Multiple Sclerosis Therapeutics

Question 0

Spasticity

Answer 0

Baclofen, diazepam

Question 1

Treat acute MS attack

Incontinence. Seeing double. Gait. Nystagmus - shaking eyes

Answer 1

IV glucocorticoids (methylprednisolone)

Question 2

Fatigue

Answer 2

Modafinil

Question 3

Bladder retention

Answer 3

Cholinergic bethanechol

Alpha blocker tamsulosin

Question 4

Improve walking

Answer 4

Dalfampridine
Blocks voltage K channels
Prolong Transmission

Question 5

Relapsing remitting MS

&clinically isolated syndrome

Answer 5

Disease modifying therapy

ABC-R
Avonex - IM
Betaseron 1B
Copaxone - glatiramer SC daily (best for pregnancy)
Rebif - subQ

Increase TH2 balance
Decrease T cell activation

Question 6

ABC-R failure

Answer 6

Natalizumab

Inhibit A4 integrins. Prevent adhesion and leukocyte leak

Question 7

Secondary progressive MS

Answer 7

Mitoxantrone

Inhibit type 2 topoisomerase

Question 8

Fingolimod (gilyena)

Answer 8

Better than avonex (less relapse)
First oral compound for MS

Fetal risk - DC 2 months before trying to conceive

Caution Bradycardia

S1P down regulation. Decrease T cells

Question 9

Teriflunonide (aubagio)

For RRMS

Answer 9

Teratogenic contraindicated in pregnancy

Inhibit dihydroorotate dehydrogenase
Block pyrimidine synthesis

Question 10

Dimethyl fumarate (tecfidera)

For RRMS

Answer 10

May become next first line treatment
Reduce relapse more than 50%

Activate NRF2 pathway
Increase antioxidant response to autoimmune inflammation