Adult-Gerontology CNS Test Pharmacology and Therapeutics

Question 1

Which class of medications is considered potentially inappropriate for older adults per the Beers Criteria due to anticholinergic effects?

Accepted Answer

First-generation antihistamines

Answer

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?

Accepted Answer

Decreased hepatic blood flow

Answer

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?

Accepted Answer

Metformin

Answer

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?

Accepted Answer

Warfarin + aspirin

Answer

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?

Accepted Answer

Meperidine

Answer

Meperidine's active metabolite normeperidine accumulates in older adults with renal impairment, causing neurotoxicity and seizures.

Adult-Gerontology CNS Test Practice Test