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MS, ALS & Alzheimers
Treatment modalities
| Question | Answer |
|---|---|
| What is the basic defect in MS? | a disease of the central nervous system in which neurons become demylinated MS lesions, characterized by perivascular infiltration of monocytes and lymphocytes, appear as indurated areas in pathologic specimens; hence, the term "sclerosis in plaques." |
| How does interferon beta 1a differ from interferon beta 1b? | pharmokinetically, the only difference is structural, 1a differs from 1b only in that it has an amino acid sequence identical to that of natural compound and is glycosylated |
| Interferon MOA? | uncertain but beneficial effects may be due to immunomodulatory actions. Appear to limit immune attack on myelin |
| Glatiramer (Copaxone) MOA? | Since drug resembles a component of myelin, it’s thought that it may protect myelin by acting as a “decoy” attracting immune cells away from myelin |
| What are the predominant side effects of interferon administration? | flu-like symptoms (muscle ache, fever, chills, asthenia); Injection site reactions; Antibody formation (can limit effectiveness of drug); severe depression |
| What are the predominant side effects of glatiramer? | Generally well tolerated - Injection site reactions; Flushing, chest tightness or pain, shortness of breath (within 15 min); Joint pain; Muscle stiffness. |
| What is mitoxantrone (Novantrone) and what is its MOA? | a cancer chemotherapeutic agent recently approved to treat advanced MS - Acts by suppressing immune attack on myelin |
| What are common side effects of mitoxantrone? | Common side effects include nausea, bladder infections, mouth sores, and loss of menstrual cycle. Patients should only receive the drug for 2-3 years due to a cumulative effect on cardiac conduction |
| What drugs are commonly used to treat depression in MS patients? | Fluoxetine (Prozac), sertraline (Zoloft), amitriptyline (Elavil) |
| What drugs are commonly used to treat spasticity in MS patients? | Baclofen, TIZANIDINE (Zanaflex), dantrolene, diazepam (Valium), intrathecal baclofen delivered via programmable pump |
| What drugs are used to treat painful neuralgias in MS patients? | carbamazepine (Tegretol) and phenytoin |
| What drugs are used to treat urinary dysfunction in MS patients? | imipramine and oxybutanin |
| Vertigo is common in MS patient, what drugs are used to treat? | meclizine or diazapam |
| What drug is used to treat fatigue and tremors in MS patients? | amantadine (Symmetrel) |
| What is Amyotrophic Lateral Sclerosis or ALS? | A progressive degenerative disease of motor neurons. Glutamate “excitotoxicity” may be responsible for the disease |
| What is the only drug available for treatment of ALS and what is its MOA? | Riluzole (Rilutek) is a voltage-gated sodium channel blocker which is thought to act by inhibiting glutamate release |
| Riluzole ADRs? | Asthenia, dizziness, vertigo; Nausea, diarrhea, vomiting; Circumoral parethesias; SGPT elevation (monitor liver chemistry – may require DC) |
| What is Alzheimer's Disease? | A progressive, neurodegenerative disease d/t degeneration of cholinergic neurons in the cortex & hippocampus →deficient cholinergic neurotransmission. Occurs later in life, the most common type of senile dementia with cognitive deficits, behavior disorder |
| Acetylcholinesterase inhibitors MOA? | increase cholinergic activity in the cortex and hippocampus by decreasing metabolism of acetylcholine. Benefit is modest and short-lived |
| Name the reversible acetylcholinesterase inhibitors used to treat AD? | Donepezil (Aricept); Galantamine (Reminyl); Rivastigmine (Exelon);Tacrine (Cognex) |
| Memantine (Namenda) MOA? | “use-dependent” NMDA receptor antagonist → blocks glutaminergic overstimulation of NMDA receptors, which can be toxic to neurons which are important in learning and memory, but allows low levels of receptor activation. |
| Memantine ADRs? | Dizziness, headache, constipation, and confusion |
| Your AD patient is on Aricept but is showing signs of decreasing cognition; what drug would you add? | Memantine |
| What herbal preparation has been shown to modestly improve memory in AD? | ginko biloba |
| most common side effect of the reversible acetylcholinesterase inhibitors? | nausea, usually dose related |
Created by:
psfisher50
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