Miscellaneous Quiz / Multiple Sclerosis Agents

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Can you name the Multiple Sclerosis Agents?

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

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