Multiple Sclerosis Flashcards
What is the corticosteroid most commonly used for acute MS attacks? What are 2 other options?
Methylprenisilone (shortens attack, speeds recovery)
-other options: ACTH or plasmaphoresis
What are the 4 IFN-beta-1a agents? Which aspect of MS are they used to treat? Which is first-line?
Avonex Rebif (1st line) Betaseron Extavia All used to treat relapsing-remitting MS (RRMS)
What is the mechanism of action of Rebif and the others in its class?
IFN-beta-1a: inhibit T-cell activation, shift from Th1 to Th2, inhibit lymphocyte movement into CNS, anti-proliferative effect, apoptosis of T-cells, anti-viral, IFN-g antagonism
What are the side effects of Betaseron and others in its class?
IFN-beta-1a: Anemia, leukopenia, menstrual irregularities, depression, increase LFT and hypothyroidism (monitor every 3 mo.)
[Avonex has less SE but LFT elevation that should be monitored every 6 mos]
What is the mechanism of Glatiramer acetate? Use?
- active in CNS
- Causes T-cell apoptosis (looks like MBP), induces anti-inflammatory Th2 cells (cytokine shift from Th1), induces Treg with induction of anergy
- Used for RRMS
What is 2nd line treatment for RRMS? mechanism of action? Worrisome SE?
Natalizumab
Binds VLA4 (integrin subunit on all leukocytes), inhibiting leukocyte migration across BBB
PML is serious SE
What oral agent is used to treat RRMS but patients must have VZV vaccine? Mechanism of action?
Fingolimod (Sphingosine-1-phosphate analog)
-internalization of receptors on lymphocytes leading to sequestration in lymph organs
What agent used for RRMS blocks de novo pyrimidine synthesis? SIde effects?
Teriflunomide (immunosuppresant)
hepatotoxicity, teratogenicity
What is a drug used to treat psoriasis that was shown to help treat MS?
Dimethyl Fumarate
What is the only FDA approved treatment for Secondary-Progressive MS (SPMS)? Mechanism?
Mitoxantrone (also RRMS 2nd line)
Broad immune suppression and modulation of B cells, T cells and macrophages; decreases frequency of clinical relapse, reduces disease progress, and reduces disability
Side effects of Mitoxantrone?
Dose-dependent cardiac toxicity (decreased LVEF, irreversible CHF); induction of acute leukemia
Nausea and vomiting, alopecia, menstrual irregularities, increased susceptibility to infection
What are the 4 immunosuppressants used to treat SPMS? SE’s?
Azathioprine Methotrexate Cyclophosphamide Mycophenolate mofetil SE: Systemic toxicity: monitor blood for changes
