Term
| primary underlying issue with MS |
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Definition
| destruction of myelin sheath |
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Term
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Definition
| acts as insulator for nerve and allows normal nerve transmission |
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Term
| myelin sheath can be repaired by may not always be repaired in MS patients |
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Definition
| more severe cases can damage nerve such that it cannot be repaired, causing progression of symptoms |
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Term
| in MS, destruction of myelin caused by |
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Definition
| attack from the immune system |
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Term
| immune system attack requires that the BBB be altered to |
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Definition
| allow immune cells to get to the CNS, immune cells are not normally in CNS and the BBB only allows immune cells in for infection |
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Term
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Definition
| responsible for nourishing myelin, possibly could be the immune system target rather that myelin itself |
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Term
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Definition
| help to prevent further nerve damage and reduce symptoms of MS |
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Term
| because the immune system is affected |
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Definition
| there is more chance for infection, and it is important to notify the doctor if you get sick |
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Term
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Definition
| difficulty walking, visual disturbances, neuropathy, bowel/bladder issues, depression, sexual dysfunction, thermoregulation and others |
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Term
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Definition
| apparently no long-term disability, may not be entirely benign |
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Term
| type of MS: relapsing-remitting |
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Definition
| have times where they don't have any symptoms and then have episodes of an attack, then goes back to normal |
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Term
| type of MS: secondary progress |
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Definition
| less fequent relapses but increased disability following each attack |
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Term
| type of MS: relapsing progressive |
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Definition
| Patient experiences relapses but also has progressive disability |
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Term
| type of MS: primary progressive |
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Definition
| slow, gradual progression without attacks or noticeable relapses |
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Term
| MS has partial genetic link |
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Definition
| and is correlated with latitude, almost non-existent at equator, seems to have genetic predisposition along with some kind of trigger |
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Term
| Vitamin D may be involved |
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Definition
| nurses health study found less MS in patients who took Vit D |
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Term
| research into viral and bacterial link |
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Definition
| greater presence in MS patients, possibly could trigger immune response, not sure if they initiate issue or just opportunistic |
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Term
| no definitive link to Hanford |
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Definition
| islands off Scotland have highest incidence, same altitude as inland northwest, very similar ethnic mix and not industrialized |
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Term
| reduce number of relapses |
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Definition
| may not go away entirely, monitored by patient |
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Term
| reduce severity of relapses |
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Definition
| also partly monitored by patient, is patient better able to function? |
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Term
| slow the progression of disability |
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Definition
| can be monitored by MRI, based upon number and severity of lesions |
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Term
| Dx-modifying MS treatments |
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Definition
| Interferons (Betaseron, Extavia, Avonex, Rebif) and glantiramer acetate (Copaxone) |
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Term
| Dx-modifying ORAL MS treatments |
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Definition
| fingolimod (Gilenya), teriflunomide (Aubagio), dimethyl fumarate (Tecfidera) |
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Term
| seconday Dx-modifying agents *generally used if others not effective or not tolerated* |
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Definition
| natalizumab (Tysabri), mitoxantrone (Novantrone), and other immune modulators methotrexate and rituxan |
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Term
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Definition
| play a role in immune regulations |
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Term
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Definition
| may not be as effective as other interferons but studies are mixed |
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Term
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Definition
| have the same generic names, considered to be different biologic agents, Rebif is actually a higher dose of medication, debate over what dose is needed |
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Term
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Definition
| same drug as Betaseron marketed by different company |
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Term
| Severity of SEs differ between interferons but similar type |
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Definition
| Avonex may NOT be "best" tolerated |
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Term
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Definition
| injection site reactions, flu-like symptoms, increased depression |
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Term
| antibodies can develop against interferons |
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Definition
| most likely with Betaseron, may/may not require change in therapy, if these are clinically problematic, likely need to switch to something other than interferon |
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Term
| Betaseron and Extavia freq of admin |
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Definition
| 0.25 mg every OTHER day and increase gradually |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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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, well tolerated |
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Term
| unusual post-injection reaction after Copaxone |
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Definition
| chest pain or throat swelling, happens periodically and is NOT an allergic reaction, no long-term complications |
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Term
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Definition
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Term
| National MS Society recommends using a disease-modifying agent, doesn’t endorse one over the other |
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Definition
| patient preference is a major consideration, potential of efficacy vs. tolerability, frequency and rout of medication administration, prescriber opinion plays a major role |
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Term
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Definition
| 1st oral treatment for MS, unique sphingosine-1 phosphate receptor modulator, keeps lymphocytes in lymph nodes, subsequently reduces immune response |
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Term
| fingolimod (Gilenya) side effects |
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Definition
| bradycardia/ heart block, macular edema, infections |
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Term
| Fingolimod showes decreased annual relapse rates |
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Definition
| compared head to head with Avonex, relapse rate low |
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Term
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Definition
| newest oral agent for MS, active metabolite of Lufunomide, potentially high toxic to the liver, watch BP-possible HTN |
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Term
| pregnancy category X for teriflunomide (Aubagio) |
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Definition
| *can stay in body for up to 2 years* protocol to eliminate it more quickly with cholestyramine or |
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Term
| dimethyl fumarate (Tecfidera) |
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Definition
| new TWICE dialy roal med that targets BOTh inflammatory mediators and oxidative stress |
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Term
| dimethyl fumarate (Tecfidera) side effects |
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Definition
| flushing, GI, lymphopenia and leukopenia |
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Term
