Ch 51...Geriatric Patients

Question 1

Principles of prescribing for older adults include

Answer 1

Starting at a low dose and increasing the dose slowly

Question 2

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

Answer 2

Decreased plasma proteins

Question 3

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

Answer 3

Decrease tubular secretion of medication will require dosage adjustments.

Question 4

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

Answer 4

Asking the patient to bring a list of current prescription medications to the visit

Having the patient bring all of your prescription, over the counter, and herbal medications to the visit

Asking what other providers are writing prescriptions for him

Question 5

Steps to avoid polypharmacy include

Answer 5

Evaluating for duplications and drug therapy and discontinuing any duplications

Question 6

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:

Answer 6

Use of another person’s medication

Hoarding medications

Changing his medication regime without telling his provider

Answer: all of the above

Question 7

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

Answer 7

Assess cognitive functioning in the elderly

Question 8

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

Answer 8

Stool softener’s such as docusate

Question 9

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

Answer 9

Acetaminophen is the first line drug of choice

Question 10

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

Answer 10

Diuretics

Question 11

The GFR for a 91-year-old woman who weighs 93 pounds and is 5‘1“ with the serum creatinine of 1.1, and for a 202 pound, 25-year-old male who is 5‘9“ with the same creatinine clearance according to the Crockcroft Gault formula are

Answer 11

25 ml/min and 103 ml/min respectively

Question 12

In geriatric patients the percentage of body fat is increased. What are the pharmacological implications of this physiological change ?

Answer 12

A lipid solvable medication will accumulate in fat tissue and irs duration of action may be prolonged.

Question 13

All of the following statements about the beers list are true except

Answer 13

It is a list of medications on medication classes that should generally be avoided in persons 65 years or older because they are either in effective are they pose unnecessarily high risk for older patients and a safer alternative is available

Question 14

You are reviewing the data from several meta-analyses that addresses 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 causes of the problems in the older adults?

Answer 14

Renal function /clearance

Question 15

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

Answer 15

Steady state is reached more quickly in the older adult