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Multiple Sclerosis
Overview
53
Architecture
3rd Grade
04/01/2014

Additional Architecture Flashcards

 


 

Cards

Term
Primary underlying issue of MS
Definition
destruction of myelin sheath: acts as insulator for nerve, allows normal nerve transmission
Term
Immune System Attack
Definition
Blood Brain Barrier must be altered; Oligodendrocytes are affected
Term
responsible for nourishing myelin; possibly could be the immune system target rather than myelin
Definition
Oligodendrocytes
Term
MS symptoms
Definition
difficulty walking, visual disturbances, neuropathy, bowel/bladder issues, depression, sexual dysfunction, thermoregulation
Term
Benign MS
Definition
apparently no long term disability: may not be truly benign
Term
Relapsing-Remitting MS
Definition
patients experience "relapses" but then have "remission"-- majority of cases
Term
Secondary Progressive MS
Definition
less frequent relapses but increased disability following each attack
Term
Relapsing Progressive MS
Definition
Patient experiences relapses but also has progressive disability
Term
Primary Progressive MS
Definition
slow, gradual progression without attacks or noticeable relapses
Term
Goals of MS Therapy
Definition
Reduce number of relapses, reduce severity of relapses, Slow progression of disability, patient education helps with understanding goals
Term
Primary Disease-Modifying MS Treatments
Definition
Interferons; Glatiramer Acetate; Fingolimod; Teriflunomide; Dimethyl fumarate
Term
Interferons
Definition
Betaseron, Extavia, Avonex, Rebif
Term
Secondary Disease-Modifying Agents
Definition
Natalizumab, Mitoxantrone, OTher immune modulating agents: methotrexate, rituxan
Term
Interferons
Definition
play a role in immune regulation; differences in efficacy debated
Term
may not be as effective as other interferons but mixed studies
Definition
Avonex
Term
Interferon side effects
Definition
injection site reactions, flu-like symptoms, increased depression
Term
Antibodies to interferon can develop
Definition
most likely with Betaseron; may/may not require change in therapy; if these are a problem clinically, likely need to switch to something other than an interferon
Term
Betaseron/Exavia
Definition
0.25 mg every other day (increase gradually)
Term
Avonex
Definition
30 mcg once weekly
Term
Rebif
Definition
22 or 44 mcg 3x/week (increase gradually)
Term
Avonex given
Definition
IM
Term
Betaseron and Rebif given
Definition
SC
Term
Glatiramer (Copaxone)
Definition
may increase suppressor T-cells; may also be a "suicide drug": take place of myelin
Term
Unusual post-injection rxn- can feel chest pain or throat swelling, happens periodically and not an allergic reaction, no long-term complications
Definition
Glatiramer (Copaxone)
Term
Glatiramer dose
Definition
gien as 20 mcg once daily SC
Term
Fingolimod (Gilenya)
Definition
first oral txt for MS, Unique mechanism (sphingosine-1 phosphate receptor modulator), keeps lymphocytes in lymph nodes- subsequently reduces immune response
Term
Fingolimod SEs
Definition
bradycardia/heart block, macular edema, infections
Term
Teriflunomide
Definition
newest oral agent for MS; active metabolite of Lefunomide; Pregnancy cat X; potentially highly toxic to the liver, watch blood pressure (possible HTN)
Term
Dimethyl fumarate
Definition
new twice daily oral med; approved late March 2013; 2 targets in MS (inflammatory mediators, oxidative stress)
Term
DImethyl fumarate SE
Definition
flushing, gastrointestinal, lymphopenia and leukopenia
Term
Dimethyl fumarate no CYP340 involvement for metabolism
Definition
undergoes hydrolysis rapidly, no metabolic drug interactions, only identified interaction is potential addition immune suppression with other immunosuppressants
Term
Dimethyl fmarate (Tecfidera) Precautions
Definition
pregnancy category C, male reproductive effects?, immune suppression
Term
being studied; may stimulate endogenous opioids that inhibit immune system
Definition
Naloxone
Term
Treatment more severe cases
Definition
Natalizumab or Mitoxantrone
Term
Natalizumab (Tysabri)
Definition
given IV once every 4 weeks, binds ot alpha-4 integrins; keeps immune cells from getting into CNS, may be more effective than 1st line meds
Term
associated with progressive multifocal leukoencephalopathy (PML)- demyelinating disease, cuased by opportunistic JC virus
Definition
Natazlimuab (Tysabri)
Term
Patients/prescribers/pharmacies must enter TOUCH program; not studied beyond 2 years
Definition
Natazlimuab
Term
Mitoxantrone (Novantrone)
Definition
chemotherapeutic agent, maximum lifetime dose of 140 mg/m2 (12 mg/m2/dose); may develop heart failure at lifetime <100mg/m2; can be given every 3 months but may not be given this often- may wait to spare toxicity, patients doing well may not need a dose this frequently
Term
Pregnancy
Definition
may decrease MS symptoms especially during 3rd trimester
Term
Primary treatment for acute symptoms of relapses; don't seem effective long-term to prevent progression of disease but help relapse symptoms
Definition
Corticosteroids
Term
Corticosteroids
Definition
high doses recommended; minor relapses may not need steroid treatment
Term
stimulates GABA receptor: can be used in an intrathecal pump, some patients may get excessive muscle weakness
Definition
Baclofen
Term
central alpha2 agonists; less muscle weakness but more drowsiness than baclofen, liver function monitoring
Definition
Tizanidine
Term
benzodiazepines
Definition
long acting more helpful; clonazepam less likely to accumulate than diazepam (used for spasticity)
Term
Dantrolene (Dantrium)
Definition
(used for spasticity); effective, decreases muscle contraction by decreasing intracellular calcium release, not typically used because of potential livery toxicity
Term
Neuropathy in MS
Definition
gabapentin less expensive than pregabalin, TCAs may be effective for some pts and less expensive than venlafaxine or duloxetine; nortriptyline, desipramine have least pronounced anticholinergic effects of the TCAs; nortriptyline causes drowsiness, desipramine tends to cause stimulation
Term
Fatigue in MS
Definition
Caffeine: most expensive, Amantadine: 100 mg AM and early afternoon; Modafanil: 200 mg per day; Methylphenidate: 10-20 mg AM and noon; Prokarin: combo of histamine and caffeine, expensive
Term
Dalfampridine
Definition
Potassium channel blocker: indicated to improve walking in MS patients- seizures biggest onvern
Term
Overactive bladder
Definition
anticholinergics: most newer agents more selective for bladder muscarinic receptors (darifenacin, tolterodine, solifenacin, fesoterodine)
Term
bladder overflow
Definition
alpha blockers/prostate meds may help
Term
anticholinergics
Definition
may help with catheter-associated bladder spasms; monitor for infection
Term
pseudo-bulbar affect
Definition
uncontrollable laughing or crying; one medication approved: Nuedexta
Term
Nuedexta
Definition
combo of dextromethorphan/quinidine (20mg/10mg BID); quinidine present to inhibit breakdown of dextromethorphan
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