Multiple Schlerosis Flashcards
Multiple sclerosis (MS)
(MS) is a chronic, unpredictable, progressive, degenerative disorder of the central nervous system (CNS). It is characterized by demyelination of the nerve fibers of the brain and spinal cord.
Clinical Manifestations
the first sign: Vision changes like blurred or double vision, red-green color distortion, or blindness in 1 eye
Extremity muscle weakness and problems with coordination and balance that affects walking and standing.
numbness or tingling
speech problems, hearing loss, tremors, and dizziness
nystagmus, ataxia, dysarthria, and dysphagia.
fatigue that can be exacerbated by Heat, humidity, deconditioning, and medication side effects
Lhermitte’s sign
is a temporary sensory symptom described as an electric shock going down the spine or into the limbs with neck flexion
Complications asscociated with MS
Constipation
Spastic bladder
flaccid (hypotonic) bladder
Sexual problems such as ED; decreased libido, difficulty with orgasm, painful intercourse, and decreased vaginal lubrication
Diagnostic Studies
No one specific diagnostic test for MS exists
Drug Therapy
DMD
Corticosteroid
Anticholinergic
TCA
potassium channel blockers
DMD’s
interferons, monoclonal antibodies, and synthetic agents.
β-Interferon
Assess for depression and suicidal thoughts.
- Teach patient to wear sunscreen and protective clothing when exposed to sun.
- Tell the patient that flu-like symptoms are common after starting therapy.
Teriflunomide
is an immunomodulatory agent with antiinflammatory properties
can cause life threatening liver toxicity
IV monoclonal antibodies
For more active forms of MS, may suppress immunologic activity
natalizumab (Tysabri), alemtuzumab (Lemtrada), and ocrelizumab (Ocrevus)
these are only given to patients who had an inadequate response to other treatments
Ocrelizumab
approved for relapsing remitting and progressive forms of MS.
It slows disease progression and improves symptoms
Ocrelizumab
increases the risk for infection and breast cancer
IV corticosteroids
(e.g., prednisone) can be used to treat acute MS exacerbations
reduce edema and acute inflammation at the site of demyelination.
They speed recovery, but do not affect the residual neurologic impairment from the exacerbation
Therapeutic plasma exchange (plasmapheresis) and IV immunoglobulin G
may be considered for a short time when treatment with corticosteroids alone does not achieve symptom improvement.
amantadine, modafinil (Provigil), and fluoxetine (Prozac)
used to treat fatigue in MS
Anticholinergics (oxybutynin, propantheline)
can treat bladder spasm
Tricyclic antidepressants and antiseizure drugs
treats chronic pain.
selective potassium channel blocker
Dalfampridine (Ampyra)
may improve walking speed;
improves nerve conduction in damaged nerve segments.
may cause seizures, especially at higher doses.
Bethanechol
common treatment for urinary retention.
how is spasticity treated?
can be treated with stretching, physical therapy, baclofen, intrathecal pumps, or onabotulinumtoxin A (Botox).
Neurologic problems
improve with physical therapy; Excercise like water therapy is recommended
What are the triggers for MS?
infection, trauma, live virus immunizations, childbirth, stress, and change in climate.
How to combat heat?
cooling vests
Avoiding the midday heat will help manage symptoms in the summer.
What is the focus of care during acute exacerbation of MS?
prevent complications of immobility such as respiratory complications, UTIs, and pressure injuries.
How to reduce illness?
avoiding fatigue, extremes of heat and cold, and exposure to infection.
a good balance of exercise and rest
minimize caffeine intake and eat a healthy diet
