Multiple Sclerosis Flashcards
what is MS
chronic inflammatory autoimmune disorder
- potentially disabling of the brain and spinal cord
what are the characteristics of MS
- inflammation
- demyelination
- scar development (gliosis, plaque formation)
what is the cause of MS
unknown
- maybe triggered by infection
- genetic predispostion
what are the known risk factors of MS
- 20-40
- women
- moderately cool climate
- caucasian
- fam hx
what are possible risk factors of MS
- smoking
- vit d def
- obesity
- infection
what is the patho of MS
consistent autoimmune attack against the myelin sheath
- t lymphoctyes migrate to CNS and cross the BBB
- antigen-antibody rxn in the CNS initiates inflammatory response
- axons are demyelinated and plaques/sclerosis form
- axons eventually become destroyed
what cells produce the myelin sheath and are destroyed during the inflammation process?
oligodendrocytes
what happens when there is damage to myelin sheath
- disruption of nerve conduction
- slows the nerve impulse
- eventually leads to brain atrophy
how are the neurons affected during the early stages of MS
- nerve fiber is not affected and impulses are still transmitted
- may be able to notice some weakness
how are the neurons affected during the later stages of MS
- axons are destroyed
- impulses are completely blocked
- permanent loss of function
what are the different types of MS course progression
- benign
- relapsing-remitting
- primary progressive
- secondary progressive
- progressive relapsing
what is benign MS
exacerbation with a return to baseline
what is relapsing remitting MS
most common, long periods of remission with occasional exacerbations that can leave permanent deficients
- always coming back a little bit weaker
what is primary progressive MS
gra\dual progression of sx without periods of remission
what is secondary progressive MS
initial exacerbation with some loss of function but later exacerbations/remission periods become shorter and with inc in deficits
what is progressive relapsing MS
gradual progression of decline with each exacerbation and remission
what are the clinical manifestations of MS
it depends on what area of the CNS is being affected
- ex: numbness, tingling, walking difficulty, pain, fatigue, h/a, dizzy, depression, etc
what are sx to monitor in pt with MS
- cognitive problems
- vision problems
- depression
- fatigue
- pain
- bowel/bladder
- weakness
- sexual issues
- muscle stiffness/spasms and numbness/tingling
- walking/balance –> vertigo
what is the cure for MS
none
what is the goal of pharm therapy for MS
- slow disability
- reduce frequency or relapses
- reduce new brain lesions
what types of drugs are typically used to treat MS
- drugs that modifying the disease process
- treat an acute relapse
- manage sx
what drugs are used to modify the disease process of MS
Avonex: intergeron beta
copaxone: glatiamer acetate
fingolimod
dimethyl fumarate
natalizumab
alemtuzumab
mitoxantrone
what is the moa of interferon beta-1a/b
inhibit pro inflammatory WBCs from crossing the BBB
* block immune system which helps to dec inflammation*
what is the advantage of interferons
dec relapse rate by 30%
