Neuromuscular

• Myasthenia gravis


  A chronic autoimmune neuromuscular disease that affects approximately 20 in 100,000 persons
• Acetylcholinesterase (AChE) inhibitors


  Drugs used to manage myasthenia gravis
• Acetylcholinesterase inhibitors for myasthenia gravis

  • Edrophonium - for diagnosing MG
  • Neostigmine - for controlling MG
  • Pyridostigmine - for controlling MG
• Pyridostigmine


  • Short-acting AChE inhibitor with a half-life of 0.5 to 1 hour
  • Must be given on time to prevent muscle weakness
  • Intermediate action, given every 4 to 6 hours
• Multiple sclerosis (MS)


  An autoimmune disorder that attacks the myelin sheath of nerve fibers in the brain and spinal cord, resulting in lesions called plaques
• Classifications of multiple sclerosis

  • Relapsing remitting MS (RRMS): Relapse with full recovery and residual deficit (85%)
  • Primary progressive MS (PPMS): Slowly worsening neurologic function from the beginning, no relapses or remissions (10%)
  • Secondary progressive MS (SPMS): Initial course is relapsing remitting, followed by progression with or without occasional relapses, minor remissions, and plateaus (50% of RRMS develop SPMS within 10 years)
  • Progressive relapsing MS (PRMS): Progressive from onset, with clear acute relapses with or without full recovery (5%)
• Immunomodulators


  • Disease-modifying drugs (DMDs) or disease-modifying therapies (DMTs), the first line of treatment for MS
  • Can slow the progression of the disease and prevent relapses
  • Tailored to the disease pattern and manifestations of the patient
• Drugs for multiple sclerosis

  • Beta interferon - decreases number and severity of MS attacks, slows progression of disability in relapsing remitting MS
  • Glatiramer citrate - treatment of relapsing-remitting MS
  • Teriflunomide - treatment of relapsing-remitting MS
• Beta Interferon


  Has been shown to decrease both the number and severity of MS attacks (Relapses) and to significantly slow the progression of physical disability associated with relapsing remitting MS
• Immunosuppressants

  • Mitoxantrone
  • Dimethyl fumarate
• Sphingosine 1-Phosphate receptor modulators

  • Fingolimod
• Monoclonal antibody

  • Alemtuzumab
  • Natalizumab
• Muscle relaxants


  Relieve muscular spasms and pain associated with traumatic injuries and spasticity from chronic debilitating disorders (e.g., MS, stroke [CVA], cerebral palsy, head and spinal cord injuries)
• Spasticity


  Increased muscle tone from hyperexcitable neurons; this is caused by increased stimulation from the cerebral neurons or lack of inhibition in the spinal cord or at the skeletal muscles
• Centrally acting muscle relaxants


  Depress neuron activity in the spinal cord or brain, or they enhance neuronal inhibition on the skeletal muscles
• Skeletal muscle spasticity


  Muscular hyperactivity that causes contraction of the muscles, resulting in pain and limited mobility
• Centrally acting muscle relaxants used to treat spasticity


  • Baclofen
  • Dantrolene
  • Tizanidine
• Centrally acting muscle relaxants used for muscle spasm


  • Carisoprodol
  • Chlorzoxazone
  • Cyclobenzaprine
  • Metaxalone
  • Methocarbamol
  • Orphenadrine citrate
• Diazepam, a benzodiazepine, has also been effective for treating spasticity
• Cyclobenzaprine


  Alleviates muscle spasm associated with acute painful musculoskeletal conditions