Multiple Sclerosis: Medication Options (Nursing)

by Prof. Lawes

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    00:00 Now, let's break down those medications.

    00:02 You know I love pharm, so I want to talk to you a little bit about the medication options that are available.

    00:07 Now we've got multiple options for disease modifying therapies, okay? We don't have a cure.

    00:12 We already talked about that. I want to keep reinforcing it.

    00:15 But you'd be positive with your patients and help them know they have options.

    00:20 Now, sadly, a lot of the medications carry significant health risks.

    00:24 But you and I both know there's no absolutely safe medication.

    00:30 Every medication comes with decisions that have to be made.

    00:33 But most effective therapy involves considering multiple factors, how severe the symptoms are, how long they're lasting, how long they've had MS, what has worked for the patient before, what's been effective, what other comorbidities.

    00:48 And comorbidities means what other disease processes are going on in that patient's body.

    00:53 We also want to look at the cost of medications and can we provide that to the patient.

    00:57 And last, childbearing status.

    00:59 If this is a female patient who wants to have children, we want to be really careful about the medication plan.

    01:07 So, many of the relapse-remitting MS drugs are injectable.

    01:12 First one is Beta interferons.

    01:14 See this look on my face? Well, it's one of the most commonly prescribed medications for MS, but it is not an easy one to take.

    01:23 You do inject it under the skin or you take it IM, and it can reduce the frequency and severity of relapses.

    01:29 So, why do I sound so kind of sad about that? Well, its side effects for some people are pretty severe, makes them feel like they have the flu.

    01:39 Injection site reactions are usually pretty minor.

    01:43 But you know if you're already dealing with MS, flu-like symptoms really isn't a lot of fun.

    01:48 She'll have to work with the patient, get lots of feedback with them, see if we can monitor those symptoms, and see how they do with this medication.

    01:56 We know that it will be effective and help dealing with that relapse, but if they're dealing with severe flu-like symptoms, their body just doesn't take this very well, we're gonna have to keep working with them to find a solution.

    02:08 Also, flu, and you want to watch their liver.

    02:12 Sometimes people have trouble with their liver on Beta interferons.

    02:15 So, it's a pretty effective drug, but it's going to be a matter of, "Can we manage those side effects?" Now, let's talk about the symptoms of a relapse, might affect their vision, have this weakness or poor balance, might interfere with their able-- ability to move or to walk safely.

    02:32 So, it's definitely a safety issue or an overall ability to function might be a problem.

    02:37 So, most neurologists recommend treatment with corticosteroids.

    02:42 So someone has an MS attack, we're gonna look at corticosteroids.

    02:48 I know I always say it that way because I want to remind you, this is like the same thing that comes from your adrenal gland, right? We just help you take it in as a medication.

    02:58 Corticosteroids come from the adrenal cortex.

    03:02 So we can also look at plasmapheresis.

    03:04 Remember, you've got some antibodies with MS, So, the symptoms really aren't responding, we can try plasmapheresis, the same thing we do with like Guillain-Barre.

    03:13 So the symptoms are new if they're severe and they haven't responded to corticosteroids.

    03:18 Another therapy that they'll consider is plasmapheresis.

    03:23 Okay.

    03:24 So, we've talked about two options for medication.

    03:28 The first one was the Beta interferons which are pretty cool, but also their side effects are pretty bad.

    03:34 So the patient can't tolerate those. We need another plan.

    03:37 Also, we can use for relapse, corticosteroids.

    03:40 If those don't work, then we can try plasmapheresis.

    03:45 So, so far, we've kind of got three options to consider for patients with MS.

    03:51 Now, the most common treatment regimen, I just want to go over this a little bit, just so you know what to expect, do not memorize this, okay? I just want to give you a feel for what the treatment plan would be like.

    04:03 Choose your 3- to 5-day course of high-dose IV corticosteroids to knock that inflammation out and end the relapse more quickly.

    04:11 Now, this may or may not be followed by a slow tapering off of oral prednisone.

    04:18 Corticosteroids aren't believed to have any long-term benefit on the disease, but it might help us deal with those exacerbations.

    04:24 So, you can look giving up some high-dose IV Solu-Medrol, high-dose oral Deltasone, or ACTH.

    04:34 Now, remember that one. That's another hormone.

    04:37 That's adrenocorticotropic hormone.

    04:40 And when your body gets that, it's going to put out more of those corticosteroids because that's the job of ACTH.

    04:48 Now, some other medication options.

    04:50 Before we look at these, pause the video, see if you can recall the medication options we've already talked about without looking at your notes.

    04:58 Jot yourself a quick note on the top of this slide.

    05:04 Okay, cool. You know the deal.

    05:05 Every time you pause and recall, you're really on your way to mastering the concept.

    05:11 Now, let's talk about muscle relaxants.

    05:13 Remember, they might have that problem with spasticity, Baclofen or Zanaflex are two options for that.

    05:19 If they're feeling really tired, we might look at something amantadine, modafinil, methylphenidate, and possibly an SSRI which we normally use for depression.

    05:29 Oh, if they're having problems with their walking speed, there's a medication that we can use.

    05:33 And we've got this other list of medications.

    05:37 See, the key here is not to memorize these medication names.

    05:41 What I want you to look at are the green boxes on the top of each category.

    05:45 Knowing that your patient with MS, if they're having spasticity, we're going to use a muscle relaxant.

    05:52 If they're feeling really tired, we're going to consider these medications.

    05:56 If they're feeling like they have issues with the walking speed, there is a medication for that.

    06:01 But with so much for your brain to learn for this, I'm just gonna ask you to memorize the green categories, right? Just the big concepts.

    06:10 You can always look up the individual drugs when you're dealing with the patient.

    About the Lecture

    The lecture Multiple Sclerosis: Medication Options (Nursing) by Prof. Lawes is from the course Chronic Neurological Disorders (Nursing).

    Included Quiz Questions

    1. Liver enzymes
    2. Hemoglobin and hematocrit
    3. Basic metabolic panel
    4. Erythrocyte sedimentation rate
    1. Corticosteroids
    2. Plasmapheresis
    3. Beta-interferon
    4. H.P. Acthar gel (ACTH)
    1. Muscle relaxant
    2. Opioids
    3. Benzodiazepines
    4. Antidepressants

    Author of lecture Multiple Sclerosis: Medication Options (Nursing)

     Prof. Lawes

    Prof. Lawes

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