Adult-Gerontology CNS Test Advanced Pharmacology & Therapeutics 2 — Questions and Answers
Question 1: Statins are first-line therapy for reducing cardiovascular events in adults with hyperlipidemia primarily due to their ability to:
- Raise HDL levels dramatically
- Reduce LDL-C and stabilize atherosclerotic plaques through pleiotropic effects (Correct answer)
- Lower triglycerides below 150 mg/dL
- Prevent platelet aggregation
Correct answer: Reduce LDL-C and stabilize atherosclerotic plaques through pleiotropic effects
Statins inhibit HMG-CoA reductase to lower LDL-C and also stabilize vulnerable plaques through anti-inflammatory and endothelial-protective pleiotropic effects.
Question 2: SGLT2 inhibitors have demonstrated benefit beyond glycemic control in type 2 diabetes by:
- Increasing insulin secretion from beta cells
- Reducing cardiovascular mortality, hospitalizations for heart failure, and slowing CKD progression (Correct answer)
- Blocking glucagon release from alpha cells
- Enhancing peripheral glucose uptake in muscle
Correct answer: Reducing cardiovascular mortality, hospitalizations for heart failure, and slowing CKD progression
Clinical trials show SGLT2 inhibitors reduce heart failure hospitalizations and cardiovascular death and slow CKD progression through glucose-independent cardioprotective and renoprotective mechanisms.
Question 3: Proton pump inhibitors (PPIs) used long-term in older adults are associated with increased risk of:
- Peptic ulcer disease recurrence
- Hypomagnesemia, C. difficile infection, community-acquired pneumonia, and fracture risk (Correct answer)
- Hyperkalemia and metabolic alkalosis
- Hepatotoxicity and elevated liver enzymes
Correct answer: Hypomagnesemia, C. difficile infection, community-acquired pneumonia, and fracture risk
Long-term PPI use is linked to hypomagnesemia, impaired calcium absorption increasing fracture risk, C. diff susceptibility, and altered gastric microbiome predisposing to pneumonia.
Question 4: Anticholinergic medications are particularly dangerous in older adults because they can cause:
- Excessive diuresis and dehydration
- Cognitive impairment, urinary retention, constipation, and increased fall risk (Correct answer)
- Serotonin syndrome when combined with SSRIs
- Hepatic failure from CYP450 inhibition
Correct answer: Cognitive impairment, urinary retention, constipation, and increased fall risk
Older adults have reduced cholinergic reserve, making them vulnerable to anticholinergic side effects including delirium, urinary retention, ileus, blurred vision, and falls.
Question 5: When prescribing bisphosphonates for osteoporosis, the CNS should monitor for:
- Hyperphosphatemia and hypercalcemia
- Esophageal irritation, osteonecrosis of the jaw, and atypical femur fractures with long-term use (Correct answer)
- Agranulocytosis and thrombocytopenia
- Peripheral neuropathy from pyridoxine depletion
Correct answer: Esophageal irritation, osteonecrosis of the jaw, and atypical femur fractures with long-term use
Oral bisphosphonates require upright positioning to prevent esophagitis; rare but serious long-term risks include osteonecrosis of the jaw and atypical subtrochanteric femoral fractures.
Question 6: Digoxin toxicity in older adults is most commonly precipitated by:
- High-fat meal intake
- Hypokalemia from concomitant diuretic use or hypomagnesemia (Correct answer)
- Hypernatremia from dehydration
- Concurrent beta-blocker therapy
Correct answer: Hypokalemia from concomitant diuretic use or hypomagnesemia
Hypokalemia sensitizes the myocardium to digoxin's toxic effects by competing with digoxin at the Na/K-ATPase binding site, increasing risk of arrhythmias.
Adult-Gerontology CNS Test Advanced Pharmacology & Therapeutics 2
Statins are first-line therapy for reducing cardiovascular events in adults with hyperlipidemia primarily due to their ability to: