Deck 27: Drugs and Older Adults

Question 1

A visiting nurse is referred to Walter Jacobsen, an 89-year-old male living independently in a small apartment. During her intake interview, the nurse asks Walter about his medical history and his current medications. He reports his history to the nurse and then retrieves a large brown paper bag from the kitchen with numerous medications, explaining that he takes all of the medications in the bag. The nurse should instruct Walter, at a minimum, to keep a list of which medications

A) Only prescription drugs
B) Prescription drugs and OTC drugs
C) Prescription drugs, OTC drugs, and vitamins
D) Prescription drugs, OTC drugs, vitamins, and herbal or mineral supplements

Answer 1

It is advisable for the adults to keep a list of all medications that they are consuming, not the only list of over-the counter (OTC) or prescription drugs. During an emergency, the list of all the medications may be needed for prompt decision of treatment.
Hence, the options (a), (b) and (c) are incorrect.
The health care professional should instruct the older adults to keep a list of all drugs that they are consuming including the vitamins, herbal, or mineral supplements, apart from the prescription and OTC drugs.
Hence, the option (d) Prescription drugs, OTC drugs, vitamins, and herbal or mineral supplements is correct.

Question 2

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Which one of these is an appropriate antidepressant to treat older adults with no history of seizure disorder

A) Prozac
B) Amitriptyline
C) Doxepin
D) Wellbutrin

Answer 2

Hence, the option (a) is incorrect.
Amitriptyline and doxepin are not given to the older adults due to their potential of causing anticholinergic effects.
Hence, the options (b) and (c) are incorrect.
Wellbutrin is a heterocyclic drug used for treating depression. It is given to the patients who have no history of seizures as they can interact with patients with seizure causing severe side effects.
Hence, the option (d) Wellbutrin is correct.

Question 3

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. You are educating an older adult who is taking a quinolone antibiotic in conjunction with an antacid. When should the patient be instructed to take the quinolone

A) Take with the antacid.
B) Take 1h prior to the antacid.
C) Take 1h post antacid.
D) Do not take within 2h of antacid.

Answer 3

Quinolone antibiotics and antacids should never be consumed simultaneously.
Hence, the option (a) is incorrect.
Antacids should always be consumed at least 2 h before taking quinolone antibiotics.
Hence, the options (b) and (c) are incorrect.
Antacids are medications given for relieving the symptoms of acidity. These drugs are very commonly used by the older adults. These drugs contradict with some drugs like quinolone antibiotics, isoniazid, tetracycline, ketoconazole and iron salts. After taking antacids, a patient should avoid consuming quinolone antibiotics for at least 2 hours to prevent contradictory effects.
Hence, the option (d) Do not take within 2 h of antacid is correct.

Question 4

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Which organ's function decreases with age, resulting in a decline of creatinine clearance

A) Liver
B) Kidney
C) Small intestine
D) Large intestine

Question 5

Kita Wong is concerned that her 78-year-old mother, SuLyn, is not taking her medications correctly. SuLyn is on phenytoin, theophylline, digoxin, and a benzodiazepine. What is the best method for monitoring SuLyn's phenytoin therapy

A) 24-h urine check
B) Patient reports of seizure activity
C) Serum phenytoin level
D) EEG

Question 6

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Which two categories of drug therapy are responsible for more than two-thirds of drug-related hospitalizations in older adult patients

A) Antidiabetic/antithrombotic
B) Antihypertensive/anticoagulants
C) Antidiabetic/antihypertensive
D) Antidepressant/antihypertensive

Question 7

A visiting nurse is referred to Walter Jacobsen, an 89-year-old male living independently in a small apartment. During her intake interview, the nurse asks Walter about his medical history and his current medications. He reports his history to the nurse and then retrieves a large brown paper bag from the kitchen with numerous medications, explaining that he takes all of the medications in the bag. The nurse decides to set up a system for Walter. What method will be most beneficial for Walter to take the correct pills on the correct days

A) A note on his bathroom mirror
B) Daily pillbox organizer
C) A mailed reminder card from his primary care physician
D) Monthly phone call reminders from the local pharmacy

Question 8

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Older adults are very sensitive to drug actions and are more likely to have adverse reactions to anticholinergics. What is one potential side effect of an anticholinergic

A) Drooling
B) Constipation
C) Urinary frequency
D) Diarrhea

Question 9

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Cumulative effects of drugs in older adults can be due to:

A) Increased GI motility
B) Higher metabolism
C) Inadequate absorption
D) Improved renal function

Question 10

Kita Wong is concerned that her 78-year-old mother, SuLyn, is not taking her medications correctly. SuLyn is on phenytoin, theophylline, digoxin, and a benzodiazepine. Consider that water accounts for only 45% of a senior's body weight. How will this most likely affect SuLyn's physiological response to theophylline

A) SuLyn may need a larger dose.
B) SuLyn's vital signs may be critically affected.
C) SuLyn's response will not be affected by this.
D) SuLyn may need a smaller dose.

