MS disease modifying Rx
Who should be treated Clinically definite relapsing remitting MSD (RRMS) Some patients with Clinically isolated syndrome (CIS) secondary progressive MS (SPMS) Choice of therapy depends on: age, severity of disease, patient choice, risk of side effects Highest efficacy High to low efficacy is based on limited randomized trials All...
MS Acute Treatment
Multiple Sclerosis review Acute exacerbation IV methylprednisolone: 1000 mg iv daily for 5 days (3 to 7 days) with or without short taper Oral prednisone: 50 mg tab x 20 tab daily for 5 days without taper some previous study suggested iv more effective for optic neuritis ACTH (corticotropin)...
Aducanumab
approved by FDA for mild Alzheimer’s disease: uncertain as to which patients may benefit A recombinant monoclonal antibody reduce amyloid plaque on pet imaging Coverage: not covered by public & private payers Cost: about $60,000 per year, depends on weight inconsistant clinical effects on rating scales Dosing MRI brain...
COVID-19 VACCINE
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Apoaequorin – Prevagen
Apoaequorin is a protein that was originally discovered in the jellyfish species Aequorea victoria. When apoaequorin binds with calcium, a blue light is produced. This compound is being marketed as Prevagen as a supplement to improve memory. There has been some concern over false advertising claims being made by...
Antidepressants
A quick reference of the commonly used “antidepressants”. More appropriately, these medications should be called Serotonin agonist....
Anticonvulsants
Nice table from Neurology Residents AED table 1 – side effect, Pregnancy class AED dosage, formulation table Epilepsy Foundation on medications Drugs that lower seizure threshold Antidepressants and seizure incidence Antiepileptic drugs in transplant patients Sharpen your skill in reading EEG...
Opioid daily dose
Dose over 50 MME/day, greater than 2x risk for overdose MME = Morphine milligram equivalent Over 50 MME means over 50 mg of hydrocodone (Norco) or over 33 mg of oxycodone or over 12 mg of methadone For other drugs, use conversion table to calculate...
Pimavanserin – Nuplazid
Reduce delusions in Parkinson disease patient 34 mg qd Approved in 2016 not approved for the treatment of patients with dementia-related psychosis Strong cyp3a4 inhibitors Cost 34 mg 30 cap – $3400...
Seasonal Influenza
Antiviral therapy Oseltamivir (Tamiflu) 75 mg bid x 5 days (about $30) available in 30, 45, 75 mg generic may cause headache, vomiting reduce symptom duration by about 3 days Greatest benefit if given in first 48 hr of illness. May still effective after 48 hr Baloxavir (Xofluza) Dose...