multiple sclerosis pharm Flashcards
pharm
no cure
goals: slow, decrease relapses, decrease new brain lesions
drugs modify disease process, treat acute relapse, manage s
acute relapse
pref treatment: high dose IV glucocorticoid -> avoid freq/long term use, may need insulin
IV gamma globulin when intol to glucocorticoid
ACTH (H.P. acthar gel): adrenocorticotropin hormone in gel form, prolonged release after injection, when cant tolerate steroids or they havent been effective
plasmaparesis
blood out, replace plasma with donor
symptom management
pt dependent
urinary freq: antichol
urinary retention: chol
c: bulk forming lax
fatigue: rest periods, amantidine
muscle spasms: muscle relaxants
cog dysF: donepezil
Interferon beta: types
Avonex (1a)
Betaseron (1b)
Extavia (1b)
Plegridy (pegylated 1a)
Rebif (1a)
Interferon beta
Inhibit proinflam wbc from crossing BBB
Decrease MS relapse
30% Flu like rxns, liver tox, bone marrow suppression, dep, drug interactions
Injectable, naturally occurring
Copaxone
Glatopa
glatiramer acetate
Increased production of anti-inflam T cells which cross BBB and suppress inflammation MS
Injection site rxn
Post injection rxn: flush, palpations, chest pain, rash, laryngeal constriction, lasts 15-20 min, treatment not necessary
Injectable
Similar efficacy
fingolimod
Retain lymphocytes in lymph nodes, prevent from crossing BBB -> decrease inflam
RRMS
oral
Dimethyl fumarate
Thought to inhibit immune cells and may have antioxidant properties
MS
oral
natalizumab
Prevent circulating t cells from leaving vasculature and crossing BBB MS and chrons
HA and fatigue most common
Progressive multifocal leukoencephalopathy (TOUCH program, risk increases when combo with another immunosuppressant)
Hepatotox, hypersensitivity
Monotherapy only – not used with any other agent, relapsing form of MS
infusion
alemtuzumab
For pt with poor response to 2 or more MS meds
infusion
mitoxantrone
Secondary progressive
Progressive relapsing
Worsening RRMS (without complete remission)
infusion
