NABP NAPLEX Exam - Topic 5 Question 107 Discussion

Actual exam question for NABP's NAPLEX exam

Question #: 107
Topic #: 5

LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.

His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN's medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS

with 20K at 125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1mg. lock-out every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/ dl, K 5.0mmol/L, Na 135mmol/L. Day 3 post-operation LN's pain was much better and only used 3 mg of hydromorphone in the 24hrs.

Physician wants to change to oral morphine. What would be your best recommendation?

AMorphine SR 10mg po daily and morphine 5mg po q6h prn for breakthrough pain

BMorphine 60mg ER po daily and morphine 15mg po q6h prn breakthrough pain

CMorphine 30mg ER po q6hr and morphine 5mg q6h prn for breakthrough pain

DMorphine 15mg ER po q12hr and morphine 15mg po q6h prn for breakthrough pain

EMorphine 15mg ER po q12hr and morphine 5mg po q6h prn breakthrough pain
Section: (none)
Explanation

Show Suggested Answer

Suggested Answer: E

Since LN used 3 mg of hydromorphone, this would be equivalent to a total of morphine 60 mg po daily. Since you would start with 70-80% of that dose, Morphine 15mg ER po q12hr and morphine 5mg po q6h prn breakthrough pain would be appropriate regimen.

by Fatima at Jul 03, 2025, 08:11 AM

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Ernie

5 months ago

Totally agree, he should have enough coverage for breakthrough pain!

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Eleni

5 months ago

15mg ER seems low for someone post-op.

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Cristal

5 months ago

Looks like he’s on a lot of meds already.

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Samira

6 months ago

I think option E sounds reasonable for his pain management.

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Refugia

6 months ago

Wait, why switch to oral morphine so soon? Isn’t that risky?

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Cordelia

6 months ago

I'm a bit confused about the breakthrough pain dosing. I think we should ensure the prn doses are appropriate based on the patient's recent usage.

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Laurel

6 months ago

I recall that for patients transitioning from IV to oral opioids, we often reduce the total daily dose. Maybe option E could be a safer choice?

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Blair

7 months ago

I think I practiced a similar question where we had to adjust opioid dosages based on patient pain levels. I feel like option B might be too high for this patient.

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Anastacia

7 months ago

I remember we discussed calculating the conversion from hydromorphone to oral morphine, but I'm not entirely sure about the exact ratios.

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Rosenda

7 months ago

This is a tricky one, but I think I've got a good handle on it. I'd go with option B - Morphine 60mg ER daily and 15mg q6h prn. That should provide adequate pain control while accounting for the patient's opioid tolerance.

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Carisa

7 months ago

I'm a little unsure about this one. There are a lot of factors to weigh, like the patient's other medications and lab values. I'll need to double-check my work to make sure I'm recommending the safest and most appropriate option.

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Alyce

7 months ago

Okay, I've got this. Based on the patient's current hydromorphone use and pain control, I think option E - Morphine 15mg ER q12hr and 5mg q6h prn - would be the best approach to transition him to oral morphine.

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Lynsey

8 months ago

Hmm, lots of details to consider here. I'll need to think through the patient's opioid tolerance, renal function, and other comorbidities to make sure the morphine dosing is safe and effective.

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Tayna

8 months ago

This seems like a pretty straightforward pain management question. I'll need to carefully review the patient's medication history and current status to determine the best oral morphine regimen.

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Isabella

10 months ago

I see your point, but LN may not need that much morphine.

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Lura

10 months ago

Ah, the joys of post-op pain management. I'm leaning towards D) Morphine 15mg ER po q12hr and morphine 15mg po q6h prn for breakthrough pain. Gotta keep our buddy LN comfortable, right?

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Georgene

9 months ago

I think D is a good choice too, we want to make sure LN is pain-free.

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Rosio

10 months ago

I agree, D sounds like a good option to keep LN comfortable.

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Ciara

10 months ago

I'm feeling a bit like a doctor myself here, but I think E) Morphine 15mg ER po q12hr and morphine 5mg po q6h prn breakthrough pain is the best option. Gotta keep that pain in check, you know?

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Cory

10 months ago

But wouldn't option C provide better pain control?

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Quentin

10 months ago

I agree, because LN's pain is much better now.

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Milly

10 months ago

Hmm, I wonder if LN's back pain is from all that weight he's carrying around. Maybe we should prescribe him a treadmill along with the morphine.

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Denna

9 months ago

Maybe LN should consider some weight management options along with the pain medication.

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Rikki

9 months ago

E) Morphine 15mg ER po q12hr and morphine 5mg po q6h prn breakthrough pain

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Vilma

9 months ago

A) Morphine SR 10mg po daily and morphine 5mg po q6h prn for breakthrough pain

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Rossana

11 months ago

I think option A is the best choice.

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Madonna

11 months ago

Hmm, I think B) Morphine 60mg ER po daily and morphine 15mg po q6h prn breakthrough pain is the way to go. That should provide good pain relief while minimizing the risk of adverse effects.

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