Multiple Sclerosis Flashcards
Dosing of steroids of MS
IV methyprednisolone for 3-5 days then oral 60-80 mg tapering to lower over 12-20 days period
What is the issue with long term administration of interferon
Development of antibodies
Route of IFN-B
Subcutaneous
Treatment for spatic bladder in MS
Propantheline
Oxybutinin
This is a copolymer I that mimics action of MBP
Glatiramer
Postural tremor in MS can be treated by
INH with pyridoxine
What can be given to ameliorate the flu like symptoms by administration
administer steroids
Adverse effects of Glitaramer I
Flushing
Chest tightness
Palpitation
Anxiety
Dose of steroids that proven to have reduction of disability as well as degree of brain atrophy on T1W1
Methylprednisolone 1g/d for 5 days over 5 years
What is the mechanism of action of fingolimod
This is an oral drug that interfere with egress of lymphocytes from lymphnode
Clinical benefit of Natalizumab
reduction in the mRI lesion and reduces relapse
What trial compare alemtuzumab to interferon in MS
CAMMS223 Trial investigators
superior than interferon
Route of IFN-B-1a
Intramuscular
What is the mechanism of action of Rituximab
B-cell depleting monoclonal antibody that targets CD20 lymphocytes
How is Alemtuzumab given
5 consecutive days annually
Adverse effect of fingolimod
lymphophenia Bradycardia AV block macular edema Herpes infection Elevated liver function test
Advantage of natalizumab
Once monthly dosing and lack of acute side effects
Adverse effect of Rituximab
lymphoma
This medication can hastened the attacks of optic neuritis
Steroids
Percentage of antibody development
30% - daily
18% - alternate use
5% - weekly
2% - one year use
Adverse effect of Alemtuzumab
ITP and autoimmune thyroiditis
Severe disabling tremor can be managed surgically by:
ventrolateral thalamotomy
This is a nonglycosylated bacterial cell product within amino acid sequence
IFN-B-1B
What is the condition observed in patient undergo plasma exchange to rapidly clear natalizumab to reverse PML
Immune reconstitution inflammatory syndrome (IRIS)
IRIS can be ameliorated by
Steroids
Fatigue in MS can be given
Amantadine
Modafinil
Premoline
Dextroamphetamine
Monoclonal antibodies
Natalizumab
Alemtuzumab
Rituximab
AFFIRM study
Natalizumab,
68% reduction of relapse
80% reduction of T2 lesion
96% reduction in gadolinium enhancing lesion
Steroids hastened the optic neuritis by how many months
6 months
What is the management for urinary retention in MS
Betanechol
pain symptoms in MS can be given
CBZ or Gabapentin
Result of PRISM Study
IFN-B-1B delayed the progression of the disease for 9-12 months in a period of 2-3 years
What is the mechanism of action of Alemtuzumab
targets CD 52 reducing the expressed B lymphoctyes and T lymphocytes for longer period.
What is the route of administration of Glitaramer
SQ
SENTINEL Study
Study that combined natalizumab and interferon gives better results
What is the serious side effect of Natalizumab
PML
Mechanism of action of Natalizumab
- Alpha integrin antagonist - blocks lymphocytes and monocytes adhesion to the endothelial cells and their migration to vessel wall
