MS Flashcards
what is MS?
chronic inflammatory autoimmune disorder
potentially disabling disease of brain and spinal cord
Characteristics of MS
inflammation
demyelination
Gliosis (scar formation)
what is the cause of MS?
unknown
autoimmune my be triggered by infection
genetic
risk factors for MS
age- 20-40 women mod. cool climate Caucasian family history
possible other risk factors for MS
smoking
vitamin d deficiency
obesity
epstein-barr virus
pathogenesis of MS
autoimmune attack against myelin sheath T lymphocytes migrate to CNS and cross BBB creates inflammatory response axons are demyelinated and plaques form axons destroyed
early MS
nerve fiber not affected
impulses still transmitted
may notice weakness
late MS
axons destroyed
impulses are totally blocked
permanent loss of function
benign MS
no disability with return to normal between attacks
relapsing-remitting MS
unpredictable attacks may leave permanent deficits follow by periods of remission
primary-progressive MS
steady increase in disability without attacks
secondary-progressive MS
initial relapsing-remitting MS that suddenly begins to decline without remission
progressive-relapsing MS
steady decline since disease onset with superimposed attacks
clinical manifestations of MS
Cog Fog visual problems depression fatigue pain (chronic or acute, burning or stabbing) bowel, bladder weakness sexual issues muscle stiffness/spasms walking/balance
goals of pharm for MS
slow disability
reduce frequency of relapse
reduce new brain lesions
drugs are used to modify disease process, treat acute relapse, manage symptoms
drugs that modify disease process
avonex
copaxone
interferon beta 1a/b
inhibits pro-inflammatory WBC from crossing BBB
naturally occurring substance
avonex- injectable
side effects of interferon beta 1a/b
flu like symp. liver toxicity bone marrow suppression depression drug interactions
glatiramer acetate
copaxone- injectable
increased production of anti-inflammatory T cells that cross BBB and suppress inflammation
side effects of glatiramer acetate
site reaction
flushing, palpitations, chest pain, rash, laryngeal constriction
usually last 15-20 min
no tx needed
fingolimod
oral MS disease modifying
retain lymphocytes in lymph nodes, preventing them from crossing BBB, decreasing inflammation
RRMS
dimethyl fumarate
oral MS disease modifying
thought to inhibit immune cells and may have anti-oxidant properties
natalizumab
prevents circulating T cells from leaving the vasculature and crossing BBB
treats MS and crohns
MONOTHERAPY- not used with others
used for relapsing form of MS
side effects of natalizmab
headache fatigue
MUST BE GIVEN in touch program due to PML (progressive multifocal leukoencephalopathy)
hepatotoxicity
hypersensitivity
alemtuzumab
infusion for MS
reserved for patients with poor response to 2 or more MS drugs
mitoxantrone
infusion
secondary progressive
progressive-relapsing
worsening RRMS without complete remission
treating a MS relapse
high dose IV glucocorticoid
IV gamma globulin
ACTH
what is used to treat urinary frequency
anticholinergics
what is used to treat urinary retention
cholinergic
what is used to treat constipation?
bulk forming laxative
what is used to treat fatigue
amantadine
what is used to treat muscle spasms
muscle relaxers
what is used to treat cognitive dysfunction
donepezil
