Adult-Gerontology CNS Test Advanced Pharmacology & Therapeutics 1 — Questions and Answers
Question 1: Which class of medications is first-line for reducing mortality in patients with HFrEF?
- Loop diuretics and digoxin
- ACE inhibitors or ARBs, beta-blockers, and mineralocorticoid receptor antagonists (Correct answer)
- Calcium channel blockers and nitrates
- Hydralazine alone
Correct answer: ACE inhibitors or ARBs, beta-blockers, and mineralocorticoid receptor antagonists
Guideline-directed medical therapy for HFrEF includes ACE inhibitors/ARBs, evidence-based beta-blockers, and MRAs as the mortality-reducing cornerstone of treatment.
Question 2: The Beers Criteria is used by CNS practitioners to:
- Calculate antibiotic dosing in renal failure
- Identify medications potentially inappropriate for use in older adults (Correct answer)
- Determine opioid equivalency conversions
- Screen for drug interactions in all age groups
Correct answer: Identify medications potentially inappropriate for use in older adults
The American Geriatrics Society Beers Criteria lists medications that pose increased risk in older adults due to side effects, drug interactions, or age-related pharmacokinetic changes.
Question 3: Polypharmacy in older adults most significantly increases risk of:
- Antibiotic resistance
- Adverse drug reactions, drug-drug interactions, and medication non-adherence (Correct answer)
- Vitamin toxicity
- Renal calculi formation
Correct answer: Adverse drug reactions, drug-drug interactions, and medication non-adherence
Using five or more medications exponentially increases the risk of adverse drug reactions, drug-drug interactions, falls, and non-adherence in older adults.
Question 4: Direct oral anticoagulants (DOACs) are preferred over warfarin in non-valvular atrial fibrillation primarily because:
- They are less expensive and have no dietary restrictions
- They have predictable pharmacokinetics, require no routine INR monitoring, and have comparable or superior efficacy with lower intracranial bleeding risk (Correct answer)
- They can be reversed more easily than warfarin
- They are safer in severe renal impairment
Correct answer: They have predictable pharmacokinetics, require no routine INR monitoring, and have comparable or superior efficacy with lower intracranial bleeding risk
DOACs offer predictable dosing without routine monitoring, have fewer drug and food interactions, and clinical trials show lower rates of intracranial hemorrhage compared to warfarin.
Question 5: Metered-dose inhaler (MDI) technique in older adults is frequently suboptimal because:
- Older adults have increased lung compliance reducing drug deposition
- Coordination difficulties, arthritis, and cognitive impairment reduce proper actuation-inhalation synchrony (Correct answer)
- MDIs deliver too high a drug concentration for older lungs
- Older patients metabolize inhaled drugs faster
Correct answer: Coordination difficulties, arthritis, and cognitive impairment reduce proper actuation-inhalation synchrony
Effective MDI use requires coordination of breath and actuation, which is impaired by arthritis, cognitive decline, and reduced inspiratory flow in older adults.
Question 6: Which opioid is considered safest for pain management in older adults with renal impairment?
- Morphine
- Codeine
- Hydromorphone
- Oxycodone with careful dose titration (Correct answer)
Correct answer: Oxycodone with careful dose titration
Morphine and codeine have active renally-cleared metabolites that accumulate in renal failure; oxycodone has fewer renally-cleared active metabolites and is preferred with dose adjustment.
Adult-Gerontology CNS Test Advanced Pharmacology & Therapeutics 1
Which class of medications is first-line for reducing mortality in patients with HFrEF?