CO Pharmacology & Medication Management 3 — Questions and Answers
Question 1: A patient using selective serotonin reuptake inhibitors (SSRIs) for depression reports increased bruising. Which orthotic design modification is MOST appropriate?
- Avoid all rigid materials
- Add extra padding and soften trim lines to reduce pressure (Correct answer)
- Switch to a bilateral orthotic system
- Prescribe compression stockings beneath the orthosis
Correct answer: Add extra padding and soften trim lines to reduce pressure
SSRIs can impair platelet aggregation, leading to easy bruising; extra padding and careful trim lines minimize pressure that could cause skin breakdown and bruising.
Question 2: Phenytoin (Dilantin) is prescribed for a patient with seizures. Which musculoskeletal side effect should the orthotist be aware of?
- Hyperuricemia causing gout-like joint pain
- Peripheral neuropathy and gingival hyperplasia
- Severe muscle hypertrophy requiring larger orthotic shells
- Hypocalcemia and vitamin D deficiency leading to softened bones (Correct answer)
Correct answer: Hypocalcemia and vitamin D deficiency leading to softened bones
Long-term phenytoin use impairs vitamin D metabolism, leading to hypocalcemia and osteomalacia, which can cause bone pain and stress fractures relevant to orthotic management.
Question 3: A diabetic patient's orthotic fitting reveals areas of erythema that persist 20 minutes after device removal. What is the BEST next step?
- Reassure the patient that erythema is normal skin adaptation
- Adjust the orthosis to relieve pressure and recheck within 24 hours (Correct answer)
- Prescribe topical corticosteroids to the erythematous areas
- Refer to a dermatologist before continuing orthotic use
Correct answer: Adjust the orthosis to relieve pressure and recheck within 24 hours
Persistent erythema exceeding 20 minutes after device removal indicates excessive pressure and requires immediate orthotic adjustment to prevent ulceration, especially in diabetic patients.
Question 4: Which medication used for heart failure can cause bilateral lower extremity pitting edema that complicates orthotic fitting?
- Diuretics
- Calcium channel blockers like amlodipine (Correct answer)
- Digoxin
- Beta-blockers like metoprolol
Correct answer: Calcium channel blockers like amlodipine
Calcium channel blockers, particularly amlodipine, cause peripheral vasodilation and edema as a dose-dependent side effect, directly complicating orthotic fit.
Question 5: A patient taking lithium for bipolar disorder presents with hand tremors. How does this affect upper extremity orthotic goals?
- Tremors are a contraindication to all upper extremity orthotics
- Dynamic stabilization orthoses can help manage fine motor tremor (Correct answer)
- Static resting hand splints are contraindicated due to muscle rigidity
- Upper extremity orthotics have no role when tremors are medication-induced
Correct answer: Dynamic stabilization orthoses can help manage fine motor tremor
Lithium-induced tremors can impair functional hand use, and dynamic stabilization orthoses can help suppress or compensate for tremor during purposeful tasks.
Question 6: A patient on long-term prednisone therapy develops a Charcot-like foot deformity. What is the PRIMARY orthotic goal?
- Correct the deformity through serial casting
- Offload and protect the foot to prevent ulceration and further collapse (Correct answer)
- Prescribe rigid custom insoles to restore arch height
- Avoid all foot orthotics to prevent skin complications
Correct answer: Offload and protect the foot to prevent ulceration and further collapse
Charcot arthropathy management focuses on offloading and protecting the foot from further structural collapse and ulceration rather than attempting deformity correction.
Question 7: A patient prescribed opioid analgesics for chronic back pain presents for spinal orthosis fitting. Which consideration is MOST clinically relevant?
- Opioids increase muscle spasm, requiring a more rigid TLSO
- Sedation and reduced proprioception may affect tolerance and compliance (Correct answer)
- Opioids cause bone softening that changes TLSO design parameters
- Pain relief from opioids eliminates the need for a spinal orthosis
Correct answer: Sedation and reduced proprioception may affect tolerance and compliance
Opioid-induced sedation and reduced proprioceptive awareness may impair the patient's ability to report orthotic discomfort and affect compliance with wearing schedules.
CO Pharmacology & Medication Management 3
A patient using selective serotonin reuptake inhibitors (SSRIs) for depression reports increased bruising.
Which orthotic design modification is MOST appropriate?