Episode 14 - Pharmacology – Side Effects

A physical therapist reviews a patient’s medication list as part of an examination. The patient is ten days post left total hip arthroplasty. Which medication would MOST likely prohibit the patient from driving? 

1. Celecoxib (Celebrex)
2. Meloxicam (Mobic)
3. Methylprednisolone (Medrol)
4. Tramadol (Ultram)

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A physical therapist reviews a patient’s medication list as part of an examination. The patient is ten days post left total hip arthroplasty. Which medication would MOST likely prohibit the patient from driving? 

1. Celecoxib (Celebrex)
2. Meloxicam (Mobic)
3. Methylprednisolone (Medrol)
4. Tramadol (Ultram)

Physical therapists should review the list of all medications a patient is currently taking to assess the potential impact the pharmacological treatment may have on any interventions included in the plan of care and on the patient’s ability to safely participate in functional activities and exercise. Pharmacological intervention post total hip arthroplasty will routinely include pain medications, anti-inflammatories, and anticoagulants.

Pharmacology can be a tricky area to study since it can quickly become a black hole. There are literally thousands of potential medications and it’s impossible to know them all. My recommendation is to study only common categories of medications and focus on five specific items:

Pharmacology Focus Areas:

Action
Indications
Side Effects
Implications for PT
Examples

Let’s make the Pharmacology Focus Area come to life with a representative example. 

Beta Blocker Agents
Action: decrease the myocardial oxygen demand by decreasing heart rate and contractility

Indications: hypertension, angina, arrhythmias, heart failure

Side effects: bradycardia, cardiac arrhythmias, fatigue, depression, dizziness, weakness, blurred vision

Implications for PT: Heart rate and blood pressure response to exercise will be diminished. Rate of perceived exertion may be used to monitor exercise intensity. Closely monitor patients during positional changes due to an increased risk for orthostatic hypotension.

Examples: Atenolol (Tenormin), Metoprolol (Lopressor)

Sure this is a fair amount of information, but you will be doing this for only the most mainstream classes of pharmacological agents. 

Remember, the question is asking which medication would most likely prohibit a patient that is ten days post left total hip arthroplasty from driving?

Let’s explore each of the options:

Option 1 - Celecoxib (Celebrex)
Celecoxib (Celebrex) is a nonsteroidal anti-inflammatory drug (NSAID) that is specifically classified as a COX-2 inhibitor. COX-2 inhibitors may cause less gastric irritation side effects than are seen with traditional NSAIDs, but may cause serious cardiovascular events (e.g., stroke, heart attack), especially in patients with other cardiovascular risk factors (e.g., hypertension). Taking celecoxib (Celebrex) would not prohibit a patient from driving.

Option 2 - Meloxicam (Mobic)
Meloxicam (Mobic) is a nonsteroidal anti-inflammatory drug (NSAID) that is used to treat pain and inflammation caused by arthritis. The side effects associated with NSAIDs, primarily gastrointestinal discomfort, are unlikely to have a negative effect on physical therapy sessions and would not prohibit a patient from driving.

Option 3 - Methylprednisolone (Medrol)
Methylprednisolone (Medrol) is a corticosteroid used to treat inflammation. Common side effects include weakening with breakdown of supporting tissues (e.g., bone, ligament, tendon), gastrointestinal distress, drug-induced Cushing’s syndrome, and mood changes. Taking methylprednisolone (Medrol) would not prohibit a patient from driving.

Option 4 - Tramadol (Ultram)
Tramadol (Ultram) is a narcotic-like medication used to treat moderate to severe pain. Common side effects include sedation, mood swings, dizziness, constipation, and dulled cognitive function. Patients should be off of all narcotics prior to driving following surgery.

My guess is that a reasonable percentage of students that attempted to generate an answer to the question prior to reviewing the options immediately thought of opioids. If you did this, you were half way home, but still would have needed to recognize that Tramadol (Ultram) was within the opioid family. 

The correct answer is Option 4

Let’s explore the all student data:
12% of students selected Option 1, Celecoxib (Celebrex)
10% of students selected Option 2, Meloxicam (Mobic)
15% of students selected Option 3, Methylprednisolone (Medrol)
63% of students selected Option 4, Tramadol (Ultram), the correct response

System Classification
This question is a Musculoskeletal System question which represents approximately 27% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 2 question since the question requires students to integrate numerous pieces of information or to apply knowledge in a given clinical scenario. Remediation of Level 2 questions occurs by increasing flexibility with academic content and by carefully analyzing decision making processes when answering applied examination questions.

Academic Focus Area
Looking to review related academic content? Pages 126-127 from our review book PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!

Watch the video version of this Q&A episode on YouTube - https://youtu.be/N8NPOHKBswU