Autoimmune Dx - Multiple Sclerosis (MS) Flashcards
How do pts experience MS?
Periods of dx activity ff by intervals of remission
Primary goal of MS therapy?
Prevention of dx progression; whats lost in neuronal fxn can’t be regained
Which chemo therapeutic agent is sometimes used for MS and is FDA approved?
Mitoxantrone
Which chemo therapeutic agent is sometimes used for MS and is not FDA approved?
Cyclophosphamide
Azathioprine
IV immunoglobulin
Alemtuzumab
What’s the brand name of Glatiramer acetate?
Copaxone
MOA of Glatiramer acetate (Copaxone)?
Immune modulator, mech not well-defined
SE of Glatiramer acetate (Copaxone)?
Injection site rxns (inflammation, erythema, pain, pruritus, mass)
Infection
Pain
Flushing
Diaphoresis
Chest pain
Weakness
Anxiety
Rash
Nausea
Howz Interferon beta-1a (Avonex) used?
IM 30mcg weekly
Howz Interferon beta-1a (Rebif) used?
SC 22mcg or 44mcg three times per week
Howz Interferon beta-1b (Betaseton, Extavia) used?
SC: 0.25mg Every other day
SE of interferon beta?
Injection site rxns
Which interferon are used SC?
Rebif and Betaseron/Extavia
How do u inject Rebif or Betaseron/Extavia?
SC injections
Pinch skin, inject into SC tissue in abdomen, left and right arm, thighs, buttocks, rotate sites
Should small air bubble in pre-filled syringes be expelled? Why or why not?
No, small air bubbles shouldn’t be expelled.
Bcuz dose may be reduced
What’s Natalizumab?
Recombinant humanized monoclonal antibody
Brand name of Natalizumab?
Tysabri
How’s Natalizumab (Tysabri) used?
300mg IV given over 1hr, Q4WEEKS
What’s the black box warning of Natalizumab (Tysabri)?
Can cause progressive multifocal leukoencephalopathy (PML)
List oral immune modulator agents
Fingolimod (Gilenya)
Teriflunomide (Aubagio)
Dimethyl fumarate (Tecfidera)
What’s warning associated with Fingolimod (Glienya)?
Decrease in heart rate (must monitor)
Monitoring parameters for Fingolimod (Gilenya)?
CBC (baseline and periodically thereafter)
ECG (baseline; repeat after initial dose observation period)
Why’s ECG monitoring important for Fingolimod (Gilenya)?
Postdose symptomatic bradycardia can occur
Howz Dimethyl fumarate (Tecfidera) not to be used?
Don’t crush, chew or sprinkle content on food
MOA of Dalfampridine (Ampyra)?
Potassium channel blocker, may increase nerve signal conduction
What changes may happen to the body temp when on interferons (Avonex; Rebif; Betaseron/ Extavia)?
Signs of infection such as fever if 100.5F (38C) or higher, chills, very bad sore throat, cough, sputum, or change in color of sputum, sweating or pain
What sx control agent is used for incontinence in MS?
Anticholinergic
What sx control agent is used for constipation in MS?
Laxatives
What sx control agent is used for diarrhea in MS?
Loperamide
What sx control agent is used for muscle spasms/spasticity in MS?
Skeletal muscle relaxants
What sx control agent is used for localized pain and spasms in MS?
Botulinum toxin (Botox) can be used to relief pain for up to 3 months
What sx control agent is used for tremor in MS?
Propranolol
What sx control agent is used for depression in MS?
Antidepressants
SNRI if chosen can work for both neuropathic pain and depression
What sx control agent is used for fatigue in MS?
Modafinil or stimulants used in ADHD such as methylphenidate
What sx control agent is used for dizziness and vertigo in MS?
Meclizine and Scopolamine
What sx control agent is used for cognitive fxn in MS?
Acetylcholinesterase inhibitors, including Donepezil
What sx control agent is used for erectile dysfunction in MS?
Can be treated with phophodiesterase inhibitors
What’s multiple sclerosis (MS)?
Chronic, progressive autoimmune dx in which the pts immune system attacks the myelin peptide antigens, destroying the fatty myelin sheaths that surround the axons in the brain and spinal cord (CNS)
