MS Treatment Flashcards
Acute attacks (relapses)
Glucocorticoids
Relapsing-Remitting MS
Interferon beta (Avonex, Betaseron, Extavia, Rebif) Glatiramer (Copaxone) Teriflunomide (Aubagio) Dimethyl fumarate (Tecfidera) Fingolimod (Gilenya) Natalizumab (Tysabri) Mitoxantrone (Novantrone)
Primary Progressive
Dz modifying treatments not as effective
Secondary progressive/progressive relapsing
Interferon beta
Natalizumab
Mitoxantrone
Interferon beta (Avonex, Rebif, Betaseron, Extavia, Pegridy) - First Line for relapsing forms of MS (decrease attack frequency/delay physical disability)
- Injection only
- MOA: immunomodulary/antiviral/antiproliferative effects/ binds cellular surface receptor leading to expression of gene products and markers/increase IL 10 levels
- USE: RRMS/SPMS experiencing relapses
- ADR: flu like sx; insomnia; injxn site rx; peripheral edema; malaise; HTN; incoordination
- WARNING: depression/suicide/psychotic disorder; hepatotoxicity; new autoimmune disorder; CHF; blood dyscrasias; seizures
Glatiramer acetate (Copaxone) - Reducing relapse frequency in RRMS
- MOA: unknown- immunomodulator
- ADR: vasodilation; rash; dyspnea; chest pain; anxiety; diaphoresis; nausea; pain; weakness; infection
- SubQ dosing
- WARNING: post injxn rxn (flushing, chest pain, palpitations, anxiety, dyspnea, urticaria, throat constriction); transient chest pain; lipoatrophy; skin necrosis at injx site; immunosupression
Mitoxantrone (Novantrone)
- Antineoplastic
- Reducing neurologic disability/relapse frequency
- MOA: intercalates into DNA causing crosslinks and strand breaks; topoisomerase inhibitor; inhibits Tcells Bcells and cytokines
- USE: RRMS and progressive MS; hormone refractory prostate CA; acute nonlymhpocytic leukemia in adults; secondary progressive or progressive relapsing MS
- ADR: N; alopecia; menstual changes/amenorrheal; URI/UTI; blue-green urine
- WARNING: MYELOSUPRESSION (when used for leukemia); CARDIOTOXICITY; SECONDARY AML
- Preg cat D
Natalizumab (Tysabri)
- Used in combo w/ IFN (not first line): reduce exacerbations and delay disability in relapsing MS
- MOA: binds leukocytes and inhibits adhesion; may block inflammatory cells
- USE: crohn’s dz
- WARNING: Progressive multifocal leukoencephalopathy
Dimethyl fumarate (Tecfidera) - First line for relapsing MS
- MOA unknown
- ADR: leukopenia; FLUSHING/REDNESS (40%); Rash; N/V/D/abd pain/indigestion
- Oral
Fingolimod (Gilenya)
- Reduce exacerbations and delay disability in relapsing forms of MS
- First dose BRADYCARDIA (EKG prior to dosing/ monitor 6 hrs after first dose)
- MOA: Sphingosine 1-phosphate receptor modulator; keeps WBC in lymph nodes so does not cross BBB and go to CNS; decrease inflammatory damage to nerve cells
- ADR: varicella zoster; increased mortality; PML; HA; influenza; D; back pain; abnormal LFT; cough
- Oral
Teriflunomide (Aubagio)
- Not first line for relapsing forms of MS
- LOTS of issues
- MOA: pyrimidine synthesis inhibitor (inhibits immune cells/ may reduce activated lymphocytes in CNS)
- ADR: hepatotoxic/ teratogenic/ bone marrow suppression/ peripheral neuropathy/ hyperK/ transient renal failure; D/N/abnormal LFTs/flu/alopecia
- Oral
Dalfampridine (Ampyra)
- Improve walking in MS pts (increases walking speed)
- MOA: K channel blocker
- CONTRAINDICATION: renal impairment, seizures
Dantrolene (Ryanodex, Dantrium)
- First Line for Malignant hyperthermia
- MOA: relieves cramping, spasms, muscle tightness
- USE: spasticity, MS
- ADR: drowsiness; dizziness; malaise; D
- CONTRAINDICATION: active liver dz
Nuedexta
- First med for pseudobulbar affect (involuntary crying or laughing) in MS
- MOA: Dextromethorphan/quinidine
- ADR: N/V/D; cough; liver
- CONTRAINDICATIONS: long GT; AV block
- Metabolized by CYP2D6
Multiple Sclerosis
- Chronic CNS immune mediated dz
Relapsing Remitting MS
Primary Progressive MS
Secondary Progressive MS
Progressive Relapsing MS
