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Topic 14 DQ 1-Neuropathy Management

Topic 14 DQ 1-Neuropathy Management

Sample Answer 

Topic 14 DQ 1-Neuropathy Management

Neuropathy Management

Neuropathy is the damage of nerves that may result in pain, numbness, or muscle weakness in the site affected. Mostly, neuropathy starts in the limbs and may involve other body areas too. Peripheral neuropathy is the most common type of neuropathy which is due to problems in the peripheral nervous system (Voican CS et al., 2014). Some causes of neuropathy include diabetes, trauma, an autoimmune disorder, infections, and even some medication

A couple of drugs can be used to manage neuropathy, with amitriptyline being the most commonly used drug in neuropathic management. Amitriptyline is a tricyclic antidepressant that has found use in the management of neuropathic pain. The metabolism of amitriptyline is affected by genetic polymorphism in that it is metabolized via CYP2C19 and CYP2D6. Metabolism by CYP2C19 leads to active metabolites, while that by CYP2D6 leads to less active hydroxyl metabolites. There are ultrarapid CYP2D6 and CYP2C19 metabolizers and CYP2C19 and CYP2D6 poor metabolizers (Voican CS et al., 2014). For ultrarapid metabolizers, there is a possibility of no efficacy warranting avoidance of amitriptyline. In both genetic variations, if it turns out to be poor metabolizers, then dose reductions up to 50% are recommended so as to avoid side effects.

Amitriptyline acts by blocking the activity of serotonin transporter and norepinephrine transport, blocking the reuptake of serotonin and norepinephrine, therefore increasing the concentrations of these two neurotransmitters in the synaptic cleft (Rabenda V et al., 2013). Monitoring of patients on amitriptyline helps dictate its continuity; some of these include baseline electrocardiograms for patients over 50 years, liver function tests, and serum amitriptyline concentration. Side effects include orthostatic hypotension, dizziness, arrhythmias, and blurred vision (Voican CS et al., 2014). Drug interactions occur with monoamine oxidase inhibitors, which increase amitryptiline toxicity; when used together with procarbazine, it results in serotonin syndrome. Additionally, interaction with ST John’s wort (Hypericum perforatum) reduces its concentration as it induces the CYP450 system (Rabenda V et al., 2013).

Amitriptyline has been used in a randomized controlled clinical trial to determine its ability to manage neuropathy, and in this case, it has been used in managing lower back pain, one of the major clinical and public health problems.

References

Rabenda, V., Nicolet, D., Beaudart, C., Bruyère, O., & Reginster, J. Y. (2013). Relationship between use of antidepressants and risk of fractures: A meta-analysis. Osteoporosis International, 24(1), 121–137. https://doi.org/10.1007/s00198-012-2015-9

Voican, C. S., Corruble, E., Naveau, S., & Perlemuter, G. (2014). Antidepressant-induced liver injury: A review for clinicians. In American Journal of Psychiatry (Vol. 171, Issue 4, pp. 404–415). American Psychiatric Association. https://doi.org/10.1176/appi.ajp.2013.13050709

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Question 


Topic 14 DQ 1-Neuropathy Management

Select a medication and discuss the ethnic, cultural, or genetic differences that must be considered in its use to treat neuropathy. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including interactions with CAM. In addition, include a clinical trial related to the use of this medication for neuropathy. Include the name of the medication in the subject line so that the medications can be followed. Include references using APA format.

Topic 14 DQ 1-Neuropathy Management

Topic 14 DQ 1-Neuropathy Management

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