Miscellaneous / Multiple Sclerosis Agents

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Can you name the Multiple Sclerosis Agents?

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Modafinil class
Fingolimod class
Dose: 1 gram/day IV for 3-5 days
Cyclophosphamide class
SE: Thyroid disorders, ITP (with fatal brain hemorrhage), infections.
Dose: Oral daily (first PO MS drug)
Baclofen class
Dose: IM weekly
MOA: Immune modulator, exact mechanism not known.
Venlafaxine class
Carbamazepine class
Second line agent for RRMS that produces reduction in progression of disabilty
Methylprednisone class
Mycophenolate class
Dose: IV infusion every 3 months
SE: HR reduction of 10-20 bpm, occasionally bradyarrhythmias or AV block -- screen for cardiac dz (6 hr monitoring w/ first dose). Macular edema in 1% (reversible). Check varicella
Rituximab class
IFN beta 1-a (Avonex) class
Dose: SC injection 2-3 times weekly
Excreted by kidney: contraindicated in moderate to severe renal failure
MOA: Potassium channel blocker. Possibly increases conduction in demyelinated axons
Mitoxantrone class
Second line agent MOA: monoclonal Ab
Alemtizumab class
Dalfampridine class
SE: Inj site rxn w/ high doses, flu-like s/s (responds well to naproxen), monitor liver fx, may develop neutralizing Ab, may increase depression.
Daclizumab class
Use: Depression. Also helps with fatigue
MOA: Sphingosine 1-phosphate receptor modulator. Sequesters lymphocytes.
Dose: 1250 mg/day PO for 3-5 days
Use: pain and paroxysmal disorders
MOA: alkylating agent
SE: Localized inj site reactions. Self-limited (15-20 min) acute rxn resembling a panic attack (palpitations, dyspnea, flushing) -- not an indication to stop tx
Second line agent: RRMS, SPMS, Progressive Relapsing MS
First line drugs for disease modification
Second line agent: RRMS. Reduced relapses & progression of disability
Dose: Oral. In extreme cases intrathecal
MOA: Purine analog
Off line agent used in the treatment of acute attacks
MOA: Immunomodulator/antineoplastic
Duloxetine class
Methotrexate class
Tricyclic class
IFN beta 1-a (Rebif) class
Use: For pts who do not respond to corticosteroids during acute attacks
SE: Seizures at higher than recommended doses (contraindicated in pts with a hx of seizure)
Bupropion class
MOA: Anti-organ rejection drug
Axathioprine class
MOA: Synthetic form of myelin basic PRO copolymer 1. Binds to MHC molecules. Competes w/ myelin antigens for presentation to T cells.
Tizanidine class
Second line agent given IV monthy
Plasmapheresis class
Natalizumab class
Use: Fatigue
Use: Depression. Also helps with pain
MOA: Monoclonal Ab. Shows functional improvement not just slowing of decline
SE: Risk of progressive multifocal leukoencephalopathy. Rare fatal viral (polymyxoma JC virus) reactivation infxn affecting white matter in immunosuppressed (only a risk to pts w/
Gabapentin class
Dose: SC injection every other day
MOA: Antimetabolite and antifolate
Methylphenidate class
First line RRMS agent injected SC daily
Use: treatment of spasticity
Prednisone class
Use: Fatigue, cognitive impairment (long acting agent)
IFN beta 1-b (Betaseron) class
Glatiramer acetate class

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