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Patho 2 > MS > Flashcards

MS Flashcards

1
Q

MS

A

chronic inflammatory autoimmune disorder
- loss of the myelin sheath and axons which slows transmission

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2
Q

What cells are affected with MS

A

white and gray matter of the brain and spinal cord

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3
Q

Neuronal char of MS

A

inflammation, demyelination, scar dev (Gliosis)

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4
Q

cause of MS

A

unknown
- genetic predis, autoimm, enviro

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5
Q

known risks for MS

A

20-40Y, women, moderately cool climate (N. US), Caucasian, fam hx

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6
Q

possible risk fx for MS

A

smoking, vit D def. obese, infx (Epstein-Barr)

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7
Q

How does MS affect men?

A

Get worse and more prog sx

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8
Q

MS patho

A
  • autoimm against myelin sheath
  • T lymph to CNS cross the BBB, causing inflam
  • antigen-antibody rxn in CNS–inflam
  • axon demyelination
  • plaque/sclerosis forms
  • axons are destroyed and die
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9
Q

Neuronal effects of MS (early vs late)

A

Dec nerve fxn and transmission can cause eventual damage to the axons
- early–fiber not affected, impulse still transmitted, weakness
- late–axon destroyed, impulse blocked, perm loss of fxn

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10
Q

benign MS

A

no prog loss of fxn and very few exac that are weak

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11
Q

relapsing-remitting MS

A
  • most common
  • long remissions w/o exac and minimum prog weakness
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12
Q

Primary progressive MS

A

steady prog w/o remissions

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13
Q

Secondary progressive MS

A

initial relapse and remission then progressive decline w/o remissions

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14
Q

Progressive relapsing MS

A

Gradual progressive decline w/o many remissions

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15
Q

CM of MS

A

tingling, numbness, paresthesia in face, trunk, and legs, weakness and loss of fxn, vision loss, impaired gait, incontinence, sz, cog fog, depression, fatigue, pain (acute/chronic, burn/stab), bowel/blad (esp constipation), sexual probs, muscle stiffness/spasm, vertigo and falls

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16
Q

Goals of MS pharm

A

Improve fxn, limit lesions, dec exac
- modify disease process

17
Q

tx of acute MS relapse

A
  • pulse dose of IV glucocorticoids (v high dose for 3-5d)–avoid long-term/freq use
  • IV gamma globulin–for pt intolerant to glucocort
  • ACTH (acthar gel)–prolonged ACTH release; for intolerant to steroids
  • plasmapheresis–take plasma out and replace it with donor plasma
18
Q

Drugs to tx MS symptoms

A
  • anticholinergics and cholinergic for urine freq/retention
  • bulk form lax
  • amantadine for fatigue and longer rest
  • muscle relaxants for muscle spasms
  • donepezil for cog fog
19
Q

Interferon beta-1a/b class and MOA

A
  • Naturally occurring sub
  • Inhibit pro-inflam WBCs T-cells from crossing BBB
20
Q

Interferon beta-1a/b SE and NC

A
  • Flu-like, liver tox, bone marrow supp, dep, drug intx
  • dec relapse rate by 30%
21
Q

Glatiramer acetate MOA

A

Inc prod anti-inflam T cells that cross BBB and supp inflam

22
Q

Glatiramer acetate SE and NC

A
  • IJ site rxn, IJ rxn–flush, palpitations, chest pain, rash, laryngeal constriction
  • IJ rxn usually last 15-20 min and tx not necessary
  • sim efficacy to other drug
23
Q

fingolimod

A

Retain lymphocytes in lymph nodes, prevent from migrating to BBB–dec inflam
- for RRMS
- oral

24
Q

Dimethyl fumarate

A
  • Inhibit immune cells and may have antioxidant properties
  • oral
25
Q

natalizumab MOA and indications

A

Prevent circ T cells from leaving vasculature and crossing BBB
- Relapsing MS and Crohn’s

26
Q

natalizumab SE and NC

A
  • HA, fatigue; prog multifocal leukoencephalopathy (PML), hepatotox, hypersensitivity
  • dec relapse by 68%
  • monotherapy only
  • need to be in TOUCH program to take
  • risk for PML inc with combo therapy; PML can be fatal
  • infusion med
27
Q

alemtuzumab

A

For pt with poor response to 2+ MS meds
- infusion med
- 2nd line

28
Q

mitoxantrone

A

2nd prog, prog-relapsing, worsening RRMS
- infusion

Patho 2 (15 decks)

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