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MS IOS 8 -4
Multiple Sclerosis
| Question | Answer |
|---|---|
| MS etiology | Abnormal response to infectious agent, increase risk as move away from equator, genetic predispositio 15X risk (more women) |
| Neuropathy | Demylanation(regeneratable), axon loss (irreversible), immune mediated damage |
| MS course | Early replase and remitting, late RRMS, Clinical impairment |
| Prognostic Factors Unfavorable | Older age at onset, Male, Higher relapse leads to atrophy, early motor or cerebral disability, high T2 lesions (white matter) |
| Prognosis- Favorable | Young at onset, female, low relapse, sensory symptoms, no disability, normal MRI at onset |
| Early replapse and remitting MOA | T-cells become activated- and present adhesion molecules and activate metalloproteinase which pinch holes in the BBB and allow T-cells to penetrate into BBB and eat myelin, release of Cytokinin, upregulate immune, ROS, complement and myelin damage |
| Goals of MS therapy | 1. Shorten recovery time 2, Decrease the n# and severity of relapse 3, Stop the number and severity of relapse 3 Stop secondary and progressive 4 stop pregression |
| Acute Exacerbations treatment | Methylpredinisolone 1g IV x 3-5 days |
| Methylpredisolone benefits | Reduce focal defects, improves patches in the BBB, and reduces EDEMA NOW |
| Prevention of relaps and remiting | Interferons-ABCR drugs |
| Interferon B-1B-Betaseron | Synthesized in E.Coli given 250 SQ-high |
| Betasetron Effects | Decrease relapses 33%, , not cognitive, or brain atrophy seen |
| Betasetrin SE | FLU(pre-treat) , Decrease WBC, CBC, PTL, Increase LFT, spontanous aborton, sucide, depression |
| Interferon B-1A Avonex | Recombinant humanized 30mcg IM PER WEEK (latex allergy) |
| Avonex effects | Decrease relapse (32%), 1 point change to halt progression,decrease brain atrophy, improve cognition |
| Interferon 1B-1A-Rebif | Recombinant humanized 44mcg SQ M, W, F |
| Refif effects | Decrease relapse 32%, 1 point to halt disease progression, not other data |
| Blatiramer acetate-Capaxone effect | 30mg Daily SQ shown to decrease relapse by 29% |
| Capozone SE | Dizziness, flushing, chest tightness that is not related to cardia and lasts only a few minutes (pre-medicate it site reaction) |
| Mitoxantrone indication | ONLY medication approved for secondary progressive or RRMS |
| Mitoxantrone dose | 12mg/m2 with(pre-medicatekorazepam or Dex) dose limit of 140mg/m2 can be given with ACBR drugs |
| Mitoxantrone special testing | Must have MUGA, CBC, Urinalysis w/culture & pregnancy |
| Methotrexate indication | RRMS and Chronic progression #1 used 7.5mg Q week |
| Visual symptoms treat with | Methylpredinsolone |
| Weakness treat with | 4-aminopyridine (famprodine) blocks the K channel to allow more conduction-must be compounded |
| Spacsticity | Baclofen (fast withdrawl=seizure), Tiazanidine, BZD |
| Bladder -nocturia | DDVAP |
| Hyporeflexic bladder(cannot empty) | Bethanechol chloride |
| Hyperreflexic bladder(incontence) | Oxtbutinin (Ditropan)Tolterodine (detrol) |
| Sphincter-detrusor dyssynergia-incomplete emptying | Prazocin (alpha 1 block) |
| UTI treatment must always be checked | Could develop sepsis and they have loss of feeling so often do not have symptoms |
| Sexual dysfunction | MUSE, Viagra, Leveitra, Cialis |
| Fatique | Amantadine, Pemoline |
| Pain | Carbamazepine |
| Depression | TCA, SSRI, St Johns |
| Emotional Lability | Amitriptyline |
| MOA of interferons | Decrease response against myelin, decrease cell migration into BBB, , Decrease T-cell , TNF alpha, Increase IL 10, enhance T helper2 thus supress T-helper 1 |
Created by:
liza001
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