Adult-Gerontology CNS Test Advanced Pharmacology & Therapeutics 3

Question 1

The pharmacokinetic change most responsible for increased drug levels in older adults is:

Accepted Answer

Decreased hepatic and renal clearance leading to drug accumulation

Answer

Increased gastric acid production enhancing absorption

Answer

Increased volume of distribution for all drugs

Answer

Enhanced protein binding reducing free drug levels

Question 2

Triple whammy combination causing acute kidney injury in older adults consists of:

Accepted Answer

ACE inhibitor/ARB + NSAID + diuretic

Answer

Statin + fibrate + niacin

Answer

Beta-blocker + calcium channel blocker + digoxin

Answer

Antibiotic + antifungal + antiviral

Question 3

Medication reconciliation is critical at care transitions in older adults primarily to prevent:

Accepted Answer

Medication discrepancies, omission errors, and adverse drug events during handoffs

Answer

Duplicate laboratory testing

Answer

Insurance billing errors from formulary changes

Answer

Pharmacy dispensing delays

Question 4

When initiating beta-blockers for a patient with newly diagnosed HFrEF, the CNS should:

Accepted Answer

Start at a very low dose and uptitrate slowly over weeks to months as tolerated

Answer

Start at the target dose to quickly achieve benefit

Answer

Avoid beta-blockers until the patient is already on IV diuretics

Answer

Use only cardioselective beta-blockers in doses equal to hypertension doses

Question 5

Azithromycin should be used with caution in older adults with cardiovascular disease because it:

Accepted Answer

Prolongs the QTc interval, increasing risk of torsades de pointes

Answer

Causes hypertension through sympathomimetic effects

Answer

Inhibits CYP3A4, raising statin levels dangerously

Answer

Causes hyperkalemia when combined with ACE inhibitors

Question 6

Melatonin is preferred over benzodiazepines for insomnia in older adults because:

Accepted Answer

Benzodiazepines cause dependence, next-day sedation, cognitive impairment, and fall risk in older adults

Answer

Melatonin is more potent and faster acting

Answer

Melatonin has a longer half-life ensuring sustained sleep

Answer

Benzodiazepines are renally cleared and accumulate in CKD