Week 2 Neuro Summary PDF

2.2 medical management pharmacological interventions for acute exacerbation pharm management recommended for MS 1. methyprednisolone a corticosterioid drug w intention of decreasing inflammation w/in body and provides an immunosuppressive effect to decrease symptoms of attack administration: large d...

2.2 medical management pharmacological interventions for acute exacerbation pharm management recommended for MS 1. methyprednisolone a corticosterioid drug w intention of decreasing inflammation w/in body and provides an immunosuppressive effect to decrease symptoms of attack administration: large doses intravenously for 3-5 days followed by a tapered oral administration many side effects! 1. plasmapheresis -provided after acute exacerbations utilized when pts do not respond well to corticosteroid treatment how its done healthcare professionals extract blood from pt and run it thru machine that separates red blood cells, white blood cells and plasma plasma portion is discarded and replaced w albumin substitution fluid disease modifying agents (DMA) attempt to decrease future disease attacks 4 themes of DMAs 1. need for early disease control to reduce i think we need to know these degree of disability 2. recognizing physical impairments that result from attacks and progression-one aspect of disability that needs to be mitigated 3. variable prognosis amongst pts 14 pharm DMAs approved by FDA 4. treatment adherence and any barriers to adherence-early one DMA is synthetic interferon drugs or beta interferons ex; avonex slows down immune response and prevent activated T cells from crossing BBB kappas and colleagues say deep delay in disability after administration primary progressive MS ocrevus monoclonal antibody that works to deplete B cells from circulating side effects of all these drugs flu like symptoms injection site discomfort rash cardiac toxicity (severe cases) anaphylaxis hepatotoxicity amenorrhea infertility ALL ARE FOR RELAPSING FORMS OF MS spasticity does not moderate symptoms can lead to lethargy and sleepiness 1. oral baclofen in decreasing spasticity consider: oral meds- no regulation of usually 1st to be prescribed and very effective initial administration is low w titration is based on results ???girl what effects on particular region of body pts that rely on spasticity to move can present w flaccidity instead bc of meds 2. tizanidine decreases ability for fxnal intervention 3. dantrolene sodium 4. diazepam (valium) 5. intrathecal baclofen (ITB) more invasive, less sedating pts have to demonstrate lack of efficacy w oral spasmodic and/or adverse effects and no contraindications to surgery administration: small pump inserted w a catheter into intrathecal space of sc to make direct contact with CSF.. pump then able to be titrated thru pts skin if more/less meds needed not local intervention may decrease muscle tone 6. botox used to assist w local spasticity doesnt affect body systemically lasts 3-4 months PT needed to improve length and ex: for this pt they use botox and it helped w his extension proprioceptive aspects of muscle in hopes to decrease ROM deficits 7. tendon lengthening last resort bc it comes w most challenges mostly used for improved QoL pain 1. neuropathic pain: burning type or pins & needles cymbalta® (selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) lyrica® (Pregabalin) to treat pain 2. paroxysmal pain: characterized by erythema of skin and warmth (flushed) w attacks of extreme pain tegretol® (Carbamazepine) elavil® (Amitriptyline) dilantin® (Phenytoin) valium® (Diazepam) neurontin® (Gabapentin) 3. dysesthesias: noxious sensitivities to touch elavil® (Amitriptyline) tofranil® (Imipramine) norpramin® (Desipramine) flashcards fatigue 1. symmetrel (amantadine) 2. provigil (modafinil) 3. fatigue management/exercise: better than meds tremor and nausea 1. Tremor a. antihistamines b. propranolol (Beta Blocker) c. Klonopin® (Clonazepam – Anti deep brain stimulator may be surgically implanted to help manage side effects Anxiety) d. deep Brain Stimulators (DBS) 2. Nausea a. Antivert® (Meclizine) can be used for general nausea b. Zofran® (ondansetron) a,b prescribed c. Phenergan (promethazine) c not very effective cognitive and emotional deficits 1. Cognitive Deficits a. cognitive Retraining b. aricept® (Donepezil) c. namenda® (Memantine) for alzheimer’s 2. Emotional Deficits/Anxiety a. prozac® (Fluoxetine) b. paxil® (Paroxetine) c. zoloft® (Sertraline) treated w consultation of a speech and language pathologist cognitive retaining protocols often used anti anxiety meds depression bowel and bladder deficits 1. neurogenic bladder: unable to control urine output due to NS deficits a. spastic : cause incontinence and abnormal emptying -anticholinergic medications 2. flaccid - crede maneuver: manual downward pressure on abdomen - intermittent self-cathetarization ~4-5x a day 3. both (dyssenergic) - alpha adrenergic blockers - anti-spasmodics pts w MS often have difficulty w bowel impaction caused by constipation 4. bowel programs & dietary recommendations of increasing fiber intake are recommended to prevent stool impaction pts should have an organized toileting routine to improve QoL and social QoL Summary Medical Management of the disease Methylprednisolone Plasmapheresis Disease-Modifying Agents (DMAs) Medical Management of the symptoms Pharmacological agents Patient education