Multiple Sclerosis

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Multiple Sclerosis
2013-04-09 07:35:06

therapeutics, side-effects, drug interactions
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  1. GoT of MS Tx
    • reduce the number, severity and duration of MS attacks
    • slow progression
    • improve QoL
  2. S/E of IFN-B and management
  3. Risk factors for mild increase in LFTs with IFN-B
    • male
    • high dose and frequency
    • first year of Tx
    • increased weight
    • NSAID use
  4. Mitoxantrone doses for MS Tx
    • Mitoxantrone IV infusion q3months
    • *max dose=140mg/m2

    MOA: inhibits T and B-cell activation
  5. S/E of mitoxantrone
    • cardiotoxicity
    • acute myelogenous leukemia
    • nausea
    • hair loss
    • amenorrhea
  6. Monitoring parameters for mitoxantrone
    • cardiac LVEF
    • LFT
    • neutrophil count
  7. Fingolimod doses for MS Tx
    fingolimod PO 0.5mg-1.25mg

    • MOA: binds lymphocyte surface and stops it from leaving the lymph nodes
    • *phosphorylated prodrug is a sphingosine-1-phosphate R agonist

    *superior to IFN-B-1a IM
  8. S/E of fingolimod
    • cardiovascular|: bradycardia, AV block
    • infection: LRTI, reactivation of herpes
    • macular edema
    • increased LFTs
    • mild HTN
  9. Monitoring parameters for fingolimod
    test for herpes and vaccinate if negative
  10. Cladribine doses for MS Tx
    cladribine PO

    MOA: inhibits DNA synthesis and repair to reduce circulating T cells
  11. S/E of cladribine
    • lymphocytopenia
    • herpes
    • death: latent TB, acute MI, pancreatic cancer
  12. Tx of relapse
    • 1. urine screen to rule out UTI
    • 2. short-term CC: methyprednisolone IV 1g QD x3days or PO (just as effective but needs taper)
  13. Causes of fatigue in MS patients
    • 1. primary:
    • a. decrease strength of AP in demyelinated area
    • b. increased TNFa and IFNy
    • 2. secondary:
    • a. medications
    • b. insomnia

    *80% of MS patient experience fatigue
  14. Management of fatigue in MS patients
    • 1. lifestyle: frequent rests, cooling, exercise
    • 2. unlicensed drugs: amantadine, modafinil, fluoxetine, 4-AP
  15. Use of 4-aminopyridine (4-AP) for Tx of fatigue in MS patients
    MOA: K+ channel blocker (increase AP)

    • Other uses: improving walking speed
    • *not disease modifying
  16. CI of 4-AP
    • seizure
    • renal dysfunction
  17. S/E of 4-AP
    • insomnia
    • dizziness
    • seizures
    • nausea
    • abdominal pain
    • UTIs
  18. Place of estrogen in MS Tx
    • theory: MS improves during pregnancy and relapses during post-partum
    • *Th1-->Th2 shift in pregnancy

    OCPs= associated with short term decrease risk of MS
  19. Other MS Tx
    • 1. Vitamin D: UV and 25-OH vitamin D have immunomodulatory effects
    • 2. cannabanoids: for spasticity and pain
    • a. can be legally prescribed for MS in BC
    • 3. Vitamin B12
    • 4. PUFA
    • 5. statins: reverse EAE, and has immunomodulatory effects in cardiac transplants
  20. S/E of cannabanoids
    • psychosis
    • immunosuppression
    • memory impairment
    • appetite stimulation