TY - CHAP M1 - Book, Section TI - Multiple Sclerosis A1 - Bainbridge, Jacquelyn L. A1 - Miravalle, Augusto A1 - Wong, Pei Shieen A2 - DiPiro, Joseph T. A2 - Talbert, Robert L. A2 - Yee, Gary C. A2 - Matzke, Gary R. A2 - Wells, Barbara G. A2 - Posey, L. Michael PY - 2017 T2 - Pharmacotherapy: A Pathophysiologic Approach, 10e AB - Patient Care Process for Multiple SclerosisCollect:Patient specific demographics such as age, race, gender, geographical places of residence before or after the age of 15, current smoking level and history, family history of MS, and previous infection with certain viruses.Laboratory values such as vitamin D, liver function tests, complete metabolic panel, and complete blood countMagnetic Resonance Imaging (MRI) of brain and spinal cord with and without contrastLumbar puncture for oligoclonal bandsVisual evoked potential resultsOptical coherence tomography (OCT)Current diagnosis and date of initial diagnosis and current and past medications.Assess:Clinical classification of MS (RRMS, SPMS, PPMS, or PRMS)Progression of diseases using the Expanded Disability Status Scale (EDSS), and MRITotal number of disease exacerbations or relapsesDuration of therapy and dose for current and past medications, side effects experienced during treatment, and medication adherence.Plan:Choose a therapy that has the best risk vs. benefit profile for use in the specific form of MS diagnosed, as well as patient specific characterizations and previous treatment history.Choose a therapy with the best adherence profile (twice yearly infusion vs. 3 times weekly injectable), and more tolerable side effects based on stratified risk factors (JC virus).Create a patient specific monitoring plan based on the therapy chosenIdentify presence of secondary symptoms requiring pharmacologic managementImplement:Start primary MS therapy as soon as possible to decrease the chance for disease progression during treatment changes.Add pharmacologic treatment for secondary symptoms when appropriateDiscuss with patients the role of complementary and alternative treatmentsFollow up: Monitor and EvaluateSafety of current DMT at each visit to ensure the current treatment is best fitted for the specific patient case.Monitor for common side effects with each specific DMT, or any side effects that are new once therapy is initiated or changed.Treatment response (reduction in primary, secondary and tertiary symptoms of MS) or the occurrence of exacerbations and relapses.Change in lesions via yearly MRI.Change in daily functioning using the Expanded Disability Status Scale (EDSS) and other clinical factors used to predict MS prognosis. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1164369497 ER -