AOTA Pharmacology & Medication Management 3 — Questions and Answers
Question 1: A school-based OT is developing a sensory diet for a child on clonidine. How should the medication's sedative properties influence scheduling of therapy?
- Schedule high-alerting activities immediately after the child takes clonidine
- Time alerting sensory activities when clonidine's peak effect has subsided (Correct answer)
- Avoid all vestibular activities due to clonidine's cardiovascular effects
- Use clonidine's sedative effect to introduce deep-pressure massage
Correct answer: Time alerting sensory activities when clonidine's peak effect has subsided
Scheduling alerting sensory activities when clonidine's sedative peak has passed maximizes the child's capacity to engage and benefit from treatment.
Question 2: Which medication used in autism spectrum disorder management has been shown in research to reduce repetitive sensory-seeking behaviors?
- Methylphenidate
- Aripiprazole (Correct answer)
- Sertraline
- Dextroamphetamine
Correct answer: Aripiprazole
Aripiprazole (Abilify) is FDA-approved for irritability in autism and has been shown to reduce repetitive behaviors, which can include stereotyped sensory-seeking patterns.
Question 3: An OT reviews a chart and sees a client is on a medication with known anticholinergic properties. Which sensory system function should the OT monitor most closely?
- Tactile discrimination
- Proprioceptive processing
- Vestibular ocular reflex
- Interoceptive awareness including dry mouth and vision changes (Correct answer)
Correct answer: Interoceptive awareness including dry mouth and vision changes
Anticholinergic medications block muscarinic receptors, causing dry mouth, blurred vision, and constipation, all of which affect interoceptive awareness relevant to occupational function.
Question 4: During a sensory integration session, a child on stimulant medication exhibits a 'rebound effect' as the drug wears off. How should the OT adjust the session plan?
- Increase the intensity of proprioceptive input during rebound to maximize gains
- Use calming, organizing activities as the medication wears off to support self-regulation (Correct answer)
- Avoid all physical activities during the rebound period
- Document the rebound and cancel remaining therapy for the day
Correct answer: Use calming, organizing activities as the medication wears off to support self-regulation
The stimulant rebound often causes increased irritability and dysregulation, so organizing and calming sensory activities support the child's nervous system during this transition.
Question 5: A pediatric OT is consulting about a child whose melatonin supplementation has been increased. What sensory integration consideration becomes most relevant?
- Risk of increased tactile hypersensitivity during waking hours
- Possible residual drowsiness affecting morning alertness and engagement (Correct answer)
- Hyperactivation of the vestibular system during the day
- Reduction of proprioceptive thresholds requiring lower-intensity input
Correct answer: Possible residual drowsiness affecting morning alertness and engagement
Higher melatonin doses can cause residual morning drowsiness, which reduces a child's readiness for alerting sensory activities often scheduled in morning therapy slots.
Question 6: Which pharmacological property is most important for an OT to understand when working with clients on lithium?
- Its tendency to increase fine motor tremors at therapeutic levels (Correct answer)
- Its enhancement of serotonin receptor sensitivity
- Its suppression of the vestibular ocular reflex
- Its blockade of tactile receptor transmission
Correct answer: Its tendency to increase fine motor tremors at therapeutic levels
Lithium commonly causes fine motor tremors even at therapeutic serum levels, which is directly relevant to OT goals involving upper-extremity dexterity and handwriting.
Question 7: A child taking valproate (Depakote) for seizures is referred to OT. Which potential nutritional side effect should the OT be aware of due to its impact on neurological function?
- Vitamin D deficiency leading to bone fragility
- Carnitine depletion affecting mitochondrial energy and motor fatigue (Correct answer)
- Iron-deficiency anemia reducing tactile sensitivity
- Magnesium excess increasing muscle tone
Correct answer: Carnitine depletion affecting mitochondrial energy and motor fatigue
Valproate can deplete carnitine, impairing mitochondrial energy metabolism and contributing to muscle weakness and fatigue that affect motor and sensory performance in OT sessions.
AOTA Pharmacology & Medication Management 3
A school-based OT is developing a sensory diet for a child on clonidine.
How should the medication's sedative properties influence scheduling of therapy?