Question 1

In geriatric patients, the percentage of body fat is increased. What are the pharmacologic implications of this physiologic change?

Accepted Answer

RAT: Lipid medications will accumulate in fatty tissues prolonging the half-lives of these drugs.

Question 2

Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include:

Accepted Answer

A

Question 3

When an elderly diabetic patient is constipated the best treatment options include:

Accepted Answer

D

Question 4

Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen?

Accepted Answer

As people age, their renal function decreases, and this can result in decreased tubular secretion of medications. This can lead to increased drug concentrations in the body and an increased risk for adverse drug reactions. Therefore, dosage adjustments may be necessary to avoid toxicity in older adults. The other options, A, C, and D, are not relevant to the changes in elimination that occur with aging.

Question 5

A medication review of an elderly person's medications involves:

Accepted Answer

A medication review for an elderly person should include all of these aspects to ensure a comprehensive understanding of the patient's medication regimen, including potential interactions and duplications.

Question 6

All of the following statements about the Beer's List are true except:

Accepted Answer

RAT: The Beer's criteria are intended as a guide and not a punitive regulatory tool. In 2011, the American Geriatrics Society (AGS) assembled a team to develop an evidence-based tool based on the original work of geriatrician Dr. Beers. Disease states are discussed in the updated AGS version.

Question 7

You are reviewing the data from several meta-analyses that addressed the most common causes of adverse drug reactions in the older adult. Which of the following would you find to be decreased and the most common cause of these problems in older adults?

Accepted Answer

RAT: Renal function declines with age, causing drug elimination to be slowed in older adults. Older adults have increased body fat. Liver dysfunction and hypoalbuminemia are not normal age-related changes but can be seen in association with disease states.

Question 8

Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?

Accepted Answer

With aging, there is a decrease in plasma proteins (such as albumin), which can result in an increase in the concentration of free drug in the blood. This can lead to increased drug toxicity and the need for dose adjustments.

Question 9

Principles of prescribing for older adults include:

Accepted Answer

Starting at a low dose and increasing the dose slowly is a principle of prescribing for older adults, as they may be more sensitive to drugs due to physiological changes that come with age. Avoiding prescribing any newer high-cost medications or keeping the total dose at a lower therapeutic range may not always be necessary or appropriate, and should be determined on an individual basis.

Question 10

The GFRs for a 91-year-old woman who weighs 93 pounds and is 5'1" with a serum creatinine of 1.1, and for a 202-pound, 25-year-old male who is 5'9" with the same serum creatinine according to the Cockcroft Gault formula are:

Accepted Answer

RAT: Remember to use ideal body weight (IBW) in the formula. The woman's IBW is 105 pounds and the man's is 156 pounds. Note the huge difference in GFR based on weight and age and the fact that looking at the serum creatinine alone can be very misleading in predicting GFR.

Question 11

To improve positive outcomes when prescribing for the elderly the nurse practitioner should:

Accepted Answer

Assessing cognitive functioning is important because the elderly may have a decreased ability to understand and follow medication instructions, which increases the risk of medication-related problems. Encouraging drug holidays or cutting medications in half without consulting a healthcare provider can also be dangerous and cause harm to the patient.

Question 12

Steps to avoid polypharmacy include:

Accepted Answer

The answer of Steps to avoid polypharmacy include:
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Question 13

Robert is a 72-year-old patient who has hypertension and angina. He is at risk for common medication practices seen in the elderly including:

Accepted Answer

Elderly patients, like Robert, are at risk for using another person's medications, hoarding medications, and changing their medication regimen without telling their healthcare provider. These practices can lead to serious medication errors and complications. It is important for healthcare providers to educate elderly patients about the importance of proper medication management and to regularly review their medication regimen to ensure it is still appropriate for their needs.

Question 14

Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be followed when prescribing pain management for Delta?

Accepted Answer

Acetaminophen is generally considered the first-line drug of choice for mild low-back pain in older adults due to the potential increased risk of adverse effects associated with other agents such as NSAIDs or opioids. It is important to avoid over-dosing on acetaminophen or any other medication.

Question 15

Which of the following is not consistent with the rules for geriatric prescribing:

Accepted Answer

RAT: Due to an increased half-life of lipid-soluble drugs, steady state will likely take longer to achieve in older adults. The other statements are True with respect to geriatric prescribing.

Quiz 51: Geriatric Patients