Neuropathy Neuropathy Medications and Drug-Induced Neuropathy 2 — Questions and Answers
Question 1: Thalidomide, used in multiple myeloma, causes a neuropathy that is predominantly which type?
- Motor neuropathy
- Sensory-predominant axonal neuropathy (Correct answer)
- Acute demyelinating neuropathy
- Autonomic neuropathy
Correct answer: Sensory-predominant axonal neuropathy
Thalidomide causes a cumulative-dose-dependent sensory axonal neuropathy, often irreversible, that limits its clinical use.
Question 2: Disulfiram (Antabuse), used in alcohol use disorder, can cause neuropathy through which mechanism?
- Thiamine depletion
- Inhibition of axonal transport by blocking dopamine beta-hydroxylase (Correct answer)
- Direct myelin toxicity
- Immune-mediated nerve attack
Correct answer: Inhibition of axonal transport by blocking dopamine beta-hydroxylase
Disulfiram inhibits dopamine beta-hydroxylase and other enzymes critical for axonal transport, leading to peripheral neuropathy.
Question 3: Which antiepileptic drug has been associated with causing a reversible peripheral neuropathy with long-term use?
- Levetiracetam
- Phenytoin (Correct answer)
- Valproate
- Lamotrigine
Correct answer: Phenytoin
Long-term phenytoin use can cause peripheral neuropathy, particularly affecting sensory fibers, as a recognized adverse effect.
Question 4: Linezolid, an antibiotic for resistant gram-positive infections, causes peripheral neuropathy through which toxic mechanism?
- Blocking nerve sodium channels
- Mitochondrial protein synthesis inhibition (Correct answer)
- Folate antagonism in Schwann cells
- Autoimmune mimicry
Correct answer: Mitochondrial protein synthesis inhibition
Linezolid inhibits mitochondrial ribosomal protein synthesis, leading to peripheral neuropathy with prolonged use.
Question 5: Amiodarone, an antiarrhythmic drug, is associated with which type of neuropathy?
- Acute motor axonal neuropathy
- Demyelinating polyneuropathy resembling CIDP (Correct answer)
- Pure autonomic neuropathy
- Mononeuritis multiplex
Correct answer: Demyelinating polyneuropathy resembling CIDP
Amiodarone can cause a demyelinating polyneuropathy similar to CIDP, as the drug and its metabolite accumulate in lysosomes of Schwann cells.
Question 6: Which immunosuppressant used in organ transplantation is a recognized cause of peripheral neuropathy?
- Mycophenolate mofetil
- Tacrolimus (FK506) (Correct answer)
- Azathioprine
- Hydroxychloroquine
Correct answer: Tacrolimus (FK506)
Tacrolimus can cause peripheral neuropathy in transplant patients, thought to be related to its calcineurin inhibition affecting Schwann cells.
Neuropathy Neuropathy Medications and Drug-Induced Neuropathy 2
Thalidomide, used in multiple myeloma, causes a neuropathy that is predominantly which type?