chap 51 Geriatrics

Question 1

1. Principles of prescribing for older adults include:
2. Avoiding prescribing any newer high-cost medications
3. Starting at a low dose and increasing the dose slowly
4. Keeping the total dose at a lower therapeutic range
5. All of the above

Answer 1

2. Starting at a low dose and increasing the dose slowly

Question 2

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?
3. Increased volume of distribution
4. Decreased lipid solubility
5. Decreased plasma proteins
6. Increased muscle-to-fat ratio

Answer 2

3. Decreased plasma proteins

Question 3

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 when prescribing for Glen?
4. Increased glomerular filtration rate (GFR) will require higher doses of some renally excreted drugs.
5. Decreased tubular secretion of medication will require dosage adjustments.
6. Thin skin will cause increased elimination via sweat.
7. Decreased lung capacity will lead to measurable decreases in lung excretion of drugs.

Answer 3

2. Decreased tubular secretion of medication will require dosage adjustments.

Question 4

4. A medication review of an elderly person’s medications involves:
5. Asking the patient to bring a list of current prescription medications to the visit
6. Having the patient bring all of their prescription, over-the-counter, and herbal medications to the visit
7. Asking what other providers are writing prescriptions for them
8. All of the above

Answer 4

4. All of the above

Question 5

5. Steps to avoid polypharmacy include:
6. Prescribing two or fewer drugs from each drug class
7. Reviewing a complete drug history every 12 to 18 months
8. Encouraging the elderly patient to coordinate their care with all of their providers
9. Evaluating for duplications in drug therapy and discontinuing any duplications

Answer 5

4. Evaluating for duplications in drug therapy and discontinuing any duplications

Question 6

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:
7. Use of another person’s medications
8. Hoarding medications
9. Changing his medication regimen without telling his provider
10. All of the above

Answer 6

4. All of the above

Question 7

7. To improve positive outcomes when prescribing for the elderly the nurse practitioner should:
8. Assess cognitive functioning in the elder
9. Encourage the patient to take a weekly “drug holiday” to keep drug costs down
10. Encourage the patient to cut drugs in half with a knife to lower costs
11. All of the above

Answer 7

1. Assess cognitive functioning in the elder

Question 8

8. When an elderly diabetic patient is constipated the best treatment options include:
9. Mineral oil
10. Bulk-forming laxatives such as psyllium
11. Stimulant laxatives such as senna
12. Stool softeners such as docusate

Answer 8

4. Stool softeners such as docusate

Question 9

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?
10. Keep the dose of oxycodone low to prevent development of tolerance.
11. Acetaminophen is the first-line drug of choice.
12. Avoid prescribing NSAIDs.
13. Add in a short-acting benzodiazepine for a synergistic effect on pain.

Answer 9

2. Acetaminophen is the first-line drug of choice.

Question 10

10. Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include:
11. Diuretics
12. Trazodone
13. Clonazepam
14. Levodopa

Answer 10

1. Diuretics

Question 11

11. 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:
12. 25ml/ min and 133 mL/min respectively
13. 25 mL/min and 103 mL/min respectively
14. 22 ml/min and 133 mL/min respectively
15. 22 ml/min and 103 mL/min respectively

Answer 11

2. 25 mL/min and 103 mL/min respectively

Question 12

12. In geriatric patients, the percentage of body fat is increased. What are the pharmacologic implications of this physiologic change?
13. A lipid-soluble medication will be eliminated more quickly and not work as well.
14. A lipid-soluble medication will accumulate in fat tissue and its duration of action may be prolonged.
15. Absorption of lipid-soluble drugs is impaired in older adults.
16. The bioavailability of the lipid-soluble drug will be increased in older adults.

Answer 12

2. A lipid-soluble medication will accumulate in fat tissue and its duration of action may be prolonged.

Question 13

13. All of the following statements about the Beer’s List are true except:
14. It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available.
15. It is derived from the expert opinion of one geriatrician and is not evidence-based.
16. These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities.
17. These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration.

Answer 13

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

Question 14

14. 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?
15. Body fat content
16. Liver function
17. Renal function/clearance
18. Plasma albumin levels

Answer 14

3. Renal function/clearance

Question 15

15. Which of the following is not consistent with the rules for geriatric prescribing:
16. Half-life will be longer in older adults
17. Steady state is reached more quickly in the older adult
18. Reduce the number of drugs in the patient’s regimen whenever possible
19. Adverse drug responses present atypically in the older adult

Answer 15

2. Steady state is reached more quickly in the older adult