Term
| Primary underlying issue of MS |
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Definition
| destruction of myelin sheath: acts as insulator for nerve, allows normal nerve transmission |
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Term
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Definition
| Blood Brain Barrier must be altered; Oligodendrocytes are affected |
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Term
| responsible for nourishing myelin; possibly could be the immune system target rather than myelin |
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Definition
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Term
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Definition
| difficulty walking, visual disturbances, neuropathy, bowel/bladder issues, depression, sexual dysfunction, thermoregulation |
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Term
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Definition
| apparently no long term disability: may not be truly benign |
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Term
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Definition
| patients experience "relapses" but then have "remission"-- majority of cases |
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Term
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Definition
| less frequent relapses but increased disability following each attack |
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Term
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Definition
| Patient experiences relapses but also has progressive disability |
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Term
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Definition
| slow, gradual progression without attacks or noticeable relapses |
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Term
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Definition
| Reduce number of relapses, reduce severity of relapses, Slow progression of disability, patient education helps with understanding goals |
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Term
| Primary Disease-Modifying MS Treatments |
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Definition
| Interferons; Glatiramer Acetate; Fingolimod; Teriflunomide; Dimethyl fumarate |
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Term
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Definition
| Betaseron, Extavia, Avonex, Rebif |
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Term
| Secondary Disease-Modifying Agents |
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Definition
| Natalizumab, Mitoxantrone, OTher immune modulating agents: methotrexate, rituxan |
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Term
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Definition
| play a role in immune regulation; differences in efficacy debated |
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Term
| may not be as effective as other interferons but mixed studies |
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Definition
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Term
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Definition
| injection site reactions, flu-like symptoms, increased depression |
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Term
| Antibodies to interferon can develop |
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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 |
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Term
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Definition
| 0.25 mg every other day (increase gradually) |
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Term
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Definition
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Term
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Definition
| 22 or 44 mcg 3x/week (increase gradually) |
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Term
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Definition
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Term
| Betaseron and Rebif given |
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Definition
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Term
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Definition
| may increase suppressor T-cells; may also be a "suicide drug": take place of myelin |
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Term
| Unusual post-injection rxn- can feel chest pain or throat swelling, happens periodically and not an allergic reaction, no long-term complications |
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Definition
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Term
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Definition
| gien as 20 mcg once daily SC |
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Term
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Definition
| first oral txt for MS, Unique mechanism (sphingosine-1 phosphate receptor modulator), keeps lymphocytes in lymph nodes- subsequently reduces immune response |
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Term
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Definition
| bradycardia/heart block, macular edema, infections |
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Term
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Definition
| newest oral agent for MS; active metabolite of Lefunomide; Pregnancy cat X; potentially highly toxic to the liver, watch blood pressure (possible HTN) |
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Term
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Definition
| new twice daily oral med; approved late March 2013; 2 targets in MS (inflammatory mediators, oxidative stress) |
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Term
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Definition
| flushing, gastrointestinal, lymphopenia and leukopenia |
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Term
| Dimethyl fumarate no CYP340 involvement for metabolism |
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Definition
| undergoes hydrolysis rapidly, no metabolic drug interactions, only identified interaction is potential addition immune suppression with other immunosuppressants |
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Term
| Dimethyl fmarate (Tecfidera) Precautions |
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Definition
| pregnancy category C, male reproductive effects?, immune suppression |
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Term
| being studied; may stimulate endogenous opioids that inhibit immune system |
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Definition
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Term
| Treatment more severe cases |
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Definition
| Natalizumab or Mitoxantrone |
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Term
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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 |
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Term
| associated with progressive multifocal leukoencephalopathy (PML)- demyelinating disease, cuased by opportunistic JC virus |
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Definition
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Term
| Patients/prescribers/pharmacies must enter TOUCH program; not studied beyond 2 years |
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Definition
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Term
| Mitoxantrone (Novantrone) |
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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 |
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Term
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Definition
| may decrease MS symptoms especially during 3rd trimester |
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Term
| Primary treatment for acute symptoms of relapses; don't seem effective long-term to prevent progression of disease but help relapse symptoms |
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Definition
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Term
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Definition
| high doses recommended; minor relapses may not need steroid treatment |
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Term
| stimulates GABA receptor: can be used in an intrathecal pump, some patients may get excessive muscle weakness |
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Definition
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Term
| central alpha2 agonists; less muscle weakness but more drowsiness than baclofen, liver function monitoring |
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Definition
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Term
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Definition
| long acting more helpful; clonazepam less likely to accumulate than diazepam (used for spasticity) |
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Term
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Definition
| (used for spasticity); effective, decreases muscle contraction by decreasing intracellular calcium release, not typically used because of potential livery toxicity |
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Term
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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 |
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Term
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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 |
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Term
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Definition
| Potassium channel blocker: indicated to improve walking in MS patients- seizures biggest onvern |
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Term
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Definition
| anticholinergics: most newer agents more selective for bladder muscarinic receptors (darifenacin, tolterodine, solifenacin, fesoterodine) |
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Term
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Definition
| alpha blockers/prostate meds may help |
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Term
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Definition
| may help with catheter-associated bladder spasms; monitor for infection |
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Term
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Definition
| uncontrollable laughing or crying; one medication approved: Nuedexta |
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Term
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Definition
| combo of dextromethorphan/quinidine (20mg/10mg BID); quinidine present to inhibit breakdown of dextromethorphan |
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