| dimethyl fumarate (Tecfidera) has NO CYP 450 involvement for metabolism |
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Definition
| undergoes hydrolysis rapidily, no metabolic drug iteractions, Only identified interaction is potential addition immune suppression with other immunosuppressants |
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Term
| precautions with dimethyl fumarate (Ticfidera) |
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Definition
| pregnancy category C, male reproductive effects? (based on animal data), immune suppression |
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Term
| primary progressive MS not currently treatable with meds |
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Definition
| recently studying naloxone which may stimulate endogenous opiods that inhibit immune system |
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Term
| treating more severe cases |
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Definition
| Natalizumab (Tysabri), mitoxatrone (Novantrone) |
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Term
| Natalizumab (Tysabri) administration and MOA |
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Definition
| given IV every 4 weeks, binds to alpha-4 integrins and keeps immune cells from getting into CNS, may be more effective than 1st line meds |
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Term
| Natalizumab (Tysabri) side effects |
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Definition
| associated with progressive multifocal leukoencephalopathy (PML), a demeylinating disease caused by opportunistic JC virus, must enter TOUCH program (pharmer, PT, and MD) |
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Term
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Definition
| chemo agent, max lifetime dose of 140 mg/m2 (12 mg/m2/dose), can develop heart failure |
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Term
| mitoxatrone (Novantrone) frequency |
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Definition
| can be given every 3 months but may not be given this often, may wait to spare toxicity, PTs doing well may not need a dose this frequently |
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Term
| various immune suppressants have been studies for MS |
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Definition
| combo trials with methotrexate are ongoing, other chemo agents and immuno suppressants |
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Term
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Definition
| pregnancy may decrease MS symptoms, especially during 3rd trimester, may be related to estriol (hormone more specific to pregnancy, potentially higher rate of nausea), clinical trials with estriol are in progress |
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Term
| interferon meds can affect vision BUT |
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Definition
| MS pt's can develop optic neuritis, can cause permanent damage, can be treated with corticosteroids to prevent damage |
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Term
| patient should be evaluated URGENTLY |
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Definition
| for vision changes to reduce possibility of vision damage |
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Term
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Definition
| primary treatment for acute symptoms of relapse |
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Term
| corticosteroids don't seem effective |
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Definition
| long-term to prevent progression of Dx but help relapse symptoms |
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Term
| high dose corticoids recommended for relapse |
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Definition
| 500-1000mg IV methylprednisolone for 3-5 days, some MDs use lower doses of oral agents but may not be as efficacious |
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Term
| minor relapse may not need steroid treatment |
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Definition
| Presence of disability is deciding factor, ie. visual changes is more extreme |
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Term
| pain and difficulty walking from contractures in her legs |
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Definition
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Term
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Definition
| Typical muscle relaxants may be ineffective, so other agents used |
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Term
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Definition
| stimulates GABA receptor, can be used in an intrathecal pump, some PTs may get excessive muscle weakness |
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Term
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Definition
| central alpha2 agonist, less muscle weakness but more dowsiness than baclofen, liver function monitoring needed |
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Term
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Definition
| long-acting more helpful for spasticity, clonazepam less likely to accumulate than diazepam |
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Term
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Definition
| effective, decreases muscle contraction by decreasing intracellular Ca release, not typically used because of potential liver toxicity |
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Term
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Definition
| Treated with same agents as neuropathy from diabetes; pregabolin, gabapentin, TCAs, venlafaine, duloxetine, nortriptyline, despiramine |
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Term
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Definition
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Term
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Definition
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Term
| Gabapentin less expensive |
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Definition
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Term
| TCAs may be effective for some PTs |
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Definition
| and Less expensive than venlafaxine or duloxetine for neuropathy |
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Term
| Nortriptyline and desipramine |
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Definition
| have the least pronounced anticholinergic effects of the TCAs |
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Term
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Definition
| caffeine, amantadine (Symmetrel), modafanil (provigil), methylphenidate (Ritalin), Prokarin |
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Term
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Definition
| combo of histamine and caffeine, can be compounded by pharmacists |
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Term
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Definition
| 100 mg AM and early afternoon |
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Term
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Definition
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Term
| methylphenidate (Ritalin) |
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Definition
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Term
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Definition
| K channel blocker that improves walking distance in MS pts, compounded by pharmacists |
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Term
| seizures biggest concern for dalfampiridine |
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Definition
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Term
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Definition
| fiber supplements require WATER, can be OK if patient is having diarrhea |
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Term
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Definition
| some antidepressants have dual effect |
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Term
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Definition
| for women estrogen may have dual effect, for men small study indicates testosterone may help MS symptoms |
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Term
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Definition
| cooling vests, free from national MS society |
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Term
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Definition
| anticholinergics (darifenacin, tolterodine, solifenacin, festerodine), ER oxybutynin and patch have low SE profile |
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Term
| trospium for overactive bladder |
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Definition
| not able to cross BBB, perhaps best for cognitive issues but effects with altered BBB in MS pts?? |
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Term
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Definition
| consider alpha blockers or prostate meds |
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Term
| some cases may have neurogenic bladder |
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Definition
| bladder may not function, severe urinay retention, catheter may be necessary, anticholinergics or cholinergics |
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Term
| anticholinergics (overactive bladder agents) |
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Definition
| may be helpful with catheter-associated bladder spasms, monitor for infection |
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Term
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Definition
| uncontrollable laughing or crying |
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Term
| One medication approved for Pseudo-Bulbar Affect |
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Definition
| Nuedexta (combo of dextromethorphan/quinidine twice daily) |
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