Week 5: Meds for MS

what is MS

focal areas of demyelination with reactive gliosis (autoimmune)

where do does MS occur in white matter

brain, SC, optic nerves

presentation is dependent on

where demyelination is

presentation of MS

weakness, numbness, tingling, unsteady, discoordination, visual changes, sphincter disturbances

3 main types of treatment for MS

disease modifying therapy (DMT), exacerbation treatment, symptoms management

meds for DMT

beta inferons, immunomodulators, monoclonal antibodies, antineoplastics, IVIG

meds for exacerbation treatment

steroids

meds for symptom management

muscle relaxants for spasticity, fatigue management

2 main goals for MS meds

reduce frequency of exacerbations, slow disease progression

4 meds to reduce frequency of exacerbations

interferons, immunomodulators, antineoplastics, ivig

1 main med to slow disease progression

monoclonal antibodies

DMT: Beta interferons use

endogenous interferons synthesized as part of immune response to viruses, reduces autoimmune destruction of glial cells in people with MS

beta interferons types

1a: Avonex(IM), Rebif(SQ)

1b: Betaseron which is SQ every other day

adverse effects of beta interferons

flu like symptoms

DMT Immunomodulators 2 types

glatiramer (Copaxone), and dimethyl fumarate (Tecfidera)

glatiramer (Copaxone) function

may activate t lymphocyte suppressor cells specific to myelin antigen, daily injection

glatiramer (Copaxone) adverse effects

flu like symptoms

dimethyl fumarate (Tecfidera) function

unknown but has immunomodulatory effects, capsule/BID doses

dimethyl fumarate (Tecfidera) adverse effects

flushing, abdominal pain, diarrhea

DMT: monoclonal antibodies 2 main types

natalizumab (Tysabri), ocrelizumab (Ocrevus)

natalizumab (Tysabri) function

prevents leukocyte movement and decreases inflammation, given weekly

natalizumab (Tysabri) adverse effects

fatigue, diarrhea

ocrelizumab (Ocrevus) function

binds to B lymphocytes and causes destruction of them, Iv infusion every 6 months.

ocrelizumab (Ocrevus) adverse effects

respiratory and skin infections

DMT: antineoplastics types

chemotherapy, mitoxantrone (Novantrone), cladribine (Mavenclad)

chemotherapy adverse effects

nausea, hair loss, immunosuppression

mitoxantrone (Novantrone) function

stops immune system cells from crossing BBB into CNS, infusion every 3 months

cladribine (Mavenclad) function

cytotoxic effects on B and T lymphocytes, oral doses week 1 and 5

DMT IVIG function

improves immune system responses

DMT IVIG adverse effects

muscle aches, headache, fatigue

exacerbation management

use steroids for powerful anti-inflammatory effects, given via IV for 3-5 days with oral taper

side effects of exacerbation management

weight gain, elevated blood glucose, osteoporosis, leukocytosis

management of spasticity meds

baclofen, tizanidine, dantrium

management of fatigue meds

dalfampridine (Amprya)-increases action potentials to demyelinated axons

modafinal (Provigil)-increases dopamine

management of urinary symptoms meds

exact agent depends on symptoms (retention, incontinence, weak stream)

CAM used for MS

bee venom

bee venom use

modulates immune response and suppresses damage caused by the activation and attack of cells on tissues, painful with risk of anaphylaxis

people with MS may be on

on meds, more severe need it to slow, corticosteroids in acute exacerbations, meds for symptoms