Multiple Sclerosis Flashcards
What is the risk of developing MS, mean age of onset, women outnumber men by?
Risk is 1:1000, mean age 30, women outweigh men by 2:1
High risk of MS is lived in an area farther away from equator at what age?
before the age of 15
What produces myelin, the protective covering around neurons that allows for transmission?
Oligodendrocytes
What factors lead to MS lesions or plaques?
demyelination and inflammatory repsonse
What produces and releases antibodies against myelin resulting in inflammation?
b-lymphocytes
MS affects what areas of the body?
brain, optic nerve, spinal cord
What criteria is needed to diagnosis MS?
Dissemination in space and time
2 attacks, 2 lesions = MS
What enhances the MS diagnosis?
t2-weighted lesions, and gadolinium on MRI
Increased CSF immunogloblobulin G index and presence of oligoclonal bands
Measured electrical activity
What is the first attack of MS called?
Clinically isolated syndrome CIS
85% of patients present with what form of MS?
RRMS relapsing-remitting MS
Patients diagnosised with RRMS may progress to what form of MS?
SPMS secondary-progressive MS
worsening of symptoms
10% may never have relapse or remissions after initial presentation is this form of ms?
PPMS primary-progressive MS
Progressive worsening of disease without recovery period is what form of MS?
PRMS progressive relapsing MS
What are the indicators for unfavorable prognosis?
onset age >40, male, high attack frequency, progressive
What is the first treatment for RRMS?
interferon B or glatitamer acetate
When should therapy be accessed when first treating RRMS?
6-12 months before determining if yields suboptimal response
What are indicators of suboptimal response?
frequent relapses
progressive of disability
rising use of resources
imaging changes reflecting increased disease activity
Treatment with what drug is associated with the production of neutralizing antibodies?
interferon b
serum of NAb of what value of positive? Titer greater than what value will impact efficacy?
serum titer >= 20
>100-200 impact efficacy
How long should you wait to test for NAb after the last corticosteroid dose?
30 days
What are corticosteroids role in MS?
Manage relapses
methylprednisolone 500-1000mg IV q 3-5 days up to 10 days.
IV dexamethasone may be substituted.
insomnia, dysphoria, anxiety, hyperglycemia, headache, easy bruising, edema, palpitation, GI distress, myalgia are side effects of?
corticosteroids
The administration of high dose steroids in an intermittent manner is called what?
Pulsed steroids for patients developing SPMS or failed other therapies
These drugs reduce antigen presenatation and t-cell proliferation, alter cytokine and matrix metalloproteinase expression?
interferons
When should high dose interferons be considered?
Patient on avonex who is responding poorly clinically or radiographically and antibody negative
what are interferons ability to decrease relapse, MRI lesions, and disability progression?
relapse 33%
MRI lesions 80%
Disability progression moderate
Depression, hepatotoxicity, flu-like symptoms, injection site reactions are side effects of?
interferons
What are flu-like symptoms?
fever, chill, fatigue, sweating, headache, myalgia. occur for up to 24 hours.
What things need to be monitored with interferons?
LFT, CBC, TFT, depression symptoms, aspetic technique
What is the Brand name, route of interferon b-1b?
Betaseron
Subcutaneously every other day
Titrate over 6 weeks
What is the Brand name, route interferon b-1a?
Avonex
intramuscularly once weekly
What is the Brand name, route interferon b-1a (2)?
Rebif
subcutaneously three times a week
Titrate by 20% increase over 4 weeks
What drug modifies the immune response that results in CNS inflammation, demyelination and axonal loss?
Glatiramer acetate(copaxone)
What is the efficacy of Copaxone?
relapse 30-40%
MRI lesions 30-40%
no effect on disability progression
What is the brand and route of glatiramer acetate?
Copaxone
20mg Subcutaneously once daily
nausea, back pain, chest pain, vasodilation, rash, injection site reaction are side effects of?
Glatiramer acetate (copaxone)
This inhibits alpha4-integrin mediated adhesion of lymphocytes to endothelium, preventing migration of leuocytes across the blood brain barrier.
Natalizumab (Tysabri)
Efficacy of Tysabri is not known beyond how long?
2 years
Tysabri evidence is?
relapse 66%
MRI lesions 90%
Disability progression 50%
What is the brand and route of natalizumab?
Tysabri
300mg IV infusion over 1 hour every 4 weeks
What drug is associated with PML progressive multifocal leukoencephalopathy?
Natalizumab (tysabri)
What is PML, symptoms?
PML progressive multifocal leukoencephalopathy caused by JC virus, an opoortunistic viral infection of the brain in immunocompromised patients.
weakness on one side of body, vision, thinking, memory problems
Headache, arthralgia, UTI, lower respiratory infection, gastroenteritis, vaginitis, depression are side effects of?
natalizumab (tysabri)
What is the touch prescribing program?
Enrollment to receive/dispense natalizumab (tysabri). re-authorize treatment every 6 months
This inhibits the proliferation of t-cells, b-cells, macrophages. impairs the secretion of molecules that promote inflammation.
Mitoxantrone (Novantrone)
What is the brand name and route for mitoxantrone?
Novantrone
12mg/m2 IV infusion over 5-15 minutes every 3 months
What is the maximum lifetime amount of mitoxantrone?
140mg/m2
What are the contraindications with novantrone?
LVEF < 50%, neutrophil count <1500cells
Which drug do you monitor for heart failure symptoms, myelosuppression, blue-green urine color, bluish sclera?
mitoxantrone (novantrone)
This is a sphingosine 1-phosphate receptor modulator that blocks capacity of lymphocytes to egress from lymph nodes.
Fingolimod (Gilenya)
What is the brand name and route for fingolimod?
Gilenya
0.5mg orally daily with or without food
What monitoring should be done for Gilenya?
Bradycardia - ECG infections CBC with differential macular edema - eye exam respiratory effects - FEV1, DLCO hepatic effects - LFT
How are some symptoms of MS managed?
Fatigue - provigil(modafanil)
Interferon B - suicidal ideation
Urinary incontience - anticholinergic
