Pharmacology · chapter 11 · Drugs to Treat Parkinson’s Disease and Multiple Sclerosis
Introduction to Multiple Sclerosis
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
What MS does to nerves
This disease is characterized by a progressive and irreversible demyelination and axonal degeneration of the brain, spinal cord, and optic nerves.
Why myelin matters
It allows rapid conduction of a nerve impulse down the axon. Degeneration of the myelin sheath results in the inability of nerves to conduct electrical impulses.
Remissions and exacerbations
Typically, the client experiences remission s and exacerbations throughout the progression. Sensory and motor deficits become worse as the client ages.
MS is autoimmune
MS is an autoimmune disorder that occurs when there is a malfunction of the immune system and the body mistakenly attacks its own tissue. In this case, it attacks the myelin sheath of the CNS.
Risk factors
Other potential risk factors include geographic location, exposure to heavy metals, cigarette smoking (contributes to inflammation), lack of sunlight exposure, and deficient vitamin D levels.
No definitive test
Diagnosis is sometimes delayed because there is no definitive test for MS, and many early clinical manifestations are subtle and correlate with other diagnoses.
MRI with contrast
An MRI test with contrast is the most sensitive method available to identify areas of demyelination.
What the CSF shows
Clients with MS have high protein levels, oligoclonal bands (OCBs), IgG/IgM, and T and B lymphocytes in their CSF.
Triggers of exacerbation
Some clients will have very little disability, whereas others experience a steady decline with increasing disability. Fever, sun exposure, and stress can trigger exacerbations.
Relapsing-remitting form
The most common form of MS is the relapsing-remitting form, which consists of brief episodes of several weeks to 3 months. These episodes are followed by a complete or almost complete return to baseline.
Primary-progressive form
The primary-progressive form does not have any remissions or exacerbations. The onset of this form is around age 40.
Goals of drug therapy
There is currently no cure for MS; however, the use of drugs has made a significant difference in the lives of those with MS. Most of the drugs target specific symptoms, reduce relapse rates, and delay progression.
IV glucocorticoids for acute relapse
These drugs suppress inflammation and can reduce the severity and duration of an attack. When used short-term, these drugs are safe except for a possible elevation of blood glucose levels.
Harms of long-term steroids
In contrast, long-term use (e.g., over 3 weeks) can cause multiple adverse effects in numerous areas of the body, including adrenal insufficiency leading to fluid and electrolyte imbalances, osteoporosis, high risk for infections, myopathy, and psychological disturbances (agitation, anxiety, or irritability).
Terms to know
- Lhermitte sign
- Some clients experience Lhermitte sign, an electrical shock–like sensation that runs down the back and into the limbs.
- Myelin
- Myelin is a protective sheath that acts as an insulator of the electrical signal.
- gliotic plaques
- As the myelin deteriorates, oligodendrocytes repair the damage but also form scar tissue called gliotic plaques.
- Plasmapheresis
- Plasmapheresis (removal of abnormal antibodies) can be done for those who do not respond well to drugs.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
A client with relapsing-remitting MS asks how to reduce the chance of a flare. Which advice matches the known triggers?
- Take long hot baths to relax the muscles.
- Stop all exercise.
- Avoid overheating, long sun exposure and high stress when possible.
- Stay in bed most of the day.
Answer: Avoid overheating, long sun exposure and high stress when possible.
Fever, sun exposure and stress can trigger MS exacerbations, so limiting them is reasonable. Bed rest and stopping exercise go against the advice to include exercise in the daily routine, and heat is not relaxing for this client.
A client with MS reports an electric shock sensation running down the back into the legs when bending the head forward. The nurse recognizes this as:
- Dysarthria
- Nystagmus
- Ataxia
- Lhermitte sign
Answer: Lhermitte sign
Lhermitte sign is an electrical shock-like sensation down the back into the limbs, mainly when the head bends forward. Nystagmus is an eye movement problem, ataxia is a coordination problem and dysarthria is a speech problem.
A client with MS is receiving a short course of high-dose IV methylprednisolone for an acute relapse. Which assessment should the nurse monitor most closely during this short course?
- Serum vitamin D
- Blood glucose
- Bone density
- Visual acuity
Answer: Blood glucose
Short-term glucocorticoids are safe except for a possible rise in blood glucose. Osteoporosis is a risk of long-term use, and vision and vitamin D are not effects of the short course described.
A nurse is assessing a client newly diagnosed with MS. Which findings are consistent with the disease? Select all that apply.
- Urinary urgency
- Numbness and tingling in the extremities
- Double vision
- Fatigue and loss of recent memory
- Pill-rolling resting tremor
Answer: Urinary urgency, Numbness and tingling in the extremities, Double vision, Fatigue and loss of recent memory
Diplopia, sensory deficits, elimination problems such as urgency, and cognitive changes such as fatigue and memory loss are characteristic manifestations of MS. A pill-rolling resting tremor is not listed among MS manifestations.
A client with MS has been on oral glucocorticoids for two months. Which complications should the nurse watch for? Select all that apply.
- Infection
- Agitation or irritability
- Fluid and electrolyte imbalance
- Improved bone strength
- Osteoporosis
Answer: Infection, Agitation or irritability, Fluid and electrolyte imbalance, Osteoporosis
Long-term glucocorticoid use can cause adrenal insufficiency with fluid and electrolyte imbalance, osteoporosis, high infection risk, myopathy and psychological disturbances. It weakens bone rather than strengthening it.
A client asks why an MRI was ordered to check for multiple sclerosis. What is the nurse's best response?
- MRI replaces the need for a neurological examination.
- MRI confirms the Epstein-Barr virus.
- MRI measures vitamin D in the brain.
- MRI with contrast is the most sensitive way to find areas of demyelination.
Answer: MRI with contrast is the most sensitive way to find areas of demyelination.
MRI with contrast is the most sensitive method to identify demyelination. It does not detect viruses or vitamin D, and a thorough history and neurological examination remain the first steps.
Where every quote comes from
Section 11.3 Introduction to Multiple Sclerosis of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.