Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

(UNI) Neuropharmacology (3rd Year) > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is multiple sclerosis?

A

Multiple sclerosis (MS) is a progressive, chronic autoimmune disease that involves the immune system and neurological system. It is not very well understood and although it is progressive, patients can remain in one state for a while – remission and relapse are important terms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is one of the key physiological signs of MS?

A

One of the key physiological signs of MS is multifocal areas of demyelination which disrupts the ability of a nerve to conduct electrical impulses. This in turn leads to symptoms; these symptoms can be quite vague as there is a range of symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the age of onset of MS?

A

20-50.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do MS symptoms first present?

A

20-30.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who is more likely to develop MS, men or women?

A

Women are twice as likely to develop MS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How many cases of MS are there in the UK?

A

100-140 per 100,000.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many cases of MS are there in NI?

A

170 per 100,000.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How many cases of MS are there in Scotland?

A

190 per 100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Around the world, how many people are suffering with MS?

A

2.5 million.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which racial group has the greater prevalence of MS?

A

White Caucasians of Northern European Ancestry.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where in the world is MS more prevalent?

A

North of the equator.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the genetic component of MS.

A

There is a genetic component to MS; it is polygenic (more than one gene). There are both MS susceptibility genes and MS-associated genes, which may influence the overall clinical course of MS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

As well as a genetic component, what else is believed to be linked to the development and/or progression of MS?

A
  • Vitamin D3.
  • Infection (e.g. viruses, EBV, Chlamydia pnemoniae).
  • Environmental factors.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the symptoms of MS?

A
  • Vision problems.
  • Numbness.
  • Difficulty walking.
  • Fatigue.
  • Depression.
  • Emotional changes.
  • Vertigo & dizziness.
  • Spasticity.
  • Sexual dysfunction.
  • Coordination problems
  • Balance problems.
  • Pain.
  • Changes in cognitive function.
  • Bowel/bladder dysfunction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is MS diagnosis often hard?

A

One can see from this list that there is no strong link between the symptoms. Because there is no strong link, it is difficult to diagnose patients until they have had MS for a while, diagnosis isn’t early. The symptoms may be thought to be caused by something other than MS.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe Lhermitte’s Sign (Barber’s Chair Syndrome).

A

Lhermitte’s sign or Lhermitte’s syndrome is a sudden sensation resembling an electric shock that passes down the back of the neck and into the spinal column and can radiate out to the fingers and toes.
It is usually triggered by flexing the neck, that is, bending your head down, chin towards chest and is sometimes referred to as barber’s chair syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Is Lhermitte’s sign often treated? Why?

A

Lhermitte’s sign is rarely treated as the pain is so sharp and sudden that it does not usually last long enough for pain treatments to take effect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe Uhthoff’s Sign.

A

Uhthoff’s phenomenon or Uhthoff’s sign is the temporary worsening of symptoms, most often visual symptoms but sometimes motor or sensory - caused by an increase in temperature.
The visual symptoms may present as double vision, sharpness of vision, or black spots in the eyes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does MS present clinically?

A
  • Loss or reduction of vision in 1 eye with painful eye movements.
  • Double vision.
  • Ascending sensory disturbance and/or weakness.
  • Problems with balance, unsteadiness or clumsiness.
  • Altered sensation travelling down the back and sometimes into the limbs when bending the neck forwards (Lhermitte’s symptom).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

People with MS present with neurological symptoms or signs, what else is also common?

A
  • Are often aged under 50 and
  • May have a history of previous neurological symptoms and
  • Have symptoms that have evolved over more than 24 hours and
  • Have symptoms that may persist over several days or weeks and then improve.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Before referral to a neurologist for a formal diagnosis, what must be done?

A

Alternate diagnosis must be ruled out.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

One should not routinely suspect MS if a person’s main symptoms are fatigue, depression, or dizziness unless what?

A

Do not routinely suspect MS if a person’s main symptoms are fatigue, depression or dizziness unless they have a history or evidence of focal neurological symptoms or signs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the key factor preventing MS investigation being done routinely?

A

It is expensive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

After a patient with suspected MS is referred to a neurologist, what is carried out?

A
  • Medical history.
  • Neurological examination.
  • Medical investigations, including MRI, to identify areas of sclerosis in the brain or spinal cord (McDonald Criteria 2010).
  • Lumbar puncture to test for abnormalities of the CSF.
  • Evoked potentials, to measure time taken for nerves to respond to electrical stimulation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When diagnosing MS, what conditions should be ruled out?

A
  • Viral infections.
  • Lyme disease.
  • B12 deficiency.
  • CVA.
  • Lupus.
  • Rheumatoid arthritis.
  • Other connective tissue disorders.
  • Vasculitis.
  • Syphilis.
  • Tuberculosis.
  • HIV.
  • Sarcoidosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe the molecular pathology of MS.

A

In MS, there is peripheral priming of T-cells by environmental factors (e.g. viral protein). There is then migration of T-cells across BBB in genetically susceptible host. Local expression of pro-inflammatory mediators leads to myelin damage, leucocyte infiltration across BBB,
chemokine release; leading to central damage.

