MS Pharm (Exam 2) Flashcards
Injectables to modify the disease process
Interferon beta
(Avonex) (1a)
glatiramer acetate
(Copaxone)
interferon beta-1a
Avonex
interferon beta-1a/b (avonex): MOA
Inhibit Inflammatory WBCS from crossing the BBB
Decrease relapse rate in MS by up to 30%
interferon beta-1a/b (avonex): Adverse Effects
Flu like reactions
Liver toxicity
Bone marrow suppression
glatiramer acetate
copaxone
glatiramer acetate (copaxone): MOA
Increase production of anti-inflammatory T cells which cross the BBB and suppress inflammation
glatiramer acetate (copaxone): Adverse Effects
Injection site reactions
Post injection:
-Flushing
-Palpitation
-Chest pain
-Laryngeal constriction
(Only last 12-20 min so do not need treatment unless laryngeal constriction)
Oral Medication to modify the disease process
fingolimod
dimethyl fumarate
Infusing medication to modify the disase process
natalizumab
fingolimod: MOA
Retain lymphocytes in the lymph nodes, preventing them from crossing the BBB - decreasing inflammation
RRMS
fingolimod: Indication
RRMS
dimethyl fumarate: MOA
Developed for MS
Thought to inhibit immune cells and may have anti-oxidant properties
Decrease inflammation
natalizumab: MOA
Infusion that prevents circulation T cells from leaving the vasculature and crossing the BBB
natalizumab: Therapeutic uses
MS (reduce relapse by 68%)
Crohn’s disease
natalizumab: NSG consideration
Monotherapy
NOT used with any other agent
Relapsing and remitting form of MS
RRMS
natalizumab: Adverse Effects
Most Common:
-Headache
-Fatigue
-Progressive Multifocal leukoencephalopathy (PML)
-Hepatotoxicity
Because natalizumab can cause PML it is only available through
TOUCH program
Only certain people can prescribe and give the drug
Higher risk of PML when taking with immunosuprressants
alemtuzumad
used for patient with poor response to 2 or more MS medications
Preferred Treatment of ACUTE RELAPSE of MS
High dose of IV glucocorticoid:
-500 mgs to 1 gm of methylprednisolone daily x 3-5 days (pulse dose)
-Frequent use or long term use should be avoided
IV gamma globulin:
-patient intolerant to glucocorticoid therapy
ACTH (H.P acthar Gel):
-adrenocorticotropin hormone in gel form
-Prolonged release of ACTH after injection
-For people who are unable to tolerate steroids or they have not been effective
Managing MS Symptoms: Urinary Frequency and Urinary retention
Anticholinergics (dry up)
Cholinergics (make you go)
Managing MS Symptoms: Constipation
Bulk-forming laxative
Managing MS symptoms: Fatigue
Amantadine
Managing MS symptoms: Muscle Spasm
Muscle relaxants
Managing MS symptoms: Cognitive dysfunciton
Donepezil (same use for dementia)
