethyl fumarate
Relapsing or Progressive MS
Clinically Isolated Syndrome
Frist episode of neurologic sx's that lasts @ least 24 hrs
what do we use to treat exacerbation sx's?
When should you initiate high dose corticosteroids (Methypredniolone, IV) with onset of sx's? When do you start toe ee improvement of sx's?
Within 2 weeks of sx onset
Improvement in 3-5 days
Longer durations of IV methylprednisolone ADEs
2. Fungal infection
3. Mood alteration
Short term ADEs of methylprednisolone
1. Metallic taste
2. Sleep disturbances
Which medication carries a pregnancy category X rating?
What labs would we monitor for adverse effects in Teriflunomide
1. Pregnancy test
5. TB tst
IFN Beta 1a MOA
Alters expression and response to surface antigens enchanting immune cell activities
IFN Beta 1b MOA
1. Balances the expression of pro and anti-inflammatory agents in the brain
2. Reduces number of inflammatory cells that cross the BBB
Glatiramer acetate MOA
1. Mimics the antigenic properties of Myelin Basic Protein (MBP)
2. Inhibits binding of MBP t oTe-cell receptors
3. Reduces inflammation, demyelination, and axonal damage
4. Neuroprotective effect
Which medication has an indication for CIS and RRMS?
Three of the interferons are considered to be high potency medications. Which medication is consider a low potency medication?
Interferon beta 1a- brande name Avonex
If our patient was a female, which agent is a Category B Pregnancy?
Our patient reports a PMH of depression. Which medications would be considered a possible contraindication?
Interferons beta 1a and beta 1b
What is appropriate monitoring parameters for the interferon medications?
4. Thyroid function
List the drugs that are used in cases of inadequate response or intolerance to first-line agents
what is the life time list of dose for mitoxantrone?
2. AML (acute myeloid leukemia)
3. Pregnancy D
When is fingolimod contraindicated?
Class I and III antiarrythmic drugs
When is Mitoxantrone indicated?
3. Worsening RRMS