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MS - block 6
Pharm'14 block 2
Name | MOA | USE | AE/BB | Contra/Inter | Monitor/Pearls |
---|---|---|---|---|---|
Glatimer Acetate (copaxone) | May promote proliferation of T2 helper cells (neuroprotective), compete with myelin basic protein thereby inhibiting re-activation of the T-cells in the CNS | RRMS CIS | Lipoatrophy (dimpling of skin) injection reaction chest pain (tach, SOB, CP) | not immune suppressing NO lab monitoring: big benefit | |
Fingolimod (gilenya) | sequestrating of lymphocytes into the lymph node thus decreasing lymphocyte migration into the CNS | RRMS | Low WBC -> around 2 1st degree heart block bradycardia macular edema | Cardiac Problems | immune suppressing monitor 1st dose EKG monitor: CBC, LFT, OTC every 3-6 months |
Natalizumab (tysabril) | binds to the surface of Tcells, Bcells and macrophages -> prevents movement across the BBB | JC virus activation -> PML infections infusion reactions elevated LFTs | prescreeen LFTs and JC virus | ||
Dimethyl fumarate (tecfidera) | unknown: thought to decrease activated T1 helper cells (proinflammatory) and increase T2 helper cells (neuroprotective) | RRMS | GI upset (30%) N/V/D Flushing; eat w/ meal or take ASA elevated LFTs | prescreen: CBC Monitoring: CBC, CMP | |
Teriflunomide (aubagio) | inhibiting pyrimidine synthesis -> decreases proliferation of T and Bcells in periphery | RRMS | elevated LFTs Alopecia Diarrhea BBW: sever liver dz Preg X | prescreen lab: LFTs, CBC, TB monitor LFTs monthly for 6 then every 6 slowly eliminated from plasma (8months - 2yrs) | |
Interferon Beta 1a (avonex) | Not sure-> Think: decrease TCell proliferation, decrease antigen prentation, andalter cytokine release which reduces the number of cells that cross through the BBB | RRMS CIS | Flu-like sx depression -> ceases within months injection site reactions elevated LFTs Hypothyroidism | Not immune suppressing Monitor : CBC, LFT, TSH |