However, there is good evidence that self-antigens are extinguished. So, no memory T cells should form against myelin.
Disease progression/relapse associated with epitope spreading (autoimmunity) but this is not critical. Is MS more complex than just too much inflammation?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the early progression of MS.

A

Early symptoms of MS are a result of demyelination with associated oedema and inflammation. Over time these symptoms can abate as the inflammation resolves and partial re-myelination occurs.
Inflammation caused by activated leucocytes infiltrating the BBB results in hardening along the neurones (sclerosis) which blocks signal transmission to and from the brain and spinal cord. This causes long term damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What percentage of patients develop benign MS?

A

5-10%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What percentage of patients will have little or no disabilities allowing them to live independently whilst not in relapse from MS?

A

33%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What percentage of MS patients will have severe disability?

A

33%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the overall reduction in life expectancy for MS patients?

A

5-10 Years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When is the MS prognosis worse?

A
  • Older age of onset.
  • Male.
  • Progressive form.
33
Q

What types of MS are there?

A

Relapsing-Remitting MS (RRMS), Secondary-Progressive MS (SPMS), Primary-Progressive MS (PPMS), Progressive-Relapsing MS (PRMS), Benign MS.

34
Q

Describe relapsing-remitting MS (RRMS).

A
  • Affects 85% of newly diagnosed.
  • Attacks followed by partial or complete recovery.
  • Symptoms may be inactive for months or years.
35
Q

Describe secondary-progressive MS (SPMS).

A
  • Occasional relapses but symptoms remain constant, no remission.
  • Progressive disability late in disease course.
  • ~ 50% of those with RRMS develop SPMS during the first 10 years of illness.
36
Q

Describe primary-progressive MS 9PPMS).

A
  • Affects 10-15% of MS population.
  • Slow onset but continuous worsening condition.
  • Symptoms become continuous.
37
Q

Describe progressive-relapsing MS (PRMS).

A

• Rarest form.
• Affects ~5% of patients.
• Steady worsening of condition at onset.
• Patients have distinct relapses with or without full recovery.
o Between relapses the disease continues to gradually worsen.

38
Q

Describe benign MS.

A
  • 20% of MS patients.

* Mild relapses followed by long periods of remission with little or no decline in function.

39
Q

For what means is treatment for MS used?

A
  • Treatment of acute episodes.
  • Prevention of future attacks.
  • Slow or prevent disease progression.
  • Treatment the chronic symptoms of the disease.
40
Q

As well as drug therapy, what can treatment include?

A

As well as drug therapy, treatment can include; physical support and psychosocial support.

41
Q

What does treatment of an acute MS episode include?

A

• IV methylprednisolone.
o 500 mg–1 g daily, for between 3 and 5 days or
o High-dose oral methylprednisolone, 500 mg–2 g daily, for between 3 and 5 days.
o Up to 3 courses per year.
 Intermittent (4-monthly) short (1–9 days) courses of high-dose methylprednisolone.
• IV immunoglobulin.
o Immune modulation.
• Azathioprine.
• Mitoxantrone.
• Plasma exchange.
• Physical therapy.

42
Q

What drugs/therapies can be used to prevent future MS attacks and reduce disease progression?

A 
•	Immune modulating drugs.  
o	Beta Interferon.  
o	Glatiramer acetate.
o	Humanized monoclonal antibodies.
•	Immunosuppressant drugs. 
o	Anti-cancer agents.
•	Combination therapies.
43
Q

What side effects can be seen from MS medication?

A
  • Local injection site irritation/reactions.
  • Flu like symptoms.
  • Rise in liver enzymes.
  • Decreased white cell count and platelets.
  • Opportunistic infections.
  • Depression.
  • Progressive multifocal leukoencephalopathy (PML).
44
Q

What two interferons are used ion the treatment of MS?

A

There are two interferons used for the treatment of MS; Interferon beta-1a and Interferon beta-1b.

45
Q

Describe interferon beta-1a.

A

This is a protein replica of human interferon. It suppresses the immune system and helps maintain the BBB.
It can come as Avonex IM (weekly) and Rebif SC (3 times a week). The side effects of using interferon beta-1a include flu-like symptoms.
This interferon is used in definite progressive MS.

46
Q

Describe interferon beta-1b.

A

This interferon is different from human interferon so is more accepted by certain religious/cultural groups.
It has the same action as beta-1a however is injected SC every 48 hours.
Side effects include; irritation, bruising and redness at the injection site, as well as flu like symptoms.
This is also used in definite progressive MS.

47
Q

What is galtiramer acetate (Copaxone)?

A

This is a synthetic combination of 4 amino acids, resembling the myelin protein surrounding nerve fibres. It is thought to lessen the immune reaction that attacks myelin as the immune system attacks this instead of the myelin sheath.
This decreases the reoccurrence of relapse however it has to be administered SC daily.

