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CC May 2016 Diabetic peripheral neuropathy (DPN)

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echoecho's version from 2016-07-24 17:39

Section

Question Answer
List the several types of diabetic neuropathy?1) symmetrical polyneuropathy (diabetic peripheral neuropathy {DPN}) 2) autonomic neuropathy 3) polyradiculopathy 4) mononeuropathy
Which of the several types of diabetic neuropathy is the most common and what does it present with?1) diabetic peripheral neuropathy 2) presents with loss of sensation in a symmetrical distribution
In severe cases, DPN may cause what?motor loss
Once DPN develops, does glycemic control reverse the condition?no
What is of key importance regarding DPN?prevention
*** There is high-quality evidence that good glycemic control significantly reduces the risk of developing DPN in patients with which type of diabetes (type 1 vs type 2)? type 1
*** In clinical trials, enhanced glucose control in patients with what type of diabetes (type 1 vs type 2) non-significantly reduces the risk of developing clinical DPN, but at the risk of an increased incidence of hypoglycemia?type 2
In those with type 2 DM, the studies did show a reduction in abnormalities on tests of neuropathy, give an example of a test?nerve conduction
What care of a the diabetic patient's body part is vital for patients with diabetes?foot care (should have regular foot exams and daily exam of the feet by patient and appropriate footwear)
Patients with type 1 DM for > ____ years and all patients with type 2 DM should be screened for DPN using both med hx and physical exam?1
List the typical symptoms of early DPN?pain, burning, tingling
List the typical symptoms of late DPN?when larger nerve fibers are affected (numbness and loss of protective sensation) and development of a symmetric "glove-stocking" distribution
List the screening tests recommended by the ADA?1) pinprick and temperature sensation (small fiber neuropathy) 2) 10-g monofilament and vibration perception (large fiber neuropathy)
List the web site on how to perform a monofilament test? http://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=toolsFCMono
Is formal electrophysiology testing needed to dx DPN?rarely
DPN should be considered a dx of _____?exclusion
Patients with symptoms of neuropathy should be evaluated for what other medical conditions?1) vit B12 deficiency 2) hypothyroidism 3) renal disease 4) malignancy (especially multiple myeloma and lung cancer) 5) HIV 6) toxinx (alcohol)
A small percentage of patients with DPN will develop painful DPN. List the cases where painful DPN resolves spontaneously?1) when the onset of the DPN is associated with a sudden metabolic change (ketoacidosis) 2) short duration of diabetes 3) marked weight loss that occurred PRIOR to pain onset
For the majority of patients, the pain is ____ and can be debilitating?chronic
List the 3 medications approved by the FDA for treatment of painful DPN?1) pregabalin (Lyrica) 2) duloxetine (Cymbalta) 3) tapentadol (Nucynta)
What is Tapentadol?an opioid analgesic with potential for use and abuse
Even when used in combination, these treatments do not provide complete symptom relief, true or false?true
List other medications used for treating symptoms of painful DPN?1) TCAs 2) gabapentin (Neurontin) 3) venlafaxin (Effexor) 4) carbamazepine (Tegretol) 5) Tramadol (Ultram) 6) topical capsaicin
The American Academy of Neurology provides guidelines on the treatment of painful DPN based on strength of evidence. List the strength of evidence and their recomemndations? 1) strong (Pregabalin should be offered) 2) Moderate (Gabapentin and sodium valproate should be considered. Amitriptyline, venlafaxine and duloxetine should be considered. Dextromethorphan, morphine, Tramadol (Ultram) and Oxycodone (although concerns regaridng chronic use of opioids was raised in the guideline) should be considered. Capsaicin and isosorbide dinitrate spray should be considered 3) Weak ( Venlafaxine may be added to Gabapentin for better response. Lidoderm patch may be considered 4) Insufficient (Topiramate (Topamax). Desipramine (Norpramin, imipramine (Tofranil), fluoxetine (Prozac) or the combination of nortriptyline (Pamelor) and Fluphenazine)
The American Academy of Neurology guidline on the treatment of painful DPN states what 3 drugs should NOT be considered for treatment?1) Oxcarbazepine (Trileptal) 2) Lamotrigine (Lamictal) 3) Lacosamide (Vimpat)
*** A 2014 Cochrane review concluded that there is moderate-quality evidence from manufacturer-sponsored trials that ________ in doses of 60 mg and 120 mg is effective in the treatment of DPN?duloxetine
A 2013 Cochrane review found that the only antiepileptic drugs with evidence of improved symptoms of painful DPN are what?1) gabapentin 2) pregabalin
*** SUMMARY = DPN is the most common neuropathy in patients with diabetes and presents how?loss of sensation symmetrical distribution and in severe cases there may be motor loss
*** SUMMARY = Patients with type 1 DM for > ____ years and all pts with type 2 DM should be screened for DPN using both med hx and physical exam?5
*** SUMMARY = What 3 medications have the best evidence to support their use for painful DPN?1) gabapentin (Neurontin) 2) pregabalin (Lyrica) 3) duloxetine (Cymbalta)
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