Multiple Sclerosis

Question 1

Chronic, progressive, degenerative, autoimmun disorder that affects the myelin sheath and conduction pathways of the CNS

Answer 1

Multiple Sclerosis

Question 2

Onset: (Multiple Sclerosis)

Answer 2

20-50 yo

Question 3

Gender (Multiple Sclerosis)

Answer 3

Women 2x Risk

Question 4

Patho (Multiple Sclerosis)

Answer 4

T-cells: activated from systemic circ., enter CNS & Stay→ chronic inflammation–> demyelination, scarring, axon damage

Question 5

demyelination (Multiple Sclerosis)

Answer 5

damage to oligodendrocytes

Question 6

scarring (Multiple Sclerosis)

Answer 6

proliferation of astrocytes

Question 7

axon damage (Multiple Sclerosis)

Answer 7

impulses are totally blocked (final)

Question 8

gliosis

Answer 8

sclerosis

Question 9

Optic Nerve (CN 2): (Multiple Sclerosis)

Answer 9

Visual disturbances

Question 10

Acoustic Nerve (Multiple Sclerosis)

Answer 10

Tinnitus, Vertigo,Dysarthria (Speech), dysphagia (Swallowing)

Question 11

damage to spinal cord (Multiple Sclerosis)

Answer 11

Bowel/bladder function loss

Question 12

Lhermitt’s Sign:

Answer 12

specific pain, electric shock that moves from the spine to the legs, occurs with neck flexion

Question 13

Relapsing Remitting: (Multiple Sclerosis)

Answer 13

85%, Acute attack w/ remission & relapse

Question 14

Secondary Progressive: (Multiple Sclerosis)

Answer 14

• Begins as relapsing remitting

* Progressive between flares

Question 15

Primary Progressive: (Multiple Sclerosis)

Answer 15

Non-distinct flare, continues to progress, never relapses (mountain)

Question 16

Progressive relapsing: (Multiple Sclerosis)

Answer 16

• Progressive from onset
• Clear relapses
• Distinct flares, continues to progress, never relapses

Question 17

Dx: (Multiple Sclerosis)

Answer 17

No definitive tests
***MRI most distinctive, will see gliosis
Evoked Potential)Testing: Nerve Transmission speeds

Question 18

Drug Therapy: (Multiple Sclerosis)

Answer 18

Interferons (Avonex, Betaseron, Rebif)
Copaxone
Novantrone (IV)
Gilenya 
Tysabri

Question 19

blockT cells & prevent immune cell activation; found to decrease flare-ups by 30-40% (MS)
• Admin: injection only
• SE: flu-like (Tylenol or ibuprofen)

Answer 19

Interferons (Avonex, Betaseron, Rebif)

Question 20

Copaxone

Answer 20

SubQ admin blocks T cells

Tx MS

Question 21

Gilenya

Answer 21

better then interferon agents

Tx MS

Question 22

Tysabri:

Answer 22

Binds to WBC (T cells)- prevents myelin damage; NOT a first like tx→ asc with Fatal viral infection

Question 23

Acute exacerbation treatment

Answer 23

• decrease edema & inflam @ site of demyelination
• ACTH (adrenocorticotropic hormone) IV
• Methylprednisolone (solu-Medrol) IV 1-2 wks
• D/C with prednisone 2-4 wks

Question 24

Urinary retention: (MS)

Answer 24

Cholinergics (Bethanecol)

Question 25

Spastic Bladder: (MS)

Answer 25

Anticholinergics (Ditropan)

Question 26

**Fatigue** (MS)

Answer 26

Symmetrel, cylert, Ritalin, provigil

Question 27

Spasticity (MS)

Answer 27

Valium, Baclofen

Question 28

Bradykinesia (MS)

Answer 28

Dalfampridine (Ampyr)

Question 29

Dalfampridine (Ampyra)

Answer 29

improves nerve conduction

Question 30

Nutritional Therapy: (MS)

Answer 30

Low fat, gluten free, raw veggies

Question 31

Triggers: (MS)

Answer 31

* illness * trauma * immunization * stress/depression * temperature extremes

Question 32

Bladder control (MS)

Answer 32

may need to teach self-cath. (if bladder retention), drink (3L/day, times); s/s of UTI, Regular Schedule

Question 33

Bowel Control (MS)

Answer 33

regular schedule, movement, stool softeners

Question 34

Coping (MS)

Answer 34

chronic illness w/ unpredictable course, challenging for patient and support system