Adult-Gerontology CNS Test Pharmacology and Therapeutics 1 — Questions and Answers
Question 1: Which class of medications is considered potentially inappropriate for older adults per the Beers Criteria due to anticholinergic effects?
- ACE inhibitors
- First-generation antihistamines (Correct answer)
- Beta-blockers
- Statins
Correct answer: First-generation antihistamines
First-generation antihistamines like diphenhydramine cause anticholinergic effects including confusion and urinary retention in older adults.
Question 2: Which pharmacokinetic change in older adults most significantly affects first-pass drug metabolism?
- Increased total body water
- Decreased hepatic blood flow (Correct answer)
- Increased lean body mass
- Increased albumin levels
Correct answer: Decreased hepatic blood flow
Decreased hepatic blood flow in older adults reduces first-pass metabolism, leading to higher bioavailability of many oral drugs.
Question 3: Which medication requires the most careful dosing adjustment in an older adult with a GFR of 35 mL/min?
- Lisinopril
- Metformin (Correct answer)
- Amlodipine
- Atorvastatin
Correct answer: Metformin
Metformin requires dose reduction when GFR is 30 to 45 mL/min and is contraindicated below 30 mL/min due to lactic acidosis risk.
Question 4: A CNS is reconciling medications for an 80-year-old. Which drug-drug interaction is most clinically significant?
- Metoprolol + amlodipine
- Warfarin + aspirin (Correct answer)
- Lisinopril + amlodipine
- Metformin + sitagliptin
Correct answer: Warfarin + aspirin
Warfarin combined with aspirin significantly increases bleeding risk by combining anticoagulant and antiplatelet mechanisms.
Question 5: Which opioid is listed as potentially inappropriate for older adults per the Beers Criteria due to neurotoxic metabolite accumulation?
- Morphine
- Meperidine (Correct answer)
- Oxycodone
- Hydromorphone
Correct answer: Meperidine
Meperidine's active metabolite normeperidine accumulates in older adults with renal impairment, causing neurotoxicity and seizures.
Question 6: What is the recommended first-line pharmacological treatment for osteoporosis in postmenopausal women?
- Calcium supplementation alone
- Bisphosphonates (Correct answer)
- Selective estrogen receptor modulators
- Calcitonin
Correct answer: Bisphosphonates
Bisphosphonates such as alendronate are first-line therapy for postmenopausal osteoporosis due to proven fracture risk reduction.
Adult-Gerontology CNS Test Pharmacology and Therapeutics 1
Which class of medications is considered potentially inappropriate for older adults per the Beers Criteria due to anticholinergic effects?