LN is 84 YOM who is in hospital for a back surgery.

NABP NAPLEX Question Answer

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?

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

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

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

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

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