Question 11

A visiting nurse is referred to Walter Jacobsen, an 89-year-old male living independently in a small apartment. During her intake interview, the nurse asks Walter about his medical history and his current medications. He reports his history to the nurse and then retrieves a large brown paper bag from the kitchen with numerous medications, explaining that he takes all of the medications in the bag. The nurse decides to give Walter further instructions regarding his medications. Which item should she include in her teaching plan

A) In case of a missed dose, take two pills at the next scheduled dose.
B) Memorize the purpose of each medication.
C) Keep an updated list of all medications, including dose and frequency, in wallet.
D) Always request a generic medication when filling a prescription.

Question 12

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. What is an example of an antipsychotic drug that produces significant anticholinergic effects in older adults

A) Amitriptyline
B) Benztropine
C) Chlorpromazine
D) Diphenhydramine

Question 13

Kita Wong is concerned that her 78-year-old mother, SuLyn, is not taking her medications correctly. SuLyn is on phenytoin, theophylline, digoxin, and a benzodiazepine. SuLyn has just been diagnosed with reduced renal function. What category of drugs may be particularly dangerous for her

A) Aminoglycosides
B) Antihistamines
C) Salicylates
D) Calcium channel blockers

Question 14

A visiting nurse is referred to Walter Jacobsen, an 89-year-old male living independently in a small apartment. During her intake interview, the nurse asks Walter about his medical history and his current medications. He reports his history to the nurse and then retrieves a large brown paper bag from the kitchen with numerous medications, explaining that he takes all of the medications in the bag. When the nurse is reviewing Walter's medications, she is following a moral, ethical, and legal responsibility when she:

A) Questions an inappropriate medication and/or dose
B) Disregards Walter's concerns about a particular medication
C) Discards pills that Walter did not take
D) Changes the dose of a medication to better address his symptoms

Question 15

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Which one of these is an appropriate medication to treat arthritis pain for older adults

A) Indocin
B) Ketorolac
C) Acetaminophen
D) Talwin

Question 16

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. The aging process is:

A) The same in individuals in similar decades of life
B) Very individualized
C) Different based upon ethnicity
D) Slowed in males versus females

Question 17

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Which one of these is an appropriate medication to treat allergies in older adults

A) Benadryl
B) Claritin
C) Chlor-Trimeton
D) Vistaril

Question 18

Kita Wong is concerned that her 78-year-old mother, SuLyn, is not taking her medications correctly. SuLyn is on phenytoin, theophylline, digoxin, and a benzodiazepine. What is the most likely age-related effect for SuLyn of the medications she takes every day

A) High risk for periodic severe hypoglycemia
B) Frequent changes in the dose and schedule of her medications
C) Slowed clearance of drugs from her system, resulting in potentially cumulative effects
D) Increased clearance of drugs, resulting in the need for higher doses of the medication

Question 19

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Which one of these is an appropriate pain medication for older adults after surgery

A) Morphine
B) Indocin
C) Demerol
D) Talwin

Question 20

A visiting nurse is referred to Walter Jacobsen, an 89-year-old male living independently in a small apartment. During her intake interview, the nurse asks Walter about his medical history and his current medications. He reports his history to the nurse and then retrieves a large brown paper bag from the kitchen with numerous medications, explaining that he takes all of the medications in the bag. Polypharmacy is the use of medication, more specifically defined as:

A) Applying to prescription drugs only
B) Taking two drugs at a time
C) Taking one drug for at least 14 days
D) The use of multiple drugs, either OTC or prescription

Question 21

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. When starting an older adult patient on a new drug, which is the best method of dosing

A) Allow the patient to titrate the dose to the desired effect.
B) Start with a high dose and then reduce to the desired effect.
C) Start with a moderate dose for the least risk with the most effectiveness.
D) Start at the lowest effective dose and increase slowly to avoid adverse effects.

Question 22

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. As an individual ages, the gastric pH:

A) Stays at the same level
B) Fluctuates over time
C) Increases
D) Decreases

Question 23

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Which category of drugs is most likely to cause dizziness or motor impairment, increase the risk of falls, and impact sexual functioning in older adults

A) Anticoagulants
B) Antihypertensives
C) Anti-infectives
D) Antidiabetics

Question 24

Kita Wong is concerned that her 78-year-old mother, SuLyn, is not taking her medications correctly. SuLyn is on phenytoin, theophylline, digoxin, and a benzodiazepine. How do benzodiazepines affect older adults as opposed to younger adults

A) They have a decreased sensitivity to the drug.
B) They have largely the same reaction to the drug as young adults.
C) They require an increased dosage of the drug.
D) They have an increased sensitivity to the drug.

Question 25

Choose the correct answer. Please note that some questions require you to refer to the Updated Beer's Criteria for PIM use in older adults. Which of these cardiac drugs is least appropriate for older adults

A) Norpace
B) Vasotec
C) Procardia XL
D) Hydralazine