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32 Cards in this Set
- Front
- Back
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What are the common initial symptoms of MS? |
1. Weakness in one or more limbs 2. Visual changes similar to optic neuritis 3. Paresthesias 4. Diplopia |
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What are the signs of MS in CSF? |
1. Modest or no increase in cells 2. Increased total protein 3. Increased IgG |
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What are visual evoked potentials (VER)? |
measurement of central conduction time - is slowed in demyelination |
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What cells cause inflammation and demyelination in MS? |
Acive T cells |
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What is focal gliosis? |
scar tissue which follows demyelination |
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Can remyelination occur? |
Yes, but tends to be aberrant and incomplete |
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How do Interferons work in MS treatment? |
Decrease leukocyte crossing of BBB → inhibition of cloning and increase apoptosis of autoreactive Tcells |
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What are the Adverse effects of Betaseron (Beta interferon 1b)? |
- injection site reaction - CNS depression, anxiety, confusion - flu like syndrome - menstrual irregularities - abortifacient
Labs: - leukopenia - thrombocytopenia - elevated liver enzymes |
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What are the adverse effects of Avonex (Beta Interferon 1a)? |
- caution in pt with seizures or depression - injection site rxn/inflammation (very low) - flu like symptoms - abortifacient
Labs: - recommended monitoring of WBC, platelets, liver enzymes
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What are the adverse effects of Rebif (Interferon beta 1a)? |
- injection site reaction - flu like symptoms - headache - poss seizures |
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Which is more antigenic, interferon 1a or 1b |
1a is less antigenic |
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What type of patients have lower interferon bioavailability and may require larger doses? |
Nab (+) --=---
Slide 31- it seems contradictory in the notes |
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What is the moa of Glatiramir Acetate? |
inhibits clonal expression of autoreactive T cells and reduces production of proinflammatory cytokines
--possible neuroprotective/remylination activity |
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What are the side effects of Copaxone (copolymer)? |
- injection site pain - asthenia (lack of energy and strength)
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What are the parameters for defining "suboptimal" response? |
progression of EDSS > 1.5 points in 6-12 months
> 2 clinically relevant attacks w/in 6 months |
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What is the moa of Tysbri (natalizumab)? |
binds to integrins expressed on leukocytes and inhibits adhesion prevents migration into inflamed tissue |
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What is the Black Box Warning for Tysarbi (natalizumab)? |
Progressive Multifocal Leukoencephalopathy
(rare infection that damages myelin) |
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What condition is Mitoxantone (Novatrone) indicated for? |
Secondary progressive or progressive-relapsing MS
short IV infusion q 3 months |
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What are the adverse effects of Mitoxantone (Novatrone)? |
- nausea - alopecia - leukopenia - menstrual cycle disorders |
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What is the moa of Fingolimod (Gilenya)? |
sphigosine 1-phosphate receptor modulator, seems to down regulate receptor that is important in egress of T cells from lymph into circulation |
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What are the adverse effects of Fingolimod (Gilenya)? |
- mild hypertension - cardiac conduction problems - macular edema - shortness of breath |
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What is the moa of Teriflunomide (Aubagio)? |
tetrapeptide epoxyketone proteasome inhibitor
Drug interactions: CYP 2C8 inhibitor, 1A2 inducer |
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What are the adverse effects of Teriflunomide (Aubagio)? |
- parasthesia, hepatotoxicity, teratogenicity, influenza - headache, diarrhea, nausea - elevated blood pressure
QD dosing
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What is the moa of Dimethyl fumerate (Tecfidera)? |
activates Nuclear Factor-Like 2 pathway |
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What are the adverse effects of Dimethyl fumerate (Tecfidera)? |
- flushing - reduce lymphocyte counts |
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What are the adverse effects of Dalfampridine (Ampyra)? |
- dizziness, insomnia - UTI - seizures (CI: CrCl < 50 mL/min)
BID dosing |
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What treatment should be used for difficulty walking (slowness)? |
dalfamipridine (Ampyra) |
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What treatments are used for muscle spasticity? |
baclofen tizanidine diazepam clonazepam dantrolene |
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What treatment is used for eye problems? |
methylprednisolone (Solu-Medrol) |
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What treatments are used for fatigue and emotional outbursts? |
anti-depressants amantadine (fatigue) modafinil (fatigue) amitriptyline
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What treatments are used for bladder dysfunction? |
antibiotics Vitamin C oxybutynin (Ditropan) |
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What treatments are used for sexual dysfunction? |
sildenafil (Viagra) tadalafil (Cialis) vardenafil (Levitra) papaverine vaginal gels |
