Exam 2 - Multiple Sclerosis Flashcards
what is multiple sclerosis
- chronic, inflammatory autoimmune disorder
- potentially disabling disease
- brain and spinal cord: white and gray matter
characteristics of MS
- inflammation
- demyelination
- scar development (gliosis)
MS etiology
- unknown
- autoimmune may be triggered by infection
- genetic predisposition
MS risk factors
- age: 20-40
- gender: women
- location: moderately cool climate
- race: caucasian
- genetics: family history
possible risk factors for MS
- smoking
- vitamin D deficiency
- obesity
- infection (including epstein-barr)
MS pathogenesis
- consists of an autoimmune attack against the myelin sheath
- T lymphocytes migrate to the CNS and cross the BBB
- antigen-antibody reaction in CNS initiates an inflammatory response
- axons are de-myelinated and plaques/sclerosis forms
- axons are destroyed
early disease neuron effects
- nerve fiber not affected
- impulses still transmitted
- may notice weakness
later disease neuron effects
- axons are destroyed
- impulses are totally blocked
- permanent loss of function
disease course
- benign
- relapsing remitting
- primary progressive
- secondary progressive
- progressive relapsing
benign
exacerbation but return to baseline
relapsing-remitting
- long periods of remission with few exacerbations
- stable between and minimal disability
- won’t return to baseline
- don’t return to previous state with each flare
primary progressive
gradual progression of disease without periods of remissions
secondary progressive
- initial relapsed followed by remissions with some loss of function with each flare
- eventually shifts to progressive
progressive-relapsing
- gradual progression and exacerbations
- fewer remissions
MS symptoms to monitor
- cognitive problems
- vision problems
- depression
- fatigue
- pain: chronic or acute, burning or stabbing
- bowel/bladder
- weakness: including paralysis
- sexual issues
- muscle stiffness/spasm: numbness/tingling
- walking/balance: vertigo
is there a cure for MS
no
goals of therapy for MS
- slow disability
- reduce frequency of relapses
- reduce new brain lesions
what are drugs for MS used for
- modify the disease process
- treat an acute relapse
- manage symptoms
interferon beta 1a/1b
avonex
glatiramer acetate
copaxone
interferon beta 1a/1b MOA
- naturally occurring substance
- inhibit pro-inflammatory WBCs from crossing BBB
- decrease relapse rate by up to 30%
interferon beta 1a/1b adverse effects
- flu like symptoms
- liver toxicity
- bone marrow suppression
- depression
- drug interactions
glatiramer acetate MOA
increased production of anti-inflammatory T cells which cross the BBB and suppress inflammation
- similar efficacy
glatiramer acetate adverse effects
- injection site reactions
- post-injection reactions
- flushing, palpitations, chest pain, rash, laryngeal constriction
- last 15-20 min, treatment not necessary
fingolimod
- oral agent
- retain lymphocytes in the lymph nodes, preventing them from crossing the BBB, decreasing inflammation
- RRMS
dimethyl fumarate
- oral agent
- thought to inhibit immune cells and may have anti-oxidant properties
natalizumab MOA
prevents circulating T cells from leaving the vasculature and crossing the BBB
natalizumab adverse effects
- headache, fatigue
- progressive multifocal leukoencephalopathy: only available through the TOUCH program
- hepatotoxicity
- hypersensitivity
alemtuzumab
- infusion med
- reserved for patients with poor response to 2 or more MS medications
mitoxantrone
- infusion med
- progressive-relapsing
- worsening RRMS without complete remission
treating an acute relapse
- preferred: high dose IV glucocorticoid
- IV gamma globulin: used for patients intolerant to glucocorticoids
- adrenocorticotropin (ACTH)
managing MS symptoms
- urinary frequency: anticholinergics
- urinary retention: cholinergics
- constipation: bulk-forming laxative
- fatigue: amantadine
- muscle spasms: muscle relaxants
- cognitive dysfunction: donepezil
