Summer E1 Neuro MS Flashcards
Multiple Sclerosis
Med Classes and Meds
Acute relapse: CS
DMT: Beta Interferons
Glatiramer Acetate
Terifazadone
Fingolimod
Dimethyl Fumarate
Natalizumab
Mitoxantrone
Before starting MS meds,
must test for what?
TB
CS
MOA
“CBT”
inhibit activation of Cytokines, B/T cells
Beta Interferons
MOA
Inhibit activation of cytokines, T cells
Suppress MMPs.. maintain BBB
preserve myelin
assist in repair of CNS
Glatiramer Acetate
MOA
“2 T’s”
inhibit activation of T cells
increase T helper2 cells (prevents inflamm)
Terifluromide
MOA
Stop proliferation of B, T cells
Inhibits lymphocyte entry to CNS
Dimethyl Fumarate
MOA
shifts cytokines from PRO to ANTI INFLAMMATORY!!
Decreases oxidative stress
Prevent immune cells f entering CNS
Fingolimod
MOA
Decrease inflammatory cells/cytokines in CNS
Natalizumab
MOA
Decrease activation of/
Prevents immune cells/lymphocytes f entering CNS
Mitoxantrone
MOA
APOPTOSIS in T cells
Which MS meds are given SubQ?
Beta Interferon (also given IM)
Glatiramer Acetate
Which MS meds are given PO?
Teriflunomide
Dimethyl Fumarate
Fingolimod
Which MS meds are given IV?
Natalizumab
Mitoxantrone
Which MS meds may help SLOW PROGRESSION?
Dimethyl Fumarate
Fingolimod
Natalizumab
Mitoxantrone
MS in PREGNANCY..
Which meds contraindicated?
Teraflunomide (also not ok for potential fathers!!)
Mitoxantrone
MS in PREGNANCY..
Which meds may be ok?
BETA interferons
GLATiramer acetate
NATalizumab
Teriflunomide
Interactions
CYPs.. ↓t1/2 by cholestyramine
Fingolimod
Contraindications
HEART ISSUES MI, unstable angina, some CHE past 6 mo, AV blocks, Prol QT, antiarrhythmic use class Ia or III
STROKE/TIA
Natazilumab
Contraindications
Immunocompromised
*Restricted use to rapidly progressing MS, failed other tx
What is PML?
What med may cause this?
Progressive Multifocal Leukoencephalopathy:
rare, serious -
rapidly progressive sx that may mimic MS sx..
causing death / permanent disability
(more with increased infusion, MONITOR carefully)
CS
AE
GI sx, insomnia, mood disturbance, other l/t
Beta Interferons
AE
COMMON!
Injection site rxn
Flu-like sx
Anemia, leukopenia
Elev liver enzymes
Glatiramer Acetate
AE
Injection site rxn
SYSTEMIC rxn mimics MI :
(flushing, chest tight, SOB, anxiety, palpitations)
Alopecia, Menstrual disorders/ Amenorrhea, UTI, Leukopenia
Elev liver enzymes/ GGT
Teriflunomide
AE
Gen well tolerated
Incr Liver Enzymes
Alopecia, diarrhea
Dimethyl Fumarate
AE
Flushing +/- itching
GI effects
Leukopenia/lymphapenia
Fingolimod
AE
EXTENSIVE MONITORING NEEDED!!!!
Macular edema
*Bradycardia
Incr Liver enzymes
Decr FVCs
Diarrhea, cough
Lymphopenia, influenza, infections
Natazilumab
AE
**Risk of PML!!! Rare, life threatening
headache, fatigue,
UTI, arthralgia,
hypersensitivity, infusion rxn
**Pts can develop Ab’s.. increases relapse, disablity, hypersensitivity
Mitoxantrone
AE
“Be Careful And Never Allow Men Under Night Gown Lest Married”
Blue sclera, urine
Cardiotoxicity (NO NSAIDs/COX2 inhibitors!!)
Arrhythmia
Nausea
Alopecia
Menstrual disturbances
UTI
Neutropenia
GGTs (incr)
Leukopenia
Myelogenous Leukemia
Which MS med has a lifetime max dose?
Contraindication for this med?
Mitoxantrone
Contraindicated if pt has Cardiomyopathy
Which MS meds should you never give LIVE virus vaccines
while they’re on?
Teraflunomide, Fingolamod, Mitoxantrone
Which MS med may make vaccines less effective?
Fingolamod
Which MS med must we wait to give for 4-6 wks after administration of vaccine?
Mitoxantrone
Which meds are helpful for Fatigue Sx of MS?
Amatadine, Methylphenidate
Which meds are helpful for Spasticity Sx of MS?
Botulinum toxin,
Muscle Relaxants (Baclofen, tizanidine)
