Neuropathy Neuropathy Medications and Drug-Induced Neuropathy 1 — Questions and Answers
Question 1: Which antiretroviral drug class is most commonly associated with antiretroviral toxic neuropathy (ATN)?
- Protease inhibitors
- Nucleoside reverse transcriptase inhibitors (NRTIs) (Correct answer)
- Integrase inhibitors
- CCR5 antagonists
Correct answer: Nucleoside reverse transcriptase inhibitors (NRTIs)
Older NRTIs (stavudine, didanosine, zalcitabine) cause mitochondrial toxicity in peripheral nerves, producing a painful sensory neuropathy.
Question 2: Bortezomib (Velcade), used in multiple myeloma, causes neuropathy through which primary mechanism?
- Autoimmune demyelination
- Disruption of axonal transport and mitochondrial dysfunction (Correct answer)
- Direct myelin protein degradation
- Inflammatory cytokine release
Correct answer: Disruption of axonal transport and mitochondrial dysfunction
Bortezomib causes peripheral neuropathy by disrupting axonal transport and inducing mitochondrial dysfunction in dorsal root ganglion neurons.
Question 3: Pyridoxine (vitamin B6) toxicity from mega-dose supplementation causes which type of neuropathy?
- Motor neuropathy with foot drop
- Pure sensory ganglionopathy with sensory ataxia (Correct answer)
- Autonomic neuropathy with orthostatic hypotension
- Cranial neuropathy affecting vision
Correct answer: Pure sensory ganglionopathy with sensory ataxia
Excessive vitamin B6 causes a sensory ganglionopathy by directly damaging dorsal root ganglion neurons, producing sensory ataxia.
Question 4: Which antibiotic is associated with peripheral neuropathy, particularly with prolonged use or in patients with renal failure?
- Amoxicillin
- Metronidazole (Correct answer)
- Doxycycline
- Azithromycin
Correct answer: Metronidazole
Metronidazole can cause peripheral neuropathy with prolonged use, particularly affecting sensory fibers, and risk increases in renal impairment.
Question 5: Colchicine toxicity causing neuromuscular complications presents as which pattern?
- Pure sensory neuropathy with paresthesias
- Neuromyopathy with proximal weakness and elevated CK (Correct answer)
- Acute demyelinating polyneuropathy
- Mononeuritis multiplex
Correct answer: Neuromyopathy with proximal weakness and elevated CK
Colchicine toxicity typically causes a combined neuromyopathy with proximal muscle weakness and elevated creatine kinase, especially in renal failure.
Question 6: Which lipid-lowering medication class is associated with a small but recognized risk of peripheral neuropathy?
- Fibrates
- Bile acid sequestrants
- Statins (Correct answer)
- Niacin
Correct answer: Statins
Statins carry a small risk of peripheral neuropathy, thought to be related to mitochondrial dysfunction and coenzyme Q10 depletion.
Neuropathy Neuropathy Medications and Drug-Induced Neuropathy 1
Which antiretroviral drug class is most commonly associated with antiretroviral toxic neuropathy (ATN)?