ch 23 MS drugs Flashcards
MS signs and symptoms
(symptoms vary depending on where plaques are)
- paresthesias,
- muscle or motor problems
- visual impairment
- bladder and bowel symptoms
- sexual dysfunction
- disabling fatigue
- emotional lability
- depression
- cognitive impairment
- slurred speech
- dysphagia
- dizziness
- vertigo
- neuropathic pain
4 subtypes of MS
- Relapsing-remitting MS is characterized by recurrent, clearly defined episodes of neurologic dysfunction (relapses) separated by periods of partial or full recovery (remissions).
- Secondary progressive MS occurs when a patient with relapsing-remitting MS develops steadily worsening dysfunction, with or without occasional plateaus, acute exacerbations, or minor remissions.
- In ,primary progressive MS symptoms grow progressively more intense from the outset, although some patients may experience occasional plateaus or even temporary improvement.
Progressive-relapsing MS, which is rare, is much like primary progressive MS but with
drug therapy for MS
- Relapsing-remitting MS treated with:
- Interferon beta 1a & 1b
- glatiramer acetate
- natalizumab
- fingolimod
- terflunomide
- dimethyl fumarate
- Secondary progressive MS treated with:
- Interferon beta
- mitoxantrone
- Primary progressive MS treated with:
- methotrexate
- azathioprine
- cyclophosphamide
- Progressive-relapsing MS treated with:
- mitoxantrone
treating acute episodes of MS
- high-dose IV glucocorticoid
- Glucocorticoids suppress inflammation and can thereby reduce the severity and duration of a clinical attack.
- IV gamma globulin
-
Interferon beta 1a & 1b
(immunomodulator)
Therapeutic Use:
- secondary progressive MS
- can reduce the severity and frequency of attacks
Adverse effects:
- flu like symmptoms
- hepatotoxicity
- myelosupression
- injection site reaction
- depression*
- suicidal thoughts*
Glatiramer Acetate
(immunomodulators)
-long term therapy of relapsing remitting MS
Adverse effects:
- well tolerated
- injection site reaction (pain,erythmea,itching,pitting)
- does not cause flu like symptoms,myelosuppression, or liver toxicity
- no significant interaction with other MS drugs
Dimenthyl Fumarate
(immunomodulator)
-approved for management of relapsing MS
Adverse effects:
- flushing
- GI discomfort
- lymphopenia
- rash
- alt. lab results (high titers)
Drug interactions:
- reduce bodys response to vaccines
- other immunosupressants
Natalizumab
(immunomodulator)
-approved only for monotherapy of relapsing forms of MS.
Common reactions:
- headache and fatigue.
- abdominal discomfort,
- arthralgia,
- depression,
- diarrhea,
- gastroenteritis,
- urinary tract infections,
- lower respiratory tract infections
Serious adverse effects:
PML,
liver injury
hypersensitivity reactions
*
Fingolimod
(immunomodulator)
-reducing the frequency of MS exacerbations and delaying disability in patients with relapsing forms of the disease
Adverse effects:
- bradycardia
- macular edema
- liver injury
- infection
- reduce lung function
- headache
- diarrhea
- cough
- back pain
- influenza
Drug interactions:
- ketoconazole
- cardiac drugs
drugs
Mitoxantrone
(immunosuppressant)
-approved for reducing neurologic disability and clinical relapses in patients with worsening relapsing-remitting MS, secondary progressive MS, and progressive-relapsing MS
Adverse effects:
myelosuppression-
- cardiotoxicity
- fetal injury
- hair loss
- injury to the gastrointestinal mucosa
How to minimize risk:
- Perform complete blood counts at baseline, before each dose, and 10 to 14 days after each dose.
- Perform liver function tests at baseline and before each dose.
- Perform a pregnancy test before each dose.
- Determine left ventricular ejection fraction before each dose and whenever signs of heart failure develop.