48
Q

What adverse effects may be seen with galtiramer acetate (Copaxone)?

A

There is no flu like symptoms, but occasional redness may occur at the injection site. Few people experience brief shortness of breath.

49
Q

What is fingolimod FTY720 Gilenya?

A

This is the first oral agent developed for prevention of relapse. It is second line therapy however NICE evaluates it as being not cost effective.

50
Q

How much fingolimod FTY720 is administered daily?

A

0.5mg.

51
Q

How does fingolimod FTY720 work?

A

This drug works by modulation of lymphocyte S1P1 receptors. It inhibits lymphocyte egress from the lymph nodes which prevents lymphocytes from infiltrating inflammatory lesions in the CNS.

52
Q

What other drugs can be used to modify the disease state in MS?

A
  • Cladribine: Purine nucleoside analogue which preferentially depletes lymphocytes.
  • Dimethyl fumarate (BG12): May have both anti-inflammatory and neuroprotective properties.
53
Q

What disease modifying drugs are used in the treatment of MS?

A

Interferons, galtiramer acetate (copaxone), fingolimod FTY720 Gilenya, cladribine, dimethyl fumarate (BG12).

54
Q

What immunosupressants are used in the treatment of MS?

A

Azathioprine, methotrexate, mitoxantrone, cyclosporine A.

55
Q

How does azathioprine with in the treatment of MS?

A

This is an immunosuppressive antimetabolite drug; an imidazolyl derivative of 6- mercaptopurine. It is cleaved in vivo to mercaptopurine and converted to 6- thiouric acid by xanthine oxidase.

56
Q

What is azathioprine commonly used for?

A

Azathioprine is generally used in treatment of organ and tissue transplantation and diseases with an auto-immune or inflammatory component.

57
Q

Is azathioprine used on label for the treatment of MS?

A

No.

58
Q

Describe azathioprine’s toxicity profile.

A

Azathioprine has an unpleasant toxicity profile which one must monitor for.

59
Q

Describe methotrexate.

A

Methotrexate is an immunosuppressive anti-metabolite drug used for some neoplasias (including leukemia), psoriasis, and rheumatoid arthritis.

60
Q

How does methotrexate work?

A

It interferes with DNA synthesis, repair, and cellular replication. Inhibits dihydrofolic acid reductase, which participates in synthesis of thymidylate and purine nucleotides.

61
Q

Is methotrexate used on label for MS?

A

No.

62
Q

How does mitoxantrone work?

A

This is a type II topoisomerase inhibitor which disrupts DNA synthesis and DNA repair and engages in intercalation.

63
Q

How effective is mitoxantrone in the treatment of MS?

A

It Has been shown to reduce relapse rate and slows disease progression in MS.

64
Q

What limits the dose of mitoxantrone?

A

Toxicity limits the dose.

65
Q

Describe the use of cyclosporine A in MS.

A

This is a broad immunosuppressant which has shown some benefits when used for the treatment of MS.

66
Q

Describe the toxicity of cyclorporine A.

A

Benefits are outweighed by the toxicity of the doses required; it is nephrotoxic.

67
Q

What mono-clonal antibodies are used in the treatment of MS?

A

Natalizumab, alemtuzumab, ocrelizumab.

68
Q

How does natalizumab work in the treatment of MS?

A

This mab binds to alpha-4-beta-1 protein expressed by inflammatory cells, preventing lymphocyte passing the BBB.

69
Q

What is natalizumab indicated for in regards to MS?

A

It is Indicated for relapsing MS and to reduce symptom exacerbation frequency. It has been shown to reduce relapse rate by 68% after one year.

70
Q

How does alemtuzumab work in the treatment of MS?

A

This mab binds to antigen CD52 which is found on the surface of certain B and T-cells and kills them (lymphocyte depletion).

71
Q

How does ocrelizumab work?

A

This is an anti-CD20 mab which depletes B lymphocytes.

72
Q

What do the NICE guidelines suggest about the use of linoleic acid in MS?

A

NICE guidelines suggest that people with MS should be advised that linoleic acid 17–23 g/day may reduce progression of disability.

73
Q

What are rich sources of linoleic acid?

A

Rich sources of linoleic acid include sunflower, corn, soya and safflower oils.

74
Q

What drugs can be used to treat the spasticity associated with MS?

A

Baclofen, Tizanidine, Diazepam, Dantrolene.

75
Q

What drugs can be used to treat the optic neuritis associated with MS?

A

Methlyprednisolone, Oral steroids.

76
Q

What drugs can be used to treat the fatigue associated with MS?

A

Antidepressant, Amantadine.

77
Q

What drugs can be used to treat the pain associated with MS?

A

Codeine, Aspirin.

78
Q

What drugs can be used to treat the sexual dysfunction associated with MS?

A

Viagra, Pravatine.

79
Q

What drugs can be used to treat the tremor associated with MS?

A

Isoniazid, Primidone, Propranolol.

(UNI) Neuropharmacology (3rd Year) (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions