Question

List the pharmacological interventions for Acute inflammatory demyelinating polyradiculopathy, and state the category the drug belongs as well as the actions and side effects of the drugs

Answer 1

Acute inflammatory demyelinating polyradiculopathy is an autoimmune disease characterized by weakness and pain as primary symptoms. These symptoms are because of the inflammation of nerves located outside the brain and spinal cord.

Other names: Guillen Barre Syndrome

Etiology: unknown, an autoimmune disease.

Sex and age predilection: No specific age and sex predilection. Can occur in anyone at any time.

Treatment:

Its treatment includes immunomodulating drugs as it is an immune disorder. Other interventions are for the treatment of complications and symptomatic relief.

Immunomodulatory agents

• Immune globulin IV
• Plasmapheresis or plasma exchange

Immune globulin IV

Mechanism of action:

1. It down-regulates antibody production and by neutralizing antibodies specific for myelin as immune dysregulation is against myelin.
2. It also down-regulates pro-inflammatory cytokines, such as IL-1 and gamma-IFN.
3. It interferes with the complement cascade of our body.

Injectable solution

• 5% (Flebogamma, Gammaplex)
• 10% (Flebogamma, Asceniv, Bivigam, etc)

Side effects

• Headache
• Fatigue
• Nausea
• Chills
• Vomiting

All these side effects are common in every brand of IGIV injection.

• Other less common symptoms and depending on the specific brand like Privigen include back pain, diarrhea, pyrexia, blood total bilirubin increased, hematocrit decreased, etc.

Plasmapheresis or plasma exchange

Mechanism of action:

• It includes the fractionation of blood components into plasma and blood cells. Then blood cells are replaced in fresh frozen plasma, albumin, or saline.
• This plasma segregation allows us the removal of antibody, complement components, immune complexes, lymphokines, and acute-phase reactants from the patient's body.
• Alternate days plasma exchange with a total of 6 exchanges in 2 weeks, with 3-3.5 L plasma exchanged per treatment.

Adverse effects

• Bleeding diathesis- severe adverse effect
• Transient hypotension
• Paresthesias, and
• Rarely hypersensitivity reactions and hypocalcemia.

Other treatments

Anticoagulant agents like heparin for a critical and bedridden patient with an increased risk of deep venous thrombosis.

Mechanism of action: It interacts with naturally present antithrombin III in our body and increases its potency to decrease clot proliferation.

Adverse effects

• Heparin-induced Thrombocytopenia
• Mild pain
• Hemorrhage
• Injection site ulcer
• Increased liver aminotransferase
• Anaphylaxis
• Immune hypersensitivity reaction
• Osteoporosis (long-term, high-dose use)

Supportive medical care includes mechanical ventilators, trained staff, enteric nutrition by nasogastric tube, cardiac monitoring in patients. Bedridden patients need prophylaxis against thromboembolism. These interventions needed for critically ill patients.

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