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PT2 Neuro 10-11 and Pain 1-4 > MS therapeutics > Flashcards

MS therapeutics Flashcards

(70 cards)

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1
Q

multiple sclerosis

A

autoimmune, inflammatory, demyelinating disease of the CNS

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2
Q

risk factors for MS

A
  • female
  • scandinavian ancestry
  • further from equator
  • age 15-45
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3
Q

the pathophysiologic response in MS

A
  • t-cells activated in the periphery
  • permeability of the BBB is increased, immune cells easily enter CNS
  • In CNS more immune and inflammatory cells activated against myelin
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4
Q

the end result of demyelination

A

eventual transection of axons and permanent disability

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5
Q

symptoms of MS

A
  • vary based on damage location*
  • visual disturbances
  • mental changes
  • depression
  • muscle spasms
  • limb weakness
  • incontinence
  • loss of sensation
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6
Q

relapsing-remitting MS

A

stable with acute relapses

85% initially

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7
Q

secondary progressive MS

A

gradual progression after a period of RRMS

-50% develop in 10 years, 90% w/i 25 years

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8
Q

primary-progressive MS

A

gradual progression from onset

15%

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9
Q

progressive-relapsing MS

A

gradual progression with intermittent relapses

-rarest

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10
Q

benign course MS

A

-progression doesn’t occur

10-20% have this

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11
Q

gold standard for MS diagnosis

A

MRI, looking for lesions separated in space and time

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12
Q

treatment goals of acute attacks

A
  • shorten duration

- decrease severity

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13
Q

treatment goals of disease modifying therapies (DMT)

A
  • alter course

- diminish progressive disability

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14
Q

main goal of therapy

A

maintain quality of life

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15
Q

relapse definition

A
  • worsening of symptoms lasting >24 hours
  • at least 30 days after previous relaps
  • absence of infection and fever
  • EDSS increased by 1 point from baseline
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16
Q

expanded disability status scale (EDSS)

A

point scale that measures the level of a persons disability

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17
Q

when to treat a patient

A

when they have functional disability

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18
Q

corticosteroid use in MS

A
  • mainstay of treatment
  • effective in 75%
  • reduce severity and length of relapse
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19
Q

corticosteroid MoA in MS

A
  • reduce edema in demyelination areas
  • restore BBB integrity
  • reduce cytokine release
  • exact MoA unknown*
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20
Q

typical corticosteroid dosing in MS

A
  • methylprednisolone 500-1000 mg IV qd for 3-10 days

- may be followed by prednisone taper for 1-3 weeks

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21
Q

corticosteroid side effects

A
  • mood changes
  • N/V
  • hyperglycemia
  • exacerbation of infection
  • decreased bone density
  • changes in taste or flushing during infusion
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22
Q

first line disease modifying therapy injections

A
  • interferon beta

- glatiramer acetate

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23
Q

oral second line disease modifying therapy injections

A
  • fingolimod (Gilenya)
  • teriflunomide (Aubagio)
  • dimethyl fumarate (Tecfidera)
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24
Q

IV second line disease modifying therapy injections

A
  • natalizumab (Tysabri)
  • mitoxantrone (Novantrone)
  • alemtuzumab (Lemtrada)
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25
what to use asap after RRMS diagnosis
interferon beta or glatiramer (copaxone)
26
interferon beta MoA
- exact is unknown - alters antigen presentation - interferes with t-cell proliferation - inhibits cytokine release - prevents inflammatory cells crossing BBB
27
interferon beta RRMS efficacy
- 30% reduction in relapse rate | - 50-75% reduction in MRI disease activity
28
interferon beta efficacy in PPMS or SPMS
not effective without relapses
29
interferon beta side effects
- flu-like symptoms | - depression
30
glatiramer acetate MoA
- exact is unknown - may divert immune destruction of myeline - Th2 cells that promote release of anti-inflammatory cytokines are produced
31
glatiramer efficacy in relapsing MS
- 30% reduction of relapse rate - 30% reduction in MRI activity - reduce disability progression
32
glatiramer efficacy in CIS
- delays time to second relapse | - reduces risk of clinically definite MS
33
interferon efficacy in CIS
- reduce risk of new activity on MRI - prolong time to 2nd relapse - reduce progression to clinically definite MS
34
glatiramer side effects
-transient systemic post injection reaction that may feel like a heart attack
35
Interferon beta IM injection
Avonex
36
how to avoid flu-like symptoms with beta interferon
- titrate dose - pre/post treat with NSAID or tylenol - inject before bedtime - often subsides over time
37
fingolimod use
relapsing forms of MS | -oral
38
fingolimod MoA
inhibits t-cells and lymphocytes migration out of lymph nodes
39
fingolimod side effects
- first dose bradycardia | - infection
40
fingolimod monitoring
lots more than 1st line - vaccinations - CBC - LFTs - opthalmic - first dose monitoring
41
teriflunomide MoA
- suppression of pyrimidine synthesis (immune response) | - reduces T and B cell proliferation
42
teriflunomide side effects
increased LFTs
43
interferon beta monitoring
CBC LFTs efficacy after 6-12 months
44
glatiramer monitoring
efficacy after 6-12 months
45
teriflunomide monitoring
- negative TB test prior to initiation | - teratogenicity and hepatotoxicity
46
dimethyl fumarate MoA
- induces apoptosis of activated T-cells - activation of antioxidant response elements - decreased inflammatory cells in CNS
47
dimethyl fumarate side effects
- lymphopenia | - elevated LFTs
48
dimethyl fumarate monitoring
- CBC | - signs of infection
49
natalizumab use
recommended for patients w/ inadequate response to or intolerance of first line treatment
50
natalizumab withdrawn due to
progressive multifocal leukoencephalopathy (PML) | -serious brain infection with high mortality
51
natalizumab MoA
activated lymphocytes can't cross BBB
52
natalizumab efficacy in RRMS
- 42% reduction of progression - 68% reduction relapse rate - 83% MRI lesion recdution
53
natalizumab side effects
- allergic reaction to infusion - neutralizing antibodies to medication - fatigue - infection - PML
54
mitoxantrone use
clinically worsening of RRMS, SPMS, and PRMS
55
mitoxantrone MoA
- inhibits topoisomerase II - reduce inflammatory cytokines - inhibit T, B cell, and macrophage proliferation
56
mitoxantrone dosing
max 140 mg/m^2 in a lifetime due to cardiotoxicity
57
mitoxantrone
ECHO every month for cardiotoxicity
58
mitoxantrone efficacy
for RRMS and SPMS - 60-70% reduction in relapse rate - reduced disability progression
59
mitoxantrone side effects
- chemotherapy side effects | - cardiotoxicity
60
alemtuzumab use
RRMS and inadequate response to two or more drugs
61
alemtuzumab MoA
-apoptosis of T cells
62
alemtuzumab efficacy
- 40% reduction in disability progression | - 51% reduction in relapse rate
63
alemtuzumab side effects
- rash - headache - nasopharyngitis
64
alemtuzumab monitoring
CBC skin exams TSH infections
65
treatment for ambulation problems in MS
dalfampridine
66
dalfampridine MoA
blocks K channels in CNS
67
treatment for fatigue in MS
stimulants (amantadine, modafinil, methylphenidate)
68
treatment for spasticity in MS
baclofen
69
treatment for urinary urgency in MS
anticholinergic
70
treatment for urinary retention in MS
catheter | alpha blocker

PT2 Neuro 10-11 and Pain 1-4 (5 decks)

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