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IM4 > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

What is MS?

A

A chronic, unpredictable, progressive, degenerative disorder of CNS
- No cure!
- Segmental demyelination of nerve fibers of brain and spinal cord

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2
Q

MS is characterized by

A

Periods of remission and exacerbation

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3
Q

Vitamin D reduces risk of MS
T/F

A

True

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4
Q

Possible risk factors of MS

A
  • Infection
  • Smoking
  • Physical injury
  • Stress
  • Excessive fatigue
  • Pregnancy
  • Poor health
  • Genetics
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5
Q

What 3 pathologic processes characterize MS?

A
  • Chronic inflammation
  • Demyelination
  • Gliosis (scarring) in the CNS
    Immune system attacks the myelin sheath
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6
Q

Patterns of multiple sclerosis

A
  • Relapsing remitting
  • Primary progressive
  • Secondary progressive
  • Progressive relapsing
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7
Q

Relapsing remitting

A

Clearly defined attacks of worsening neuro function (relapse) with partial or complete recovery (remission)

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8
Q

Primary progressive

A

Steadily worsening neurologic function from the beginning with minor improvements but NO distinct relapses or remissions

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9
Q

Secondary Progressive

A

A relapsing-remitting initial course, followed by progression with or without occasional relapses, minor remissions, and plateaus

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10
Q

Progressive relapsing

A

Progressive disease from onset, with clear acute relapses, with or without full recovery. Periods between relapses are characterized by continuing progression

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11
Q

Clinical manifestations of MS

A
  • 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
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12
Q

Sensory manifestations

A
  • Numbness and tingling
  • Pain
  • Tremor
  • Decreased hearing, vertigo, tinnitus
  • Lhermitte’s sign
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13
Q

Motor manifestations

A
  • Weakness or paralysis of limbs and trunk
  • Spasticity of muscles
  • Scanning of speech
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14
Q

Bowel and bladder manifestations

A
  • Constipation
  • Variable urinary problems
  • Spastic bladder
  • Flaccid bladder
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15
Q

Sexual dysfunction manifestations

A
  • Erectile dysfunction
  • Decreased libido
  • Painful intercourse
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16
Q

Cognitive manifestations

A
  • Short term memory attention
  • Information processing
  • Attention/planning
  • Visual perception
  • Word finding
17
Q

MS diagnostic studies

A
  • No definitive test
  • History, S/S
  • MRI
  • CSF analysis
  • Evoked potential studies
  • Neuropsychological testing
  • Sexual history
18
Q

For a diagnosis of MS, must have

A
  • At least 2 inflammatory demyelinating lesions in 2 diff locations
  • Damage or attack occurring at different times
  • All other diagnoses ruled out
19
Q

Vision problems =

A

MS

20
Q

MS medial management

A
  • No cure
  • Goal is to delay progression, manage symptoms, treat acute exacerbations
  • Early intervention is most effective
21
Q

Drug therapy for MS

A

Disease modifying drugs (DMDs)
- Decrease frequency and severity of relapses
- Reduce development of brain lesions
- Decrease future disability

22
Q

Disease modifying drugs I

A

Drugs that suppress the immune system to modify disease progression, prevent relapses

23
Q

Immunomodulators

A
  • 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)
24
Q

Interferon Beta

A

Is a naturally occurring glycoprotein with antiviral, antiproliferative, and immunomodulatory actions

25
Q

Interferon Beta Therapeutic use

A
  • Reduces the frequency and severity of attacks
  • Reduces number and size of lesions detectable with MRI
  • Delays progression of disability
26
Q

Interferon Beta A/E

A
  • Flu-like reactions
  • Hepatotoxicity
  • Myelosuppression
  • Injection site reactions
  • Depressin
  • Suicidal thoughts
  • Drug interactions
27
Q

Mitoxantrone therapeutic use

A

Decreases neurologic disability and clinical relapses

28
Q

Mitoxantrone MOA

A

Binds with DNA and inhibits topoisomerase

29
Q

Mitoxantrone adverse effects

A
  • Myelosupression
  • Cardiotoxicity
  • Fetal harm
  • Reversible hair loss, N/V, amenorrhea, allergies, blue-green tint to urine and sclera
30
Q

What drugs can be used to manage exacerbations?

A

Corticosteroids

31
Q

MS spasticity treatments

A
  • Surgery
  • Dorsal column electrical stimulation
  • Intrathecal baclofen pump
32
Q

MS nursing interventions

A
  • Promote physical mobility
  • Enhance bowel and bladder control
  • Teach

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