Deck 22: Prescribing for the Geriatric Patient

Question 1

Drugs with anticholinergic properties cause all of the following problems in the elderly except:

A)Increased sedation.
B)Visual problems.
C)Hyper alertness.
D)Increase risk of falling.

Answer 1

Hyper alertness.

Question 2

Which statement is true regarding drugs such as galantamine (Razadyne)and donepezil (Aricept)in the treatment of Alzheimer's disease?

A)They increase the amount of acetylcholine by inhibiting cholinesterase enzymes.
B)They produce a large improvement in cognitive function.
C)They are associated with constipation.
D)They prevent progression to end-stage dementia.

Answer 2

They increase the amount of acetylcholine by inhibiting cholinesterase enzymes.

Question 3

The most commonly used drugs among community-dwelling adults are:

A)Analgesics.
B)Cardiovascular medications.
C)Dermatologic preparations.
D)Sedative-hypnotics.

Answer 3

Analgesics.

Question 4

Which statement regarding changes in pharmacodynamics in the elderly is true?

A)Altered receptor sensitivity in older adults can cause increased CNS sedation with benzodiazepines,opiates,and neuroleptics.
B)Elderly patients are more sensitive to the effects of diuretics.
C)Elderly patients are more responsive to beta-adrenergic blockers,such as metoprolol.
D)Elderly patients are less likely to experience adverse effects at normal doses.

Question 5

Which statement regarding hypertension in the elderly is true?

A)Hypertension is diagnosed in more than 70% of older adults.
B)Diastolic blood pressure is the main target.
C)Systolic blood pressure decreases with age.
D)Lifestyle changes,such as a low-sodium diet and reduction in body weight,have little effect on blood pressure.
E)Orthostatic hypotension is not a common problem in patients treated with antihypertensives.

Question 6

Which of the following best describes the results of the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)?

A)Thiazide diuretics were superior for reducing vascular outcomes in hypertensive patients.
B)Alpha blockers were best tolerated in the elderly population.
C)Angiotensin-converting enzyme inhibitors (ACEIs)produced the largest reduction in blood pressure.
D)Calcium channel blockers (CCBs)were with least effective in reducing vascular outcomes.

Question 7

Which statement regarding CCBs in the elderly is true?

A)CCBs are first-line agents for treating hypertension in the elderly.
B)CCBs cause vasogenic edema.
C)CCBs should be combined with beta-adrenergic blockers.
D)CCBs can increase serum potassium levels.

Question 8

Which statement regarding pharmacokinetic changes in the elderly is false?

A)Absorption of orally administered medications is dramatically reduced in elderly patients.
B)Total body water and extracellular fluid volume decrease with age.
C)Water-soluble drugs have a reduced volume of distribution in elderly patients.
D)Percentage of total body fat rises steadily with age,affecting lipid-soluble drugs.

Question 9

The Cockcroft and Gault equation factors in all of the following parameters except:

A)Age.
B)Weight.
C)Serum creatinine.
D)Muscle mass.
E)Gender.

Question 10

Which statement regarding adverse drug reactions (ADRs)in the elderly population is true?

A)If ADRs were ranked as a disease,they would be the fourth to sixth leading cause of death in the United States.
B)ADRs are less common in the elderly population.
C)ADRs are not a common cause of hospitalizations.
D)Dietary supplements do not cause ADRs.

Question 11

Which statement regarding medication use in the elderly is true?

A)Less than 5% of elderly patients take more than five medications.
B)Elderly male patients take more medications than do elderly female patients.
C)Individuals older than age 65 utilize about one-third of all prescribed medications.
D)Use of dietary supplements in the elderly is rare.

Question 12

Which statement regarding medication use in the elderly is true?

A)The average community-dwelling older adult uses less than two medications per day.
B)Institutionalized adults use an average of seven to eight medications per day.
C)Drug interactions are uncommon in the elderly population due to better monitoring by clinicians.
D)Elderly patients do not use over-the-counter medications as much as younger adults do.

