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112 Cards in this Set
- Front
- Back
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MS is more common in females 2.4:1
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YES
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When is diagnosis of MS
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20-50 years of age
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The incidence of MS DECREASES the closer you are to
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the equators
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THe increase of MS INCRAES above
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the 37th parallens
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Does smoking increase the risk of MS
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YES
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MS is abnormal immunologic response which may be caused by
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infectionous agent
genetic predispostion envionrmental |
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MS first results in the
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delymelination or plaques in the CNS
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Demelination of MS is reversible what happens next
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axonal loss (irrversible)
then immune midated damge |
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Immune mediated damages results in disability--which is
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the number 1 cause of disability in early adulthood
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The first attack of MS is AKA
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CIS
Clinially isolated syndrome |
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What is relaping and Remitting MS (MOST COMMON CLINICAL TYPE OF MS
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After the CIS---is followed by replases and remissions,
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Relapsing-Remitting MS then converts to
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Secondary progessive MS
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Secondary Progessive MS is characterized by
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progessive neuorolgical deterioion, w/ or w/o clinical replases
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What is median time ot covert to Secondary Progessive MS
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10 years
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What is primay progessive MS
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progressive disease form the onset of MS--with temporary improvements
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What is Progessive relasping MS (LEAST COMMON)
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Progressive disease from the onset, with or without recdovery---least common
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Is high T2 leasion load at presentation of MS a bad prognostic factor
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YES
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MS is an autoimmune diesase whatar ethe key iniatiors in myelin destruction
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T cells which are activate int he peripheraly
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Once T cells are activated in the periphery, what do they do
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activate matix metalloprotesinsase, and have adhesion molecues which allow them to gain intery into the BBB
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Once the T cells are in the BBB what do they do
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release cytokines, whicle opens the BBB more damges the myelin and axons
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What is the function of the BBB
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is to establishm and maintain homeostatis in the CNS
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Treatment of MS should be early to redcue lesions, they shold be treated with
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interferon beta therapy
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What are causes of Psedo-exacerbating in MS
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Temperatue-Heat
Infections--UTIs Stress |
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What is the treatmnet of choice in actue exacerbation of MS
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Steriods--high dose methylprednisone
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What is MOA of steriods and benefit
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immunomodulatory--reduce inflmmation and improve the integiry of the BBB
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What is dosing of methlprednisolone
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1000mg IV 3-5 days
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When would you use dexamethasone
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ONLY if methylprednisolone shortage
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Is a taper neceassary for acute excerbations
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NO--short chose
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What may be used for SEVERE exacerbations of MS
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plsama exhanges which is directed at antibiotics
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Methlyprenisolone does NOT affect progession of the dicrease but what does it do
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shorten the druation of exacetion
new lesion less liely delay onset of MS with optic nueritsi |
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What are the disease modifying therapies for relasting remitting MS
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Interferon beta-1b (betaseron)
Interferon beta 1a (Avoenx) interferon beta 1a (Rebif) Galatiramer acetate |
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What is counseling pt for pts taking interferon therapy or glatiramer acetate therapy to see effiacacy
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efficacy is seen in 1-2 yers
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What are agents used when interferon beta therapy or glatirmaer acetate is not working
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mitoxantrone
natlizumab |
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What is MOA of interberon beta theapryt
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immunomodulation
decrease cell migration into the CNS and reducing the inflmamtion of CNS |
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What are 2 things that INteferon beta therapy increases
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IL-10
TH2--supress TH1--then decrease gammainterferon |
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How is interferon beta-1b (Betaseron) production
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E. Coli
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What is dose of Interferon Beta-1b
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8 (MIU) millon internation units) SC every other day
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How is Interferon B-1 beta stored and packaged
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room temperature, and auto injector
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How is interferon beta-1a both (avonex and Rebif) produced
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mammalina cell line---so indential to human interferon and are glycosylates
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What is dose of Interferon beta-1a (Avonex)
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6 MIU IM once weekly
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What is dose of Interferon beta 1-a (Rebif)
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44mcg SC TID
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How are Interferon beta 1a stored (both Rebif and Avonex) and package
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refigerated---ok at room temp for 30 days
pre filled syringe |
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What Interferon beta-1a has a storage case
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Interferon beta 1a Rebif
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What is common side effect almost every experienes from Interfron beta thearpt
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flu-like symptoms
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What Interferon beta therapy is most likely to have injection site reactions
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Betaseron
Interferon beta 1b |
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What is MAJOR contraindication of interferon beta therapy
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severly depressed pts
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Can interferson also decrease WBC/RBCs and platelts and inrease LFT,a nd cause spontaneous absortions
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YES
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When should you inject Interferon beta therapy
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at night
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How do you manage interferon beta SEs
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BIRD P
Inject at BODY temp Ice/heat at site Rotate injection site Dose esclation every week Pre medicate |
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PRE MEDICATE is must for interferon beta therpay with what
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NSAID or APAP q4h for 24hrs then PRN
may also use diphenhydramine or prednisone |
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What is MOA of Glatiramer aceta
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immunomodalting and bind to MHC Class II and hibitsing its binding to myelin base protein
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What is the overall response of Glatriarmer acetate
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down regulation of the immatory and autoimmune response associated with MS
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Glatramier acetate is a syntheic
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polypetid from 4 amino aics
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What is dosing of Glatiramer acetate
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20mg Sub-q daily
