A physical therapist reviews the current pain management protocol of a patient three days post total hip arthroplasty. Which of the following medications would the patient MOST likely have been prescribed for breakthrough pain as needed?

1. Acetaminophen (1,000 milligrams)
2. Meloxicam (15 milligrams)
3. Oxycodone (5 milligrams)
4. Tramadol (100 milligrams)

Transcript

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.

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A physical therapist reviews the current pain management protocol of a patient three days post total hip arthroplasty. Which of the following medications would the patient MOST likely have been prescribed for breakthrough pain as needed?

1. Acetaminophen (1,000 milligrams)
2. Meloxicam (15 milligrams)
3. Oxycodone (5 milligrams)
4. Tramadol (100 milligrams)

Breakthrough Pain

Breakthrough pain is a sudden and brief flare-up of pain that becomes severe enough to “break through” the management of pain from the current regular dosing regimen of pain medications. Breakthrough pain may occur following surgery if the effects of the patient’s current pain medication start to wear off before it’s time for the next dose. Breakthrough pain is usually treated with a “rescue medication” that can relieve pain quickly, but only lasts a short period of time. 

Let’s explore each of the options:

Option 1 – Acetaminophen (1,000 milligrams)

Acetaminophen is a nonopioid analgesic used to treat mild to moderate pain. A typical dosage following surgery is 1,000 milligrams every four to six hours. The maximum dosage should not exceed 4,000 milligrams in a 24-hour period in order to prevent toxic levels that have the potential for liver damage. Acetaminophen would therefore not be helpful for breakthrough pain.

Option 2 – Meloxicam (15 milligrams)

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that is used to treat pain and inflammation often caused by arthritis. Typical doses of this NSAID are 7.5 to 15 milligrams per day. Meloxicam would not be used to treat breakthrough pain.

Option 3 – Oxycodone (5 milligrams)

Oxycodone is an opioid agent used to treat moderate to severe pain.  A dose of 5 milligrams is an immediate-release, short-acting dosage often used for breakthrough pain. Dosages for oxycodone that are used to maintain pain control following surgery are typically 10 milligrams or higher with extended release. 

Option 4 – Tramadol (100 milligrams)

Tramadol is a narcotic-like medication used to treat moderate to severe pain. A typical dosage of tramadol for post-operative pain management would be 100 milligrams every four to six hours with a maximum dosage of usually 400 milligrams per day. A 100 mg dose of tramadol would not be appropriate for the treatment of breakthrough pain.

The correct answer is Option 3.

Warning! Lowest Dose - Shortest Duration

Current guidelines recommend prescribing the lowest effective dose of opioids for the shortest possible duration to minimize the risks of dependence, addiction, and side effects. There is significant concern about the potential for opioid misuse and addiction, even after a short course of treatment following surgery.

Let’s explore the all student data:

23% of students selected Option 1 -  Acetaminophen (1,000 milligrams)
4% of students selected Option 2 - Meloxicam (15 milligrams)
60% of students selected Option 3 - Oxycodone (5 milligrams) – the correct response
13% of students selected Option 4 - Tramadol (100 milligrams)

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 & 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? Check out pages 135-136, 141, 198-199 in PTEXAM: The Complete Study Guide.
 
Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!