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46 Cards in this Set
- Front
- Back
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what is the epidemiology of MS
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these pts at higher risk:
live above equater female @ 2x risk white people at greater risk age 15-45 (peaks at 4th decade of life) |
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what is the evidence that viral and bacterial infections may play a role in MS
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increase IgG synthesis in CNS
increased antibody titers Epstein Barr virus in children |
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what are the categories of MS
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benign MS
relapsing/remitting (RRMS) secondary progressive (SPMS) - break > long attack > break primary progressive (PPMS) - no remittance just straight decline |
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what are some of the primary signs and symptoms of MS
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gait problems and falls
spasticity tremor bowel and bladder dysfunction sexual dysfunction fatigue cognitive changes visual complaints/optic neuritis |
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what are some of the secondary symptoms of MS
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recurrent UTIs
kidney stones depression respiratory infections decubiti and osteomyelitis |
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what are some of the tertiary symptoms of MS
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financial problems
personel/social problems emotional problems |
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how is MS diagnosed
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by exclusion
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what is used to diagnose MS
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imaging studies (MRI)
-look at T2 burden the higher the increase risk of susceptibility CSF evaluation -look for increase IgG in CNS, normal serum IgG, and increased IgG index |
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what does methylprednisolone treat
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benign MS
|
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what is the MOA of methylprednisolone
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decrease edema in area of demyelination
regulates gene expression |
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what are the SE of methylprednisolone
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blood sugar elevation in DM
-sleep disturbances, GI upset, acne from prolonged use |
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what is Interferon B1b (betaseron) used to treat
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RRMS
SPMS |
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what are some of the possible MOA of interferon B1b (betaseron)
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decrease IFN gamma secretion by activated lymphocytes (IFN gamma is inflammatory cytokine)
suppress T cell proliferation and decrease BBB permeability (meaning IgG may not be able to reach CNS) |
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Interferon B1b brand
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betaseron
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Interferon B1a brand
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avenox, rebif
|
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what is Interferon B1a used to treat
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RRMS
SPMS |
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how is Avonex dosed
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once weekly this increases compliance
Rebif is dosed 3x a week |
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what are the SE of interferon
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injection site redness
flu like symptoms depression |
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what are the counseling for Interferon
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injection site recommendations (hydrocortisone for redness, inject at site bellow body temp, rotate sites)
can take NSAID/APAP for flue like symptoms |
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what is Glatiramer Acetate used to treat
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RRMS
|
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what is the MOA of glatiramer
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mimics myelin binding protein (MBP) and may bind to MHC2 Rc inhibiting MBP from binding to T cell Rc complexes
|
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what are the SE of glatiramer acetate
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one time transient reaction consisting of: chest tightness, flushing, dyspnea
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what is the brand of Glatiramer Acetate
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copaxone
|
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what does Natalizumab treat
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RRMS
|
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what is the MOA of natalizumab
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attaches to very late antigen (VLA-1) and blocks its interaction with vascular cell adhesion molecule (VCAM-1)
|
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what are the SE of natalizumab
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progressive multifocal leukoencephalopathy (PML) - typically seen in HIV pt
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what does Fingolimod treat
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RRMS
|
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what is the MOA of fingolimod
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sequesters circulating lymphocytes into secondary lymphoid organs and decrease infiltration of T lymphoctes and macrophages into CNS
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whata re the SE of fingolimod
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pronounced first dose bradycardia, infections, macular edema, increase liver enzymes
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what does Mitoxantrone treat
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SPMS (chronic)
PRMS worsening RRMS |
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what is the brand of Fingolimod
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gilenya
|
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what is the MOA of mitoxantrone
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intercalates with DNA causing crosslinks and strand breaks
interfers with RNA and inhibits Topo2 |
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what is the lifetime dose of Mitoxantrone
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140mg/m2
most check pt LVEF and EKG before giving this drug since it can cause cardiotoxicity |
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what are the SE of Mitoxantrone
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alopecia, upper respiratory tract infections, UTI, leukemia, menstrual disorder
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what drugs are used to treat Gait difficulties and spasticity
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tizanidine
baclofen |
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what drugs are used to treat Tremors
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propranolol
|
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what drug is used to treat bowel and bladder symptoms
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oxybutyn
tolteradine |
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what drug is used to treat sensory symptoms
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gabapentin
pregabalin |
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what drugs are used to treat fatigue
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methylphenidate
dextroamphetamine |
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why is there a theoretical risk with vitamin use
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Zn increase immune system therefore may have more of a reactive response
|
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what vaccination should MS pts get
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influenza but avoid FluMist since it is a live attenuated virus
|
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what are the prognostic indicators for favorable prognosis
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<40
woman low attack frequency in early disease initial symptoms of optic neuritis or sensory symptoms relapsing/remitting disease |
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what drugs are used to treat benign MS
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corticosteroids
|
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what drugs are used to treat RRMS
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interferons
glatiramer acetate mitoxantrone natalizumab fingolimod |
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what drugs treat SPMS
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interferons
mitoxantrone natalizumab fingolimod |
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what should you monitor with Interferon use
|
LFT
CBC Platelets |