Question 13

Which of the following is an N-methyl-D-aspartate (NMDA)antagonist used for the treatment of moderate to severe Alzheimer's disease?

A)memantine (Namenda)
B)donepezil (Aricept)
C)rivastigmine (Exelon)
D)galantamine (Razadyne)

Question 14

Which statement regarding diuretics and the elderly is false?

A)Low-dose thiazide diuretics are the first-line treatment for hypertension in the elderly.
B)Diuretics can cause dehydration and increase the risk of falls.
C)Diuretics can cause electrolyte imbalances such as hypokalemia.
D)Beta-adrenergic blockers are superior to diuretics in elderly patients.

Question 15

The uniqueness of drug-taking problems among older adults includes all of the following except:

A)Slowed renal clearance.
B)Reduced hepatic clearance.
C)Increased risk of central nervous system (CNS)side effects.
D)Enhanced autonomic function.
E)Reduced ability to adapt to postural changes.

Question 16

Which type of drug is used the most in the institutionalized adult patients?

A)Antipsychotics
B)Analgesics
C)Gastrointestinal medications
D)Dermatologic medications
E)Antihistamines

Question 17

As with patients taking ACEIs,patients taking angiotensin receptor blockers (ARBs)must be monitored for:

A)Hyperkalemia.
B)Dementia.
C)Confusion.
D)Hypercalcemia.

Question 18

Which statement regarding pharmacokinetic changes in the elderly is true?

A)Hypoalbuminemia can increase drug effects by increasing the amount of free drug.
B)Elderly patients experience no change in first-pass effect.
C)Liver size and blood flow are not affected by age.
D)Phase I and phase II metabolism are not affected by age in normal patients.

Question 19

Which antimuscarinic drug is used for the treatment of overactive bladder and urge incontinence?

A)darifenacin (Enablex)
B)phenylephrine (Neo-Synephrine)
C)terazosin (Hytrin)
D)phenazopyridine (Pyridium)

Question 20

Which statement regarding geriatric pharmacology is false?

A)Decreased glomerular filtration rate can reduce renal elimination of many drugs.
B)Increased blood flow to the liver can improve metabolism of many drugs.
C)Polypharmacy contributes to increased drug interactions and ADRs.
D)Lower medication dosages may be required to compensate for age-related functional decline in organs.

Question 21

Which statement regarding polypharmacy is not true?

A)It is best defined by a specific number of drugs prescribed per day.
B)It is best defined as the act of prescribing more medications than clinically necessary.
C)It accounts for adverse drug event-related hospital admissions,which are twice as common among older adults than younger adults.
D)It cannot be avoided in the geriatric population.

Question 22

Which statement regarding use of opiates in older adults is true?

A)They are dangerous and should be avoided in the elderly
B)They cause constipation that must be managed with laxatives and osmotic agents
C)They are less effective in the elderly
D)They are not commonly associated with confusion or sedation

Question 23

Which short-acting benzodiazepine is safest to use for anxiety in the elderly population?

A)diazepam (Valium)
B)chlordiazepoxide (Librium)
C)clorazepate (Tranxene)
D)lorazepam (Ativan)

Question 24

All of the following statements regarding Coumadin use in older adults are true except:

A)It is used for nonvalvular atrial fibrillation.
B)It is used to prevent stroke.
C)It is associated with serious bleeding in 2% to 3% of patients.
D)It rarely requires monitoring after 2 weeks of starting the medication.

Question 25

Which treatment is least appropriate for management of degenerative joint disease?

A)Use of chronic NSAIDs
B)Acetaminophen
C)Referral for physical therapy
D)Referral to an orthopedist for joint injections

Question 26

Which drug class should the elderly and their caregivers be counseled to avoid when concomitant use of cholinesterase inhibitors is used for dementia?

A)Penicillins
B)Antihistamines
C)Antifungals
D)Antiepileptics

Question 27

A patient is given an antidepressant for diabetic neuropathy and sees you 1 month later with complaints of constipation,dry mouth,palpitations,difficulty urinating,light-headedness,and blurry vision.Which medications most likely caused her problems?

