MS Flashcards
definition of MS
–chronic, inflammatory autoimmune
–potentially disabling disease (brain and spinal cord)
characteristics of MS
–inflammation
–demyelination
–scar development
etiology of MS
–unknown
–autoimmune may be triggered by infection
–genetic predisposition
risk factors for MS
–age: 20-40
–gender: women
–location: moderately cool climate (Northern US)
–race: Caucasian
—-genetics: family hx
possible risk factors for MS
–smoking
–vitamin D deficiency
–obesity
–infection (Epstein Barr)
patho of MS
–consists of autoimmune attack against the myelin sheath
–T lymphocytes migrate to CNS and cross the blood brain barrier
–antigen-antibody reaction in CNS initiates an inflammatory response
–axons are demyelinated and plaques/sclerosis forms
–axons are destroyed
early disease effects of MS on nerves
–nerve fiber not affected
–impulses still transmitted
–may notice weakness
later disease effects of MS on nerves
–axons are destroyed
–impulses are totally blocked
–permanent loss of function
types of disease progression with MS
–benign
–relapsing-remitting
–primary-progressive
–secondary-progressive
–progressive-relapsing
benign progression of MS
no disability with a return to normal between attacks
relapsing-remitting progression of MS
unpredictable attacks which may leave permanent deficits followed by periods of remission
primary-progressive progression of MS
steady increase in disability without attacks
secondary-progressive progression of MS
initial relapsing-remitting MS that suddenly begins to decline without periods of remission
progressive-relapsing progression of MS
steady decline since disease onset with superimposed attacks
symptoms of MS
–numbness, tingling
–walking difficulty
–pain
–fatigue
–muscle spasms
symptoms to monitor with MS
–cognitive problems (Cog Fog)
–vision problems
–depression
–fatigue
–pain
–bowel/bladder
–weakness
–sexual issues
–muscle stiffness/spasm
–walking/balance (vertigo; fall risk)
goals of therapy for MS
–slow disability
–reduce frequency of relapses
–reduce new brain lesions
what are drugs used for with MS?
–modify disease process
–treat acute relapse
–manage symptoms
which MS drug is an injectable - interferon beta?
avonex
which MS drug is an injectable - glatiramer acetate?
copaxone
MOA of avonex
inhibit pro-inflammatory WBCs from crossing BBB
adverse effects of avonex
–flu-like reactions
–liver toxicity
–bone marrow suppression
–depression
–drug interactions
effectiveness of avonex
decreases relapse rate by up to 30%
MOA of copaxone
increased production of anti-inflammatory T cells which cross the BBB and suppress inflammation
adverse effects of copaxone
–injection site reactions
–post-injection reactions (flushing, palpitations, chest pain, rash, laryngeal constriction)
how long do side effects of copaxone last?
15-20 minutes
oral MS meds
–fingolimod
–dimethyl fumarate
infusion MS meds
natalizumab
MOA of fingolimod
retain lymphocytes in the lymph nodes, preventing them from crossing the BBB – decreasing inflammation
which progression stage does fingolimod target?
RRMS
MOA for dimethyl fumarate
thought to inhibit immune cells and may have antioxidant properties
MOA of natalizumab
prevents circulating T cells from leaving the vasculature and crossing the BBB
therapeutic uses of natalizumab
MS and Crohn’s
specifics about natalizumab
–monotherapy only
–relapsing form of MS
adverse effects of natalizumab
–most common = HA, fatigue
–progressive multifocal leukoencephalopathy (PML)
–hepatotoxicity
–hypersensitivity
progressive multifocal leukoencephalopathy
–drug only available through TOUCH prescribing program
–risk increases when combined with another immunosuppressant
TOUCH prescribing program
only prescribers, infusion sites, and their associated pharmacies enrolled with the program are able to prescribe, distribute, or infuse
alemtuzumab
–infusion
–reserved for patients with poor response to 2 or more MS meds
mitoxantrone
–secondary progressive
–progressive-relapsing
–worsening RRMS
preferred treatment for acute relapses
–high dose IV glucocorticoid (frequent use or long-term use should be avoided)
–IV gamma globulin (for patients intolerant to glucocorticoids)
ACTH in treating acute relapse
–ACTH in gel form
–prolonged release of ACTH after injection
–unable to tolerate steroids or they have not been effective
MS drug used to treat urinary frequency/retention
–anticholinergics
–cholinergics
MS drugs used to treat constipation
bulk-forming laxative
MS drugs used to treat fatigue
amantadine
MS drugs used to treat muscle spasms
muscle relaxants
MS drugs used to treat cognitive dysfunction
donepezil
