CO Pharmacology & Medication Management 2 — Questions and Answers
Question 1: A patient with diabetes mellitus is prescribed metformin. Which orthotic consideration is MOST important when fitting this patient?
- Monitor for signs of peripheral neuropathy affecting sensation (Correct answer)
- Avoid all thermoplastic materials due to drug interactions
- Prescribe high-top shoes to reduce glucose absorption
- Delay orthotic fitting until metformin is discontinued
Correct answer: Monitor for signs of peripheral neuropathy affecting sensation
Metformin is used for type 2 diabetes, which commonly causes peripheral neuropathy, reducing sensation and increasing ulceration risk in orthotic fitting.
Question 2: Which class of medications can cause osteoporosis as a long-term side effect, directly impacting orthotic prescription goals?
- ACE inhibitors
- Corticosteroids (Correct answer)
- Beta-blockers
- Antihistamines
Correct answer: Corticosteroids
Long-term corticosteroid use reduces bone mineral density, increasing fracture risk and making orthotic offloading and protection critical.
Question 3: A patient taking warfarin presents for a lower extremity orthosis fitting. What special precaution should the orthotist take?
- Avoid all metal components to prevent electromagnetic interference
- Use extra padding to minimize skin breakdown and bleeding risk (Correct answer)
- Prescribe a KAFO instead of an AFO to reduce vascular compression
- Discontinue the orthosis if INR is above 1.0
Correct answer: Use extra padding to minimize skin breakdown and bleeding risk
Warfarin is an anticoagulant that increases bleeding risk, so extra padding reduces the likelihood of skin breakdown that could lead to significant bleeding.
Question 4: NSAIDs like ibuprofen are commonly taken by orthotic patients. Which systemic side effect is MOST relevant to long-term orthotic use?
- Hyperglycemia leading to neuropathy
- Renal impairment and fluid retention causing edema (Correct answer)
- Osteoporosis leading to pathological fractures
- Peripheral vasoconstriction reducing limb perfusion
Correct answer: Renal impairment and fluid retention causing edema
NSAIDs can cause renal impairment and fluid retention, leading to lower extremity edema that affects orthotic fit and requires frequent reassessment.
Question 5: A patient on gabapentin for neuropathic pain reports dizziness and impaired balance. What is the MOST appropriate orthotic response?
- Fit a rigid AFO to fully restrict ankle motion
- Recommend discontinuing gabapentin before orthotic fitting
- Consider gait aids and fall-prevention orthotic strategies (Correct answer)
- Switch to a more flexible orthotic material
Correct answer: Consider gait aids and fall-prevention orthotic strategies
Gabapentin commonly causes dizziness and ataxia; orthotic planning should incorporate fall-prevention strategies such as gait aids and appropriate stability devices.
Question 6: Which medication class used for rheumatoid arthritis can cause joint laxity and soft tissue fragility that directly impacts orthotic design?
- Proton pump inhibitors
- Disease-modifying antirheumatic drugs (DMARDs)
- Corticosteroids (Correct answer)
- Calcium channel blockers
Correct answer: Corticosteroids
Corticosteroids cause skin thinning, soft tissue fragility, and reduced collagen synthesis, requiring carefully padded and trimmed orthotics to prevent injury.
Question 7: A patient treated with bisphosphonates for osteoporosis presents with an atypical femoral fracture. How should this influence the orthotic management?
- Avoid all weight-bearing orthotics permanently
- Provide a protective KAFO to offload the femoral shaft during ambulation (Correct answer)
- Use only soft-goods orthoses to prevent further bone stress
- Refer immediately for orthotic shoe inserts only
Correct answer: Provide a protective KAFO to offload the femoral shaft during ambulation
Atypical femoral fractures associated with bisphosphonate use require protective orthotics such as a KAFO to offload the fracture site and support ambulation.
CO Pharmacology & Medication Management 2
A patient with diabetes mellitus is prescribed metformin.
Which orthotic consideration is MOST important when fitting this patient?