Fundamentals of Nursing Q 382

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A client with diabetic neuropathy reports a burning, electrical type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain?

  

     A. Amitriptyline (Elavil)

     B. Corticosteroids

     C. Methylphenidate (Ritalin)

     D. Lorazepam (Ativan)

    

    

Correct Answer: A. Amitriptyline (Elavil)

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Antidepressants such as amitriptyline can be given for diabetic neuropathy. The American Diabetes Association recommends amitriptyline, a tricyclic antidepressant, as the first choice; however, titration to higher doses is limited by its anticholinergic adverse effects.

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Option B: Corticosteroids are for pain associated with inflammation. Corticosteroids produce their effect through multiple pathways. In general, they produce anti-inflammatory and immunosuppressive effects, protein and carbohydrate metabolic effects, water and electrolyte effects, central nervous system effects, and blood cell effects.

Option C: Methylphenidate is given to counteract sedation if the client is on opioids. Methylphenidate is FDA-approved for the treatment of attention deficit hyperactivity disorder (ADHD) in children and adults and as a second-line treatment for narcolepsy in adults. Children with a diagnosis of ADHD should be at least six years of age or older before being started on this medication.

Option D: Lorazepam is an anxiolytic. Lorazepam has common use as the sedative and anxiolytic of choice in the inpatient setting owing to its fast (1 to 3 minute) onset of action when administered intravenously. Lorazepam is also one of the few sedative-hypnotics with a relatively clean side effect profile.

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