Multiple Sclerosis Flashcards
What is MS?
A chronic, unpredictable, progressive, degenerative disorder of CNS
- No cure!
- Segmental demyelination of nerve fibers of brain and spinal cord
MS is characterized by
Periods of remission and exacerbation
Vitamin D reduces risk of MS
T/F
True
Possible risk factors of MS
- Infection
- Smoking
- Physical injury
- Stress
- Excessive fatigue
- Pregnancy
- Poor health
- Genetics
What 3 pathologic processes characterize MS?
- Chronic inflammation
- Demyelination
- Gliosis (scarring) in the CNS
Immune system attacks the myelin sheath
Patterns of multiple sclerosis
- Relapsing remitting
- Primary progressive
- Secondary progressive
- Progressive relapsing
Relapsing remitting
Clearly defined attacks of worsening neuro function (relapse) with partial or complete recovery (remission)
Primary progressive
Steadily worsening neurologic function from the beginning with minor improvements but NO distinct relapses or remissions
Secondary Progressive
A relapsing-remitting initial course, followed by progression with or without occasional relapses, minor remissions, and plateaus
Progressive relapsing
Progressive disease from onset, with clear acute relapses, with or without full recovery. Periods between relapses are characterized by continuing progression
Clinical manifestations of MS
- Vague symptoms occur intermittently over months or years
-Mental changes - decreased concentration, attention deficit, memory loss, depression and unstable mood - Limb weakness, loss of coordination and balance
- Loss of sensation, tremors
- Dizziness
- Speech impediment
- Fatigue, numbness, tingling and prickling pain
- Bladder and bowel dysfunction
- Visual disturbances
Sensory manifestations
- Numbness and tingling
- Pain
- Tremor
- Decreased hearing, vertigo, tinnitus
- Lhermitte’s sign
Motor manifestations
- Weakness or paralysis of limbs and trunk
- Spasticity of muscles
- Scanning of speech
Bowel and bladder manifestations
- Constipation
- Variable urinary problems
- Spastic bladder
- Flaccid bladder
Sexual dysfunction manifestations
- Erectile dysfunction
- Decreased libido
- Painful intercourse
Cognitive manifestations
- Short term memory attention
- Information processing
- Attention/planning
- Visual perception
- Word finding
MS diagnostic studies
- No definitive test
- History, S/S
- MRI
- CSF analysis
- Evoked potential studies
- Neuropsychological testing
- Sexual history
For a diagnosis of MS, must have
- At least 2 inflammatory demyelinating lesions in 2 diff locations
- Damage or attack occurring at different times
- All other diagnoses ruled out
Vision problems =
MS
MS medial management
- No cure
- Goal is to delay progression, manage symptoms, treat acute exacerbations
- Early intervention is most effective
Drug therapy for MS
Disease modifying drugs (DMDs)
- Decrease frequency and severity of relapses
- Reduce development of brain lesions
- Decrease future disability
Disease modifying drugs I
Drugs that suppress the immune system to modify disease progression, prevent relapses
Immunomodulators
- Treatment should begin as soon as diagnosed
- Modify the disease progression and prevent relapses
- Interferon B-1a (SQ Rebif and Plegridy; IM Avonex)
- Interferon B-1b (SQ Betaseron and Extavia)
- SQ Glatiramer acetate (Copaxone)
Interferon Beta
Is a naturally occurring glycoprotein with antiviral, antiproliferative, and immunomodulatory actions
Interferon Beta Therapeutic use
- Reduces the frequency and severity of attacks
- Reduces number and size of lesions detectable with MRI
- Delays progression of disability
Interferon Beta A/E
- Flu-like reactions
- Hepatotoxicity
- Myelosuppression
- Injection site reactions
- Depressin
- Suicidal thoughts
- Drug interactions
Mitoxantrone therapeutic use
Decreases neurologic disability and clinical relapses
Mitoxantrone MOA
Binds with DNA and inhibits topoisomerase
Mitoxantrone adverse effects
- Myelosupression
- Cardiotoxicity
- Fetal harm
- Reversible hair loss, N/V, amenorrhea, allergies, blue-green tint to urine and sclera
What drugs can be used to manage exacerbations?
Corticosteroids
MS spasticity treatments
- Surgery
- Dorsal column electrical stimulation
- Intrathecal baclofen pump
MS nursing interventions
- Promote physical mobility
- Enhance bowel and bladder control
- Teach
