Home' Australian Pharmacist : Australian Pharmacist July 2013 Contents 50
Australian Pharmacist July 2013 I ©Pharmaceutical Society of Australia Ltd.
1. Which of the following statements is
a) Duloxetine exerts its analgesic
effects by binding to the mu-opioid
receptor and inhibiting reuptake of
noradrenaline and serotonin.
b) Oxycodone is recommended as part of
the long term management of diabetic
c) Topical capsaicin is well tolerated and
can be used for diabetic neuropathy
d) Tricyclic antidepressants are the
first line treatment for diabetic
2. Which of the following statements
a) Diabetic neuropathy is reversible.
b) Diabetic neuropathy can result in limb
c) Diabetic neuropathy occurs in 60% of
people with diabetes.
d) Tight blood pressure control alone
will slow the progression of diabetic
3. Which of the following statements is
a) Regular podiatry check-ups as well
as daily foot care by the patient
is recommended to prevent foot
complications from diabetic
b) Transcutaneous electrical nerve
stimulation (TENS) devices can be
considered in accelerating foot ulcer
c) Exercise programs can be harmful to
the patient with diabetic neuropathy
due to the potential for further
injury resulting from existing altered
biomechanics of the foot.
d) Target blood pressure ≤ 130/80 mmHg
is recommended to slow the
progression of diabetic neuropathy.
4. Which of the following statements is
a) Evidence to date is showing that
alpha-lipoic acid is involved in
treating the pathogenesis of diabetic
neuropathy and nerve dysfunction.
b) Duloxetine has no significant
affinity for adrenergic, cholinergic,
histaminergic, opioid, glutamate and
GABA receptors, thus starting at an
oral dose of 120 mg per day will be
c) Duloxetine is not suitable for patients
who are heavy drinkers.
d) Nortriptyline is the TCA of choice in
the frail elderly person to minimise
anticholinergic adverse effects.
5. Which of the following statements is
a) Health education on tight blood
glucose control is sufficient for
slowing the progression of diabetic
b) Early pharmacological intervention,
health education on tight blood
glucose and blood pressure control
and self-management strategies with
focus on improving lifestyle factors is
essential for slowing the progression
of diabetic neuropathy.
c) Annual podiatry check-ups are all that
is needed to slow the progression of
d) The effects of tight glycaemic control
on the development of diabetic
neuropathy is only known for type
1 diabetes, thus managing with
a wholistic approach will only be
necessary for those with type 1
• Tight glucose and blood pressure
control is the key to slowing the
progression of diabetic neuropathy
and is achieved by adequate health
education that promotes self-
management of the condition.
• Early disease intervention and
management should be multimodal,
including pharmacological and non-
• Individualised treatment for diabetic
neuropathy should consider
factors such as tolerability, adverse
effects, efficacy, cost-effectiveness,
improvement of sleep, mood, and
quality of life.
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the epidemiology of painful diabetic peripheral neuropathy,
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diabetic peripheral neuropathic pain. Vasc Health Risk Manag Dec
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5. Neuropathic pain. Therapeutic Guidelines; 2013.
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11. Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-
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12. Martin CL, Albers J, Herman WH, et al. Neuropathy among the
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Practice Essentials. Nov 2003;179:498–503.
You advise Simone that the numbness in
her hands and feet is a sign of progressive
diabetes. You explain to her the importance
of addressing factors that may contribute
to unstable diabetes control such as diet,
exercise and medication compliance so that
she gains self-management skills in slowing
the progression of diabetic neuropathy.
You also remind Simone of the importance
of daily foot care even if she is seeing a
podiatrist regularly. You advise her on the
role of duloxetine in the management of
her diabetic neuropathy so that she has the
correct understanding and expectation of
this new medication. Simone is educated
about diabetic neuropathic pain and the
type of pain symptoms to discuss with her
GP. You give Simone written information
about diabetic neuropathy to reinforce
COUNSELLING IN PRACTICE
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