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What is stonge of Glatiramer acetate
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refrigerate--ok at room temp for 7 days
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Glatriramer is injected daily does it have lock box for the refrigerator
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YES
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What are the common SEs of Glatriamer acetica
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TRIAD
Flushing Chest tightness SOB injeciton site regations |
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Glarmaer should also be injected at night, how to you manage SEs
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BIRD
body temp injection Ice/heat rotate injection NO dose escualtion |
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Do you need to pre-mediate with Glarirmaer acetate like interferon therapy
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ONLY if needed
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Disease modfying therapy decrease replase by 33%, and decrease number of
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white matter lesion and black holes
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Disease modiying therapy have only long-term benfit and when do you treat
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1st attack CIS
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When do you use Mitoxantrone
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ONLY approved for pts with Secondary Progressive MS or WORSENING RRMS
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What is MOA of Mitoxantrone
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down regulated the immune response
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What is dosing of Mitoxantrone
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12mg/m2 IV Q3 months
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What is maximum lifetime dose of Mitoxantrone
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140mg/m2
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Mitoxantrone may cause cardiac toxicity, what must be obtain prior to all doses
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MUGA, CBC< urinalysis with C&S and pregnacy test
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How should be premidate with Mitxantrone
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lorazepam and dexamethasone
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What is indicatoin of Natalizumab
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pts with an inadequate response or intolerance to other therapies
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What is MOA Natalizumab
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MAB that attaches to VLA-1 and activated lymphocytes are denied entry past BBB
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In clinical trials Natalizumab decrease NEW lesions by 90% (HUGE) and relapse by 60%, what is negative (HUGE)
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PML--progessiv emutifocal leukeencephalogpathy
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What is program four Natalizumab to prescrib
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TOUCH programs
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What other disease modifying therapies (tablets)
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Methotrexate
Mcyophenolate |
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What is indication of Methotrexate
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RRMS, and Progessive relapsing MS
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What is dose of metotrexate
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2.5 TID or 7.5 once weeks
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When should you give Mycophenolate
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1 hr before meals or 2 hours after
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Mcyophenolate may cuase nausea, vomting, what must you monitor
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full chemistry panel
CNC and urine CMV |
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How do you treat visual loss in MS
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IV methlyprednisolone
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Weakness in MS can be treated with physical therapy and occupation theray, what drug therapy
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4-amoinopyridine or Fampridine
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What is MOA of 4-aminopyridine or Fampridine
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blocks K+ channel in the excitoary mebrane, allowing for more efficent condution
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What 3 agents can be used to treat spasticity in MS
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Baclofen
Tizanidine Dnatorlene |
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What is MOA of Baclofen
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Gabab aonists at the dorsal horn of the spinal cord
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What dosing of baclofen
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2-25mg TID
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What is only agent that can be given intrathecal
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baclofen
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What are SEs of Baclofren
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confusion, sediation, and WEAKNESS
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High doses of baclofen may cuase weakness, and may impair MS pts being able to walk
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YES
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Why can't you abruptly withdrawl baclofen
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rebound spasticity and seizures
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What is MOA of Tizanidine
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alpha 2 agoinsts, incrase the inhibition of motor neurons and reduces faciilitation of spinal motor neurons
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What are SEs of Tizanidine
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confusion and hypotension and dry mouth
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What is the benfit of using both baclofen and tizanidine
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can use a lower dose of both medication as they have diffeent MOA
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What is MOA of Dantrolene
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works peripherally directly on skeletmal inhibiting calium
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What is dosing of Dnatorlenes
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25-50mg daily with max of 400mg/day
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What is a MAJOR SE of Dantrolene, which orinally require drug holidays
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hepttoxoictyc
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What agent is used for Nocturai
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DDVAP
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What is a hyporeflexive bladder
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faliure to empry
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What are non-pharm ways to treat a hyporeflxive bldder
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Crere maneuver, timed void, cathers,
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What is drug therapy to treat hyporeflxive bladder
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Bethanechol (cholinergic)
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What is spinhceter-detrusor dyssnergia
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(imcompelte baldder empyting
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What is therapy for sphincter-detrusor dyssyngergia
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prazosin or tamusulosin (alpha-1 antagonist)
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What is hyperreflexive bladder
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incontinuenecwe
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What drugs treat hyperrelfeive bladder
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oxybutin
tolerodine |
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What agent may treat incontience and depression
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amitriptyline
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What agents are used for urinary tract infeection prophylasixs
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BCKN
Bactrim Cinobac Keflex Nitrofuronation |
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What can happen if urinary tract infection are not treated
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sepsis and death
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What is the number one symptom assoicated with MS
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fatiuge
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What agent are used to treat faituge
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AMFM
Amantadine Methlyphenidate Fluoxeinte Modafinil |
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Why is Amantiadine not used as much
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tachyphylaxis
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When shooul Modafinil be given
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earily
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One of the most common sensory symptoms of MS is trigeminal neuragia which is treatment with
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carbazepine 200mg TID
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What also agents can be used to treat neuropathic pain
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TCAS, gabapenin, pregablin, and capsaicine
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Depress adn emotional lability and suicide is higher in MS pop. what are treatment option
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TCA, or SSRI
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Is Bee venom have any effiacy
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NO
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What is procarin
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transdermal patch for energy with histamine and caffieine with NO proven effiacy
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