A)amitriptyline (Elavil)
B)sertraline (Zoloft)
C)divalproex (Depakote)
D)risperidone (Risperdal)
E)bupropion (Wellbutrin)

Question 28

Memantine (Namenda)is a novel drug used for Alzheimer's dementia;its action reduces the level of which excitatory neurotransmitter?

A)Glutamate
B)Serotonin
C)Tyrosine
D)Dopamine
E)Gamma amino butyric acid

Question 29

Which statement regarding aspirin as a preventive therapy is true?

A)It is overused in the elderly population.
B)It should be dosed at 81 mg per day.
C)It cannot be combined with clopidogrel (Plavix).
D)It is most commonly used for atrial fibrillation.

Question 30

Major side effects of the cholinesterase inhibitors include all of the following except:

A)Bradycardia.
B)Nausea.
C)Anorexia.
D)Diarrhea.
E)Bullous rash.

Question 31

Which drug is approved for the treatment of all three stages of Alzheimer's disease?

A)galantamine (Razadyne)
B)donepezil (Aricept)
C)tacrine (Cognex)
D)rivastigmine (Exelon)

Question 32

Which irreversible complication of typical antipsychotics is characterized by involuntary movements of the face,lip smacking,and other tics?

A)Acute dystonic reactions
B)Torticollis
C)Akathisia
D)Tardive dyskinesia

Question 33

A black box warning associated with atypical antipsychotics in the elderly warns that these drugs:

A)Increase the rate of myocardial infarction,stroke,and vascular mortality.
B)Increase the incidence of dementia.
C)Increase the risk of pneumonia.
D)Are associated with parkinsonism and irreversible tardive dyskinesia.

Question 34

The drug type and primary mechanism of action of the medications used to treat urge incontinence are:

A)Alpha-one agonist that affects the urethral sphincter.
B)Antimuscarinic drugs that affect detrusor muscle.
C)Alpha-one antagonists that improve urinary outflow.
D)Beta agonists that relax urinary smooth muscle.

Question 35

Which medication is most commonly used to treat Parkinson's disease?

A)levodopa/carbidopa (Sinemet)
B)benztropine (Cogentin)
C)trihexyphenidyl (Artane)
D)amantadine (Symmetrel)

Question 36

NSAIDs are associated with all of the following adverse effects except:

A)Decreased renal function.
B)Increased blood pressure.
C)Gastrointestinal toxicity.
D)Increased cardiovascular risk.
E)Sedation and confusion.

Question 37

Drugs commonly associated with parkinsonism include:

A)Antipsychotics (e.g. ,haloperidol).
B)Selective serotonin reuptake inhibitors (e.g. ,sertraline [Zoloft]).
C)Lamotrigine (e.g. ,lamotrigine [Lamictal]).
D)Benzodiazepines (e.g. ,diazepam [Valium]).
E)Antihistamines (e.g. ,diphenhydramine [Benadryl]).

Question 38

Which statement regarding medication use in older adults is true?

A)Older patients are more sensitive to the effects of anticoagulants,especially because they commonly have a deficiency in vitamin K clotting factors.
B)Older adults have no issues with the sedating effects of antihistamines.
C)Parkinson's disease is hardly ever misdiagnosed in the elderly.
D)Antipsychotics have found broad and wide use in the elderly as they are found effective and with few side effects and toxicities.

Question 39

If a patient with Alzheimer's disease is taking donepezil (Aricept)and is found to also have urinary incontinence issues,providing that patient medications such as oxybutynin (Ditropan)and tolterodine (Detrol)could result in:

A)Increased side effects.
B)Reduced side effects.
C)Increased effectiveness of both agents.
D)Neutralization of effects of both agents.

Question 40

A 67-year-old female complains of urine leakage that occurs when she coughs,sneezes,or runs on a treadmill.Which type of incontinence does she have?

A)Urge incontinence
B)Overflow incontinence
C)Neurogenic incontinence
D)Stress incontinence