Autoimmune Conditions: MS Flashcards
MS is a chronic progressive autoimmune disease in which the patient’s immune system attacks the:
myelin sheath – the fatty substance that surrounds and insulates nerve fibers of the brain and spinal cord axons
*electrical impulses will dwindle
How do MS patients present in the early stages?
fatigue
weakness
tingling
numbness
burred vision
Clinical presentation as MS progresses?
deterioration of cognitive function, visual disturbances
muscle spasms
pain
incontinence
gait instability
*worse in males :)
What test is performed to make a diagnosis?
MRI, spinal fluid analysis, evoked proteins
What is the primary goal of therapy?
prevention of disease progression - medications are used to modify disease, treat relapses and manage symptoms
what is lost in neuronal function cannot be regained
a chemotherapeutic agent approved for MS
mitoxantrone
What meds are used to help with relapses?
steroids
corticotropin - SC, IM x 2-3 weeks
What parenteral drugs are the mainstay of treatment for patients with relapsing forms of MS
interferon beta formulations –> Betaseron, Avonex, Rebif, Extavia, Plegridy
glatiramer acetate –> Copaxone, Glatopa
What is the name of the PEGYLATED interferon beta? how is it dosed?
Plegridy
every 14 days
How is medication supplied/dispensed
single-dose profiled syringe & needles are provided
Some of the powders reconstituted contain what?
albumin
Brand: Copaxone
generic: glatiramer acetate
an immune modulator thought to induce and activate t lymphocyte suppressor cells in relapsing forms of MS // MOA not really defined
glatiamer acetate
This drug is dosed: SC daily, or SC 3x per week (48 hours between)
Warnings: chest pain
side effects: flushing, diaphoresis, dyspnea
glatiamer acetate
What is the drug of choice in pregnancy for MS?
glatiamer acetate
this drug alters the expression and response to surface antigens, enhancing immune cell function /// MOA not really defined
interferon beta products
generic: interferon beta-1a
Brand: Avonex, Rebif
How is Avonex dosed?
IM weekly
How is Rebif dosed?
SC three times per week/ 48 hours apart
generic: interferon beta-1b
Brand: Betaseron, Extavia
How is Betaseron dosed?
every other day
Which drug is dosed every 14 days?
Plegridy
This drug class has warnings for psychiatric disorders, injection site necrosis, increased LFTs, thyroid dysfunction (hypo and hyper)
side effects: flu like symptoms
Interferon beta products
Do yu want to expel the air bubble in profiled syringes?
no!!!!!!!
teriflunomide
fingolimod
dimethyl fumarate
diroximal fumarate
siponimod
What drug class?
Oral immunomodulators
Brand: Aubagio
teriflunomide
Brand: Gilenya
fingolimod
Which of the oral immunomodulators are contraindicated in pregnancy?
teiflunomide
Which of the oral immunomodulators cause bradycardia and needs to be monitored for at least 6 hours; contraindicated in those with CVD/stroke
use caution with drugs that cause slow HR
MS can become much worse when stopped
fingolimod
What drug can cause macular edema and needs to be monitored with eye exams. Also need to monitor LFTs and CBC
fingolimod & siponimod
Which oral immunomodulator should not be crushed, but chewed and sprinkled on food
dimethyl fumarate
diroximal fumarate
Which oral immunomodulator is contraindicated with CYP2c93/3 genotype?
siponimod
What is the name of the drug that is a potassium channel blocker and works by increasing nerve signal conduction; indicated to improve WALKING
dalfampridine/ Amprya
Brand: natalizumab
generic: Tysabri
This MAb has a boxed warning for PML and has REMS
natalizumab
Alemtuzumab
Ocrelizumab
drug class?
recombinant humanized MAb *REMS
The oral anti-neoplastic
cladribine/ Mavenclad
What drugs are used for MS symptom control?
anticholinergics for incontinence, laxatives for constipation, muscle relaxants, analgesics
propranolol can help with hand tremor
Drugs used for symptom control can…
worsen other symptoms :(
