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Multiple Sclerosis: An Overview For Pharmacists
Multiple Sclerosis: An Overview For Pharmacists
An Overview for
Pharmacists
What does MS look like?
• Sam—a 45yo divorced white man who has looked and felt
fine since he was diagnosed seven years ago
• Karen—a 24yo single white woman who is severely
depressed and worried about losing her job because of her
diagnosis of MS
• Sandra—a 30yo single mother of two who experiences
severe burning pain in her legs and feet
• Richard—who was found on autopsy at age 76 to have MS
but never knew it
• Jeannette—whose tremors are so severe that she cannot
feed herself
1396: Earliest Recorded Case of MS
From Sister Lidwina to the present…
• MS is not:
Contagious
Directly inherited
Always severely disabling
Fatal—except in fairly rare instances
• Being diagnosed with MS is not a reason to:
Stop working
Stop doing things that one enjoys
Not have children
What Causes MS?
Genetic Environmental
Predisposition Trigger
Immune Attack
Loss of myelin
& nerve fiber
What happens in MS?
“Activated” T cells...
• MS is a clinical diagnosis:
Signs and symptoms
Medical history
Laboratory tests
• Requires dissemination in time and space:
Space: Evidence of scarring (plaques) in at least two
separate areas of the CNS (space)
Time: Evidence that the plaques occurred at different
points in time
• There must be no other explanation
What tests may be used to help
confirm the diagnosis?
• Magnetic resonance
imaging (MRI)
• Lumbar puncture
What is a clinically-isolated syndrome
(CIS)?
The risk is higher in any family in which there are several family
members with the disease (aka multiplex families)
What is the prognosis?
Disability
Time Time
Disability
Disability
Time Time
• Neurologist • Psychiatrist
• Urologist • Psychotherapist
• Nurse • Neuropsychologist
• Physiatrist • Social worker/Care
• Physical therapist manager
• Occupational therapist • Pharmacist
• Speech/language
pathologist
What are the treatment strategies?
• Storage dysfunction
Small, spastic bladder in which small quantity of urine
triggers the urge to void
Sx include: urgency, frequency, incontinence, nocturia
Tx includes: anticiholinergic/antimuscarinic medication
• Emptying dysfunction
Bladder fails to empty risk of UTI
Sx include: urgency, frequency, nocturia, incontinence Tx
includes: ISC and anticholinergic/antimuscarinic medications
Managing Bowel Problems
• Incidence is unknown
• Potentially severely disabling
• No effective treatments at this time
Medications that may be tried:
• propranolol; primidone; acetazolamide; buspirone;
clonazepam
Occupational therapy
• Weighting; assistive devices
Thalamic surgery for tremor (generally poor results)
Serious Complications
• Urosepsis
• Aspiration pneumonia
• Pulmonary dysfunction
• Skin breakdown
• Untreated depression
• Osteoporosis
What can people do to feel their best?
• Diet low in saturated fat and enriched in polyunsaturated fatty acids (may
suppress immune system)
• Acupuncture: anxiety, bladder; depression; pain; sleep
• Massage: anxiety, pain, depression; pain; spasticity
• Meditation: anxiety, pain, depression, pain
• Exercise (T’ai chi; yoga): fatigue; anxiety, depression; weakness; walking
• Cooling: fatigue; spasticity; walking
• Biofeedback: anxiety; pain; sleep; bladder
• Alfalfa • Oligomeric
• proanthocyanidins
Ashwagandha
• Pycnogenol
• Astragalus
• Saw palmetto
• Cat’s claw
• Selenium
• Garlic
• Stinging nettle
• Licorice
• Vitamin A
• Melatonin
• Zinc