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.