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Patho 2 - Exam 2 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is MS?

A

Chronic, inflammatory autoimmune disorder that is potentially disabling consisting of inflammation, demyelination, and scar development (of glial cells)

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2
Q

What are the risk factors of MS?

A

20-40
Women
Moderately cool climates (in northern US)
Caucasian
Family history
Possible risk factors: smoking, vitamin D, obesity, infection (maybe Epstein Barr virus)

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3
Q

What is the patho behind MS?

A

There is an autoimmune attack against the myelin sheath.
T-lymphocytes migrate to the CNS and cross the BBB, an antigen-antibody reaction initiates an inflammatory response. There is a loss of oligodendrocytes (these produce myelin sheath) causing axons to be de-myelinated. Plaques and sclerosis then forms and axons become destroyed.

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4
Q

How are neurons affected early in the disease process of MS?

A

The nerve fiber is not affected yet. Impulses are still transmitted. Patient may begin noticing weakness.

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5
Q

How are neurons affected in the later stages of MS?

A

Axons are destroyed and impulses are totally blocked. This results in a permanent loss of function.

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6
Q

What are the types of progression of MS?

A

Benign
Relapsing - remitting
Primary - progressive
Secondary - progressive
Progressive - relapse

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7
Q

What is benign MS?

A

Exacerbation of symptoms but recovery goes back to baseline.

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8
Q

What is relapsing - remitting MS?

A

The most common type of MS. Long periods of remission and some exacerbation. Minimal disability and progression. Does not return back to baseline, although close. Each exacerbation will will pull away from baseline.

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9
Q

What is primary-progressive MS?

A

Gradual progression without periods of remission from the beginning.

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10
Q

What is secondary-progressive MS?

A

Initial exacerbation followed by remission with some loss of function. As the disease progresses, there are less periods of remission.

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11
Q

What is progressive-relapse MS?

A

Compounding remission continues to get worse - steady decline since disease onset

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12
Q

What is the most common manifestation of MS?

A

Paresthesia of the face, trunk, and limbs

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13
Q

What are symptoms to monitor for in patients with MS?

A

Cognitive problems (trouble with concentrating and thinking)
Vision problems
Depression
Fatigue
Pain
Bowel and bladder issues (constipation, incontinence)
Weakness (can include paralysis)
Sexual issues
Muscle stiffness / spasms
Numbness / tingling
Walking / balance problems (vertigo)

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14
Q

Is there a cure for MS?

A

No

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15
Q

What are the goals of pharmacological therapy with MS?

A

Slow disability
Reduce frequency of relapses
Reduce new brain lesions

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16
Q

What medications are used to modify the disease process of MS?

A

Avonex
Copaxone
Fingolimod
Dimethyl fumarate
Natalizumab

17
Q

What class of medication is avonex?

A

Interferon beta

18
Q

What is the MOA of avonex?

A

Inhibits pro-inflammatory WBC from crossing BBB

19
Q

What are the side effects of avonex?

A

Flu like symptoms, liver toxicity, bone marrow suppression, depression

20
Q

How much can avonex decrease the relapse by?

A

Up to 30%

21
Q

What is the class of Copaxone?

A

Glatiramer acetate

22
Q

What is the MOA of copaxone?

A

Increased production of anti-inflammatory T-cells which cross the BBB and suppress inflammation

23
Q

What are the side effects of copaxone?

A

Injection site reaction, post-injection reactions (flushing, palpitations, chest pain, laryngeal constriction - lasts 15-20 minutes)

24
Q

What is the MOA of fingolimod?

A

Retain lymphocytes in the lymph nodes, preventing them from crossing the BBB - which decreases inflammation

25
Q

What is the MOA of dimethyl fumarate?

A

Through to inhibit immune cells and may have antioxidant properties

26
Q

What is the MOA of natalizumab?

A

Prevents circulating T cells from leaving the vasculature and crossing BBB

27
Q

How much does natalizumab reduce the relapse rate by?

A

68%

28
Q

What are the side effects of natalizumab?

A

HA, fatigue, can lead to progressive multifocal leukoencephalopathy, hepatotoxicity, hypersensitivity

29
Q

What is the preferred treatment for an acute relapse of MS?

A

High dose IV glucocorticoid (but frequent or long term use should be avoided)

30
Q

What to give to patients that are intolerant to glucocorticoids with an acute MS relapse?

A

IV gamma globulin

31
Q

For MS, what drugs are frequently used to treat the urinary frequency and retention?

A

Anticholinergics (frequency)
Cholingerics (retention)

32
Q

For MS, what drugs are frequently used to treat constipation?

A

Bulk forming laxatives

33
Q

For MS, what drugs are frequently used to treat fatigue?

A

Amantadine (symmetrel)

34
Q

For MS, what drugs are frequently used to treat muscle spasms?

A

Muscle relaxants

35
Q

For MS, what drugs are frequently used to treat cognitive dysfunction?

A

Donepezil

Patho 2 - Exam 2 (9 decks)

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