20 - MS Flashcards
What symptoms demyelination result in?
numbness, weakness, fatigue, cognitive difficulties, ataxia, optic neuritis, bowel/bladder abnormalities and neuropathic pain
What country has highest prevalence of MS? What regions?
Canada
-Atlantic and Prairies
Could be linked to low Vitamin ___
D
Treatment for relapsing remitting MS
DMT initiated at diagnosis
Treatment for secondary progressive MS
DMT has no effect, except in relapses
Treatment for primary progressive MS
ocrelizumab
What is the McDonald diagnostic criteria for MS?
At least 2 attacks, each attack lasting > 24 hours, at the attacks have to be separated by > 30 days
non-pharms for MS?
physiotherapy, stretching, fluid intake restriction & pelvic floor exercises, respiratory training, smoking cessation
What can we use for acute relapses?
IV methylprednisolone followed by oral prednisone
____ reduce rate of relapses in RRMS
DMTs
What does DMT stand for?
Disease Modifying Therapy
PML has been reported with most of DMTs, especially ______
natalizumab
What is PML?
Progressive multifocal leukencephalopathy
- opportunistic infection
- rare brain disease caused by infection or re-activation of JC virus
List the 1st line DMTs
- dimethyl fumarate
- glatiramer
- interferon beta
- ocrelizumab
- teriflunomide
List the 2nd line DMTs
- alemtuzumab
- cladribine
- daclizumab - not approved anymore
- fingolimod
- mitoxantrone - off-label
- natalizumab
What is the adjunctive treatment that improves walking?
fampiridine (blocks K+ channels, improves walking)
How does dimethyl fumarate work?
activates Nrf2 pathway which is involved in cellular response to oxidative stress
s/e of dimethyl fumarate
flushing, n/v/d, ab pain
can decrease lymphocytes, cause proteinuria, increase liver enzymes
MOA of glatiramer
immunomodulator, inhibits myelin reactive T cells, decreased T cell proliferation and decreases interferon-gamma secretion
s/e of glatiramer
rare, acute transient post injection reaction = flushing, chest tightness, palpitations and dyspnea
avoid what with dimethyl fumarate?
live vaccines
Interferon beta may cause ?
Nabs (neutralizing antibodies)
How does ocrelizumab work?
depletes CD20 B cells
ocrelizumab has slight risk of _____
neoplasm (abnormal growth of tissue)
How does teriflunomide work?
reduces T and B cell activity
_____ has no cases of PML reported
teriflunomide
How does Alemtuzumab work?
MAB that binds to CD52 on activated lymphocytes and targets their destruction
How does cladribine work?
temporarily depletes B and T lymphocytes, followed by lymphocyte reconstitution, thus not causing continuous immune suppression
Cladribine has s/e of high grade lymphopenia which is linked to ____
HSV
How does Fingolimod work?
blocks activated lymphocytes from circulating into blood stream from lymphoid tissues.
s/e of fingolimod?
-macular edema
-bradycardia
-VZV infection
-skin cancer
-reversible hepatic dysfunction
PML
Describe mitoxantrone
off-label
-suppresses immune cell activity
s/e of mitoxantrone
cardiotoxicity, leukemia
MOA of natalizumab
blocks attachment of T cells to the BBB
*highest risk of PML
_____ is a known teratogen
Teriflunomide
If someone’s on teriflunomide and gets pregnant, you need to stop it and wash it out with ______
cholestyramine
Mainstay of care in pregnancy and breastfeeding for MS?
- These states decrease risk of relapses
- stop drugs for MS
- if need be, use corticosteroids in breastfeeding for acute relapses
All MS patients need how much of vitamin D/day?
1000 IU/day
