Multiple Sclerosis Agents

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Can you name the Multiple Sclerosis Agents?

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SE: Seizures at higher than recommended doses (contraindicated in pts with a hx of seizure)
SE: Thyroid disorders, ITP (with fatal brain hemorrhage), infections.
MOA: Monoclonal Ab. Shows functional improvement not just slowing of decline
Gabapentin class
Carbamazepine class
IFN beta 1-a (Rebif) class
Dose: SC injection 2-3 times weekly
Methotrexate class
Bupropion class
Second line agent for RRMS that produces reduction in progression of disabilty
Prednisone class
Use: treatment of spasticity
Use: pain and paroxysmal disorders
Second line agent: RRMS, SPMS, Progressive Relapsing MS
MOA: Anti-organ rejection drug
Duloxetine class
Use: Depression. Also helps with fatigue
Alemtizumab class
Dalfampridine class
Axathioprine class
Fingolimod class
MOA: Sphingosine 1-phosphate receptor modulator. Sequesters lymphocytes.
Dose: Oral daily (first PO MS drug)
Rituximab class
Natalizumab class
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
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/
IFN beta 1-b (Betaseron) class
Use: For pts who do not respond to corticosteroids during acute attacks
Methylprednisone class
Dose: Oral. In extreme cases intrathecal
Tizanidine class
Mycophenolate class
Dose: IM weekly
Baclofen class
Glatiramer acetate class
Second line agent: RRMS. Reduced relapses & progression of disability
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
Dose: 1250 mg/day PO for 3-5 days
Use: Fatigue, cognitive impairment (long acting agent)
IFN beta 1-a (Avonex) 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.
Off line agent used in the treatment of acute attacks
First line RRMS agent injected SC daily
Excreted by kidney: contraindicated in moderate to severe renal failure
Daclizumab class
Cyclophosphamide class
MOA: Synthetic form of myelin basic PRO copolymer 1. Binds to MHC molecules. Competes w/ myelin antigens for presentation to T cells.
MOA: Immunomodulator/antineoplastic
Plasmapheresis class
MOA: alkylating agent
Modafinil class
Dose: SC injection every other day
Dose: IV infusion every 3 months
MOA: Immune modulator, exact mechanism not known.
Dose: 1 gram/day IV for 3-5 days
Second line agent given IV monthy
MOA: Purine analog
Second line agent MOA: monoclonal Ab
MOA: Antimetabolite and antifolate
Tricyclic class
Use: Depression. Also helps with pain
Methylphenidate class
MOA: Potassium channel blocker. Possibly increases conduction in demyelinated axons
Mitoxantrone class
Use: Fatigue
Venlafaxine class
First line drugs for disease modification

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