TBL 4

Question 1

To prevent peripheral neuropathy, 200 mg of _____, also known as B6, is given with isoniazid in the treatment of TB.

Answer 1

Pyridoxine

Question 2

Of the following nucleoside reverse transcriptase inhibitors, which is the least likely of causing neuropathy in the treatment of HIV patients?
A. Didanosine
B. Stavudine
C. Zalcitabine

Answer 2

A. Didanosine (up to 23%)

Whereas stavudine is 6-31% and zalcitabine is >30%

Question 3

Which of the following vinca alkaloids is the most neurotoxic and is associated with a 50% incidence of peripheral neuropathy?
A. Vincristine
B. Vinblastine
C. Vinorelbine

Answer 3

A. Vincristine

Question 4

\_\_\_\_\_\_\_ is a class of medications this is known to produce axonal hyperexcitability and repetitive discharges resulting from changes in voltage dependent sodium channels and might produce neuropathy from oxidative stress.
A. Vinca alkaloids
B. Platinums
C. Taxanes
D. Antifungals
E. Antiretrovirals

Answer 4

B. Platinums

Question 5

Arrange the following platinums in order from highest incidence of neuropathy to lowest:
Oxaliplatin, carboplatin, cisplatin

Answer 5

Oxaliplatin > cisplatin > carboplatin

Question 6

Which of the following platinum agents has 2 neuropathy phases: acute and chronic:
A. Oxaliplatin
B. Carboplatin
C. Cisplatin

Answer 6

A. Oxaliplatin

Question 7

The mechanism of peripheral neuropathy of this class of medications is through an effect on axonal transport through disruption of microtubules.
A. Vinca alkaloids
B. Platinums
C. Taxanes
D. Antifungals
E. antiretrovirals

Answer 7

C. Taxanes

Question 8

The risk of peripheral neuropathy is increased with statins when you’ve had exposure to them of > ____ years.

Answer 8

2 years

Question 9

True or False: Peripheral neuropathy that may be experienced with statins is irreversible, even after discontinuation.

Answer 9

False!! It is reversible after discontinuation!

Question 10

True or False: Amiodarone is commonly associated with peripheral neuropathy, and recent data back up previous numbers of 1 or of every 3 patients.

Answer 10

False! Neurological toxicity is significantly lower than that.

Question 11

True or False: Hypothyroidism is a risk factor for drug-induced peripheral neuropathy.

Answer 11

True

Question 12

True or False: linezolid is associated with irreversible peripheral neuropathy.

Answer 12

True

Question 13

All of the following are risk factors for drug-induced peripheral neuropathy except:
A. Alcoholism
B. Diabetes Mellitus
C. Infectious diseases especially HIV
D. Liver or kidney disease
E. Smoking
F. Vitamin B12 deficiency

Answer 13

E. Smoking

Question 14

Which of the following is a drug selective for large myelinated axons, which results in disturbances of proprioception, vibration, and light touch?
A. Cisplatin
B. Paclitaxel

Answer 14

B. Paclitaxel

Question 15

Which of the following drugs is selective for small fibers, which results in pain or dysfunction in temperature sensation?
A. Cisplatin
B. Paclitaxel

Answer 15

A. Cisplatin

Question 16

_______ is a phenomenon where the distal portion of the axon degenerates and myelin sheath begins to break down more proximally toward the cell body.

Answer 16

“Dying back” phenomenon

Question 17

Deficiency of vitamin B12 can cause peripheral neuropathy. Vitamin B12 serum concentration ≤ ___ pg/mL usually indicates deficiency

Answer 17

100

Question 18

Non-steroidal anti-inflammatory drugs or acetaminophen are useful as first line agents in the treatment of neuropathic pain because they do not require a prescription, so they are useful when needed immediately. What are the proper doses for ibuprofen, naproxen, and acetaminophen OTC.

Answer 18

Ibuprofen: 200-400 mg every 4-6 hours as needed; max 1200 mg/day.
Naproxen: 200-400 mg every 8-12 hours as needed
Acetaminophen 500-1,000 mg every 6 hours as needed; max 3,000 mg/day.